Caring for a Child With an Obstetric Brachial Plexus Injury: A Metaphor Analysis.

PURPOSE: The purpose of this study was to examine the metaphors used by mothers to describe their experiences caring for their children with obstetric brachial plexus injuries. DESIGN AND METHODS: A secondary qualitative data analysis was conducted from the primary data set of a phenomenological study of mothers' experiences caring for their children with obstetric brachial plexus injuries. The type of secondary qualitative data analysis approach used was analytic expansion. Metaphor Identification Procedure was used to analyze the corpus of 132 pages of typed transcription. RESULTS: This metaphorical analysis yielded seven metaphors mothers used to describe their experiences caring for their children with obstetric brachial plexus injuries. These metaphors portrayed mothers' lives as involving a heavy weight, a maze, a juggling act, a simmering pot, a dagger to the heart, a rollercoaster, and a constant battle. CONCLUSION: The seven metaphors helped women express what they could not completely capture using only medical jargon and provide valuable insight for clinicians. Using secondary qualitative data analysis to mine for any metaphors in a primary data set gives researchers another valuable and creative opportunity to discover new knowledge from the data they had previously collected. PRACTICE IMPLICATIONS: Specific interventions can be developed to target each of these seven metaphors to help mothers in their daily care for their children with obstetric brachial plexus injuries.

A case study from a nursing and occupational therapy perspective - Providing care for a patient with a traumatic brachial plexus injury.

This paper presents a case study that demonstrates how collaborative working between professionals enhanced the holistic care for a patient following a traumatic brachial plexus injury. The paper will describe the patient's journey of care from initial presentation, diagnosis and assessment, acute care provision, discharge & rehabilitation to ongoing supportive counselling. The care encompasses input from both a nursing and occupational therapy perspective.

Home exercise DVD promotes exercise accuracy by caregivers of children and adolescents with brachial plexus palsy.

OBJECTIVE: To evaluate the accuracy of home exercise performance by caregivers of children with neonatal brachial plexus palsy (NBPP) who use digital versatile disc (DVD) guidance. DESIGN: Prospective cohort study. SETTING: Brachial Plexus Clinic at the University of Michigan. PARTICIPANTS: Seventy-six adult caregivers of a consecutive cohort of pediatric patients with NBPP. METHODS: Caregivers received the Home Exercise Program for Brachial Plexus Palsy DVD and an initial demonstration of correct hand placement and movement patterns by 1 of 2 occupational therapists. At times A, B, and C (approximately 3, 6, and 12 months), caregiver accuracy in exercise performance at each joint and standard measurements of arm function were recorded. MAIN OUTCOME MEASUREMENTS: Caregiver accuracy in correct hand placement and movement pattern during exercise performance was evaluated with use of a dichotomy scale (yes/no) at each joint. Active and passive range of motion were assessed as indicators of arm function. RESULTS: The mean patient age was 38 months, and the median Narakas score was 2. No significant difference in exercise accuracy for all upper extremity joints between the initial evaluation and times A, B, and C or between individual times was observed, except at the shoulder (98.9% initially to 88.3% at time A; P = .0002) and elbow (100% initially to 96.6% at time A; P = .04). Regarding arm function, an increase in active range of motion for shoulder flexion, elbow flexion, forearm supination, wrist extension, and finger flexion was observed during the study period. CONCLUSIONS: Shoulder and elbow exercises may be more complex, requiring more frequent performance review with the caregiver. However, the home exercise DVD may benefit patients with NBPP and their caregivers and may provide an adjunct to formal therapy sessions.

The obstetric nightmare of shoulder dystocia: a tale from two perspectives.

PURPOSE: Shoulder dystocia is one of the most terrifying of obstetric emergencies. In this secondary analysis of two qualitative studies, the experiences of shoulder dystocia are compared and contrasted from two perspectives: the mothers and the labor and delivery nurses. METHOD: In the first study mothers' experiences of shoulder dystocia and caring for their children with obstetric brachial plexus injuries were explored. The second study explored secondary traumatic stress in labor and delivery nurses due to exposure to traumatic births. Krippendorff's content analysis technique of clustering was used to identify data that could be grouped together into themes. RESULTS: It was striking how similar the perspectives of mothers and their nurses were regarding a shoulder dystocia birth. Four themes emerged from the content analysis of these two data sets: (1) in the midst of the obstetric nightmare; (2) reeling from the trauma that just transpired; (3) enduring heartbreak: the heavy toll on mothers; and (4) haunted by memories: the heavy toll on nurses. CLINICAL IMPLICATIONS: Providing emotional support to the mother during shoulder dystocia births and afterward in the postpartum period has been acknowledged. What now needs to be added to best practices for shoulder dystocia are interventions for the nurses themselves. Support for labor and delivery nurses who are involved in this obstetric nightmare is critical.

The arm: there is no escaping the reality for mothers of children with obstetric brachial plexus injuries.

BACKGROUND: Shoulder dystocia is considered the obstetric nightmare. A potentially devastating complication of shoulder dystocia to the infant is obstetric brachial plexus injury (OBPI). Between 20% and 30% of infants with OBPI experience residual functional deficits. OBJECTIVE: The objective of this study was to investigate mothers' experiences caring for their children who have an OBPI. METHODS: Colaizzi's phenomenology was the method used to examine the phenomenon of mothers' caring for their children with an OBPI. A recruitment notice was placed on the Web site of the United Brachial Plexus Network. Twenty-three mothers comprised the convenience sample. Eleven mothers participated in the study over the Internet, and 12 mothers were interviewed in person. Each mother was asked to describe in as much detail as she wished her experiences caring for her child with an OBPI. RESULTS: Six themes emerged to describe mothers' experiences caring for their children with an OBPI: (a) In an Instant: Dreams Shattered; (b) The Arm: No Escaping the Reality; (c) Tormented: Agonizing Worries and Questions; (d) Therapy and Surgeries: Consuming Mothers' Lives; (e) Anger: Simmering Pot Inside; and (f) So Much to Bear: Enduring Heartbreak. CONCLUSIONS: The results of this phenomenological study helped to make visible the daily struggle and enduring heartache of mothers who care for their children with OBPI.