INDEX Page numbers printed in bold type refer to figures; those in italic to tables

A A&E departments 6

access to child protection register 161 appropriate provision for children 15 assessment of children 17 attendances at 14--15 and community children's nurses 142 day assessment units 206 facilities 15-16 frequent attendance, and child abuse

158-9 information-giving in 77-8 paediatric nurses in 15-16, 28-9 parents' anxieties 76, 77-8 patient labelling 16--17 play area location 78 play in 74--7, 78 prioritising children's care 16--17 specialist units 19-20 staff education and training courses 16 treatment as punishment 77 triage 17

abrasions, management in the A&E department 24--5

abuse sexual 251-2, 253 see also child abuse and neglect

Accident and Emergency departments, see A&E departments

accountability 28 in nurse-led clinics 123

Accreditation for Ambulatory Health Care Inc. xii

Action for Sick Children (formerly National Association for the Welfare of Children in Hospital) 3, 54, 55, 83-4

adolescents health needs 242 mental health case studies 243-7,

247-50, 250-3 outpatients department facilities 78

advanced nursing 116--17 advocacy 49-50, 76, 77

clinical nurse specialist role 136 by cystic fibrosis clinical nurse

specialists 135 role of MacMillan paediatric nurses 108,

113 Allitt Inquiry 220 ambulatory care

clinical nurse specialism and 8-9 definition 1, 170 developing area of nursing 11 environment for 9-10 fiscal benefits 2

growth of 6--8 historical background 1-2 models 228-9 precursors to 3-5 range of services 4 scope of provision 11-12 see also hub and spoke model

ambulatory care clinic, definition 115 American Academy of Nurse Practitioners

126 Area Child Protection Committees

(ACPCs) 161 Armstrong, Dr George 1-2 Asian families, support for 192 Association for the Care of Children's

Health (North America) 54 Association for the Welfare of Child Health

(Australia) 54 Association of Genetic Nurses and

Counsellors 128 asthma

Brighton clinic 118 nurse-led discharge planning 122 support of community children's nurse

143-4 attachment theory 243, 252 audiovisual information 58-9 audit 97

audit cycle 234, 235 Bristol project 27-9 hub and spoke model 234--6

Audit Commission reports By Accident or Design 15 Children First. A Study of Hospital Services

6--7,15,201 Seen but not heard 194

autonomous nursing practice, key characteristics 20

autonomy children 75, 76 in nurse-led clinics 116--17, 120-1, 122

B battered child syndrome 157 Beckenham, Hilda Lewis House, Bethlem

Royal Hospital 193-4 Beckford, Jasmine 156 bereavement, MacMillan paediatric nurses'

role 111 bereavement groups 93 Bethlem Royal Hospital, Beckenham, Hilda

Lewis House 193-4 Birmingham Children's Hospital, Diabetic

Home Care Unit 218 blood glucose monitoring 212-13, 216 Bowlby, John 3 Bridging the Gaps 4, 127, 207 Brighton

asthma clinic 118

257

INNOVATIONS IN PAEDIATRIC AMBULATORY CARE

Royal Alexandra Hospital for Sick Children 26, 208

Bristol project, on ENP practice audit of practice 27-9 development of 22 minor injuries and illnesses in the A&E

department 24--6 nurse prescribing 26 protocols for practice 22, 24--6 training programme 23-4

British Dispensary Movement 1 British Epilepsy Association, Sapphire

Nurse Scheme 130 British Paediatric Association (now College

of Child Health) 7 Brompton Hospital, London 133 By Accident or Design (Audit Commission

report) 15

c cancer

controlled clinical trials 104 culture of 108-9 cure rate 90, 104 home care 95, 105--6 incidence 90 mortality 104 nursing role 90-1 palliative care 92, 105--6, 110-11 patient and family education 94--5, 96-7 prevalence 90, 104 psychosocial care 103 survival, uncertainty and psychosocial

consequences of 104--5 treatment 91 see also MacMillan paediatric nurses;

oncology units Cardiff, University Hospital of Wales,

diabetes management 218 care plans 96 Caring for People: Community Care in the

Next Decade and Beyond 183 CD-ROM-generated information systems

58 centres for health information and

promotion (CHIPs) 51-2 age-appropriate information 54--5 aims 51, 52-3 audiovisual information 58-9 CO-ROM-generated information

