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Title: Parental adjustment following paediatric burn injury
Author: Hawkins, L. C.
ISNI:       0000 0004 6495 9894
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Every year in the UK and Wales, 3,750 children (aged 15 years or under) are seen in accident and emergency departments following a burn injury (Child Accident Prevention Trust [CAPT], 2012). Around 95% of injuries occur at home and are predominantly the result of everyday situations, such as a scald from a hot drink or contact with electrical appliances (CAPT, 2012). Burn injuries can involve long-lasting painful and physical consequences for the child (e.g. skin grafts, rehabilitation and permanent scarring). However, the psychological impact of an injury is not limited to the child affected. Indeed, parents are often more emotionally distressed than the children themselves (Kent, King, & Cochrane, 2000). This thesis will focus on the psychological adjustment of parents following their child's burn injury. Previous research has indicated that parents experience elevated levels of distress. For instance, 50% of parents whose child required an inpatient admission met clinical criteria for traumatic stress (Bakker, Van der Heijden, Van Son, & Van Loey, 2013). High rates of depression and anxiety have also been reported (Phillips & Rumsey, 2008). In addition, parent's post-burn adjustment has direct implications for their child's emotion and physical recovery (De Young, Hendrikz, Kenardy, Cobham, & Kimble, 2014). Research can therefore play an important role in identifying factors that are associated with this adjustment process. Such findings could inform clinical practices, for instance, in providing better identification and support of families who may be struggling. To this end, the thesis will examine what puts families at risk of poor adjustment and what protects against this. The thesis takes the form of two chapters: a systematic review and an empirical paper. In the systematic review, a search of the literature was undertaken to identify all factors associated with adjustment. Poor adjustment was operationalised as the experience of symptoms of depression, anxiety and post-traumatic stress disorder. The findings were synthesised using a narrative approach. Overall it was found that objective injury characteristics (e.g. burn size) were poor predictors for parent's adjustment. Instead subjective appraisals of the burn event, parent's pre-existing difficulties, the child's symptoms of PTSD and systemic factors were all robustly associated with parents' distress. The empirical paper investigated the impact of subjective factors: guilt and shame and self-compassion on parental adjustment. The study expanded previous findings that guilt is a common experience among parents of children who have sustained a burn injury (Mason, 1993). For example, it used a validated measure of guilt to examine this complex emotion and is the first to consider the related construct of shame. A sample of parents was recruited at a regional children's burn unit (Alder Hey Children's Hospital, Liverpool) during the acute phase following their child's burn injury. Guilt, shame and self-compassion were found to be good predictors for adjustment in parents, while objective characteristics of the burn injury were less important. Furthermore this study contributed to the growing body of evidence that guilt and shame represent distinct constructs and are differentially associated with psychological outcomes (Kim, Thibodeau, & Jorgensen, 2011). Overall these two papers integrate and extend our current understanding of parental adjustment in the context of paediatric burn injuries. Both papers offer a number of clinical recommendations which may help to improve patient care.
Supervisor: Centifanti, L. ; Holman, N. ; Taylor, P. J. Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral