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Lernevall LST, Moi AL, Gjengedal E, Dreyer P. Parents' lived experiences of parental needs for support at a burn centre. Int J Qual Stud Health Well-being 2021; 16:1855749. [PMID: 33427115 PMCID: PMC7808374 DOI: 10.1080/17482631.2020.1855749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: A burn injury to a child is a traumatic event and the parent's emotional reactions and coping strategies affect the child's adaptive outcome. It is therefore important that parents get the right support. The aim was to explore parents' lived experiences of their need for support when having a child admitted to a burn centre. Methods: Semi-structured face-to-face interviews were conducted with 22 parents of children age <12 years hospitalised with an accidental burn injury, 9 to 27 days after the burn accident, from April 2017 to July 2018. A Ricoeur-inspired textual analysis method was used. Results: Four themes emerged from the analysis and describe the parents' needs for support. The parents wanted to be taken care of as a whole family and feel safe in the hands of professionals. This, in turn, depended on being informed about the child's condition and treatment, but also on getting help in dealing with feelings of guilt. Not least, parents wanted opportunities to take care of their own fundamental needs in terms of hygiene, food, adequate rest and activities. Conclusion: As an overall understanding the healthcare providers should focus on the family as a whole in care and treatment.
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Affiliation(s)
- Lina S. T Lernevall
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - A. L. Moi
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - E. Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - P. Dreyer
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Public Health, Section of Nursing, Aarhus University, Aarhus C, Denmark
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Lernevall L, Moi A, Gjengedal E, Dreyer P. Staff Members’ Experience of Providing Parental Support in a National Burn Centre. Open Nurs J 2019. [DOI: 10.2174/1874434601913010211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Paediatric burn injuries affect not only the child but the whole family, especially the parents. Knowledge of how parents are affected psychologically has increased, but there is an ongoing dearth of literature on parental support while hospitalised. There is also very little documentation of the ways in which burn staff members support parents.
Objectives
To explore staff members’ lived experiences of supporting parents with children hospitalised at a burn centre due to a burn injury.
Methods
Four focus group interviews were conducted in 2017 with a total of 21 staff members at the National Burn Centre in Norway. Seven different burn staff professions participated. Data were analysed using a Ricoeur-inspired method for text analysis and managed using NVivo 12Plus.
Results
Four themes were identified in the treatment trajectory: creating a safe, secure and trusting environment from the moment parents enter the burn centre; helping parents deal with feelings of guilt; helping parents navigate in their daily routines while continuing to be a mother or father; and gradually involving parents in wound treatment as preparation for discharge.
Conclusion
Staff must carefully consider their verbal and non-verbal (body) language and how to approach parents from the very moment they enter the burn ward. Most parents are affected by feelings of guilt and these feelings must be addressed and processed. During the treatment trajectory, parents are guided to participate in the daily care of their child and are gradually assisted in taking over the wound treatment prior to discharge.
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Heath J, Williamson H, Williams L, Harcourt D. Parent-perceived isolation and barriers to psychosocial support: a qualitative study to investigate how peer support might help parents of burn-injured children. Scars Burn Heal 2018; 4:2059513118763801. [PMID: 29873333 PMCID: PMC5987090 DOI: 10.1177/2059513118763801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Burn injuries can be traumatic and distressing for the affected child and family, with a prolonged period of recovery. This research explores parents' experiences of support following their child's injury and their thoughts on peer support specifically. METHODS Thirteen semi-structured interviews were conducted with parents/caregivers, a mean of three years after their child's injury, either face-to-face or remotely. Responses were analysed using thematic analysis. RESULTS Analysis produced four themes and 11 sub-themes. These described parents' experiences of loss, change, isolation and access to psychosocial support. This paper focuses on themes of isolation and parents' access to psychosocial support. DISCUSSION Findings indicate that parents access psychosocial support following their child's injury and often find it helpful; however, there is a prevailing sense of isolation. Parents often seek information online and find that this is lacking. Many parents reported that peer support would be valuable to them, particularly the sharing of experiential knowledge. CONCLUSION An online resource may be beneficial for parents, but further research is needed to confirm the exploratory data gained to date, ensuring that any resource developed would meet the identified needs of parents.
