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Is there something wrong?: NHS Direct Nurse practice in helping parents cope with crying babies.

Smith, Suzanne (2008) Is there something wrong?: NHS Direct Nurse practice in helping parents cope with crying babies. Doctoral thesis, University of Huddersfield.

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    Abstract

    Since the late 1990s there has been an increasing focus on parenting ability,
    support and education which is reflected in policy, practice and research in the
    UK. This research analyses how nurses might intervene to provide this support,
    specifically in relation to crying baby and the role of nurses at NHS direct. It
    involves collection and analysis of data from NHS Direct call data in 2002, and
    solo focus group data in 2006. Within the wider tradition of grounded theory, the
    methodology includes use of discourse and thematic analytical approaches.
    The research analyses the means by which NHS Direct nurses make different
    use of the algorithms and organisational protocols to make decisions and give
    advice to parents with crying babies, how their clinical knowledge and experience
    influences these decisions, and how nurses explore parents’ ability to cope. This
    is seen within the organisational context of NHS Direct, a 24 hour government
    funded telephone service described as both a triage service and an
    advice/helpline service.

    Findings from the study indicate a degree of tension between the essentially
    humanistic nursing culture and the highly scripted, protocol driven rules based
    system that underpins NHS Direct. Despite this tension, nurses will sometimes
    combine their knowledge with that of the algorithm where the call is involved with
    eliminating emergencies. The same synthesis of knowledge is not apparent with
    the knowledge contained in the algorithm regarding non-medical, nonemergency,
    value-sensitive issues relating to parental coping with excessive
    infant crying. Findings suggest that NHS Direct nurses use the ‘crying baby’
    algorithm differently and this variance is influenced by experience and familiarity
    with the algorithm. Adherence to the algorithm is perceived by nurses as safe in
    relation to the medical questions which exclude emergencies. The non-medical
    elements of the algorithm, which include prompting the nurse to ask about parent
    coping ability and the possibility of shaking their child, are treated differently and
    it is considered safe to not ask, or ask around the question and to not offer the
    advice prompted by the decision aid software. The algorithm prompt to assess
    parental coping ability is rarely successful in encouraging the nurse to do so
    overtly.

    From these findings, consideration might be given to enhancing nurses’
    knowledge, skills and confidence, supported with appropriate supervision, to
    provide effective intervention in relation to value sensitive, non-medical issues
    such as parental coping ability and in handling the uncertainty such issues may
    yield. Allied to this would be establishing clarity and recognition of the inherently
    different, but not opposing functions of providing a triage service and an advice/
    helpline service.

    Item Type: Thesis (Doctoral)
    Subjects: R Medicine > RT Nursing
    R Medicine > RJ Pediatrics
    Schools: School of Human and Health Sciences
    Depositing User: Pat Whitworth
    Date Deposited: 12 Feb 2010 10:33
    Last Modified: 28 Jul 2010 19:53
    URI: http://eprints.hud.ac.uk/id/eprint/6952

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