Saturday paediatric nurse-led drop-in clinic proves successful

Journal of Diabetes Nursing, Jan, 2003 by Adele McEvilly

Introduction

The rising incidence of childhood diabetes (Feltbower et al, 2000) and improved care of young people with diabetes have resulted in a mounting workload for paediatric diabetes specialist nurses, many of whom now care for more than the 70-100 children per WTE recommended by the RCN Working Party (1993). It is therefore important to find new ways of providing support to young people with diabetes, their families, friends and carers. This article describes a drop-in clinic that has proved particularly popular with adolescents with diabetes.

In recent years, information about diabetes has become much more readily available through the press and the Internet. Newspaper headlines and news items on such programmes as 'Tomorrow's World', stating 'Cure for diabetes,' 'Needle-free injections,' 'Islet cell transplants' or 'Pain-free blood testing', raise the expectations of young people with diabetes and their parents, only for them to find that these developments are many years away or not applicable to young children.

For some young people, this can have a catastrophic effect on how they feel about their diabetes; and when they discover that the 'cure' is not available they lose faith in their carers and medical team.

Information overload

At diagnosis, many young people with diabetes and/or their parents seek information from the Internet. However, this can provide them with more facts than they are ready to cope with, leading to greater anxiety at this very stressful time. The information may be confusing -- what families need to know is how diabetes will affect the child or young person now and in the future.

Although many have access to various diabetes-related websites and can obtain information on new developments, new products and problem solving, often they do not have sufficient knowledge to evaluate this information (Kelly et al, 2002).

As alternative methods of blood glucose monitoring and insulin administration become increasingly available, parents are eager to view and handle new equipment in order to find the most appropriate one for their child.

The combination of increasing numbers of young people diagnosed with diabetes and new developments in their care has put greater pressure on paediatric diabetes specialist nurses (PDSNs). Consequently, the opportunities for education and downloading of test results from the latest blood glucose meters may be limited.

When these are achievable, they do offer an opportunity to engage young people in discussion and feedback about the care of their diabetes, thereby providing the PDSN with the chance to develop the knowledge of the child and/or family. The ability to negotiate individual targets for care should narrow the gap between ideal and real self-management targets (Doherty et al, 2000).

Existing service

The Diabetes Home Care (DHC) service based at Birmingham Children's Hospital aims to meet the recommendations of the International Society for Paediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2000), Audit Commission (2000) and the National Service Framework for Diabetes (Department of Health, 2001), by providing a 24-hour service 365 days a year, to support and educate the 390 children with diabetes in their care.

Children newly diagnosed with diabetes are managed entirely at home if they are fit and well on presentation. Support and education are provided in the home at injection times until the family is confident in the technique. The benefits of home support and how this can reduce readmission rates in the future are clearly described by Swift et al (1993).

Contact is maintained by telephone, to provide support and advice as necessary, and families are encouraged to use the 24-hour helpline if problems occur. Continuing support is provided in the home, with twice-yearly visits to discuss care and identify problems. The team also reviews the children with diabetes in the outpatient clinic three to four times a year.

Problems

Unfortunately, these contact periods are always busy and there is never enough time for staff to answer all the questions that the families may have. Also, some parents and young people are reluctant to ask questions at the clinic because, in their own words, 'we can see the staff are busy' or 'we would be keeping other patients waiting'. In Raleigh and Clifford's study (2002) some patients felt that they did not have enough time to discuss all their concerns with the nurse or doctor.

Although all this support is available to the families, there are frequently developments or news items that raise questions between routine contacts.

Before 1998, although the DHC office was accessible, the families of children with diabetes rarely used it as a drop-in facility; there were fewer than 100 visits a year to the department. In 1997 the hospital moved to a new site and the DHC office was relocated to a small self-contained area, with considerably more space.

Aims of the open access clinic

Following the move and because of the increasing workload, it was decided that the nursing team should provide a service with easy access for advice between routine contacts. The aim was to allow time for patients and/or parents to discuss diabetes management problem, and to obtain information on new equipment. The service would also allow time for downloading the test results from blood glucose meters and offer young people with diabetes and their families an opportunity to discuss queries about recent news items about diabetes.