Are young people welcome in the English National Health Service?

An audit of baseline compliance with contemporary health care policies pertinent to the care of young people in hospital was undertaken in 1 large English District General Hospital. Children's and adult services within the hospital were benchmarked against the government audit tool standards. The aim of the study was to identify good and less optimum compliance to best practice policy driven benchmarks of care, using a 1-4 scale. Each clinical area within the hospital was contacted to make arrangements with members of the inter-professional team to complete the baseline benchmarking exercise. The audit was conducted over 3 days and the majority of the evidence sourced comprised of documented evidence and verbal affirmation of the individual perceptions of key informants of how the various clinical areas scored against the best practice benchmarks. Scores of policy compliance in some clinical areas of the hospital ranged from 1 not yet started (non-compliant) through to 4 you're welcome (fully compliant). The results demonstrate that many of the clinical areas within the hospital are making good efforts to ensure full compliance to policy guidelines and mandates. There are some aspects of policy standards that hospital has yet to fully embrace. This initial benchmarking exercise on behalf of 1 English hospital has revealed some areas of outstanding and good practice which have the potential to be shared.

GP views of nurse-led telephone referral for paediatric assessment.

Following the introduction of a new nurse-led telephone referral service to a dedicated paediatric emergency assessment unit (PEAU), a study was conducted to determine the views of general practitioners (GPs) who use the service. The PEAU operates between 10 am and 10 pm on weekdays and between 10 am and 6 pm at weekends. The unit has four beds and treatment and stabilization areas, plus associated services in a dedicated area of a regional child health unit. The design utilized a faxed questionnaire over a 1-month period to all consenting GPs using the PEAU with a postal questionnaire follow-up. Non-parametric Likert scores and qualitative data were used to determine levels of satisfaction with the service and the subsequent management of the referred children. Sixty-nine GPs referred 80 children to the PEAU via the service over a period of 1 month. All consented to participate and were sent a faxed questionnaire, which generated 39 (57%) responses. A follow-up questionnaire sent to the 39 respondents achieved a return of 25 (64%) responses. Thirty-four GPs agreed that referral via the dedicated nurse service was easier than the previous senior house officer referral system. Of the 25 GP respondents to the follow-up postal survey, the majority (17) agreed that the follow-up morning after discharge telephone call to parents by the PEAU nurses was helpful. Four GPs indicated that the 24-hour open access system, offered by the nursing staff, in which a parent may attend PEAU with a discharged child causing concern without a previous appointment, does not always work. This study has shown that a nurse-led telephone referral system to a PEAU for GPs and the subsequent management of the children has been favourably received.

Deliberate self-harm in children: the nurse's therapeutic style.

This article examines child health nursing skills in the management of deliberate self-harm in children and young people. In order for education to be effective (i.e. so that it changes practice) it must address the belief systems of the practitioner. It is suggested that such belief systems are embedded in collectively held tribal stories. The more challenging the patient's behaviour, the more powerful the influence of the tribal narrative--possibly as a defensive strategy. The authors outline strategies aimed at increasing the range and depth of the therapeutic response to episodes of self-harm, and outline nursing interventions in the management of self-harming children.

Child health nurses' perceptions of enquiry-based learning.

Since the publication of Fitness for Practice (UKCC, 1999), most preregistration nursing curriculae embrace the principles of enquiry-based learning (EBL) as a method of educating students. EBL uses genuine real-life client scenarios which provide the students with an opportunity to explore a range of issues directly pertaining to client care in a variety of contemporary nursing settings (Long et al, 1999). This evaluative study of one group (n=12) of child branch students conducted during the last EBL session of the course reflects the students' experiences of this method of teaching over a 3-year period. Nominal group technique (Delbecq and Van de Ven, 1971) was utilized to give a quantitative dimension to the reporting and recording of individual student reflections of EBL. The results demonstrate overall satisfaction with this method of student learning. A number of concerns raised by students reflect some of the pitfalls associated with EBL and these have important ramifications for nurse educators and clinical placement mentors. However, the small size limitations of this study do not allow for generalizability.

