Elsevier

Injury

Volume 45, Issue 9, September 2014, Pages 1452-1458
Injury

Psychosocial care for seriously injured children and their families: A qualitative study among Emergency Department nurses and physicians

https://doi.org/10.1016/j.injury.2014.02.015Get rights and content

Abstract

Background

Approximately one in five children who sustain a serious injury develops persistent stress symptoms. Emergency Department nurses and physicians have a pivotal role in psychosocial care for seriously injured children. However, little is known about staff's views on this role.

Objective

Our aim was to investigate Emergency Department staff's views on psychosocial care for seriously injured children.

Methods

We conducted semi-structured interviews with 20 nurses and physicians working in an Australian Paediatric Emergency Department. We used purposive sampling to obtain a variety of views. The interviews were transcribed verbatim and major themes were derived in line with the summative analysis method. We also mapped participants’ strategies for child and family support on the eight principles of Psychological First Aid (PFA).

Results

Five overarching themes emerged: (1) staff find psychosocial issues important but focus on physical care; (2) staff are aware of individual differences but have contrasting views on vulnerability; (3) parents have a central role; (4) staff use a variety of psychosocial strategies to support children, based on instinct and experience but not training; and (5) staff have individually different wishes regarding staff- and self-care. Staff elaborated most on strategies related to the PFA elements ‘contact and engagement’, ‘stabilization’, ‘connection with social supports’ and least on ‘informing about coping’.

Conclusions

The strong notion of individual differences in views suggests a need for training in psychosocial care for injured children and their families. In addition, further research on paediatric traumatic stress and psychosocial care in the ED will help to overcome the current paucity of the literature. Finally, a system of peer support may accommodate wishes regarding staff care.

Section snippets

Participants and recruitment

We obtained approval for the study from the Human Research Ethics Committees (HRECs) of the Royal Children's Hospital Melbourne and Monash University. Participants were staff, based in the Emergency Department (ED) of the Royal Children's Hospital Melbourne during the period of July 2012–October 2012. Each year, approximately 75,000 children present at the department, 11,000 of whom are admitted to the hospital. Of these admissions, 2000 are injury-related (100–150 with major trauma).

We used

Findings

Five overarching themes emerged: (1) staff find psychosocial issues important but focus on physical care; (2) staff are aware of individual differences but have contrasting views on vulnerability; (3) parents have a central role; (4) staff use a variety of psychosocial strategies to support children, based on instinct and experience but not training; and (5) staff have individually different wishes regarding staff- and self-care.

  • (1)

    Staff find psychosocial issues important but focus on physical care

Discussion

Emergency Department staff play a pivotal role in psychosocial care for injured children. Nevertheless, to our knowledge this is the first in-depth study of nurses’ and physicians’ perspectives on the topic. Its qualitative approach enabled staff's perspectives to be heard in detail, yielding a rich dataset. That we obtained 10 h of staff narrative in a busy ED (with no staff declining interviews) in itself suggests that staff are eager for their views to be heard. The themes that emerged

Conflict of interest statement

This study was partially funded by a Monash University Larkins Fellowship (EA) and the Victorian Government's Operational Infrastructure Support Program. The authors report no conflict of interest.

Acknowledgements

We would like to thank the emergency staff for their participation in this study as well as Jean Bowra, Revathi Krishna, Odilia Laceulle, Nathan Alkemade, Samara Johnson, Thalia Lammers, Sara Nairn, and Alys Manguy for their assistance in the project.

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