Telenurses' experiences of monitoring calls to parents of children with gastroenteritis.

AIMS AND OBJECTIVE: To describe telenurses' experiences of monitoring calls in telephone advice nursing to parents of children with gastroenteritis. BACKGROUND: In previous studies, making monitoring calls is mentioned as a method used by telenurses to assess the need for care. MonitoringTHE terms 'care-seekers', 'care-seeker' and 'careseekers' are used inconsistently in the article. Please suggest which one to follow. We suggest Care-seeker calls in telephone advice nursing have been described as when telenurses call care-seekers back once or twice after an initial call. Calls from parents of children with gastroenteritis are common, and many of these calls result in telenurses providing self-care advice. METHODS: Nineteen telenurses from two healthcare call centres in Sweden were interviewed. Data were analysed using inductive qualitative content analysis. RESULTS: One main category, four generic categories and eleven sub-categories emerged. The telenurses described how working with monitoring calls aimed to provide self-care at home in a patient-safe way. Their focus on the parents aimed at increasing their feeling of security and focus on the child aimed at ensuring patient safety. Monitoring calls also provided a learning opportunity for parents and telenurses, and the possibility of relieving pressure on healthcare services. The findings indicate that the use of monitoring calls aims to provide a patient-safe form of telephone advice nursing. CONCLUSION: This study shows that many parents feel insecure when their child has gastroenteritis, and the use of monitoring calls may be an effective approach to help them feel more secure at home with their sick child.

Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department.

Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures. CONCLUSION: Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.

Coping with the outbreak of campylobacter.

Coping with the recent campylobacter outbreak which devastated Havelock North was a professional and personal challenge for a Hawke's Bay nurse practitioner.

Management of gastroenteritis in children under five years.

This article explores the causes and management of gastroenteritis in children under five years. It considers in particular national guidance from the National Institute for Health and Care Excellence. The importance of identifying and assessing dehydration is discussed, as well as its systematic management, carer education and infection prevention. Promoting carer competence, confidence and self-management is emphasised.

Rehydration of children with gastroenteritis.

Review of recent evidence with translation to practice for the advanced practice nurse role is presented using a case study module for "Intravenous Dextrose for Children With Gastroenteritis and Dehydration: A Double-Blind Randomized Controlled Trial." The study results showed that 35% of the children who received dextrose in normal saline (D5NS) were hospitalized as compared with 44% who received normal saline. The implications and clinical relevance of these findings for advanced practice nurses are discussed highlighting best evidence.

Diarrea aguda infantil. Cuidados enfermeros / Acute Infantile Diarrhea. Nursing Treatment

La diarrea aguda es causa común de enfermedad y hospitalización infantil en todo el mundo. El manejo de los niños con gastroenteritis aguda incluye el uso de soluciones de rehidratación oral, junto con la reintroducción temprana de una alimentación completa, que satisfaga los requerimientos de energía y nutrientes según la edad e historia dietética del paciente. Los niños con diarreas severas pueden precisar hospitalización, pero la mayoría de ellos pueden ser tratados ambulatoriamente o en el domicilio. En contadas ocasiones es preciso recurrir a la sueroterapia intravenosa. Los padres deberían conocer los riesgos que una gastroenteritis supone para sus hijos, y estar familiarizados con el uso de las soluciones de rehidratación oral. Éstas deberían estar presentes en cualquier hogar con niños. La educación a los padres por parte del personal de enfermería puede ser la clave para conseguir la prevención y el tratamiento precoz de las complicaciones de la diarrea aguda infantil(AU)

Acute diarrhea is a common cause of sickness and hospitalization of children throughout the world. Handling children who have acute gastroenteritis includes the use of oral rehydration solutions combined with a timely reintroduction to a complete regular diet, which satisfies the energy and nutritional requirements according to the age and nutritional history of the patient under care. Children who suffer severe diarrheas might require hospitalization, but the majority of these cases can be treated in outpatient clinics or at home. For very few cases it is necessary to resort to the use of intravenous serum therapy. Parents should be aware of the risks which gastroenteritis poses for their children, and be familiar with the use of oral rehydration solutions. These solutions should be kept on hand in all homes which have children in them. Nursing personnel’s role in teaching parents about how to deal with acute diarrhea or gastroenteritis van be the key to prevention and precocious, timely treatment of complications due to acute diarrhea in children(AU)

Managing outbreaks of norovirus in an NHS hospital.

Noroviruses are highly infectious and easily transmitted by contact with contaminated surfaces and objects, as airborne particles and by contact between individuals. While illness caused by norovirus is usually self-limiting, it can be serious in very young and elderly people, or in those who are debilitated or have a serious illness; they may require hospital treatment. Norovirus outbreaks in hospitals create significant disruption to patient care. They also have huge cost implications for NHS trusts through staff absence and ward closures, which are extremely disruptive and increase pressures on bed demand. The three most important actions during an outbreak of norovirus are effective hand hygiene, isolation of affected patients and enhanced cleaning of the environment. This article outlines how to identify norovirus infection and outbreaks, and describes how an acute trust managed outbreaks of norovirus and the procedures it adopted.

Norovirus outbreak management in a resident-directed care environment.

This article describes the setting, nature of outbreaks, control efforts, and impact of the resident-directed care philosophy on outbreak management at a senior residential community that experienced norovirus outbreaks during the past 2 winters. Suggestions are made for infection control programs in resident-directed care settings.

Development of an emergency department triage tool to predict acidosis among children with gastroenteritis.

OBJECTIVE: Design a triage assessment tool that predicts acidosis in children with vomiting, diarrhea, and dehydration. METHODS: A convenience sample of patients aged 3 months to 7 years with vomiting and/or diarrhea were enrolled in the triage area of a pediatric hospital's emergency department (ED). Caretakers of the eligible children completed a parental questionnaire assessing the patient's history of presenting illness. The triage nurse completed a 4-point physical examination assessment form. Collected information from the parental questionnaire and examination findings from the nurses' assessment were analyzed for factors that predicted acidosis in patients which was defined as having a serum bicarbonate level of 16 mmol/L or less or, if unavailable, an end-tidal carbon dioxide of 31 mm Hg or less. RESULTS: One hundred eighteen of the 130 patients enrolled had either a documented serum bicarbonate level or an end-tidal carbon dioxide and were therefore used in the final analysis for the primary outcome. Twenty-nine patients (25%) had acidosis. Univariate predictors of acidosis were younger age (mean [SD], 1.7 [1.4] vs. 3.1 [2.2] years, P = 0.002), previous evaluation by the primary care physician (62% vs. 33%, P = 0.008), being sent in by the primary care physician (66% vs. 33%, P = 0.002), and a worse overall appearance based on the triage nurse's mark on a 0-cm ("alert/playful") to 10-cm ("lethargic/limp") visual analog scale (3.7 [2.8] vs. 2.4 [2.2] cm, P = 0.013). A regression tree analysis identified age younger than 2 years, dry mucous membranes, and duration of illness more than 2 days as sequential factors predictive of patients at risk for acidosis. This decision tree identified patients with acidosis with an 89.7% sensitivity (95% confidence interval, 71.5%-97.3%) and a 93.6% negative predictive value (95% confidence interval, 81.4%-98.3%). CONCLUSIONS: The stepwise regression tree triage assessment tool dichotomizing patients based on age younger than 2 years, dry mucous membranes, and days of illness more than 2 days was able to predict acidosis with 90% sensitivity in patients presenting to the ED for evaluation of gastroenteritis. Identifying patients with acidosis early in their ED course allows the treating ED physician to focus more attention and resources toward rehydrating this at-risk population of patients with gastroenteritis.