JKAN Journal of Korean Academy of Nursing J Korean Acad Nurs 2005-3673 2093-758X Korean Society of Nursing Science 10.4040/jkan.2018.48.3.335 jkan-48-335 Original Article Perception on Parental Coping on Unintentional Injury of Their Early Infants and Toddlers: Q Methodological Approach LeeDa In1 ParkHo Ran1 ParkSun Nam2 HongSungsil3 College of Nursing, The Catholic University of Korea, Seoul Seoul Women's College of Nursing, Seoul Department of Nursing, Kangwon National University, Samcheok, Korea Address reprint requests to : Park, Ho Ran College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-7114 Fax: +82-2-532-6537 E-mail: hrpark@catholic.ac.kr 012018 15012018 483 335348 031120173105201831052018 Copyright © 2018 Korean Society of Nursing Science 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium. Abstract Purpose

The purpose of this study was to identify parental coping strategies in the face of early infant and toddler injury, and to provide basic data for a parental education program and the most desirable directions it should take.

 Methods

A Q-methodology to analyze the subjectivity of each item was used. Thirty-four Q-statements were derived from a literature review and interviews. Forty-seven parents were classified into a shape of normal distribution using a 9-point scale. Collected data were analyzed by the pc-QUANL program.

 Results

Five types of parental coping in early infant and toddler injury were identified. Type I was “hospital treatment focused”, type II was “Improving the safety of the child's environment”, type III was “expression of negative emotion”, type IV was “taking the lead in problem solving”, and type V was “Interrogating the person in charge of the situation in which the injury occurred”.

 Conclusion

The results of this study indicate that different approaches to educational programs can be used for parents in early childhood injury.

 Parent Coping Behavior Infant Child Wounds and injuries References de Sousa PetersburgoDKeyesCEWrightDWClickLAMacleodJBSasserSMThe epidemiology of childhood injury in Maputo, MozambiqueInternational Journal of Emergency Medicine201033157163https://doi.org/10.1007/s12245-010-0182-z Statistics KoreaDivision of vital statistics [Internet]DaejeonMinistry of Health and Welfare, National Statistical Officec2013[cited 2017 Sep 3]. Available from:http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=2711 SonMJChild safety accident patterns report. CISS-Consumer injury surveillance systemEumseongKorea Consumer Agency (Korea)201523 YoonSHThe risk factors affecting the injuries of young children at homeJournal of Early Childhood Education & Educare Welfare2012162101122 UzychLBook reviews: Well-being: Positive development across the life course. Edited by Marc H. Bornstein, Lucy Davidson, Corey L. M. Keyes, Kristin A. Moore, and The Center for Child Well-BeingActivities, Adaptation & Aging20042828284 ChoiHSYangEHKimGJLeeMHInfant safety educationSeoulShinJung20131521 LeeSLThe effects of traumatic event type on posttraumatic growth and wisdom: The mediating effects of social support and copingKorean Journal of Psychology2013193319341 LazarusRSLaunierRStress-related transactions between person and environmentNew YorkPlenum Press1978287327 LazarusRSFolkmanSStress, appraisal, and