Role of a paediatric nurse in primary care 2: research findings

This article is the second of a two-part article that presents the findings of a study focusing on the role and function of two qualified children's nurses, each working within a different primary healthcare team (PHCT). The first part described the variation in settings for community paediatric nurses, the paucity of literature discussing the role of a paediatric nurse working as a member of a PHCT, the application of a research methodology that incorporated practitioner values and experience, the application of naturalist inquiry and the use of a formative evaluation strategy which enabled the researcher to be involved in directing and supporting the research nurses with the data collection (Vol 11(22): 1452-60). This second part focuses on the findings and discussions where it was demonstrated that qualified children's nurses working in community setting contributes to raising the overall support and quality of care for a whole range of conditions currently perceived as low profile. There was evidence that these nurses catered for unmet needs and were, at times, functioning as nurse practitioners and on occasions as advanced practitioners. These findings may contribute as a catalyst for change in informing the development of children's nursing services as part of the Children's National Service Framework.     

Pushing boundaries in paediatric intensive care: training as a paediatric retrieval nurse practitioner

Traditionally in the UK, the transportation of the critically ill child to a paediatric intensive care unit has been carried out by a medically led team of doctors and nurses. However, in countries such as the USA and Canada, appropriately trained nurse practitioners have proven to be competent in the transportation of these vulnerable children. This nurse-led team model has also been shown to be successful in the speciality of neonatal care in the UK. The impact of changes in the National Health Service (NHS) has led to an increased demand for the transportation of the child requiring paediatric intensive or high-dependency care, the lifting of restrictions on nursing practice and the reduction of doctors' hours in keeping with the European Working Time Directive. This has led to one NHS Trust in the UK developing the role of paediatric retrieval nurse practitioners (RNP): nurses who lead the retrieval team. The purpose of this article is to describe a pilot initiative to develop the role of RNPs. The comprehensive process of recruitment, training and assessment of competency will be detailed. Personal reflection on the project will also explore the pertinent nursing issues around; role impact and definition, conflict and change management, communication, legislation and personal and professional growth. Recommendations for future initiatives will also be explored.     

The primary nurse as a care giver in a neurology research setting

Multiple sclerosis is a debilitating disease that is the focus of study in many clinical settings. In one center conducting research on multiple sclerosis, an investigational drug being studied is called polyinosinic-polycytidylic acid poly-l-lysine (Poly-ICLC). The role of the primary nurse in this research project is described and discussed. A case presentation is included to illustrate how a patient receives continuity of professional nursing care while participating in a research protocol.     

Role of advanced paediatric nurse practitioners

Children's attendance at emergency departments (EDs) is increasing every year, yet many children present with minor, self-limiting illnesses that could be managed at home. In light of Williams et al (2009) suggestion that healthcare professionals should improve the care available to patients at point of contact rather than try to change their health-seeking behaviours, this article describes how Tameside and Glossop Primary Care Trust has developed an advanced paediatric nurse practitioner (APNP) service in the ED to improve the care of children, and to reduce the number of admissions. The APNPs treat children in the ED then divert them to more appropriate services where support is given to the families to care for their children at home. The role contributes to meeting ED clinical quality indicators, frees up medical staff to deal with more seriously ill patients, and makes financial savings for the trust.     

Methodological issues in nurse staffing research

The purpose of this article is to identify and describe four issues in nurse staffing research that must be addressed before the evidence base for the relationship between nurse staffing and quality of care can be said to be theoretically and empirically sufficient. The issues are the need to build well-developed theory, use valid and reliable databases, appropriate risk-adjustment systems, and address issues of causal inference in nonexperimental research.     

Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care

AIM: to describe how a link nurse system for palliative care was established in primary care and report on an evaluation of the system undertaken as part of a larger evaluation of newly established Macmillan nurse facilitator posts. METHOD: a range of data collection techniques was used to collect information relating to the link nurse system including interview, questionnaire and observation. Various sampling strategies were adopted for the different data collection methods. This paper reports on the findings of semi structured interviews with groups of district nurses and link nurses, a questionnaire to district nurses, telephone interviews with a sample of questionnaire respondents and site observations. FINDINGS: the Macmillan nurse facilitators have established, supported and maintained a robust palliative resource nurse (PRN) group within primary care. The majority of practising clinical district nursing staff have used this important resource for a variety of reasons over the past four years. The model developed provides an opportunity for professional development for the PRNs. This initiative has been viewed as a very positive development and has been utilised for disseminating information, research and audit purposes from clinicians both within and out-with primary care. CONCLUSIONS: The establishment of a palliative resource network within primary care has been successful. It has provided an effective and efficient means of disseminating information across a large workforce and extensive geographical area. The development of a clear structured model benefits both the PRNs and the organisation by providing clear expectations of the role while offering a framework for professional development.     