systems 58 evaluating 59 information sheets 56-7 locating 55--6 philosophy of 51 range of services 56 Southampton NDU 67 staff resources 53-5 strategies 52-3 volunteer staff 53-4

change accompaniments to 67-8

bottom-up approach 62 as challenge 67 resistance to 62 resources for 62 top-down approach 62

change agent, definition 65 child abuse and neglect 154--5

categories 157 children with special needs 158 deaths resulting from 159 definition 157 and enuresis 119 ethnic minorities 158 frequent attendance in A&E

departments 158-9 liaison health visitors 159, 160 monitoring missed outpatient

appointments 159 National Commission of Inquiry into

the Prevention of Child Abuse (NCIPCA) 156-7, 159

prognosis 158 recognition of maltreatment 157-9 repeated nature of 158-9 signs and symptoms 158 see also child protection

Child Health in the Community (NHSE publication) 229

Child Health Rights 9 child neglect, see child abuse and neglect child protection 154--66

Area Child Protection Committees (ACPCs) 161

assessment 161 child protection conferences 161 children with special needs 158 confidentiality in 162 definition 154, 156 designated nurses 162 implications for practice 159--64 interagency collaboration 155, 156, 161,

162 involvement of parents/ carers 156-7,

161-2 named professionals 162-3 nurses' role in 159-64 onus on children's services in the

community 155 preventative work 160, 163--4, 164 protection plans 161 record keeping 161 responding to concerns 160-2 staff education and training 163, 164,

165 statutory agencies 156 welfare of child paramount 165 see also child abuse and neglect

child protection nurse specialists 155, 162--4, 165

child protection register 161 child psychiatric disorders 245

258

INDEX

children cognitive development 86--7 explaining treatment to 87 --S rights of 156--7 see also paediatric entries

Children Act 1989 155, 156, 162, 181, 188 Children First. A Study of Hospital Services

(Audit Commission report) 6-7, 15, 201 Children's Charter 4, 36, 48, 49, 207 children's charter, Tadworth Outreach

Service's 188, 189 children's clinic, hub and spoke model

231-2 Children's Hospital of Eastern Ontario 9 Children's Trust, Tadworth, Outreach

Service 181-97 aim 182 balancing needs of children/ families/

staff 183, 192, 196 case studies 189-90, 191-2, 193, 194 children's charter 188, 189 children's needs paramount 188 development strategy 184 families' problem areas 183 flexibility 190-2, 195 focus 188-9 forward thinking 193--4 friendliness 192 induction and ongoing training 185 initial research surveys 183 liaison with community professionals

182 origins 182, 183 overview 195--6 partnership model 182 principles 188, 196 referral process 187 --S referrals to 185, 186--7 respite for families 186 staffing 184-5, 187, 188 standards 185--6 workshops 185

CHIPs, see centres for health information and promotion

CINAHL 58 clinical nurse specialists (CNSs) 8-9,

126--38 advocacy 136 child protection 155, 162--4, 165 continuing role 136 cystic fibrosis 133-5 diabetes 131-2 epilepsy 128-30 essential ingredients of post 126--7 genetics 127-8 ICN definition 117 key role components 106 MacMillan paediatric nurses as 106--8 maintenance of data 136 need for recognition of quality service

112-13 neonatalsurgery 135-6

nephrology 135 clinics 115

practice nurse clinics 116 see also hub and spoke model; nurse-led

clinics cognitive-behavioural approach 243, 246 cognitive structures model 246 College of Child Health (formerly British

Paediatric Association) 7 communication

appropriate person to address 174-5 with children 80, 86--8 culture and 170-7 eye contact 173 illiteracy 172 non-verbal 173 respect in 176--7, 179 verbal, shortcomings of 49 written 172 see also information entries

Community Care Act 1990 140 community children's nurses

hub and spoke model 236--7 interfacing with community services

148-50 interfacing with hospital services 145-8 role 141-5, 150-1

community children's nursing services acutely orientated services 142 conditions able to be managed at home