coping3rd edNew YorkSpringer1984445 IgoeJBGiordanoBPHealth promotion and disease prevention: secrets of successPediatric Nursing1992181616266 ShinSHOhPJDevelopment of a first-aid education program and its effectiveness: A care of mothers of infant, toddler and preschool childrenThe Journal of Korean Academic Society of Nursing Education200392234243 ChangSSInfants’ safety accidents for their teachers and parentsKorean Society for Early Childhood Physical Education2014152724 YoonSHJungYKThe effectiveness of the safety education program for parents with infant and young childrenCrisis and Emergency Management: Theory and Praxis201283187204 BangKSEffect of safety education for mothers with infantsChild Health Nursing Research2005112221228 KimIOShinSHA survey on the experience of accident of infant, toddler and preschooler, and the education about emergency care for parentsChild Health Nursing Research200282174182 ShinHSYooIYParkHYSafety perception and behaviors of mothers with school age childrenJournal of East-West Nursing Research2007132130137 HongMHChongYSJangHJThe status of parents' education and their perception for young children’s safetyThe Journal of Society of Living Environment System2004135741749 HaSHSeoHAInfants’ and children’s safety accident experience based on parental safety practiceThe Journal of Eco-Early Childhood Education20141313155 KimIJA study on parents’ knowledge and practice about children’s safety, and needs for parents education [master’s thesis]SeoulSung Shin Women’s University2006183 KimJWKimYJThe relationships between mothers’ safety related behaviors and their children’s knowledge of safetyKorean Journal of Child Education and Care2005522141 KimHKAgreement between the Q block and the Q toolJournal of Korean Society for the Scientific Study of Subjectivity200816516 YunOBKangHSCharacteristics of children admitted to a pediatric emergency department following an accidentJournal of Korean Clinical Nursing Research20091517991 OhJNPerception of uncertainty and satisfaction for nursing service of children’s parents visiting to pediatrics outpatient department and emergency roomKorean Parent Child Health Journal20101313543 KimMYFactors influencing posttraumatic growth in fathers of chronically ill childrenJournal of Korean Academy of Nursing2015456890899https://doi.org/10.4040/jkan.2015.45.6.890 DaviesBGudmundsdottirMWordenBOrloffSSumnerLBrennerP“Living in the dragon’s shadow” fathers’ experiences of a child’s life-limiting illnessDeath Studies2004282111135https://doi.org/10.1080/07481180490254501 LeeEKAnHJRelationship between early childhood teachers’ knowledge and protective practice on safetyJournal of the Korean Home Economics Association20064461522 KimHGThe study of compensation and prevention about safety accidents through an analysis of safety conditions, legal basis of liability of reparation, and precedents about safety accidents in child-care centerJournal of Early Childhood Education2008172109126 FehringRJMillerJFShawCSpiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancerOncology Nursing Forum1997244663671 ScheierLMBotvinGJMillerNLLife Events, Neighborhood stress, psychosocial functioning, and alcohol use among urban minority youthJournal of Child & Adolescent Substance Abuse1999911950 Tables