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Affiliation(s)
- Jennifer Heath
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Lisa Williams
- Chelsea and Westminster Burns Service, Chelsea and Westminster Hospital, London, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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DeJong HM, Phillips M, Edgar DW, Wood FM. Patient opinion of scarring is multidimensional: An investigation of the POSAS with confirmatory factor analysis. Burns 2016; 43:58-68. [PMID: 27576936 DOI: 10.1016/j.burns.2016.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/22/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Scarring is a significant consequence for patients following a burn. Understanding how patients perceive the physiological scar and define scar severity may provide valuable information regarding how the scar influences quality of life after burn. The Patient and Observer Scar Assessment Scale was the first scar assessment tool validated to include the patients' evaluation of the scars physical qualities, following a burn. Validation studies of this tool have previously been conducted for a discrete scar-site after burn. The aim of this study was to assess the structural validity of the POSAS to capture the patients' evaluation of the total area of burn scar(s). METHOD Statistical analysis was based on 508 completed POSAS forms from 358 patients. Exploratory factor analysis (EFA) was used initially to identify the number of factors within the tool, then confirmatory factor analysis (CFA) using structural equation modelling explored areas of misfit within each factor and whether the model provided a predicable structure to capture patient perception of scar severity. RESULTS/DISCUSSION The CFA analysis confirmed that a two dimensional model was superior to a unidimensional model when assessing the patient opinion of their total burn scar. The two dimensions were the physical scar (color, stiffness, thickness and irregularity) and the sensory scar (pain and itch). Further strain analysis of the two factor model identified additional domains. Independent factors influenced the perception of color forming a separate subdomain within the physical domain. Color is a visual characteristic, whereas the other three are predominantly tactile characteristics. A significant relationship between thickness and irregularity suggested they may form another subdomain, however further research is required to confirm this. Both pain and itch were recognized as independent, multidimensional latent variables, which require assessment tools with multidimensional structures. CONCLUSIONS When assessing the entire burn scar, three independent dimensions influence patient perception: (1) the physical scar, (2) pain and (3) itch. Within the physical domain, color formed a visual subdomain separate to a tactile subdomain. Further development of these domains within a high-order multi-dimensional structure is recommended.
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Affiliation(s)
- Helen M DeJong
- Perth Scar and Pain Clinic, Mt Pleasant, 6153, WA, Australia; Medical Sciences, Edith Cowan Universtiy, Joondaplup, 6027, WA, Australia; Harry Perkins Institute for Medical Research, Nedlands, 6009, WA, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia.
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, Nedlands, 6009, WA, Australia; Centre for Medical Research, University of Western Australia, Crawley, 6009, WA, Australia; Royal Perth Hospital, Perth 6000, WA, Australia
| | - Dale W Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia; Burn Injury Research Node, The Universtiy of Notre Dame Australia, Fremantle, 6160, WA, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia.
| | - Fiona M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, 6009, WA, Australia; Burn Injury Research Node, The Universtiy of Notre Dame Australia, Fremantle, 6160, WA, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, 6150, WA, Australia; Child and Adolescent Health Service of Western Australia, Princess Margaret Hospital, Subiaco, 6008, WA, Australia.
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Lavigne JM, Patel B, Stockton K, McBride CA. Starchy liquid burns do not have worse outcomes in children relative to hot beverage scalds. Burns 2016; 42:1751-1755. [PMID: 27394079 DOI: 10.1016/j.burns.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/25/2022]
Abstract
AIM To characterise children presenting with hot beverage scalds versus scalds caused by starchy water. METHODS Retrospective survey of prospectively collected database of all children presenting over a two-year period. RESULTS There were 138 starch scalds and 262 hot beverage injuries. Children with hot beverage injuries were significantly younger (18.2 months; IQR 14.1, 27.8) than those suffering starch scald injuries (51.4 months; 18.7, 102.3; p<0.001). Perineal burns were more common in the starch group than the hot beverage scald group (10.9% vs. 2.4%, p<0.001). Chest/breast and abdominal burns were more common in the hot beverage group than the starch group (60.7% vs. 36.9%, p<0.001). Children under three years of age in both groups are significantly less likely to receive adequate first aid at the scene (p<0.001). There are no differences in the need for skin grafting or scar management when comparing hot beverage scalds and scalds caused by starchy liquids. CONCLUSIONS Scald injuries caused by starchy liquids do not appear to cause a more severe injury than hot beverage scalds. There is a different pattern of injury from starchy liquids in older children. Children under three years old are less likely to receive appropriate first aid at the scene.