143--4 flexibility 150-1 funding sources 141 historical development 140-1 objectives 142-3 rationale 140-1 resourcing 139 shift in emphasis 141 variety of services provided 142

community services Caring for People: Community Care in the

Next Decade and Beyond 183 community children's nurse's role in

interface with 148-50 and extended family's diminishing role

181 computers

CO-ROM-generated information systems 58

decision support system for telephone consultations 41-2

patient records 43 confidentiality, in child protection 162 consultations

computerised decision support systems 41-2

by telephone 32, 37, 38 see also telenursing

consumerism 33 container theory 253 continence, see enuresis

259

INNOVATIONS IN PAEDIATRIC AMBULATORY CARE

Council for the Education and Training of Social Workers 164

courses, see education and training Court Report (Fit for the Future) 4, 5 critical incident analysis 98 culture 167-80

appropriate person to address 174-5 ask! 168, 169 case studies 175, 176, 178 and communication 170-7 defining 167-70 differing approaches to health and

disease 175 ethnic origin 167 eye contact 173 and families 177-9 features of 168-9 flexible approach to 168 gender roles 171-2 individuality in 169 interpreters 171-2 link workers 171 non-verbal communication 173 sensitivity to 177 shared 169 and social space 173 support for Asian families 192 time-keeping 173--4 time orientation 174 transcultural nursing 168, 169-70 wide concept 169 written communication 172

Curnberlege Report 26 cystic fibrosis (CF), clinical nurse

specialists 133-5

D

clinical support 133 educational role 134 information-giving 134 patient advocacy 135 patient support 134 patient survival to adulthood 134 principles underpinning role of 133

databases 58 day assessment units 206 day care 198-211

advantages of 200-1 assessment/ observation unit in hub and

spoke model 236 community support 203, 210 cost and resource gains 200-1 day assessment units 206 v. day case 198 decentralisation 208 definition 198-9 discrimination in 205 family-centred 5-6 family's increased responsibilities 201-5 fasting times 202, 210 financial constraints 207 guidelines for good practice 209-10

increasing the scope of 205-6 increasing use of 4 information for parents 203--4, 210 innovation and excellence in 201-5 multidisciplinary care management and

communication 207-9, 210 non-surgical 205-6, 208, 209 opportunities for enhancing care 200-1 overnight stay 204-5 political climate 206-9 post-procedural care 203 premedication 202-3 reasons for admission 199-200 a second-class service? 204 starvation of children 202, 210 telephone follow-up 203, 205 unitary patient records 208

day case, v. day care 198 day surgery

conveyor belt? 204 information leaflets 85-6 move towards 3--4 paediatric units 203 play as preparation for 81-2 see also hospitalisation

decision support systems, computerised 41-2

demonstration dolls 87 depression

DSM IV criteria 245 and mental health 243, 244-5, 255

designated nurses, child protection 162 Desrnopressin 120 diabetes 212-27

blood glucose monitoring 212-13, 216 clinical nurse specialists 131-2 clinical practice 221--4 cost effectiveness of horne services 216,

217 horne management 214-15 hospitalisation, downward trend in 215,

216, 217, 218 hospitalisation world wide 219 hospital v. horne treatment 213-16 impact on family life 213 incidence 131, 212 initial management 216-18 ketoacidosis 218, 225 outpatient management 217 paediatric diabetes specialist nurses

131, 218, 219-21 RCN Paediatric Diabetes Special Interest

Group 131-2 research-based evidence for minimising

hospitalisation 224-5 treatment regimens 212 at University Hospital of Wales, Cardiff

218,221--4 Dickens, Charles 2, 12 discrimination, in day care 205 distraction 75-6, 79

timing of 76

260

INDEX

documentation 95-8 care plans 96 child health records, parent-held 148,

159 in child protection 161 organisational issues 97 patient care issues 96-7 patient records, computerised 43 professional issues 97-8 telephone triage 39-40 unitary patient records 208 see also information sheets/leaflets

dolls, for demonstration 87

E eczema 144 education and training

A&E department staff 16 ambulatory care clinical nurse

specialists 8 cancer, for patient and family 94-5, 96-7 in child protection 163, 164, 165 at Children's Trust, Tadworth, Outreach

Service 185 Council for the Education and Training

of Social Workers 164 by cystic fibrosis clinical nurse

specialists 134 diabetes specialist nurses 220 emergency nurse practitioners 23-4 ENB 199 course 16 ENB 928 (diabetes nursing) course 132 ENB 978 (promotion of continence and

management of incontinence) course 120

ENB child protection training course 164

enuresis 120 epilepsy 130 in genetic counselling 127-8 health education after minor trauma

24-5 higher 123, 124 hospital familiarisation projects in

schools 83-4 hub and spoke model staff 238 for NDU nurses 70 for new nursing roles 20-1 nurse practitioners 21 of paediatric clinical nurse specialists

