Solution-focused conversations: a new therapeutic strategy in well child health nursing telephone consultations

Survey of intention among public health nurses in providing solution-focused parenting support

Objective

Parenting support has shifted from a problem‐focused to a strengths‐based solution‐focused approach. This study surveyed public health nurses to explain their intention to provide solution‐focused parenting support in their practice.

Design

The design of this study was cross‐sectional.

Sample

The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands.

Measurements

Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling.

Results

A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution‐focused parenting support.

Conclusions

In this study, public health nurses strongly intended to provide solution‐focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm.

Telenurses' experiences of monitoring calls to parents of children with gastroenteritis

AIMS AND OBJECTIVE

To describe telenurses' experiences of monitoring calls in telephone advice nursing to parents of children with gastroenteritis.

BACKGROUND

In previous studies, making monitoring calls is mentioned as a method used by telenurses to assess the need for care. MonitoringTHE terms 'care-seekers', 'care-seeker' and 'careseekers' are used inconsistently in the article. Please suggest which one to follow. We suggest Care-seeker calls in telephone advice nursing have been described as when telenurses call care-seekers back once or twice after an initial call. Calls from parents of children with gastroenteritis are common, and many of these calls result in telenurses providing self-care advice.

METHODS

Nineteen telenurses from two healthcare call centres in Sweden were interviewed. Data were analysed using inductive qualitative content analysis.

RESULTS

One main category, four generic categories and eleven sub-categories emerged. The telenurses described how working with monitoring calls aimed to provide self-care at home in a patient-safe way. Their focus on the parents aimed at increasing their feeling of security and focus on the child aimed at ensuring patient safety. Monitoring calls also provided a learning opportunity for parents and telenurses, and the possibility of relieving pressure on healthcare services. The findings indicate that the use of monitoring calls aims to provide a patient-safe form of telephone advice nursing.

CONCLUSION

This study shows that many parents feel insecure when their child has gastroenteritis, and the use of monitoring calls may be an effective approach to help them feel more secure at home with their sick child.

Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

PURPOSE

To examine family (patient and parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit.

METHODS

Four focus groups with teen patients (n=16), four focus groups with parents (n=15), and one focus group with providers (n=12) were conducted using a structured moderator guide tailored to each specific population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia, or elevated blood pressure. Parents who attended their child's well-child visit and had a child meeting these same criteria were eligible. Teen focus groups were divided by gender (male/female) and age (14-15y/16-17y). Focus group transcripts were coded for concepts and themes using qualitative data and thematic analysis. Analysis was performed across groups to determine common themes and domains of intersect.

RESULTS

Teens and parents expect weight to be discussed at well-child visits, and prefer discussions to come from a trusted clinician who uses serious, consistent language. Teens did not recognize the health implications from excess weight, and both parents and teens express the need for more information on strategies to change behavior. Providers recognize several challenges and barriers to discussing weight management in the well-child visit.

CONCLUSION

A clinician-teen-family relationship built on trust, longevity, teamwork, support, and encouragement can create a positive atmosphere and may improve understanding for weight-related messages for teens and families during a well-child visit.

O processo de comunicação na Telenfermagem: revisão integrativa

RESUMO Objetivo: identificar as evidências científicas sobre o processo de comunicação na Telenfermagem e analisá-las. Método: revisão integrativa, realizada em março de 2014. A estratégia de busca, estruturada com os descritores "telenfermagem" e "comunicação", foi implementada nas bases de dados Medline, Bireme, Cinahl, Scopus, Web of Science, Scielo e Cochrane. Resultados: ao serem aplicados critérios de inclusão e exclusão, selecionaram-se 10 estudos. Os principais desafios ponderados foram: a condição clínica dos pacientes, a possibilidade de que comunicação inadequada gere erros de conduta, a ausência de referências visuais em interações sem recurso de vídeo, e dificuldade de compreensão do não verbal. Conclusão: a distância impõe barreiras comunicativas em todos os elementos: emissor, receptor e mensagem; e em ambas as maneiras de transmissão, verbal e não verbal. A principal dificuldade é compreender o não verbal. Para cuidar adequadamente neste contexto, o enfermeiro deve receber formação específica, para que desenvolva competências e habilidades comunicacionais.

The effects of intervention on quality of telephone triage at an emergency unit in Finland: Nurses' perspective

AIMS AND OBJECTIVES

The aim of this study was to investigate the effects of a nurse training intervention on the assessment of patients' care needs in telephone triage at an emergency unit. The objective of this study was to generate information about nurse training that can be utilized when developing telephone triage and health care education.

