Caregiving for children who have had a traumatic brain injury: structuring for security
This New Zealand study used a grounded theory methodology to explore the day-to-day occupations of family caregiving for children who had sustained a traumatic brain injury. Semi-structured interviews and participant observations were employed to gather data from five families including children of pre-school and school age and their parents. Constant comparative analysis of the data revealed a central caregiving category, Structuring For Security, which encompassed two simultaneous and interdependent caregiving processes. A model is presented illustrating the processes.Structuring For Security describes the way the parents' caregiving is directed towards building a framework that provides for the present and future safety and success of their children. Holding Things Together explains endeavours to contain the distressing events resulting from the accident, with a focus on protecting the children from physical and emotional dangers. Joining My Child With Others explains what is happening when parents set things up for their children to spend time in activity with other people. The two processes are mediated by support from others, and involve learning and use of practical knowledge about the child. Successful implementation of the processes results in parents' increasing awareness of their ability to cope, progress in the children, and children's successful participation with other people. Participation in the processes is ongoing, responding to change in the child and in the environment.The study findings suggest a basis for the development of a framework that families and clinicians might use to guide caregiving for children after a traumatic brain injury. The findings also indicate the importance of supporting parents in developing effective caregiving structures that fit with their concerns for their children's safety and success with others. Consideration needs to be given to policies that take into account the safety issues involved for children and the support needs of parents following the accident.