Itching and Parental guilt: Parent Responses to Children's Symptoms Following Unintentional Burn Injuries

Abstract

Background: Unintentional burn injury can be a traumatic and stressful event for the affected children and their parents. Young children experience persistent itching and emotional distress associated with the injury. Parents assume the responsibility to manage their child’s itching since young children have limited strategies to cope with the overwhelming effects of itching. Yet very little research has been focused on the experience of parents when managing their child’s itching. There is a lack of understanding about ways parents assess and respond to the child’s itching. In addition, parents experience guilt due to their perceived failure to protect the child. There is a paucity of literature examining the process of parental guilt after the incidence of burn injury. Little is known about the representation of guilt in parental responses to a child’s burn and the consequences of that guilt for the parents. Purpose: The purpose of this dissertation is to explore parents’ lived experience of managing itching in young children and the phenomenon of parental guilt following unintentional burn injuries. There are three papers in this dissertation. Paper 1 examines parents' lived experience of managing itching in young children following moderate to severe unintentional burn injury. Paper 2 discusses the conceptual and empirical literature on parental guilt and its measures. Paper 2 also proposes a framework to understand the process of guilt in the familial and social context. Paper 3 examines guilt and its representation in parental responses to a child’s burn. Paper 3 also identifies the immediate consequences of that guilt for the parents. Methods: Paper 1 and paper 3 are based on the semi-structured interview data conducted with 20 parents of children with unintentional burn injury. Parents of children with burns were recruited from a regional burn center in eastern China. Study participants were eligible if (a) they were a parent or primary caregiver of a child who was 16 months to 5 years old at the time of the burn injury; (b) their child had deep second-degree or third-degree burns at the time of the injury; (c) their child was 1–10 month(s) post-burn injury during his/her clinic visit; and (d) they were able to read, speak, and understand Mandarin. After enrollment, confidential semi-structured interviews were conducted with the participants. The interview consisted of 14 open-ended questions. Interviews lasted 40 to 70 minutes, and the audio was digitally recorded. For paper 1, data from three of the 14 interview questions were analyzed using inductive content analysis. For paper 3, data from five of the 14 interview questions were analyzed using a combination of deductive and inductive content analysis. Paper 2 reviews the empirical literature on parental guilt to build a conceptual model of this concept. Searches were restricted to the context of parental guilt related to children’s unintentional burn injury and restricted to English and Chinese language journals published within the past 30 years. Results: Paper 1 Twenty parents of children 34 (±11.5) months with moderate to severe burns of 11.2% (±8.7) total burn surface area participated in interviews. The mean length of time since burn injury was 6.4 (±3.1) months. Scratching the Itch with My Child was the core construct that captured the lived experience of parents' itching management. Parents assessed their child’s itch by observing their child's behavior, by the child explicitly telling the parent about the itch, and the parent's guessing at what the child was experiencing post-burn. Parental management of their child's itch involved five domains: shifting attention, physical touching, cooling the child, taking care of the scar, and yelling at the child. Paper 2 We discussed the nature and process of guilt. The empirical evidence on the relationships between guilt and various types of psychological symptoms in parents and children are summarized. Following this, several variables that are thought to regulate the guilt process are also discussed. A conceptual model is presented to depict guilt appraisal, which molds or structures human action, expression, and perception toward self in the context of guilt. Finally, recommendations for research and clinical practice are made regarding assessment and interventions targeting the cause and sequelae of guilt. Paper 3 Parents expressed feelings of guilt using the word “guilt” or sentences that conveyed the manifest meaning, which reflected the definition of guilt. Analysis of the data produced three conceptual domains of the consequence of guilt: (1) reappraisal of guilt toward the self, (2) motivational reactions toward the child, and (3) other accompanying emotions. Conclusion: This dissertation adds new information to the body of knowledge on parents’ experiences managing their child’s itching after the incidence of traumatic burn injury and their guilt experience. Parents were distressed managing their child’s itch, and they struggled with what more they could do to relieve the child’s incessant itching. Interventions are needed that directly assist parents or caregivers in promoting developmentally appropriate parent-child interaction in the context of itching management. As for parental guilt, results from the literature review provide insight into ways to measure guilt experiences. The proposed conceptual framework allows scholars to understand the implication of guilt on the individual behavioral tendency; that is, the resultant outcomes between maladaptive and adaptive guilt. Finally, the data-based examination of guilt suggests that guilt and its consequences are, by definition, correlated but have distinct semantic representation. Understanding the consequences of that guilt offers a new opportunity to improve the provision of care and long-term support as we position the parents of the child in the social context of their family.