Outcomes of a nurse-led telephone triage service in Australia

This paper reports on a study which comprised the first comprehensive evaluation of the Kids Kare Line telephone triage service in which experienced registered nurses respond to parents' requests for health-care advice for their child. This service is located in an acute care hospital in regional New South Wales, Australia. One hundred and one parents who telephoned the Kids Kare Line responded to a telephone-administered survey designed to determine the service's efficiency and effectiveness. Responses demonstrated that parents sought advice about a range of issues, of which the management of fever was the most frequent. All but five parents considered their call to have been answered promptly, all parents understood the advice provided to them and 96% of parents were satisfied with this advice. Fifty parents identified that they had not used another service or health practitioner for the same issue subsequent to their Kids Kare Line telephone call.     

Parental guidance and counselling by doctors and nursing staff: parents' views of initial information and advice for families with disabled children

This paper describes changes that have taken place, over a period of 10 years, in the way physicians and nursing staff in Finland give initial information and advice to the parents about their child's disability. It also discusses the association between quality of information given and parents' feelings of insecurity or helplessness. In the study, we compared the experiences of parents of older (aged 12-17) disabled children with those of parents with younger (aged 7-9 years) disabled children. There were 85 children, whose disabilities were either learning or physical, or, in a few cases, both. Parents completed a questionnaire and were interviewed by a social worker. According to these reports, the initial information and advice received by the parents with younger children about their child's disability and its treatment, and on coping with the child at home, was better than that received by the parents of the older children. The parents of the younger children also reported feeling better prepared to take care of their child. Those parents who reported having received little information and practical advice on coping with their child at home experienced feelings of insecurity and helplessness five times as often as those who were satisfied with the information and advice.     

Telephone advice nursing: parents’ experiences of monitoring calls in children with gastroenteritis

A common reason for calling a telephone advice nurse is gastroenteritis symptoms in children. A monitoring call is a follow‐up call from the telephone nurse to the care seeker in order to follow up on given advice and make a new assessment. The aim of the study was to describe the parents’ experiences of monitoring calls in telephone advice nursing in children with gastroenteritis. A qualitative interview method was chosen and data were analysed inductively with a qualitative latent content analysis. Ten parents, nine mothers and one father were interviewed. Four main categories and 13 subcategories were identified and described as useful, and the main categories were convenience – parents found it convenient to get access to self‐care advice at home, confirmation – the interaction between the telephone nurse and the parent seemed to become deeper and closer as a result of the monitoring call, support – in a vulnerable situation receiving further information and an opportunity to let the telephone nurse monitor the sick child and guidance – to be guided through the most acute phase in the child's gastroenteritis symptoms. Monitoring calls seemed to be experienced as a security enhancing, positive opportunity and a robust complement to seeking care at a healthcare facility. The results of the study indicate how inhabitants can receive expert advice, support and guidance for care and provide a useful basis for Swedish Healthcare Direct (SHD) to develop the modalities for monitoring calls.     

Dying to be home? Preferred location of death of first-generation black Caribbean and native-born white patients in the United Kingdom

Although preference for location of death has been studied in the general population little is known about the experience of people from different ethnic backgrounds and nothing about the black Caribbean population living in the United Kingdom. Over 13 months we surveyed the family and friends of deceased first-generation black Caribbean and native-born white patients with advanced disease. Of the 106 black Caribbean and 110 white patients identified, 50 interviews per ethnic group were conducted, a response rate of 47% and 45%. It was found that 21% of all patients surveyed died in their own home, 61% in hospital, 12% in a hospice, and 6% in a residential/nursing home. Thirty-four percent of black Caribbean compared to 27% native-born white patients were reported to have expressed a preference for location of death and of these over 80% of all patients wanted to die at home. Similar proportions of patients from the Caribbean (53%) and white (56%) patient groups who wanted to die at home did so. This was not related to restrictions in patients' activities of daily living or self-reported caregiver burden. Fewer respondents representing Caribbean than white patients stated that neither they (chi(2) = 8.9, p = 0.01) or the deceased patients (chi(2) = 8.6, p = 0.03) were given sufficient choice about the location of death. Our findings suggest: (1) a need to improve training in discussing care and treatment choices, including location of death, and (2) a deeper qualitative understanding of the cultural and other factors that may facilitate or prevent home deaths.     