136 as role of MacMillan paediatric nurses

111-12 telenursing 44-5 telephone triage courses 32

emergency nurse practitioners (ENPs) 18-20 case categories for management by 23 clinical decisions 19 factors in development of role 18 geographical areas 19-20 potential for role development 28

RCN definition 19 see also Bristol project

emotional contagion effect 77 emotions, producing physical effects 81 empowerment 49-51

definition 49 essential ingredients of 70 of families 34-5, 48 role of MacMillan paediatric nurses 108,

113 English National Board (ENB) training

courses child protection 164 ENB 199 16 ENB 928 (diabetes nursing) 132 ENB 978 (promotion of continence and

management of incontinence) 120 enuresis 119

see also Southampton University Hospital enuresis clinic

Enuresis Resource and Information Centre (ERIC) 120

epilepsy clinical nurse specialists 128-30 continuing education 130 epidemiology 129 health and social services costs 130 Sapphire Nurse Scheme 130

epilepsy nurse specialists (ENSs) 128 paediatric epilepsy nurse specialists

(PENSs) 128-9 Epilepsy Specialist Nurses Association

(ESNA) 130 ethnic minorities

and child abuse 158 see also culture

ethnocentrism 169

F families

behavioural standards 179 cancer education 94-5, 96-7 collaboration with multidisciplinary

team 109-10 as the cradle of culture 178-9 culture and 177-9 disenfranchisement from life health

events 5 diversity in 177 and the economic climate 177 empowerment of, by information-giving

34-5,48 extended family's diminishing role 181 increased responsibilities with day care

201-5 partnership with health professionals 5 perceptions of general and specialist

care 108-9 roles in 177-8 Southampton NDU family satisfaction

survey 65-6 spheres of responsibility 178

261

INNOVATIONS IN PAEDIATRIC AMBULATORY CARE

strain of home care 151 see also parents

family-centred care 5-6 family information centre

hub and spoke model 232-3 Southampton 51-2, 55

family systems theory 249, 250 parent-child sub-system 249 spouse sub-system 249

fasting times, pre-procedural 202, 210 Fit for the Future (Court Report) 4, 5 Flexible Options for Paediatric Care (BPA

publication) 229 Freud, Sigmund 73

G genetic counsellors 127 genetics, clinical nurse specialists 127-8 Glaxo-Wellcome 130 Grantham children's unit, hub and spoke

model 229

H head injuries, minor, management in the

A&E department 25 health education, see under education and

training HEALTH-LINE, University of Wisconsin-

Madison 43 Health Line, Winchester 43 Health Line Harmony 43 Health of the Nation reforms 50, 116 health records, see under documentation Health Reference Centre (CD-ROM) 58 helplines 35-6

see also telenursing Hidden Children 205 Hilda Lewis House, Bethlem Royal

Hospital, Beckenham 193-4 'holding' 243, 250 home care

attraction of use of 191 cancer 95, 105-6 conditions able to be managed at home

143-4 as factor in coping with bereavement

105 specialist v. general services 181-2 strain on families 151 support of community children's nurse

143-5 see also Children's Trust, Tadworth,

Outreach Service Hospital, a Deprived Environment for

Children? (Save the Children report) 72-3

Hospital and Ambulance Service Comparative Performance Guide 51

Hospital for Sick Children, Great Ormond Street, London 1

Hospital for Sick Children, Toronto 10, 39, 55,58

Motherisk telephone information service 41

telephone triage courses 32 Hospital for Sick Children, Toronto,

Medical Information Centre audit 40 call volumes 39 documentation 39-40 letters of appreciation 39-40 telephone triage service 38-9

hospitalisation children's concept of 80-1 children's worries and reactions 80-1,

213-14 downward trend in 216, 217 emotional and psychological disadvantages of 140, 198 pre-admission information leaflets 80,

85-6 pre-admission programmes 84-6 preparation by play 84, 87 preparation for admission 79-80, 82 previous, significance of 82 psychological effects of separation 198,

200,201,213-14,216 research-based evidence for minimising

224-5 and role of community children's nurse

142-3 see also day surgery

hospital league tables 50-1 hospitals

community children's nurse's role in interface with 145-8

shared care hospitals 94, 99, 101 Hospitals for Sick Children, programmed

investigation unit (PIU) 205-6 hub and spoke model 228-41

advantages 238

262

audit 234-6 charter standards 239-40 children's clinic 231-2 clinical protocols/pathways 234 community children's nursing team

