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Caring for children in their own homes

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Recent government policy emphasises caring for children at home wherever possible. This has resulted in a growing number of posts for paediatric nurses in the community.

‘In one day, I visited a family of Jehovah’s Witnesses, a Muslim family and a family of Plymouth Brethren,’ says children’s community nurse (CCN) Alison Durrant. ‘There are not many jobs where you become so closely involved with people from such different cultures and backgrounds.’

As a CCN for South Cambridgeshire and City Primary Care Trust, Ms Durrant’s role is as diverse as it is challenging. Before taking on the role eight years ago she had worked as a paediatric nurse since qualifying.

But during a stint as a school nurse she became interested in working in the community. ‘School nursing gave me an insight into children and their home environment,’ she explains. ‘Nursing a child in hospital is so different to nursing them at home. Hospital is an alien environment for a child, but when you are in their home you are their guest.’

Ms Durrant says there is a wealth of evidence to support nursing children in the community. ‘As far back as the 1950s there has been evidence to show nursing in the community is beneficial. As long as they are being treated by appropriately trained health care staff, children tend to recover more quickly when treated at home.’ Having a good team in place can also hasten hospital discharges.

The National Service Framework for children, published in September 2004, states that services should be designed around the needs of children and their families, whether in hospital or in the community. Alongside the NHS Plan, published in 2000, the NSF also advocates initiatives such as nurse-led clinics.

Ms Durrant and her colleagues have set up clinics to manage chronic constipation and eczema.

‘There are too many children being admitted to hospital unnecessarily. With the appropriate resources, some conditions are manageable in the community,’ she says.

After starting out with only two nurses a few years ago, Ms Durrant is now part of a growing multidisciplinary team - including nurses, an occupational therapist, play therapist and family support worker. Increased government funding has created new nursing roles - a CCN has recently been appointed to a government-funded post to care for children with chronic fatigue syndrome.

Training opportunities are also improving and further development is encouraged. Ms Durrant was the first nurse to undertake a community nursing degree, and has gone on to do an extended nurse prescribing course.

Community experience is not essential to the role, as on-the-job training is given. And, although recruiting staff is not a problem where Ms Durrant works, she admits that they need more male nurses. ‘We need more male paediatric nurses in general. But especially in the community, it makes it easier on the small boys.’

Ms Durrant treats children with a variety of conditions. ‘Every day is different. It ranges from those with life-threatening illnesses to the minor things like removing sutures or changing dressings.’

She also treats children who have multiple complex problems, such as developmental problems due to premature birth, and works closely with the neonatal community team, child and family teams, and health visitors.

Because some children will die in the community, the team has a close relationship with the local hospice, and helps families with the bereavement process. South Cambridgeshire and City PCT has a children’s community nurse available seven days a week, and an overnight on-call phone line.

Ms Durrant believes that treating children at home helps to reduce the stress placed on both the child and their family. ‘Although hospitals are essential and life-saving, if the child can be treated at home and the family kept together, everybody is more relaxed. It really makes a difference.

‘The local hospital is hard to get to, and you may have to spend hours waiting, which can cause problems. We can be in and out as quickly as possible, which causes much less disturbance to family life.’

Children’s community nurses have to be able to work as autonomous practitioners as well as in teams.

‘You have to go into people’s homes on your own, make decisions and be prepared to take responsibility for those decisions,’ warns Ms Durrant. ‘Sometimes it can be quite stressful, but being a school nurse was a great stepping stone for me.’

The children’s community nurse also acts as an advocate for the child. ‘We have to remember the things that are important to children,’ says Ms Durrant. ‘When a child is at home they can eat what they like, wear what they like, and bathe when they like. They can play with their own toys and have their friends to visit. We exist because it is healthier for the child to be treated at home. Ultimately, it is about empowering them.’

How do I become a children’s community nurse?

  • This could be for you if: you are good at working with children and their families and are passionate about nursing children at home.
  • You need to be: adaptable and you must have excellent communication skills. You must also be proactive and able to act as an advocate for a child.

You need to have:

  • a registered paediatric nurse qualification and one to two years’ post-registration experience.
  • You don’t need to have: any previous community experience because training will be provided.
  • Other similar jobs to consider: include a school nurse, health visitor or outreach nurse.
  • More information: The Community Practitioners’ and Health Visitors’ Association at CPHVA
  • Association of British Paediatric Nurses at www.abpn.org.uk
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