Support needs of parents of children with burns : A qualitative study of parents’ experiences and need for support in relation to their child’s burn injury during hospitalisation and after discharge

Bakgrunn: En brannskade hos barn påvirker hele familien, spesielt rammes foreldrene som har en avgjørende rolle i å ta vare på sitt barn. Foreldres behov for støtte gjennom brannskadeforløpet har likevel hittil fått lite oppmerksomhet. Mål: Avhandlingens overordnede mål var å få en dypere forståelse for foreldrenes erfaringer og behov for støtte, både i løpet av den tiden det brannskadde barnet var innlagt på sykehus med en utilsiktet brannskade og i tiden etter utskrivning, samt å skape et grunnlag for å kunne utvikle en fremtidig intervensjon til støtte for denne foreldregruppen. De spesifikke målene med de fire studiene var: 1) Å systematisk syntetisere litteraturen som omhandler støttebehov hos foreldre til brannskadde barn innlagt i sykehus. 2) Å utforske hvilke erfaringer helsepersonell ved en brannskadeavdeling har med å støtte foreldre til brannskadde barn. 3) Å utforske foreldres behov for støtte under innleggelsen av et barn på en brannskadeavdeling. 4) Å utforske foreldres erfaringer med å ta seg av sitt brannskadde barn hjemme etter utskrivelse fra en brannskadeavdeling. Metoder: De fire studiene ble strukturert etter utviklingsfasen av the Medical Research Council’s rammeverk for komplekse intervensjoner, og det ble brukt en fenomenologisk hermeneutisk tilnærming med Ricoeur-inspirert tekstanalyse som metode. Datainnsamlingen inkluderte en systematisk oversikt, fokusgruppeintervjuer og individuelle semistrukturerte intervju. Resultater: Seks behov for støtte ble identifisert hos foreldrene: «Behov for å bli behandlet som en del av en hel familie», «hjelp til å bearbeide følelser av bebreidelse, skyld og skam», «behov for informasjon for å oppleve kontroll», «behov for å bli møtt med tillit av ansatte», «tid til å ivareta egne grunnleggende personlige behov» og «behov for å tilegne seg ferdigheter som er nødvendig etter utskrivning». Konklusjoner og implikasjoner: Ansatte i brannskadeavdelinger bør ta hensyn til de seks identifiserte behovene for foreldrestøtte og inkludere disse i en familie-sentrert omsorgstilnærming.Background: A paediatric burn injury affects the whole family, especially the parents who play a crucial role in supporting their child. However, little attention has so far been payed to the parents’ needs for support during a burn trajectory. Aims: The overall aim of this thesis was to gain a deeper understanding of parents’ lived experiences and need for support both when their child was hospitalised with an accidental burn injury and during the time following discharge; and to inform the development of a future support intervention for this parental group. The specific aims of the four studies were: 1) To systematically synthesise the literature focussing on support needs of parents of burn-injured, hospitalised children. 2) To explore staff members’ lived experiences of supporting parents with children hospitalised at a burn centre due to a burn injury. 3) To explore parents’ lived experiences of their need for support when having a child admitted to a burn centre. 4) To explore the lived experience of parents caring for their burn-injured child at home after being discharged from a burn centre. Methods: The four studies were structured by the development phase of the Medical Research Council’s framework for complex interventions, and a phenomenological hermeneutic approach was chosen using a Ricoeur-inspired textual analysis method. The data collection methods included an integrative review, focus group interviews and individual semi-structured interviews. Results: In this thesis, six parental needs for support were identified; Parents of burn-injured children need to be treated as a whole family; need help to process feelings of guilt, shame and blame; need to receive information to get a sense of control; need to be met with trust by staff members; need time to see to their own fundamental personal needs; and need to obtain the right skills necessary after discharge. Conclusions and implications: Each of the six parental needs for support ought to be addressed by burn staff members, through a care programme guided by a family-centred care approach.Doktorgradsavhandlin

The Safety and Efficiency of the Ultrasound-guided Large Needle Core Biopsy of Axilla Lymph Nodes