Eigen Value, Variance, and Cumulative Percentage

Variables Type I Type II Type III Type IV Type V
Eigen value 20.45 3.60 2.93 1.70 1.26
Variance (%) 43.52 7.67 6.24 3.63 2.70
Cumulative 43.52 51.19 57.43 61.06 63.76

Demographic Characteristics and Factor Weight for P-Sample (N=47)

Type Var no. Factor weight age (yr) sex Religion Job Child gender Child age Birth order Injury type H Hospitalization
I (39.3) 1 0.87 44 M None Yes Male 1 1 2,3 No
17 2.90 36 F None Yes Male 3 1 2,6 No
18 1.75 41 F None Yes Female 5 1 2,4,6 Yes
19 1.68 45 F None Yes Male 4 1 2,6 Yes
20 3.23 32 F Christian Yes Female 2 1 2,6 No
21 1.60 38 F Christian Yes Female 3 3 2,4,6 Yes
22 1.01 36 F Christian Yes Female 5 2 2,4,6 Yes
24 1.68 36 F None Yes Male 4 1 2,6 No
25 0.40 41 M Christian Yes Female 6 2 2,6 Yes
26 2.77 47 F None Yes Male 2 1 2,6 Yes
27 0.66 41 F None Yes Female 3 2 2,6 No
28 0.94 36 F None Yes Female 4 2 2,6 No
30 0.75 41 F None Yes Male 5 1 2,6 No
32 0.60 41 F None Yes Female 6 1 2,6 No
33 1.83 38 F None Yes Male 2 1 5,6 Yes
34 1.81 41 F Christian Yes Female 4 2 1,2,6 Yes
35 1.74 36 F None Yes Male 3 1 1,2,6 Yes
36 0.88 46 M None Yes Female 5 1 2,6 No
37 1.49 30 F Christian Yes Female 1 1 1 Yes
41 0.63 40 F Christian Yes Male 2 1 4 No
II (36.0) 3 2.30 33 M None No Male 3 1 6 No
4 1.58 33 M None Yes Male 4 1 2,3 No
5 1.30 38 F None No Male 1 1 2,4 No
7 0.67 41 F Buddhism No Male 4 2 2,4 No
9 0.54 35 M None Yes Male 2 1 4,5,6 No
10 1.28 40 M None Yes Male 6 1 2,3,4,6 Yes
13 0.57 41 F None No Male 5 1 2,6 No
14 1.00 35 F Buddhism No Male 4 1 2,3,6 No
29 0.95 40 F None Yes Male 6 1 2,6 Yes
31 0.71 31 F Christian Yes Female 2 1 2,3,4 Yes
39 0.70 29 F None No Female 1 1 3 No
42 0.72 36 F Christian Yes Male 3 2 2,3,4,5 Yes
III (38.0) 8 1.46 33 F Christian Yes Female 2 1 3,4,6 Yes
11 0.68 41 M None Yes Male 4 1 2,3,6 No
12 0.78 39 M None Yes Male 5 2 4 Yes
16 0.84 39 M None Yes Female 6 1 1,4,6 Yes
47 1.02 38 M None Yes Male 2 1 1,2.4,6 Yes
IV (34.6) 6 0.67 40 F None No Male 6 3 1,2 Yes
15 0.73 36 M None Yes Male 1 1 2,3,6 No
23 0.80 38 F None Yes Male 4 1 2,6 No
38 0.77 30 F None No Male 5 1 4 No
43 1.38 33 F None Yes Female 6 2 2,3,4,6 Yes
44 0.83 35 F None No Female 4 1 1 Yes
45 1.34 32 F Christian Yes Female 2 2 2,3,6 Yes
46 0.60 33 F Catholic No Male 1 1 2,3,6 No
V (33.0) 2 1.82 41 F None No Male 3 1 2,3,5 Yes
40 0.78 25 F None No Male 5 1 1 Yes

Var=variables, Injury type 1=contusion, 2=abrasion, 3=laceration, 4=fracture, 5=dislocation, 6=burn, () = The average age of parents.

Q Statements on Parental Coping and Z-Scores (N=47)

