Reframing the Narrative: An Exploratory Study of the Concerns, Expectations and Experiences of Parents Who Bring Their Child to an Emergency Department with Non-Urgent Illness.

Abstract

Parenthood inevitably includes caring for a child suffering from mild-moderate illness requiring access to health care. Most childhood illnesses can be managed in the community, and parents are encouraged to attend the most suitable primary care service for their needs. Yet the number of children visiting emergency departments with non-urgent illness continues to rise annually, with child attendance representing over 25% of the total workload. This study investigated why parents chose to bring their child to an emergency department and explored the concerns, expectations and experiences of parents when making this decision. Parents of children aged 0-16 years presenting with non-urgent conditions were approached over an 18-month period to participate. Prior to discharge, focused interviews were used to explore the antecedent decision-making factors leading up to attendance, and parents' experiences of urgent care were explored. Parents often experienced complex journeys prior to attending the emergency department following multiple health care contacts and referrals from other providers. For most parents, attending the department was a considered decision, often prompted by their experience of interaction with professionals. Health professionals were powerful agents controlling resources and knowledge, but they were influenced by pressures and targets within the health service. The NHS is a complicated system that parents tried to navigate, but they were thwarted by its complexity and conflicting messages. When their child was unwell parents wanted a service that was simple to access, and that would offer a standard of care that would reassure and empower them to continue to care for their child. The findings challenge assumptions that lead nurses to criticize parents for misuse of emergency care, and highlight the culpability of health professionals and systems in generating increased demand for urgent care. It is important for nurses and others to reframe their perception of parental decision-making.