Stepping into nursing research: an introduction for gastroenterology and hepatology nurses.

In this second part of an introduction to research for gastroenterology and hepatology nurses, we aim to build on the first article that introduced the significance and structure of the National Institute for Health and Care Research clinical research landscape in the UK and the importance of nurse engagement. This article introduces possible career pathways available in the profession and specialty. Practical information on how to start research is provided, including an overview of the education, training and support required for a career in research delivery and academic research. Some of the potential barriers to nursing research careers are highlighted, and solutions to navigate a successful career in nursing research are proposed.

Increasing capacity in acute day care settings: patients' experiences of a pop-up day care unit.

The COVID-19 pandemic had considerable impact on paediatric ambulatory care. A pop-up paediatric day care unit for children with allergic and inflammatory bowel diseases was delivered from Nightingale Hospital Bristol (NHB) which was set up to treat patients during the pandemic. METHODOLOGY: The unit operated fortnightly between December 2020 and March 2021. Family feedback on the service was collated via an online survey. RESULTS: 72 respondents found NHB acceptable; 70 (97%) would be happy to return; 63 (90.3%) preferred the NHB to attending Bristol Royal Hospital for Children or had no preference for their appointments. Positive comments focused on service organisation and clinical environment. Families valued the availability of the close, free parking. The minimal negative comments related to travel directions, lack of catering facilities and the small number of toilets. CONCLUSION: The pop-up service model was highly acceptable to families. This highlights the need for appropriate hospital services to explore similar initiatives beyond traditional healthcare settings in order to ensure that the provision of equitable health care is in line with the NHS Long Term Plan.

Abdominal pain-related functional gastrointestinal disorders in children.

Recurrent abdominal pain is a common presentation in children and mostly non-organic in origin. Nearly one-fifth of the childhood population are known to suffer from it worldwide, although only 50% of these may seek consultation with a health professional. Non-organic recurrent abdominal pain encompasses four main conditions broadly labelled as abdominal pain-related functional gastrointestinal disorders (FGIDs). These are diagnosed following exclusion of organic pathologies and by symptom concordance with defined parameters, published as the Rome IV criteria for FGIDs. Appropriate evaluation includes assessment for 'red flag' manifestations to rule out organic causes. Appropriate review of social and family circumstances is vital to identify triggers and protective factors. Management is based on explanation, reassurance and therapeutic interventions that need to be decided on an individual basis. Treatment focuses primarily on dietary and biopsychosocial interventions, with a minimal role for pharmacological agents. A case study is included to highlight some of the challenges that may arise while managing abdominal pain-related FGIDs. Nurses play a vital role in early identification, providing support and education to children and their families. There is increasing evidence for the effectiveness of nurse-led services in managing these disorders, as well as providing continuity of care.

The role of nurses and dietitians in managing paediatric coeliac disease.

Coeliac disease (CD) is an immune-mediated genetic condition elicited by the ingestion of gluten, leading to proximal small bowel enteropathy. It affects around 1% of the population, although only a small proportion of cases are actually diagnosed. It is a multisystem disorder presenting with both gastrointestinal and extra-intestinal manifestations such as diarrhoea, abdominal pain, constipation, vomiting, iron deficiency anaemia, faltering growth, dental enamel defects, short stature, liver disease, arthropathy and recurrent aphthous ulcers. Nurses, working in different clinical settings, are best placed for early recognition and diagnosis of CD in children. Suspicion of CD should lead to immunoglobulin A (IgA)-based anti-tissue transglutaminase antibody screening tests and a diagnosis confirmed by an intestinal biopsy. Modification of European (ESPGHAN) guidelines now enables CD to be diagnosed without a small-bowel biopsy in a select group of symptomatic children. A gluten-free diet should preferably be started by paediatric dietitians. Strict adherence to a gluten-free diet is essential to maintain good health and to prevent long-term complications. A case study demonstrating some of the challenges that may be faced in children with CD in clinical practice is described. Specialist nurse-led CD clinics are gaining popularity and have been found to be equally effective in providing continuity of quality care.

Diagnosis and nursing management of coeliac disease in children.

Coeliac disease is an autoimmune condition caused by the ingestion of gluten-containing foods and affects about 1% of children and young people in the UK. Classic symptoms include diarrhoea, bloating, weight loss and abdominal pain. However, extra-intestinal manifestations, such as iron deficiency anaemia, faltering growth, delayed puberty and mouth ulcers, are increasingly being recognised. Some children have an increased risk of developing coeliac disease, such as a strong family history, certain genetic conditions and type 1 diabetes, therefore there is a need for increased awareness and early diagnosis before symptoms occur. If coeliac disease is suspected, a child should have serological screening with anti-tissue transglutaminase titres. Diagnosis is traditionally confirmed by a small bowel biopsy while the child remains on a 'normal' diet that does not exclude gluten. More recently, for a selective group of children, modification of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines has enabled non-biopsy (serological) diagnosis of coeliac disease. Children's nurses have an important role in recognising and diagnosing coeliac disease earlier as well as offering ongoing dietary support. Enabling children to maintain a gluten-free diet is essential for general wellbeing and preventing long-term complications.