Better care for children with atopic conditions

A nurse-led team in Wales is improving the care of children with asthma, eczema and allergies

A nurse-led team in Wales is improving the care of children with asthma, eczema and allergies

childrens_respiratory_and eczema_nurses
Children’s respiratory and eczema nurses Kelly Davies, Lynfa Day and Katie Harris


Children’s respiratory and atopic clinical nurse specialist at Cwm Taf University Health Board Lynfa Day is devoted to improving the care experience and well-being of children with asthma, eczema and allergies.

She has led a reorganisation to improve swift access to services for children with atopic conditions that is being rolled out across the organisation.

These changes have increased the quality, efficiency and equity of care for families throughout the region without the need for extra funding.

Ms Day’s work was recognised at the end of last year when she won the RCN in Wales Nurse of the Year children and midwifery award.

General nurse

Ms Day qualified as a general nurse in 1986, and after a short stint on adult medical wards, went to work in paediatrics at what was then East Glamorgan hospital.

In 1992, she completed a one-year course to become a registered children’s nurse, and developed an interest in caring for children with respiratory disease.

Working at the children’s respiratory and allergy centre in Cardiff gave her an insight into the children with other atopic conditions, including eczema.

After demonstrating the need to the trust, she was allocated a day a week to focus on children with eczema in 2002

‘It was clear that children with eczema in my local area had little support,’ she says.

‘While working as a staff nurse on the paediatric ward I began to develop a service for children with eczema, initially for a small number.’

Integrated service

Two years later, Ms Day began her role as children’s respiratory and allergy clinical nurse specialist.

Alongside her colleagues, began to develop an integrated service for children with respiratory and atopic disease, particularly asthma, atopic eczema and allergy.

Many of the children she and colleagues care for have more than one of these conditions, and bringing the services together leads to a more holistic approach, and fewer appointments for families.

‘The service has grown and grown and since our health board merger now covers a larger geographical area,’ Ms Day, who has also completed training in children’s community care, says.

‘We found demand was increasing beyond what we could provide.’

Care management

As part of her MSc in child health and welfare, Ms Day conducted a review of the care provision for children with atopic eczema and their families across the area served by the health board.

She found inconsistencies in primary care management of children, and frequent duplicate referrals to the dermatologist, paediatric and nurse-led clinics, leading to long waits.

Ms Day created standardised referral pathways across the region, increased nurse-led clinics and provided nurse-led clinics for children with flare-ups.

There are now also group education sessions for newly diagnosed children in primary care, and a new family support group led by parents.

Quicker access

Among the improvements recorded in the four-month pilot are reduced waiting times, fewer GP appointments and 46 dermatologist and paediatricians’ appointments saved, leading to quicker access to doctors for complex cases. More patients are seen and managed in the nurse-led clinics than before.

The approach is now being rolled out across the whole region that the board covers.

‘It is a more streamlined, holistic service that leads to patients being seen more quickly and doesn’t cost any more money to provide. The most difficult aspect has been implementing the new model while still maintaining a busy service,’ Ms Day says.

‘But I have had great support from my nursing and medical colleagues, tutors and managers to make it possible, and we have had good feedback from families, who feel better supported.’

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