Q Statement Z-score
Type I (n=20) Type II (n=12) Type III (n=5) Type IV (n=8) Type V (n=2)
Q1 I blamed myself because my carelessness resulted in my son injury. -1.65 0.96 -0.90 -0.67 -0.30
Q2 When I saw my child get hurt, I was initially surprised and embarrassed, after which I was angry at the people around him(Consciousness check, 911 report, hospital transfer, etc.). -1.58 -1.58 0.68 -1.78 -1.76
Q3 Despite the embarrassment my child’s injury caused me, I calmly resolved the situation. 1.48 0.24 -0.70 0.73 0.55
Q4 I hoped the trauma my child had suffered would not leave scars(growth) that would affect his/her appearance(obstacle). 0.64 1.57 0.90 1.14 1.48
Q5 After the trauma treatment, I explained to him why he had been injured and how to be careful in the future. 0.65 1.12 0.12 0.84 0.84
Q6 I cried endlessly at the thought of not being able go back to the moment before the child’s injury. -1.35 -1.22 0.45 -1.67 -1.74
Q7 I could not accept the situation and lamented the fact that my child had such an accident. -1.28 -1.56 0.97 -1.63 -0.60
Q8 For future reference, I studied the injuries that can befall children and the appropriate treatment methods. -0.21 -1.10 -0.84 -0.02 -1.74
Q9 Since my child got hurt, I have tried to get even the most minor injuries treated at the hospital. 1.17 -0.06 0.39 -1.45 -0.53
Q10 As I do not have sufficient knowledge regarding treatments, I consulted with my family. 0.48 -0.56 -0.25 -0.76 0.28
Q11 During the course of treatment, I stayed with my child so that he/she would not be afraid. 1.68 1.43 0.32 1.42 0.88
Q12 After my child’s injury, I became more observant about his/her careless behavior. 0.91 1.23 0.17 0.18 0.33
Q13 I felt heartbroken when my child was sick because all I could do was hug him. 0.79 0.99 1.51 0.32 0.03
Q14 I have tried to console myself with the thought that the injury could have been a lot more severe. -0.10 -0.13 -0.75 0.57 1.46
Q15 I did not want the trauma to leave my child with painful memory. -0.24 0.54 0.66 0.79 0.61
Q16 As a parent, I felt my child’s pain. 1.03 0.96 1.73 0.87 2.32
Q17 The environmental causes were removed or modified after the accident. 0.68 1.51 -0.11 0.63 0.28
Q18 I explained the treatment process to my child in a simplified manner so that he could understand it. 0.92 0.90 0.10 0.88 0.30
Q19 I treated minor injuries myself without involving a doctor. -0.61 -0.31 -2.03 0.40 0.60
Q20 I did not tell anyone except my family about my child’s injury because I wanted to handle the situation quietly. -1.05 -0.73 -1.22 -1.23 -0.88
Q21 When my child gets hurt, I check the wounded area carefully to assess the injury. 0.33 0.53 -0.08 1.53 0.02
Q22 To ensure my child’s quick recovery, I carefully followed the doctor’s instructions. 1.05 0.68 0.85 1.26 0.30
Q23 I confessed my feelings about my child’s injury to family or friends. -0.03 -0.40 -0.78 -0.18 -0.30
Q24 When my child gets hurt, I research treatment options and apply the appropriate ones. -0.64 -0.78 -1.03 1.25 -0.33
Q25 I claimed to person who was responsible for my child’s injury or who caused the accident(get apology, charge for treatment, etc.). 0.08 -1.23 0.72 -1.02 1.14
Q26 I checked the environment carefully to find any other potential causes of accidents. 0.72 1.22 0.46 0.80 -0.32
Q27 In keeping with my positive outlook on life, I expected that my child would be treated well and would not experience any trauma. 1.64 0.05 -1.34 0.72 0.26
Q28 When I went to the hospital, I was anxious about the condition of my child and urged medical staff to treat him/her as soon as possible. -1.53 -1.70 0.73 -0.91 0.56
Q29 After the injury, I carefully observed my child for any signs of aftereffects. 0.58 0.59 1.23 0.51 1.42
Q30 I did not want to think about the injury my child had suffered. -0.55 -0.63 1.76 -1.14 -0.86
Q31 I acted as if nothing happened, not to child being injured. -1.30 -1.62 -1.86 -1.68 -1.48
Q32 I have not paid much attention to the injury because everyone experiences minor trauma. -1.17 -0.71 -1.62 -0.20 -0.84
Q33 While my child was being treated, I looked for better treatment options. -0.35 -0.63 0.32 -0.33 -1.72
Q34 I thought it was a valuable experience that could prevent my family from experiencing future trauma. -1.19 0.41 -1.36 -0.15 -0.28

Z-Score Difference by Type (N=47)

