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

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

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.

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