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

Abstract

BackgroundConstipation 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.MethodsDesign 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.ResultsThe 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.ConclusionIt 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.

Parents’ Experiences and Information Needs While Caring for a Child With Functional Constipation: A Systematic Review

“…Conversely, interdisciplinary care models that can accommodate more frequent visits and as-needed contact with health care providers during symptomatic exacerbations or periods of uncertainty have shown promise. 42-45 Based on our concerning findings about the negative effects of misconceptions and parental frustration on family relationships and child outcomes, finding innovative ways to meets parents’ information and support needs is critically important to promote both parent and child well-being.…”

Optimizing care for children with difficult-to-treat and severe asthma through specialist paediatric asthma centres: expert practical experience and advice

“…Several studies have shown that these types of nurseled activity can improve the outcomes of children with asthma [31,32], as well as with other chronic conditions [33][34][35]. Those experts whose clinics employ nurses report that they are indispensable for helping patients manage their own asthma, for example by educating them on correct inhaler technique and avoiding exacerbating factors.…”

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

“…Characteristics of the included studies are provided in Tables 2 and 14 A total of 2252 children with constipation (range 15-1020 per study) were included in the 15 studies. [58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] The age of children ranged between 1 month and 20 years. One study 62 included only children additional needs, and two studies explicitly excluded children with additional needs.…”

“…The most frequently reported outcome of interest was faecal incontinence, reported by 10 studies. 58,60,61,63,[65][66][67][68]70,71 Only four studies assessed painful defaecation [59][60][61][62] and two assessed QoL. 65,67 No study assessed school attendance.…”