VOL: 102, ISSUE: 21, PAGE NO: 21
Polly Lee, MSc, BA, RSCN, RM, DipN, RGN, ILTM, is lecturer in child health nursing, St Bartholomew School of Nursing and Midwifery, City University, LondonPolly Lee, MSc, BA, RSCN, RM, DipN, RGN, ILTM, is lecturer in child health nursing, St Bartholomew School of Nursing and Midwifery, City University, London
Children, young people and their families come into contact with many health professionals. It is particularly important that those who are the 'first point of contact' with children and their families are prepared for their role in supporting children and their families. Ensuring that school nurses, nurse practitioners, practice nurses and health visitors are able to address the health needs of babies, children and young people is critically important.
A preschool child will attend their GP practice about six times a year and school-aged children will attend two or three times a year (Department of Health, 2004a). Within the general practice setting, practice nurses are often the first point of contact a child and family have with the health service. The chief nursing officer for England (CNO) recognises that children and young people are the highest users of general practice and notes that the general practice setting offers considerable scope for working with children and their families to deliver health to all children, particularly those in need (DH, 2004b).
Getting it right
Although some practice nurses may have had preparation in working with children and their families, the CNO review (DH, 2004b) highlighted that not all practice nurses may be confident in working with children and families. Therefore, the development of a self-assessment tool was proposed to assist them in identifying their current skills and competencies. It would also identify any gaps in skills that needed to be addressed. Last month witnessed the launch of Getting it Right for Children and Young People: A Self-assessment Tool for Practice Nurses (RCN and Royal College of General Practitioners, 2006). This article gives a brief overview of the tool.
Common core of skills and knowledge
The self-assessment tool comprises two parts. The first part links to the common core of skills and knowledge for the children's workforce (Department for Education and Skills, 2005). The common set of skills and knowledge has been designed for use by everyone working with children and young people. The first part of the self-assessment tool must be used in conjunction with the relevant documentation (for example www.everychildmatters.gov.uk).
Practice nurses will need to obtain a copy of the common core of skills and knowledge document and assess their current level of skills and knowledge in each of the six areas of expertise (Box 1, p22).
Perhaps the most important of these common core skills is communication, as the development and attainment of subsequent skills depends to a certain extent on effective communication. Communicating with children and young people involves much more than just a two-way exchange of information. In addition to using language that the child understands (including the need to consider where English is an additional language), health professionals must have an intrinsic positive attitude towards communicating with children. This should be demonstrated extrinsically towards the child and family.
Children, young people and families value such an approach and will soon sense health professionals who do not display such values. Once those values have been conveyed, the health professional is more likely to negotiate with the child and family as well as demonstrating confidentiality.
Key clinical skills and knowledge
The second part of the self-assessment tool highlights the key clinical skills and knowledge required to address the needs of children and young people presenting with acute illness and injury. It also looks at their environment for care and includes:
- Recognising parameters for vital signs;
- Recognising signs that may indicate illness;
- Basic clinical assessment skills;
- Treatment of anaphylaxis;
- Treatment of choking;
- Treatment of a fitting child;
- Resuscitation skills;
- First aid skills;
- Preliminary advice and support;
- Ability to signpost and refer to support agencies;
- Recognition of common child and adolescent illnesses and infestations;
- Knowledge of immunisation schedule and contraindications;
- Knowledge of normal parameters for height and weight and associated problems;
- Knowledge of the administration of medicines in childhood;
- Assessment and referral for possible child protection concerns;
- Provision of privacy and dignity policies for children and adolescents;
- Provision of policies for disabilities/special needs;
- Policies of ensuring safety and hygiene;
- Knowledge of play and distraction provision;
- Provision of information and displays promoting health or local services.
However, it is recognised that all practice nurses are in their current posts with individual prior learning and practical experience. Also the nature of their current roles may vary according to the service.
The key clinical skills aim to ensure that practice nurses can promote healthy options and identify health issues that in some cases can prevent long-term problems or even save a child's life (RCN and RCGP, 2006).
While practice nurses may not be regularly faced with a need to save a child's life, it is nevertheless one of the clinical skills with which the new self-assessment tool says that practice nurses need to be up to date. The resuscitation guidelines have recently changed (Resuscitation Council (UK), 2005) and these have particularly affected the resuscitation of infants and children.
Practice nurses may also be approached by parents about parental resuscitation and there are clear guidelines for how a lone rescuer should attempt to resuscitate an infant or child. Until all health professionals and first-aiders have been taught the new guidelines, there will be a period of potential confusion but practice nurses should be aware of how any potential confusion may arise.
Using the tool
The tool may be considered to be more than a self-assessment tool. It provides space for comments and action plans to develop the stated competencies. Practice nurses should consider how they may best use the tool. They may want to work individually or collectively but should certainly work in conjunction with other professionals who may be able to assist in the development of competencies.
Such other professionals may include:
- Community midwives;
- Health visitors;
- Community children's teams;
- PCT leads for children's services;
- A named nurse for child protection (safeguarding children).
The CNO review (DH, 2004b) recommends that all nurses working with children and young people have access to support and supervision from a qualified children's nurse and this may mean accessing a professional from the wider local workforce. Once the self-assessment tool is completed, practice nurses will then be able to work with their supervisor to develop any necessary action plans.
Furthermore, implementation of this tool will be a useful step to ensuring that the children's NSF is implemented within the general practice setting.
- This article has been double-blind peer-reviewed.
For related articles on this subject and links to relevant websites see www.nursingtimes.net