The lived experience of paediatric nurses’ caring for children with non-accidental head injuries
Gibbs, Kristy-Anne Rebecca
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Child abuse remains a significant issue in New Zealand and rates of non-accidental injuries continue to rise. Non-accidental head injury (NAHI) is a major cause of mortality in young children; further, a considerable proportion of survivors will live a life with severe developmental and neurological dysfunction. The aim of this research study is to describe, using the interpretive hermeneutic phenomenological approach, the phenomenon of the lived experiences of nurses who care for children and their families who are admitted to hospital with head injuries of a non-accidental nature. This study offers an understanding into the experience of nursing children with NAHI. The philosophical underpinnings of hermeneutic phenomenology, guided by the writings of Heidegger and van Manen were used to design and carry out this research study. Semi-structured interviews were conducted with six nurses who had at least two years’ experience of nursing children with NAHI in Auckland, New Zealand. Transcripts of the interviews were analysed with the rich participant stories, uncovering the lived experiences of working in this challenging area. Two overarching themes emerged. Nursing children with NAHI is different from the care of children admitted with accidental injuries or medical conditions. Nurses experience is different in the protocol that is followed when children are admitted to hospital; in the complex nature of relationships between the nurse and the family; and in the tension arising from maintaining a non-judgmental approach towards families. Nursing children with NAHI requires the nurse to adopt protective qualities, conceptualised in this study by the form of a shield. These qualities are used as a form of self-protection to minimise the distress of the circumstances surrounding the child’s injuries, as well as a mechanism to protect their relationship with the child’s family. These protective qualities are manifested in their care through an acute awareness of their role as a nurse; creating and maintaining professional boundaries; and shifting the focus of their care towards the child. The data raises important discussion points surrounding the emotional labour required of nurses caring for children with NAHI and their families; the maintenance of a professional demeanour; and implementing and sustaining a family-centred care approach. The findings have highlighted areas in this practice setting that are challenging to normally fundamental aspects of paediatric nursing practice. Recommendations have been made to support the improvement of nursing children and their families with NAHI which acknowledges this area of practice as unique and specialised in its complexity and emotional labour.