PURPOSE: To evaluate the safety and efficiency of the Ultrasound (US)-guided large needle core biopsy of axilla lymph nodes. MATERIALS AND METHODS: From March 2004 to September 2005, 31 patients underwent the US-guided core biopsy for axilla lymph nodes. Twenty five lesions out of 31 were detected during breast US, and 6 of 31 cases were palpable. Lymph nodes were classified based on their shape and cortical morphology. The core biopsy of axilla lymph nodes was performed on suspicious lymph nodes found during breast ultrasonography to find out whether the patients had a history of breast cancer or not. Among the 31 patients, 16 patients were associated with breast cancer. The lesion sizes varied from 0.6 cm to 3.3 cm (mean=1.59+/-0.76 cm). US-guided core biopsies were performed with 14 G needles with an automated biopsy gun. Total 3 or 5 specimens were obtained. RESULTS: Among the 31 cases of axilla lymph nodes core biopsies, 11 cases showed malignant pathology. Seven out of 11 cases were metastatic lymph nodes from breast cancer; 2 cases were from primary unknown and 2 cases from lymphomas. On the other hand, 20 histopathologic results of axilla lesions were benign: subacute necrotizing lymphadenitis (n=2), dermatopathic lymphadenitis (n=1), reactive hyperplasia (n=10) and free of carcinoma (n=7). CONCLUSION: The US-guided large needle core biopsy of axilla lesions is safe and effective for the pathological evaluation. The core biopsy is believed to be easy to perform if suspicious lymph nodes or mass lesions are found in the axillaope

Classification of Metastatic versus Non-Metastatic Axillary Nodes in Breast Cancer Patients: Value of Cortex-Hilum Area Ratio with Ultrasound

Purpose: To investigate the significance of the cortex-hilum (CH) area ratio and longitudinal-transverse (LT) axis ratio and the blood flow pattern for diagnosis of metastatic axillary lymph nodes by ultrasound in breast cancer patients. Methods: From October 2005 to July 2006, we prospectively evaluated axillary nodes with ultrasound in 205 consecutive patients who had category 4B, 4C or 5 breast lesions according to the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-Ultrasound ®). Among the 205, there were 24 patients who had pathologic verification of breast cancer and axillary lymph node status. For a total of 80 axillary nodes we measured the areas of the cortex and hilum of lymph nodes and calculated the area ratio. We also measured the length of the longitudinal and transverse axis of the lymph nodes and calculated the length ratio. We evaluated the blood flow pattern on power Doppler imaging and classified each lymp

Support needs of parents of children with burns : A qualitative study of parents’ experiences and need for support in relation to their child’s burn injury during hospitalisation and after discharge

Bakgrunn: En brannskade hos barn påvirker hele familien, spesielt rammes foreldrene som har en avgjørende rolle i å ta vare på sitt barn. Foreldres behov for støtte gjennom brannskadeforløpet har likevel hittil fått lite oppmerksomhet. Mål: Avhandlingens overordnede mål var å få en dypere forståelse for foreldrenes erfaringer og behov for støtte, både i løpet av den tiden det brannskadde barnet var innlagt på sykehus med en utilsiktet brannskade og i tiden etter utskrivning, samt å skape et grunnlag for å kunne utvikle en fremtidig intervensjon til støtte for denne foreldregruppen. De spesifikke målene med de fire studiene var: 1) Å systematisk syntetisere litteraturen som omhandler støttebehov hos foreldre til brannskadde barn innlagt i sykehus. 2) Å utforske hvilke erfaringer helsepersonell ved en brannskadeavdeling har med å støtte foreldre til brannskadde barn. 3) Å utforske foreldres behov for støtte under innleggelsen av et barn på en brannskadeavdeling. 4) Å utforske foreldres erfaringer med å ta seg av sitt brannskadde barn hjemme etter utskrivelse fra en brannskadeavdeling. Metoder: De fire studiene ble strukturert etter utviklingsfasen av the Medical Research Council’s rammeverk for komplekse intervensjoner, og det ble brukt en fenomenologisk hermeneutisk tilnærming med Ricoeur-inspirert tekstanalyse som metode. Datainnsamlingen inkluderte en systematisk oversikt, fokusgruppeintervjuer og individuelle semistrukturerte intervju. Resultater: Seks behov for støtte ble identifisert hos foreldrene: «Behov for å bli behandlet som en del av en hel familie», «hjelp til å bearbeide følelser av bebreidelse, skyld og skam», «behov for informasjon for å oppleve kontroll», «behov for å bli møtt med tillit av ansatte», «tid til å ivareta egne grunnleggende personlige behov» og «behov for å tilegne seg ferdigheter som er nødvendig etter utskrivning». Konklusjoner og implikasjoner: Ansatte i brannskadeavdelinger bør ta hensyn til de seks identifiserte behovene for foreldrestøtte og inkludere disse i en familie-sentrert omsorgstilnærming

Parents' lived experiences of parental needs for support at a burn centre

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

Parents' lived experiences of parental needs for support at a burn centre

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

Staff members' experience of providing parental support in a national burn centre

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