236-7 day care medical assessment/

observation unit 236 description 229-30 disadvantages 239 family information centre 232-3 Health of the Nation targets 239 mobile respite care 237 multi-agency audit 234-6 named nurse 232 organisation 234 Outreach clinic 232 philosophy 229-30 present position 230 relationships within 231 seriously ill children 237 services 230 staff development 237-8

INDEX

I

staffing 239 telemedicine 233-4 telephone advice lines 233-4 unbooked walk-in clinics 231, 233

illiteracy 172 imagery 88 incontinence, see enuresis information

audiovisual 58-9 databases 58 family information centre, hub and

spoke model 232-3 information seekers and information

avoiders 35 patient information strategies 50-1 retention 94-5

information exchange 140 information-giving 48-9

in A&E departments 77-8 to children 49 concept in practice 53 by cystic fibrosis clinical nurse

specialists 134 family empowerment by 34-5, 48 in outpatients departments 80 by paediatric epilepsy nurse specialists

130 role of MacMillan paediatric nurses 112 see also centres for health information

and promotion (CHIPs); communication

information sheets /leaflets 56-7, 80, 85-6 alternatives to 172 language and level 172 readability formulae 57

information systems, CD-ROM 58 ingestions, non-toxic, management in the

A&E department 25-6 insulin-dependent diabetes mellitus

(IDDM), see diabetes interface

between primary and secondary care 139, 140

role of community children's nurse 145-50

Internet 58 interpreters 171-2

JIKIL Just for the Day 80, 199, 201 ketoacidosis 218, 225 King's Fund Centre, Nursing Development

Programme 62-3,63,67-8 leaflets, see information sheets/leaflets Leicestershire, diabetes management 217 liaison health visitors 159, 160 litigation, and telephone triage 41 London, see individual London hospitals

M Macmillan paediatric nurses

during bereavement 111 as cancer specialists 109 as clinical nurse specialists 106-8 cost effectiveness of service 112 education role 111-12 as family advocate and co-ordinator

with multidisciplinary team 109-10 goals and interventions 113 information and support role 112 key points 103 outreach services 106 palliative care role 110-11 role of 106-12 support and care across the disease

trajectory 106, 107 support for 111 support role 112

management education v. management development 69

Medical Research Council 104 Medline 58 mental health 242-56

attachment theory 243, 252 automatic thought 246-7 case studies, adolescents 243-7, 247-50,

250-3 cognitive-behavioural approach 243,

246 cognitive strategies 254 container theory 253 depression 243, 244-5, 255 'holding' 243, 250 internal rules 246, 247 psychiatric disorders 245 recognising problems 243-4 schema 246, 247 'secure base' concept 249, 252, 253 self-harm 243, 253, 255 sexualabuse 251-2,253 suicide risk 248, 255 therapeutic relationship 253-4 therapeutic strategies, in case studies

246-7,249-50,252-3 untreated, subsequent problems 242,

248 working with 243-4

minor injuries, management in the A&E department 24--6

Motherisk telephone information service 41

N named nurse 67, 100, 232 National Association for the Welfare of

Children in Hospital (NAWCH) (now Action for Sick Children) 3, 54, 55, 83-4

National Commission of Inquiry into the Prevention of Child Abuse (NCIPCA) 156-7, 159

263

INNOVATIONS IN PAEDIATRIC AMBULATORY CARE

National Society for the Prevention of Cruelty to Children (NSPCC) 156

NAWCH, see National Association for the Welfare of Children in Hospital

neglect, see child abuse and neglect neonatal family care nurse specialists

(NFCSs) 135-6 neonatal surgery 135-6 nephrology, clinical nurse specialists 135 NHS Priorities and Planning Guidance 48 non-toxic ingestions, management in the

A&E department 25-6 Norah Fry Institute 183 North West Region Benchmarking Group

209 Nottingham

paediatric services 7-8 Queens Medical Centre, hub and spoke

model 229 NSPCC (National Society for the

Prevention of Cruelty to Children) 156 nurse-led clinics 115-25

accountability 123 advantages and problems 122-3 asthma clinic, Brighton 118 autonomy in 116--17, 120-1, 122 concept 115 consultant involvement 118 cost-effectiveness 122, 123, 124 definition 115 diabetes clinic, Southampton 118 diagnosis already made 117 epilepsy 130 as extension of clinical nurse specialist

role 117 informal atmosphere 122 integration between primary and

secondary care 122-3 measuring outcome effectiveness 123 outcome evidence 124 preventative health work 116 in primary care 116 research 124 saving health care resources? 122 tradition 116 see also Southampton University