小儿外科住院患儿家长对临床护理告知认知的调查

目的了解小儿外科住院患儿家长对护士参与知情告知工作的认识及需求。方法自行设计调查表对120名家长进行调查,采用等级资料率的比较进行统计分析。结果82．50％的家长清楚自己享有知情权利,医方负有告知义务;70．32％的家长认可护士的告知工作;不同年龄的家长对护士、医生所负责告知内容、范围相比较差异有统计学意义（P〈0．01）,不同居住地的家长对护理告知的内容相比较差异有统计学意义（P〈0．01）;67．50％的家长要求提前告知,53．33％的家长愿意适时、部分告知内容,75．83％的家长希望由责任护士来告知;患儿家长对护理告知需求排序前3位依次为：入院告知,可进食的饮食种类告知,用药作用、不良反应及检查相关注意事项的告知。结论患方赞同护士参与告知工作,期待有效的护理告知,告知是对其行使知情同意权利的基础保证。     

Diabetic children and foot care: are we heading in the right direction?

This study investigated parents' knowledge and understanding of foot care for their child with diabetes mellitus (Type I). Thirty parents of diabetic children in four out-patient clinics within the same trust (not the author's place of work) were asked to complete a questionnaire. There was a clear lack of parental knowledge concerning the children's foot care. Only 40 per cent of the children had had their feet examined by a healthcare professional since diagnosis; a recommendation in the Diabetes UK guidelines (2000). Only sixty-three per cent of families had ever received any foot care advice, which is consistent with the results of a study by Barnett et al in 1995. Parents wanted more verbal and written foot care advice. More emphasis needs to be placed on foot care education and regular foot examinations are essential if foot ulcers and limb amputations are to be prevented in later life.     

Developing information leaflets for parents of children with cancer

Information aids parents' understanding of and adjustment to their child's disease and treatment, and their ability to care for their child safely at home. This article describes the development of a leaflet on conditions, treatments, side effects, management advice and contacts for parents of children receiving treatment for cancer using an Ommaya reservoir. Health professionals should be aware of developments in health care, to ensure that current evidence-based information for families is provided.     

Hypospadias repair: the nursing contribution

The role of the urology nurse in the care of 50 boys undergoing hypospadias surgery was prospectively evaluated using semi‐structured interviews and data retrieved from hospital notes. Four nursing‐related areas of interest were identified: Firstly, that nurses were instrumental in preparing the families for surgery by assessing the boys and providing information to the families. This enabled the early discharge of the children. Secondly, that nurses also dealt with any problems arising from pain or the wound as well as from the catheter or stent. Thirdly, that named nurses provided seamless care to the families enabling a development of familiarity and trust. Finally, nurses provided routine back‐up and a 24‐h emergency call facility for the families at home. These were valued by the parents for their reassuring and confidence giving effect as well as the quality of the advice given. Based on the results of this evaluation it was recommended to establish and introduce a care pathway for day‐case hypospadias repairs and to upgrade the urology nurses' role towards advanced nursing practice.     

Consistency Between Preference and Use of Long-Term Care Among Caregivers of Stroke Survivors

ABSTRACT Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n₁= 324) or a preference for home care (n₂= 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.     

Transitioning care of an adolescent with cystic fibrosis: development of systemic hypothesis between parents, adolescents, and health care professionals

This qualitative study explored the experience of parents and adolescents living with cystic fibrosis prior to the transfer of the adolescent's care from a pediatric to an adult health care facility. Semistructured interviews were conducted with seven families receiving care from a specialized cystic fibrosis clinic; parents and adolescents were interviewed separately, followed by a group interview with members of a health care team comprising eight professionals from the clinic. Interviews were analyzed through a systemic lens which accounts for interaction and reciprocity in relationships. The parents' experience was marked by suffering and uncertainty that remained unexpressed to the health care team, even though team members had known the family since the child was first diagnosed. Findings led to identifying a systemic hypothesis that accounted for the interactions and relational processes between parents and the health care team. This hypothesis may guide the development of systemic family nursing interventions that target this complex, relational, transition process.     

Are we getting it right? Parents' perceptions of hospice child bereavement support services

OBJECTIVE: To determine parents' experiences and perceptions of a support service for families with bereaved children, provided by a UK charity for cancer patients in seven hospices in the UK. METHOD: Individual interviews with 25 purposively selected parents. RESULTS: Parents used the service for: advice and reassurance; support for their children while they grieved; and advice on ameliorating behavioural difficulties at home and school. Non-service users did not think formalised support was necessary or had other sufficient support. Nevertheless, important to parents in both groups was that the service existed so their children's needs were being or could be addressed. Children and their parents benefited from talking to a non-family member, and being involved in social events that reduced feelings of isolation. CONCLUSION: The hospice child bereavement service was offered as an integral part of palliative cancer care support. Future research could explore collaborative work between counsellors and other professionals.     

