开发一种早期护士主导的干预措施，以治疗因便秘或伴有粪便失禁而被转介到二级儿科的儿童。

Development of an early nurse led intervention to treat children referred to secondary paediatric care with constipation with or without soiling.

机构信息

Paediatric Epidemiology and Community Health (PEACH) Unit, University of Glasgow, Glasgow, Scotland G3 8SJ, UK.

出版信息

BMC Pediatr. 2013 Nov 20;13:193. doi: 10.1186/1471-2431-13-193.

DOI:10.1186/1471-2431-13-193

PMID:24252503

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3870966/

Abstract

BACKGROUND

Constipation is a common chronic childhood condition referred to secondary care. Effective treatment requires early intervention, prolonged medication to soften stools and behavioural support to achieve a regular habit of sitting on the toilet to pass a stool. The purpose of this audit and service development was to assess routine consultant paediatrician-led care against minimum standards and if appropriate to develop a nurse-led intervention. The new care package could then be tried out within general paediatric clinics in Glasgow as a service evaluation. NICE guideline (CG99) has a research recommendation to compare nurse-led care with routine consultant-led care.

METHODS

Design was an audit then development of a nurse-led intervention followed by a service evaluation. Participants were children (age 0-13 years), referred by their General Practitioner (GP) to the Royal Hospital for Sick Children Glasgow, with constipation the main problem in the GP letter. The audit covered appointment waiting times, intervention provided, initial follow-up and parental satisfaction with routine consultant-led practice. The nurse-led intervention focused on self-help psychology practice with NICE guideline medical support. This was compared with routine consultant paediatrician care in a service evaluation.

RESULTS

The audit found consultant-led care had long waiting times, delayed initial follow-up and variable intervention. The new nurse-led intervention is described in detail. The nurse-led intervention performed well compared with consultant-led care. Less 'nurse-led' children, 3/45 (7%), were still constipated passing less than 3 stools per week compared with 8/58 (14%) receiving consultant-led care. Less 'nurse-led' parents, 10/45 (22%), reported their child having pain passing stools in the previous week compared with consultant-led care, 26/58 (45%). The proportion of children, over 4 years, free from soiling accidents was similar, 15/23 (65%) in the nurse-led group and 18/29 (62%) with consultant-led care. Parental satisfaction was slightly better in the nurse-led group.

CONCLUSION

It is difficult to achieve minimum standards using routine consultant-led care for children referred by their GP with constipation. Nurse-led early intervention is feasible and has produced promising results in a service evaluation. An exploratory trial is planned to develop a teaching module, robust outcomes including costs and benefits, and methodology for a definitive trial recommended by NICE.

摘要

背景

便秘是一种常见的慢性儿科疾病，通常需要在二级医疗机构进行治疗。有效的治疗需要早期干预、长期使用药物软化粪便，并提供行为支持，以养成定期坐在马桶上排便的习惯。本次审计和服务发展旨在评估初级保健医生主导的常规护理是否符合最低标准，并在适当的情况下制定以护士为主导的干预措施。然后，在格拉斯哥的普通儿科诊所中，可以作为服务评估试用新的护理套餐。NICE 指南（CG99）有一项研究建议，将以护士为主导的护理与常规顾问主导的护理进行比较。

方法

设计为审计，然后开发以护士为主导的干预措施，随后进行服务评估。参与者是由全科医生（GP）转介到格拉斯哥皇家儿童医院的儿童（年龄 0-13 岁），GP 的信中主要问题是便秘。审计涵盖了预约等待时间、提供的干预措施、初始随访以及父母对常规顾问主导实践的满意度。以护士为主导的干预措施侧重于自我帮助心理学实践，并辅以 NICE 指南的医疗支持。在服务评估中，将其与常规顾问儿科医生的护理进行了比较。

结果

审计发现，顾问主导的护理等待时间长，初始随访延迟，干预措施也各不相同。新的以护士为主导的干预措施有详细描述。与顾问主导的护理相比，以护士为主导的干预措施表现良好。接受以护士为主导护理的儿童中，仍有 3/45（7%）每周排便少于 3 次，便秘未缓解，而接受顾问主导护理的儿童中，8/58（14%）仍有便秘。接受以护士为主导护理的父母中，10/45（22%）报告其孩子在上周排便时有疼痛，而接受顾问主导护理的父母中，26/58（45%）有此情况。在无粪便污染事故方面，4 岁以上儿童的比例相似，以护士为主导护理的组中为 15/23（65%），顾问主导护理的组中为 18/29（62%）。以护士为主导护理的组中，父母的满意度略高。