Hospital enuresis clinic nurse practitioners

American Academy of Nurse Practitioners' definition 126

definition 21, 117 education and training 21

nurse prescribing 26, 222 Nursing Agencies Act 1959 184 nursing development units (NDUs)

clinical leader role 64 definitions 63, 66, 68-9 King's Fund support 62-3 see also Southampton University

Hospital nursing development unit

0 Oldchurch Hospital, Romford 19 oncology units

care by telephone 93 care spectrum 91 care spheres 91-3 clinical practice 98 clinical review 91-2 developing nursing practice 98-100 diagnostic tests 91 documentation 95-8 layout 93--4 long-term follow-up 92 multidisciplinary team co-ordination 99 nursing role 98 patient and family education 94-5, 96--7 primary nursing 100 service development 100 support groups 92-3 supportive care 92 see also cancer; documentation

out-of-hours services 33--4, 42 outpatient care, transition to ambulatory

care 1-2 outpatients departments 7

facilities for adolescents 78 information-giving in 77-8 missed appointments, and child abuse

159 peer grouping in adult/joint clinics 79 play in 78-80 preparing child for admission 79-80 Southampton children's outpatient

department (COPD) 61, 68, 69 Outpatient Departments -Changing the Skill

Mix (NHSME publication) 7 Outreach clinic, hub and spoke model 232 outreach services, see Children's Trust,

Tad worth, Outreach Service Oxford, diabetes management 217-18

p paediatric diabetes clinical nurse

specialists 131-2 Paediatric Diabetes Special Interest Group,

RCN 131-2 paediatric diabetes specialist nurses 131,

218,219-21 paediatric epilepsy nurse specialists

(PENSs) 128--30 paediatric neurology liaison nurses 129 paediatric nurse practitioners 116, 124 paediatric nurses

conflict of loyalties 50 health promotion focus 48

palliative care, cancer 92 home, hospital or hospice 105-6 role of MacMillan paediatric nurses

110-11 pamphlets, see information sheets /leaflets parents

264

in A&E departments 76, 77-8 demands on 2, 4-5

INDEX

lack of information for 80 see also families

Parents and Professionals Resource Information Centre (PAPRICA) 53

partnership families and health professionals 5 partnership model, Children's Trust,

Tad worth, Outreach Service 182 partnership paradigm, dangers of cost

cutting 5 role of MacMillan paediatric nurses 108,

113 patient-centred care 66--7 patient information sheets, see information

sheets /leaflets patient records, see under documentation Patient's Charter 36, 50, 67 Patient's Charter: Services for Children and

Young People 157, 181, 188, 236--7 pharmacists, role in information-giving 37 Pharmaplus 37 Piaget, Jean 73, 86--7 Platt Report (Welfare of Children in Hospital)

3, 198 play 72-89

in A&E departments 74-7, 78 in ambulatory care areas 10 in day care medical assessment/

observation unit 236 distraction 75--6, 79 hospital playschemes history 72-3 imaginary 78 in outpatients departments 78-80 post-procedural 76 pre-admission 84, 87 as preparation for day surgery 81-2 purposes of 73 relaxation 75, 76--7 Save the Children Fund Hospital

Playscheme 72-3 Southampton NDU 67 specialists 10 therapeutic value of 7 4

poison centres 38, 39 police, and child abuse 156, 162 polyclinics 228 practice nurses, clinics 116 Preston, Royal Preston Hospital 32 primary nursing, cancer care 100 programmed investigation units (PIUs)

205--6 protocols

care protocols 41 development 22, 41 RCN definition 22 self-care 42 for telephone triage 41-2

punctuality, see time-keeping

Q quality assurance 97 Queens Medical Centre, Nottingham, hub

and spoke model 229 questioning, Socratic method 254

R Rafferty, Anne Marie 12 readability formulae, information sheets

57 records, see documentation reflective practice 50 relaxation 75, 76--7 respect, in communication 176--7, 179 respite care