Multiprofessional perceptions of a paediatric nursing development unit.

This article describes the final component of the quinquennial evaluation of a King's Fund accredited nursing development unit (NDU) within a paediatric outpatient department of a large district general hospital during the period 1993-1998. The study draws upon descriptive data obtained through a questionnaire distributed to 83 members of staff associated with the outpatient department. Overall, the results demonstrate that NDU status has enabled staff to embrace the change process more readily than might have been possible otherwise. The basic premise that NDUs should promote nursing innovation is explored and critically evaluated.

A pilot randomised controlled trial of medical versus nurse clerking for minor surgery.

BACKGROUND: Nurse led clerking is currently practiced in a growing number of UK centres, but there is a paucity of evidence to underpin the safety of this innovation. AIM: To assess the safety of nurse led clerking in paediatric day case and minor surgery. METHODS: Children aged 3 months to 15 years were randomly assigned to clerking by either a nurse or a senior house officer (SHO) (resident). All children were then independently reassessed by a specialist registrar anaesthetist to provide a "gold standard" against which practitioner performance could be judged. RESULTS: In 60 children studied, nurses identified a significantly greater proportion of the detectable abnormalities present in the sample (p = 0.16). This difference is attributable to nurses' greater accuracy in history taking (p = 0.04); no conclusions regarding the comparability of nurses' and SHOs' skills in physical examination can be derived from the current study. CONCLUSION: Evidence attests to the likelihood of nursing having superior skills in history taking to SHOs. Exploration of nursing safety in undertaking physical examination, however, requires the conduct of a large scale equivalence study. Only then can conclusions be drawn as to whether nurse led physical assessment offers children a standard of care equivalent to that which they currently receive from SHOs.

NHS Direct: issues for education, management and research.

The NHS Plan (Department of Health (DoH), 2000) specifically highlights the role of NHS Direct in its vision of a health service designed around the patient. Despite this, the new nurse-led service has come under critical attack. NHS Direct is in the process of developing an evidence base to underpin its practice. It is recognized that telephone management skills are important clinical skills and while decision support computer software can help elicit an appropriate client history, the interpersonal skills necessary to establish a professional telephone relationship are commensurate with the suitability of the appropriate education programme. This article will explore the ramifications of NHS Direct for curriculum development and evaluation. Factors such as skill mix, career pathways, recruitment and research and development will also be discussed. In a previous article the implications of NHS Direct for practice were examined (Glasper et al, 2000).

NHS Direct: examining the challenges for nursing practice.

This article examines the impact of the launch of NHS Direct which was part of the Government's vision for a modern and dependable NHS. In particular, the challenges for nursing practice are detailed within a healthcare strategy which seeks to provide fast access primary health care to the whole population. The strengths and weaknesses of NHS Direct are discussed and its interface with other agencies explored. As NHS Direct will cover the whole of England by October 2000, the evidence to underpin its effectiveness must be considered in the light of media criticisms which indicate that the quality of advice given to callers is sometimes less than optimum.

Prevalence of cycle helmet use in children.

A survey was conducted over a five-day period on a cohort of 234 families attending a busy regional children's out-patient department in the South West of England. A significant result of the survey was that parental use of helmets strongly correlated with the use of helmets by children. In addition, income was not found to be a major factor in cycle helmet ownership except in the lowest income band.

Investing in practice: enquiry- and problem-based learning.

Enquiry-based learning (EBL) and problem-based learning (PBL) are two similar methods of educating nurses and midwives which have been recommended by the UKCC in its new report 'Fitness for Practice' (UKCC, 1999). The integration of theory and practice within the student programme is the key to bridging the theory/practice gap. The incorporation of EBL and PBL into the curriculum may help resolve this gap. As these methods of education foster learning through the use of real client scenarios it is important to stress that the partnership between clinical and academic staff is of paramount importance. This article explores EBL and PBL from the practitioner's perspective and examines some of the factors necessary for its successful implementation.