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Phelps EE, Tutton E, Costa ML, Achten J, Moscrop A, Perry DC. Protecting my injured child: a qualitative study of parents' experience of caring for a child with a displaced distal radius fracture. BMC Pediatr 2022; 22:270. [PMID: 35549910 PMCID: PMC9097445 DOI: 10.1186/s12887-022-03340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- E E Phelps
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - E Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - M L Costa
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Achten
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A Moscrop
- Parent Representative, Liverpool, UK
| | - D C Perry
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Abstract
Aims The aim of this study was to explore the patients' experience of recovery from open fracture of the lower limb in acute care. Patients and Methods A purposeful sample of 20 participants with a mean age of 40 years (20 to 82) (16 males, four females) were interviewed a mean of 12 days (five to 35) after their first surgical intervention took place between July 2012 and July 2013 in two National Health Service (NHS) trusts in England, United Kingdom. The qualitative interviews drew on phenomenology and analysis identified codes, which were drawn together into categories and themes. Results The findings identify the vulnerability of the patients expressed through three themes; being emotionally fragile, being injured and living with injury. The participants felt a closeness to death and continued uncertainty regarding loss of their limb. They experienced strong emotions while also trying to contain their emotions for the benefit of others. Their sense of self changed as they became a person with visible wounds, needed intimate help, and endured pain. When ready, they imagined what it would be like to live with injury. Conclusion Recovery activities require an increased focus on emotional wellbeing. Surgeons are aware of the need for clinical expertise and for adequate pain relief but may not be as aware that their patients require support regarding their body image and help to imagine their future life. Cite this article: Bone Joint J 2018;100-B:522-6.
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Affiliation(s)
- E Tutton
- University of Warwick, Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK and Oxford University Hospitals NHS Foundation Trust, Kadoorie Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - J Achten
- University of Oxford, Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, and Kadoorie Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - S E Lamb
- University of Oxford, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, and Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - K Willett
- University of Oxford, Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, and Kadoorie Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - M L Costa
- University of Oxford, Oxford Trauma, Nuffield Department of Orthopaedics Rhenmatology and Musculoskeletal Sciences, and Kadoorie Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Costa ML, Tutton E, Achten J, Grant R, Slowther AM. Informed consent in the context of research involving acute injuries and emergencies. Bone Joint J 2017; 99-B:147-150. [PMID: 28148654 DOI: 10.1302/0301-620x.99b2.bjj-2016-0517.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/11/2016] [Indexed: 11/05/2022]
Abstract
Traditionally, informed consent for clinical research involves the patient reading an approved Participant Information Sheet, considering the information presented and having as much time as they need to discuss the study information with their friends and relatives, their clinical care and the research teams. This system works well in the 'planned' or 'elective' setting. But what happens if the patient requires urgent treatment for an injury or emergency? This article reviews the legal framework which governs informed consent in the emergency setting, discusses how the approach taken may vary according to the details of the emergency and the treatment required, and reports on the patients' view of providing consent following a serious injury. We then provide some practical tips for managing the process of informed consent in the context of injuries and emergencies. Cite this article: Bone Joint J 2017;99-B:147-150.
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Affiliation(s)
- M L Costa
- University of Oxford, NDORMS, Kadoorie Centre, Level 3 John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - E Tutton
- Oxford University Hospitals NHS Foundation Trust, Kadoorie Centre, John Radcliffe, OX3 9DU, UK
| | - J Achten
- University of Oxford, NDORMS, Kadoorie Centre, Level 3 John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - R Grant
- Warwick Medical School/CLAHRC WM/Coventry & Warwickshire Partnership Trust, University of Warwick, Warwick Medical School, Coventry CV4 8UW, UK
| | - A M Slowther
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, UK
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Haywood KL, Brett J, Tutton E, Staniszewska S. Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability. Qual Life Res 2016; 26:799-812. [DOI: 10.1007/s11136-016-1424-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/24/2023]
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Hamilton TW, Hutchings L, Alsousou J, Tutton E, Hodson E, Smith CH, Wakefield J, Gray B, Symonds S, Willett K. The treatment of stable paediatric forearm fractures using a cast that may be removed at home. Bone Joint J 2013; 95-B:1714-20. [DOI: 10.1302/0301-620x.95b12.31299] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether, in the management of stable paediatric fractures of the forearm, flexible casts that can be removed at home are as clinically effective, cost-effective and acceptable to both patient and parent as management using a cast conventionally removed in hospital. A single-centre randomised controlled trial was performed on 317 children with a mean age of 9.3 years (2 to 16). No significant differences were seen in the change in Childhood Health Assessment Questionnaire index score (p = 0.10) or EuroQol 5-Dimensions domain scores between the two groups one week after removal of the cast or the absolute scores at six months. There was a significantly lower overall median treatment cost in the group whose casts were removed at home (£150.88 (sem 1.90) vs £251.62 (sem 2.68); p < 0.001). No difference was seen in satisfaction between the two groups (p = 0.48). Cite this article: Bone Joint J 2013;95-B:1714–20.
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Affiliation(s)
- T. W. Hamilton
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - L. Hutchings
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Alsousou
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - E. Tutton
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - E. Hodson
- Wellcome Trust Centre for Human Genetics, Roosevelt
Drive, Oxford, UK
| | - C. H. Smith
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Wakefield
- The Royal Marsden Hospital NHS Trust, Department
of Radiology, Downs Road, Sutton, Surrey
SM2 5PT, UK
| | - B. Gray
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S. Symonds
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K. Willett
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Tutton E. Nursing care study - testicular hydrocele: cause unknown. Nurs Mirror 1982; 154:49. [PMID: 6918011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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