Helping parents cope with crying babies: decision-making and interaction at NHS Direct

This paper is a report of a study of how nurses at a national telephone triage centre in England (NHS Direct) make different use of the algorithms and organizational protocols to make decisions and give advice to parents with crying babies, how their clinical knowledge and experience influences these decisions, and the techniques used to enhance parental coping ability.

Parents of persistently crying babies state that they need to be listened to, understood, believed and reassured to help them cope. Nurses at NHS Direct use their clinical judgement in decision-making, and see the software as a guide that can be both valuable and problematic.

The study design was influenced by grounded theory and incorporated discourse and thematic analysis. It had two phases involving data collection and analysis over the period 2002-2006. A theoretical sample of 11 calls was analysed and later a focus group of six nurses at the same site.

NHS Direct nurses used the 'crying baby' algorithm in various ways, influenced by their experience and confidence to use the algorithm to support their clinical knowledge. Its medical elements were regarded as safe but its non-medical elements, including questions about the likelihood of shaking a child, were treated differently.

Nurses were reluctant to deviate from the algorithm when dealing with child-focused calls. However, this reluctance did not apply when they were prompted to ask the caller if they felt that they were reaching a point where they might shake their baby, or when prompted to give related advice.