Minor illness education for parents of young children

BACKGROUND: A number of previous studies on minor illness have concentrated on nurse-led clinics and the role of nurse practitioners. This study examines the effect of a minor illness education programme which aimed to increase parents' confidence and knowledge in managing childhood illnesses. AIM: The primary aim of this study was to evaluate the effectiveness of a home visit and booklet in providing education to parents about minor infant illnesses. DESIGN: A randomized controlled trial was conducted. The intervention involved a home visit to discuss parents' concerns and provide advice and information, and a booklet advising parents what to do and when to consult about infant illnesses. METHOD: A total of 120 parents of 6 week old babies were identified over a 6 month period, using health visitors' caseloads, and randomized to an intervention group (60), that received a visit and a booklet, or a control group (60) that received standard care. Groups were compared on entry to the study and at 7 months, in terms of parental knowledge and confidence about childhood illnesses, the intended use of home care activities, intention to consult professionals and actual use of health services. Data were collected by self-completed questionnaire and case note review. FINDINGS: The educational intervention resulted in a reduction in visits to the child health clinic but had little effect on use of other services. Parents in the intervention group showed a general trend towards greater certainty about the home care options they would choose, and a reduction in intention to consult a doctor. However, they also indicated a feeling of reduced confidence and knowledge. CONCLUSION: The trial showed no effect on use of services but did demonstrate reduction in parents' intentions to consult a doctor, which appeared to be because of increased certainty about home care. However, it is of concern that they indicated feeling less confident and knowledgeable. It is not possible to clarify whether this represented anxiety that was constructive, enhancing decision-making or was destructive. Further work into the role of education in parental decision-making, anxiety levels and enhancement of confidence is required.     

家长的依从性对肾病综合征患儿康复的影响

[目的 ]探讨肾病综合征 (NS)患儿家长依从性对患儿康复的影响 ,并寻找护理对策 ,达到促进患儿康复的目的。 [方法 ]对 10 8例肾病综合征患儿及家长在入院后随机分为研究组和对照组 ,每组各 5 4例 ,给予研究组家长综合性护理干预 ,对照组则给予常规护理 ,比较两组家长的依从性及其患儿平均住院日、治疗效果及并发症。[结果 ]研究组家长的依从性评分高于对照组 (P <0 .0 1) ,且研究组患儿平均住院日缩短 ,治疗有效率高 ,并发症较少。 [结论 ]提高NS患儿家长的依从性 ,可促进NS患儿的康复。护理工作中 ,在重视患儿护理的同时 ,还应重视对其家长的指导     

Preparing Parents for NICU Discharge: An Evidence-Based Teaching Tool

Preparation for discharge and transition to parents' care of infants hospitalized in the neonatal intensive care unit (NICU) is a process that begins on admission. Identifying parents' educational needs requires thoughtful assessment by experienced nurses. Caring for these infants can be daunting to parents, and participating in a discharge class can be very helpful in easing the transition to home. This article describes a NICU discharge informational DVD/video that was developed to deliver parent education and promote informed and safe transition from hospital to home.     

Weaving the seamless web of care: an analysis of parents' perceptions of their needs following discharge of their child from hospital

Changes in children's nursing services in the United Kingdom in recent years have focused on the need for adequate and efficient services to be provided in the interests of the child. Early discharge is now the norm and children are often sent home in an earlier recovery stage than adults with comparable conditions. Whilst the contributions of paediatric community nursing services have gone some way to providing specialist nursing care for children and their families in their own homes, the majority of children are discharged home without such support being available. This may place an overwhelming responsibility of caring for a recovering child onto parents. The purpose of the qualitative research reported in this paper was to identify any gaps in nursing services for acutely sick children and their families following discharge, and to suggest ways to improve integration and communication between hospital and primary care to facilitate a 'seamless web of care' for families. Families were surveyed following discharge (n=164) and interviews carried out with those experiencing problems (n=20). General practitioners were also surveyed for their opinion as key contributors of primary care. Findings revealed the isolation felt by parents following discharge, with their need for information about a child's illness and expected recovery, and for reassurance and specific advice through some means of support, which was clearly not being met. The perceived benefit of continuity of care was a common theme, with both parents and professionals acknowledging the importance of closer liaison between hospital and primary health care services. This study is valuable in providing preliminary qualitative information regarding the gaps in children's nursing services and how these can be overcome by using our present resources more imaginatively, in order to ensure the delivery of cost-effective and quality health care services in the best interests of local need.     

