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

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