BACKGROUND

With the growing number of patients coming into emergency departments and a lack of resources in healthcare, it would be valuable to determine an effective training intervention in telephone triage, particularly when assessing the training needs of nurses.

DESIGN

The study was quasi-experimental, with a pre- and post-test design.

METHODS

The data were collected from the nurses at the emergency department and joint emergency service of the Central Hospital in Northern Finland (baseline n = 28, post-test n = 26). The descriptive statistic, Fisher's χ(2) test and McNemar's test were used to analyse the data.

RESULTS

The intervention improved nurses' skills to evaluate patients' needs and health condition via the telephone triage. There was a statistically significant difference in the resources, knowledge, skills and attitudes of the nurses between the baseline and post-test measurements.

CONCLUSIONS

The nurse training intervention improved the quality of telephone triage.

RELEVANCE TO CLINICAL PRACTICE

Nurses should receive continuous training in telephone triage in order to maintain and reinforce their professional competence. When planning the training, the age and relevant work experience of the nurses should be taken into consideration as well, since the results indicate that they lead to variation in the nurses' competence.

The perfect marriage: solution-focused therapy and motivational interviewing in medical family therapy

Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy.

Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol

BACKGROUND

Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families.

METHODS/DESIGN

This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children.

DISCUSSION

The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms.

TRIAL REGISTRATION

ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

[Outcomes of home monitoring after palliative cardiac surgery in infants with congenital heart disease]

PURPOSE

Common conditions, such as dehydration or respiratory infection can aggravate hypoxia and are associated with interstage mortality in infants who have undergone palliative surgery for congenital heart diseases. This study was done to evaluate the efficacy of a home monitoring program (HMP) in decreasing infant mortality.

METHODS

Since its inception in May 2010, all infants who have undergone palliative surgery have been enrolled in HMP. This study was a prospective observational study and infant outcomes during HMP were compared with those of previous comparison groups. Parents were trained to measure oxygen saturation, body weight and feeding volume and to contact the hospital through the hotline for emergency situations. Telephone counseling was conducted by clinical nurse specialists every week post discharge.

RESULTS

Forty-one infants were enrolled in HMP. Nine hundred telephone counseling sessions were conducted. Seventy-three infants required telephone triage with the most common conditions being gastrointestinal (50.7%) and respiratory symptoms (32.9%). With HMP intervention, interstage mortality decreased from 18.6% (8/43) to 9.8% (4/41) (χ²=1.15, p=.283).

CONCLUSION

Results indicate that active measures and treatments using the HMP decrease mortality rates, however further investigation is required to identify various factors that contribute to hemodynamic complications during the interstage period.

Solution-focused coaching in pediatric rehabilitation: an integrated model for practice

This article describes the conceptual basis and key elements of a transdisciplinary model for solution-focused coaching in pediatric rehabilitation (SFC-peds). The model exemplifies a strengths-based, relational, and goal-oriented approach to clinical practice. It provides a distinct shift from a problem-oriented, therapist-directed approach to a possibilities-oriented approach where client empowerment takes precedence. The model facilitates client change through a method of working with client strengths and resources that involves the use of strategic questions to co-construct therapy intervention. Through client-therapist collaboration, therapy goals and plans are developed that align with client hopes, priorities, and readiness for change. SFC supports client self-determination and capacity for change through customized therapy goals and plans that are meaningful for the child and family. Implications for therapists include the need for relational expertise, practical coaching skills, and expertise in facilitating change. The need for research on the effectiveness of this approach in pediatric rehabilitation is discussed.

Patients’ experiences with metaphors in a solution-focused approach to improve self-management skills: A qualitative study

Aim:

To explore how participants taking part in a session based on a solution-focused approach to enhance self-management skills experienced the metaphor “Captain of the ship” used in the educational material.

Methods:

A qualitative study with semi-structured focus group interviews with 16 participants in different self-management programmes. The educational material used the metaphor “Captain of the ship”. The material had pictures of a turtle who was “Captain of the ship” in different situations. The pictures were accompanied by solution-focused questions.

Results:

Most of the participants found the metaphor “Captain of the ship” very helpful. They reported that it was easy to remember, enhanced the learning process, and could be used as a practical tool in everyday situations. Furthermore, the metaphor helped them to become more aware of their own responsibility for self-management.

Conclusions:

The metaphor “Captain of the ship” was experienced as strengthening the messages from the solution-focused approach.