"It's calm on the outside but going absolutely stir crazy on the inside": A qualitative insight into the emotional dimensions and support for parent-administered at home paediatric burn dressing changes.

Abstract

Globally, paediatric burns are the fifth most common non-fatal injury in children. In England and Wales annually over 30,000 children receive outpatient burn treatment. A paediatric burn can have a significant negative psychological impact on parents and children. In the UK, where parents are often asked to undertake their child's burn wound dressing changes at home, the role of clinical caregiver can provoke significant emotional labour. This study explored the emotional dimensions and support available to parents administering children's burn dressing changes at home. This qualitative study formed part of a larger experience-based co-design project to develop service guidance to support parent-administered home dressing changes in paediatric burns care. Clinic observations were conducted across three paediatric burns centres in England and Wales. In addition, semi-structured interviews were conducted with healthcare professionals and parents on the perspectives and experiences of parent-administered home dressing changes. A thematic framework analysis identified two key themes and sub-themes. Healthcare professionals typically recognised parental anxiety and regularly provided parents with comfort and reassurance in clinics. Healthcare professional perceptions of severity of anxiety displayed through parents' behaviour were used as indicators of suitability for home administered dressing changes. Whilst parents dealt with the practical elements of dressing changes, they were unprepared for the emotional impact. Parents expressed feeling negative emotions when administering dressing changes and employing strategies to supress emotions to minimise distress to their child. The emotional impact of paediatric burns is recognised by parents and healthcare professionals. However, a disparity exists between these perspectives. Currently guidance and reassurance provided to parents does not address the emotional impact of parent-administered dressing-changes. Healthcare professionals provide emotional support in clinic and task-related support for home dressing-changes. Resources to support parents to administer dressings at home should include psychological coping strategies to manage the negative impact on families.