Parental Perspectives on Children's Functional Experiences After Limb Fracture: A Qualitative Study

The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study

PURPOSE

To investigate the factors linked to the caregiving burden among family caregivers of pediatric patients with fractures.

METHODS

This descriptive cross-sectional research used non-probabilistic sampling involving 200 pediatric patients (0-14 years) with fractures and their family caregivers. Data was collected between November 2019 and June 2020. The Chinese version of the Zarit Burden Interview (ZBI) and Simplified Coping Style Questionnaire (SCSQ) assessed caregiving burden and coping styles. We examined clinical data of patients and caregivers, identifying factors influencing caregiving burden by integrating findings from parallel studies, and conducted statistical analyses on these factors.

RESULTS

Most family caregivers in this study were women (80.5%), with mothers comprising 56% of the total. The average ZBI score was 40.65 ± 17.27, and 81.5% of caregivers had moderate or severe burden. Factors associated with caregiving burden included caregiver gender, co-caregivers, positive and negative coping scores, and monthly income. The significant factors that were identified accounted for approximately 42.4% of the variability in the caregiving burden.

CONCLUSIONS

This study concluded that family caregivers of pediatric patients with fractures often experience moderate to severe burdens, especially female caregivers, those without co-caregivers, using negative coping strategies, and from low-income families. Thus, it is essential to provide these families with professional information, policy support, and affordable, effective care services.

IMPLICATIONS TO PRACTICE

Healthcare professionals should prioritize addressing the caregiving burden of family caregivers of pediatric patients with fractures. Nurses can actively improve the health of these pediatric patients and ease parental burden by providing information about social support systems.

What influences physician opioid prescribing for children with acute pain?

Background

Pain is one of the most common symptoms encountered in the healthcare system, and opioids are among the top three medications used to treat it. Understanding the reasoning behind physicians' opioid prescribing practices is vital to safe practice. The primary objective of our study was to describe pediatric emergency physicians' decision-making process when prescribing opioids for children's acute pain management.

Methods

This study employed qualitative methodology, using one-on-one semi-structured interviews within a grounded theory analytic framework. We employed purposeful sampling to recruit pediatric emergency physicians from across Canada. Interviews were conducted by telephone (December 2019-January 2021). Transcript analysis occurred concurrently with data collection, supporting data saturation and theory development considerations.

Results

Eleven interviews were completed with participants representing each of Canada's geographic regions. Nine major themes emerged: (1) practice setting and outpatient opioid use, (2) condition-specific considerations, (3) physician confidence in medical evidence, (4) pain assessment challenges, (5) patient and family perspectives, (6) opioid safety concerns, (7) personal biases and experiences, (8) personal practice context, and (9) the Opioid Crisis/media influence. Most clinicians felt that they limited opioid use to those who needed it most; all participants described challenges managing acute pain, emphasizing the need for accurate pain measurement and better guidelines, evidence-based data, and knowledge translation. Clinicians were more comfortable treating pain in the emergency department, compared to discharge prescribing. They recognized the importance of co-therapy with non-opioids and the need for opioid risk assessment when prescribing. A family centered approach was recognized as the goal of practice.

Conclusion

Clinicians are less comfortable prescribing opioids to children for at-home use and find pain assessment and lack of clear guidelines to be barriers to pain care. Knowledge translation strategies for safer practice and optimal acute pain management could support responsible and judicious opioid use.

Adolescent and Caregiver Perspectives on Living With a Limb Fracture: A Qualitative Study

BACKGROUND

Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families.

OBJECTIVES

The primary objective of this study was to understand how changes in functional ability impact youth with fractures.

METHODS

We conducted individual, semistructured interviews from June 2019 to November 2020 with adolescents and their caregivers 7 to 14 days following their initial visit to a pediatric emergency department. We used qualitative content analysis methodology; recruitment proceeded until thematic saturation was achieved. Coding and analysis were concurrent with recruitment and interviews. The interview script was modified in an iterative process, to reflect emerging themes.

RESULTS

Twenty-nine interviews were completed. The most frequently affected functions were (a) showering and hygiene (requiring the most caregiver support), (b) sleep (due to pain and cast-related discomfort), and (c) exclusion from sports/activities. Many adolescents experienced disruptions to social activities and gatherings. Youth valued independence and took more time to complete tasks, regardless of inconvenience. Both adolescents and caregivers reported feelings of frustration from day-to-day impacts of the injury. Generally, caregivers' perspectives were in keeping with the experiences that adolescents described for themselves. Notable family impacts included "sibling burden," or conflicts that arose when a sibling had to take on extra chores/tasks.

CONCLUSIONS

Overall, caregivers' perspectives were congruent with the self-described experiences of adolescents. Key messages for optimized discharge instructions include pain and sleep management, allowing extra time to complete tasks independently, considering impact on siblings, preparing for changes in activities and social dynamics, and normalizing frustration. These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures.

Protecting my injured child: a qualitative study of parents' experience of caring for a child with a displaced distal radius fracture

Background

Childhood fractures can have a significant impact on the daily lives of families affecting children’s normal activities and parent’s work. Wrist fractures are the most common childhood fracture. The more serious wrist fractures, that can look visibly bent, are often treated with surgery to realign the bones; but this may not be necessary as bent bones straighten in growing children. The children’s radius acute fracture fixation trial (CRAFFT) is a multicentre randomised trial of surgery versus a cast without surgery for displaced wrist fractures. Little is known about how families experience these wrist fractures and how they manage treatment uncertainty. This study aimed to understand families’ experience of this injury and what it is like to be asked to include their child in a clinical trial.

Methods

Nineteen families (13 mothers, 7 fathers, 2 children) from across the UK participated in telephone interviews. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis.

Results

Our findings highlight parents’ desire to be a good parent through the overarching theme “protecting my injured child”. To protect their child after injury, parents endeavoured to make the right decisions about treatment and provide comfort to their child but they experienced ongoing worry about their child’s recovery. Our findings show that parents felt responsible for the decision about their child’s treatment and their child’s recovery. They also reveal the extent to which parents worried about the look of their child’s wrist and their need for reassurance that the wrist was healing.

Conclusion

Our findings show that protecting their child after injury can be challenging for parents who need support to make decisions about treatment and confidently facilitate their child’s recovery. They also highlight the importance of providing information about treatments, acknowledging parents’ concerns and their desire to do the right thing for their child, reassuring parents that their child’s wrist will heal and ensuring parents understand what to expect as their child recovers.