Negotiating lay and professional roles in the care of children with complex health care needs

BACKGROUND: Children with complex health care needs are now being cared for at home as a result of medical advances and government policies emphasizing community-based care. The parents of these children are involved in providing care of a highly technical and intensive nature that in the past would have been the domain of professionals (particularly nurses). AIMS OF THE PAPER: To assess how the transfer of responsibility from professionals to parents was negotiated, the tensions and contradictions that can ensue, and the implications for professional nursing roles and relationships with parents. DESIGN: Using a Grounded Theory methodology, in-depth interviews were conducted with 23 mothers, 10 fathers and 44 professionals to gain insight into the experience of caring for children and supporting families in the community. FINDINGS: From the parents' perspective, their initial assumption of responsibility for the care of their child was not subject to negotiation with professionals. Prior to discharge, parents' feelings of obligations, their strong desire for their child to come home, and the absence of alternatives to parental care in the community, were the key motivating factors in their acceptance of responsibility for care-giving from professionals. The professionals participating in the study had concerns over whether this group of parents was given a choice in accepting responsibility and the degree of choice they could exercise in the face of professional power. However, it was following the initial discharge, as parents gained experience in caring for their child and in interacting with professionals, that role negotiation appeared to occur. CONCLUSION: This study supports other research that has found that professionals' expectations of parental involvement in the care of sick children role can act as a barrier to negotiation of roles. In this study, parental choice was also constrained initially by parents' feelings of obligation and by the lack of community services. Nurses are ideally placed to play the central role not only in ensuring that role negotiation and discussion actually occurs in practice, but also by asserting the need for appropriate community support services for families. Being on home territory, and in possession of expertise in care-giving and in managing encounters with professionals, provided parents with a sense of control with which to enter negotiations with professionals. It is important that changes in the balance of power does not lead to the development of parent-professional relationships that are characterized by conflict rather than partnership.     

Supportive and palliative care needs of families of children with life-threatening illnesses in Western Australia: evidence to guide the development of a palliative care service

OBJECTIVE: To obtain feedback from families of children receiving palliative and supportive care about their care needs in hospital and in community settings. DESIGN: A two-phase combined quantitative and qualitative study. SETTING: Western Australia. PARTICIPANTS: 134 parents and 20 service providers. RESULTS: Analysis indicated the concept of palliative care is poorly understood by health professionals and by parents. Many families are affected emotionally, financially and physically by the burden of caring for children with life threatening or chronic conditions requiring complex care at home. Parents indicated the need for clear and honest information about their child's condition and prognosis throughout the trajectory of illness and perceived this had been lacking. Families required financial and practical assistance with providing care from their children at home. Parents also wanted more practical resources and information to assist with the management of their child's nutrition and pain, as well as support for their other children. The level of respite (in home and residential) was perceived to be insufficient and inequitable. Parents also required access to, and advice from, multidisciplinary health professionals when caring for their child at home. There was a perceived lack of coordination between community services and the hospital. CONCLUSION: Education of health professionals and parents regarding the concepts and introduction of palliative and supportive care is required. Care for children and their families should be coordinated by a multidisciplinary team in consultation with children and their families, and linked and integrated with the treating hospital in collaboration with community services. More inclusive criteria are required for community services including practical aids and respite care.     

Children's postoperative pain at home: family interview study

The purpose of this study was to: (i) describe the methods that are used in the identification and management of postoperative pain in children aged 1-7 years after minor outpatient surgery at home; (ii) to identify parents' perceptions regarding children's pain and pain medication; and (iii) to examine parents' perceptions of discharge advice. Family interviews with inductive content analysis were used to gather information from families of 17 Finnish children undergoing minor outpatient surgery at a university hospital in Finland. Versatile methods were employed by the parents in the identification and management of children's postoperative pain subsequent to discharge from the hospital. The children expressed that they had experienced pain relief through the administration of pain medication, eating ice-cream and playing. The results indicate a need for further research in order to identify what elements of parents' perceptions of children's pain and pain medication should receive additional attention. In addition, the content, methods of providing and timing of discharge advice need to be developed in order to help parents with their efforts to achieve maximum pain relief in children after surgery.     

Your child has diabetes: hospital or home at diagnosis?

Historically, children with diabetes have been hospitalized at diagnosis, but increasingly, newly diagnosed children are being cared for entirely at home. The management of this chronic condition usually involves the whole family, with children often taking responsibility for much of their own care. However, this article focuses specifically on the needs of parents, forming part of an extensive literature review informing a study exploring parents' experience of home management and coping over the first year with childhood diabetes. A search of the literature revealed a scarcity of evidence overall about hospitalization or home management from a parental perspective, and none in relation to childhood diabetes. This article provides a critical appraisal of the appropriateness of these two approaches to care for parents of children with newly diagnosed diabetes. First, a brief introduction to home management in childhood diabetes is followed by an examination of the small amount of research found about home management and hospitalization from the point of view of parents. Then, the possible benefits and disadvantages of both approaches are discussed and subsequently scrutinized in the context of childhood diabetes. Finally, preliminary conclusions are drawn and suggestions made for the direction of future research in this area.