Ethical issues in paediatric nontherapeutic pain research

The purpose of this article is to describe the main ethical issues in paediatric nontherapeutic qualitative pain research. It is based on an analysis of the research literature related to ethical issues in research and on experiences from a family interview study focusing on pain assessment and management in children aged 1-6 years. In addition, different views concerning obtaining informed consent from children, as published in the research literature, are compared. Ethical challenges occur during all stages of qualitative research. The risks of emotional distress and possible benefits of the results must be assessed prior to conducting a study. However, risks and harm are difficult to avoid in a study in which the research area, pain, raises emotional distress in both parents and children. The children's assent and parental permission are both required. It is essential to obtain informed consent from all family members when family research is conducted. Participants' privacy and confidentiality should be protected during data collection, analysis and publication. Protecting children from harm may be impossible during pain research in which they are required to recall a painful postoperative period. However, after data collection they can be assisted to focus on pleasant activities, for example, by engaging in playful activities with them. Finally, the role of the nurse and the researcher should be carefully assessed, especially in qualitative research, in order to be able to analyse the data and report the findings in an unbiased manner.     

The establishment of a nurse consultant role in paediatric intensive care: a reflective analysis

Through a review of literature and research, together with reflection on clinical practice, this article reflectively analyses and evaluates the concept of the establishment and development of a nurse consultant post in paediatric intensive care. Manley's (1997) conceptual framework is used as a structure for the reflection, which has enabled a detailed and logical approach and allowed both reflection and analysis of the role in relation to the speciality. It is evident that nurse consultant posts have been developed in a variety of clinical specialities and are providing a real opportunity to improve patient care, progress nursing as a profession and provide a clinical career framework for nurses. The concept of the nurse consultant in paediatric intensive care is both innovative and strategic: Manley has identified many sub-roles, skills and processes necessary to influence and develop the role. The elements of 'transformational leadership', 'change agent' and 'collaborator' identified by Manley appear to hold the key to the ability to influence and develop paediatric intensive care nursing from a practice perspective.     

Intensified primary cancer care: a randomized study of home care nurse contacts

Newly diagnosed cancer patients (n=527) were randomised to intensified primary care or a control group. Intensified primary care comprised routines to improve general practitioners' and home care nurses' possibilities to support and monitor patients, i.e. increased information from specialist care, education and supervision in cancer care. The aims of this paper are to evaluate the effects of intensified primary care on cancer patients' home care nurse contacts, and to study if patients' use of home care services 6 months after diagnosis can be predicted. The intervention resulted in a marked increase of follow-up contacts. About 90% of intensified primary care patients reported such contacts, compared to 26% of control patients. The results indicate that standard care does not routinely include follow-up contacts, not even for the oldest (80+ years) or those with advanced disease. Only 27% and 36% of these groups of control patients reported follow-ups. Logistic regression analysis identified intensified primary care as the strongest predictor for reporting a continuing contact 6 months after diagnosis. Intensified primary care patients were 14 times more likely than controls to report a such contact. The strongest predictor of a continuing contact in the intensified primary care group was high age. Patients with advanced disease were more likely than patients with non-advanced disease to report a continuing contact, and living in a rural district was positively associated with reporting a contact. A majority of the patients (70%) assessed the time for the first contact as the 'right time' and estimated that the nurse gave expected support to a very large or large extent (67%). The results suggest that routines like those implemented through intensified primary care may be an effective strategy to increase the accessibility and continuity of care, especially for elderly people and for patients with a need for long-term contacts.     

Unemployment and health: issues in a primary care nursing practice

A group of clinical nurse specialists in primary care examined unemployment through the frameworks of stress/coping and relative deprivation theories. The moderating effect of social support was also considered. The impact of unemployment on health was elicited from unemployed clients and records kept by the nurses providing care. Nursing diagnoses were found to fall into three major categories: subsistence problems, increased psychosocial stress, and lack of necessary health care. Nursing interventions included exploration and constructive mobilization of emotional responses and assistance with problem solving, including support of existing strengths and identification of alternative behaviors and resources. The need for advocacy on behalf of clients emerged as a continuing concern.     

The primary care nurse practitioner: advocate for self care

PURPOSE: To critically analyze the role of the primary care nurse practitioner (NP) as advocate in promoting health through self care. DATA SOURCES: Selected philosophical and theoretical texts and articles, scientific literature, professional standards, and ethical arguments. CONCLUSIONS: Philosophical reasoning and nursing theory must be used to validate and direct human practice. If self-care and well-being are desirable as an end and are defined as a movement toward self-determination, then the philosophical goal of the NP must be the protection and promotion of self care and autonomy through client advocacy. IMPLICATIONS FOR PRACTICE: The role of the NP must be defined by its philosophy of care rather than by its function. The influence of philosophical reasoning, nursing, and critical social theory impact the ability of the NP to promote self-care through advocacy. Understanding the lived experience is an essential component of advocacy.     

Pressure area care in primary care: issues in equipment provision

The pressure area care needs of primary care patients are becoming more complex due to changes in health care provision. Enabling patients to remain in their own home and allowing them some independence even though they are at high risk of developing pressure damage, relies on the nurse's knowledge of prevention strategies and equipment provision locally. This article discusses the key issues in relation to the provision of pressure-relieving equipment in a rural care trust in England, and how the trust has overcome the problem of equipment failure, especially out of hours and weekends.