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Affiliation(s)
- Jordan M Lavigne
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Children's Health Queensland, Queensland, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia
| | - Bhaveshkumar Patel
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Children's Health Queensland, Queensland, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia
| | - Kellie Stockton
- Bond Institute of Health & Sport, Bond University, Queensland, Australia
| | - Craig A McBride
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Children's Health Queensland, Queensland, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia.
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Patient experiences of burn scars in adults and children and development of a health-related quality of life conceptual model: A qualitative study. Burns 2016; 42:620-32. [PMID: 26803365 DOI: 10.1016/j.burns.2015.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to understand the impact of burn scars on health-related quality of life (HRQOL) from the perspective of adults and children with burn scars, and caregivers to inform the development of a conceptual model of burn scar HRQOL. METHOD Twenty-one participants (adults and children) with burn scars and nine caregivers participated in semi-structured, face-to-face interviews between 2012 and 2013. During the interviews, participants were asked to describe features about their (or their child's) burn scars and its impact on everyday life. Two coders conducted thematic analysis, with consensus achieved through discussion and review with a third coder. The literature on HRQOL models was then reviewed to further inform the development of a conceptual model of burn scar HRQOL. RESULTS Five themes emerged from the qualitative data: 'physical and sensory symptoms', 'impact of burn scar interventions', 'impact of burn scar symptoms', 'personal factors' and 'change over time'. Caregivers offered further insights into family functioning after burn, and the impacts of burn scars and burn scar interventions on family life. In the conceptual model, symptoms (sensory and physical) of burn scars are considered proximal to HRQOL, with distal indicators including functioning (physical, emotional, social, cognitive), individual factors and the environment. Overall quality of life was affected by HRQOL. CONCLUSION Understanding the impact of burn scars on HRQOL and the development of a conceptual model will inform future burn scar research and clinical practice.
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Finlay V, Phillips M, Allison GT, Wood FM, Ching D, Wicaksono D, Plowman S, Hendrie D, Edgar DW. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn. Burns 2015; 41:1397-404. [PMID: 26233899 DOI: 10.1016/j.burns.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/04/2015] [Accepted: 06/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. METHOD A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. RESULTS AND DISCUSSION Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. CONCLUSION For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery.
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Affiliation(s)
- V Finlay
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia.
| | - M Phillips
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - G T Allison
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - F M Wood
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Ching
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Wicaksono
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - S Plowman
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia
| | - D Hendrie
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D W Edgar
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Wolf SE, Sterling JP, Hunt JL, Arnoldo BD. The year in burns 2010. Burns 2012; 37:1275-87. [PMID: 22075032 DOI: 10.1016/j.burns.2011.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 01/08/2023]
Abstract
For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each paper is considered very briefly, and the reader is referred to full manuscripts for details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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Simons M, Ziviani J, Copley J. Explanatory case study design: application in paediatric burns health services research. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.5.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Megan Simons
- Department of Occupational Therapy and Music Therapy, Royal Children's Hospital; Lecturer, School of Health and Rehabilitation Sciences, The University of Queensland, and Clinical Member, The Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Jenny Ziviani
- Children's Allied Health Research, Queensland Health and The University of Queensland
| | - Jodie Copley
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
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Invited critique: predicting functional outcome for children after burn injury: do parents hold the key? J Burn Care Res 2010; 31:766-7. [PMID: 20661147 DOI: 10.1097/bcr.0b013e3181eed24f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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