Children's Trust, Tadworth, Outreach Service 186

mobile service, hub and spoke model 237

reversibility 87 rights, children's 156--7 Rights of the Child, UN Convention 157,

188 Robertson, James 3 Romford, Oldchurch Hospital 19 Rotherham, community children's nursing

services 140 Royal Alexandra Hospital for Sick

Children, Brighton 26, 208 Royal College of Nursing, Paediatric

Diabetes Special Interest Group 131-2 Royal Preston Hospital 32

s St Bartholomew's Hospital, London 72 StThomas's Hospital, London 72 Sapphire Nurse Scheme 130 Save the Children Fund Hospital

Playscheme 72-3 schema 246, 247 schools, hospital familiarisation projects

83-4 Scope of Professional Practice (UKCC) 21, 26,

28, 32, 35 'secure base' concept 249, 252, 253 Seen but not Heard (Audit Commission

report) 194 self-care protocols 42 self-harm 243, 253, 255 shared care hospitals 94, 99, 101 signage and design 9, 55--6 social services departments, child abuse

156 social space 173 social workers, Council for the Education

and Training of Social Workers 164 Southampton Family Information Centre

51-2, 55 Southampton University Hospital, Child

Health Directorate 7-8, 11 children's outpatient department

(COPD) 61, 68, 69

265

INNOVATIONS IN PAEDIATRIC AMBULATORY CARE

paediatric epilepsy nurse specialists (PENSs) 129-30

Southampton University Hospital enuresis clinic 118 background 120 budget problems 121 consultant's perspectives 120-1 enuresis alarms 120 initial knowledge base 120 nurse autonomy in 120-1 nurse education 120 origins 119, 120 patient satisfaction survey 122 power balance, doctors/nurses 121 success, measures of 121 treatment, previous practice 119-20

Southampton University Hospital nursing development unit 62-71 change process 64 clinical leader role 64, 65, 69-70 creation of 11 environment change 65 'families first' philosophy 68 family information 67 family satisfaction survey 65-6 grant application 63 job descriptions 65 King's Fund support 63, 67-8 steering group 64 team facilitator 65, 66 team ownership 65, 69 therapeutic play 67

starvation, pre-procedural 202, 210 suicide risk 248, 255 support groups, cancer 92-3

T Tadworth, see Children's Trust, Tadworth,

Outreach Service telemedicine, hub and spoke model 233-4 telenursing 31-47

areas of advice 31-2 caller's responsibility 45---6 cancer care 93 documentation 39-40 education for 44-5 guidelines 36 helplines 35---6 nurse's responsibility 45 out-of-hours services 33-4, 42 paucity of research 38 telephone knowledge 35---6 see also telephone entries

telephone consultations 32, 37, 38 computerised decision support system

41-2 see also telenursing

telephones 37-8 advice lines, hub and spoke model

233-4 follow-up services after day care 203,

205

health information services, in Canada 44

health service research need 44 ownership 205 services via 43 voice mail 42-4

telephone triage 31-2, 36, 38, 38-9 access to medical personnel 43 and litigation 41 protocols for 41-2 see also Hospital for Sick Children,

Toronto; telenursing tertiary care, transition to ambulatory care

2 therapeutic play, see play time-keeping, cultural attitudes to value of

173-4 time orientation 17 4 Toronto, see Hospital for Sick Children,

Toronto training, see education and training transcultural nursing 168, 169-70 treatment

explaining 87-8 as punishment 77

triage 17 see also telephone triage

trust, role of MacMillan paediatric nurses 113

u UKCC, The Scope of Professional Practice 21,

26,28,32,35 unitary patient records 208 United Kingdom Children's Cancer Study

Group 104 United Kingdom Home Care Association

(UKHCA) 185 United Nations Convention on the Rights

of the Child 157, 188 University Hospital of Wales, Cardiff,

diabetes management 218, 221-4 University of Wisconsin-Madison 43

v visual imagery 88 voice mail 42-4

benefits 44

w walk-in clinics, unhooked, hub and spoke

model 231, 233 ward attenders 205, 209, 236 Warnock Report (Special Educational

Needs) 149 Welfare of Children and Young People in

Hospital (DoH publication) 6, 190 Welfare of Children in Hospital (Platt Report)

3, 198 Working Together guidelines on child abuse

and neglect 156, 161, 164 wounds, management in the A&E

department 24-5

266