Type Q statement Z-score Average Z-score Difference
I Q27 In keeping with my positive outlook on life, I expected that my child would be treated well and would not experience any trauma. 1.64 -0.07 1.71
Q9 Since my child got hurt, I have tried to get even the most minor injuries treated at the hospital. 1.17 -0.41 1.57
Q3 Despite the embarrassment my child’s injury caused me, I calmly resolved the situation. 1.48 0.20 1.27
Q1 I blamed myself because my carelessness resulted in my son injury. -1.65 -0.02 -1.63
II Q1 I blamed myself because my carelessness resulted in my son injury. 0.96 -0.67 1.64
Q34 I thought it was a valuable experience that could prevent my family from experiencing future trauma. 1.41 -0.74 1.15
Q17 The environmental causes were removed or modified after the accident. 1.51 0.37 1.13
Q28 When I went to the hospital, I was anxious about the condition of my child and urged medical staff to treat him/her as soon as possible. -1.70 -0.28 -1.41
Q25 I claimed to person who was responsible for my child’s injury or who caused the accident(get apology, charge for treatment, etc.). -1.23 0.23 -1.46
III Q30 I did not want to think about the injury my child had suffered. 1.76 -0.79 2.55
Q2 When I saw my child get hurt, I was initially surprised and embarrassed, after which I was angry at the people around him(consciousness check, 911 report, hospital transfer, etc.). -0.68 -1.67 2.35
Q7 I could not accept the situation and lamented the fact my child had such an accident. 0.97 -1.26 2.23
Q6 I cried endlessly at the thought of not being able go back to the moment before the child’s injury. 0.45 -1.49 1.94
Q28 When I went to the hospital, I was anxious about the condition of my child and urged medical staff to treat him/her as soon as possible. 0.73 -0.89 1.62
Q33 While my child was being treated, I looked for better treatment options. 0.32 -0.75 1.07
Q11 During the course of treatment, I stayed with my child so that he/she would not be afraid. 0.32 1.35 -1.03
Q34 I thought it was a valuable experience that could prevent my family from experiencing future trauma. -1.36 0.30 -1.05
Q14 I have tried to console myself with the thought that the injury could have been a lot more severe. -0.75 0.45 -1.20
Q3 Despite the embarrassment my child’s injury caused me, I calmly resolved the situation. -0.70 0.74 -1.45
Q27 In keeping with my positive outlook on life, I expected that my child would be treated well and would not experience any trauma. -1.34 0.66 -2.00
Q19 I treated minor injuries myself without involving a doctor. -2.03 0.01 -2.04
IV Q24 When my child gets hurt, I research treatment options and apply the appropriate ones. 1.25 -0.69 1.94
Q21 When my child gets hurt, I check the wounded area carefully to assess the injury. 1.53 0.19 1.33
Q7 I could not accept the situation and lamented the fact my child had such an accident. -1.63 -0.61 -1.00
Q30 I did not want to think about the injury my child had suffered. -1.14 -0.07 -1.07
Q9 Since my child got hurt, I have tried to get even the most minor injuries treated at the hospital. -1.45 0.24 -1.68
V Q14 I have tried to console myself with the thought that the injury could have been a lot more severe. 1.46 -0.10 1.56
Q25 I claimed to person who was responsible for my child’s injury or who caused the accident(get apology, charge for treatment, etc.). 1.14 -0.36 1.50
Q19 I treated minor injuries myself without involving a doctor. 0.60 -0.63 1.23
Q16 As a parent, I felt my child’s pain. 2.32 1.14 1.17
Q29 After the injury, I carefully observed my child for any signs of aftereffects. 1.42 0.72 .69
Q26 I checked the environment carefully to find any other potential causes of accidents. -0.32 0.80 -1.11
Q8 For future reference, I studied the injuries that can befall children and the appropriate treatment methods. -1.74 -0.54 -1.19
Q33 While my child was being treated, I looked for better treatment options. -1.72 -0.24 -1.47

Consensus Items and Average Z-Score (N=47)

Q statement Z-score
Q4 I hoped the trauma my child had suffered would not leave scars(growth) that would affect his/her appearance(obstacle). 1.15
Q29 After the injury, I carefully observed my child for any signs of aftereffects. 0.87
Q22 To ensure my child’s quick recovery, I carefully followed the doctor’s instructions. 0.83
Q18 I explained the treatment process to my child in a simplified manner so that he could understand it. 0.62
Q23 I confessed my feelings about my child’s injury to family or friends. -0.34
Q20 I did not tell anyone except my family about my child’s injury because I wanted to handle the situation quietly. -1.02
Q31 I acted as if nothing happened, not to child being injured. -1.59