Developing Practical Skills for Nursing Children and Young People

Alan Glasper, Marion Aylott, Cath Battrick, Alan Glasper, Marion Aylott, Cath Battrick

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781482213829
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Clinical skills are essential to the practice of nursing and learning these skills requires a wealth of both factual knowledge and technical expertise. Supplementing practical teaching, Developing Practical Skills for Nursing Children and Young People is a comprehensive skills text that describes clinical skills in the style of a tutor teaching at

CHAPTER 1

Key concepts in undertaking clinical procedures with children and young people:

A) Elements to consider before performing clinical nursing procedures Alan Glasper and Diane Gow

Chapter overview

Make the care of people your first concern, treating them as individuals and respecting their dignity

Work with others to protect and promote the health and wellbeing of those in your care, their families and carers and the wider community

Provide a high standard of practice and care at all times

Be open and honest, act with integrity and uphold the reputation of your profession

Conclusion

References

Further reading

LEARNING OUTCOMES

Upon completion of this chapter, the reader should be able to accomplish the following:

1 Recognise the importance of adhering to the NMC Code when delivering procedural care to sick children, young people and their families

2 Understand the importance of ensuring privacy and dignity when performing nursing procedures on children and young people following the prevailing philosophy of family-centred care

3 Recognise the importance of confidentiality when working with children, young people and their families

4 Acknowledge the complexity of obtaining consent in the world of children’s nursing

5 Appreciate aspects of risk when performing nursing procedures

6 Demonstrate the importance of delivering care based on best evidence only

CHAPTER OVERVIEW

This introductory chapter identifies elements of your practice that you must think about before you undertake any procedure to guarantee that the children and their families you are caring for receive the best evidence-based care by a competent children’s nurse. These procedural elements of the care you deliver are supported by all aspects of the Nursing and Midwifery Council (NMC) Code which constitutes standards of conduct, performance and ethics for nurses and midwives.¹

Although all the NMC standards are pertinent to your practice, this chapter will discuss only those aspects of the code which directly pertain to the carrying out of procedures on children and young people (Box 1).

Box 1 The NMC Code

1 Make the care of people (i.e. children and young people and their families/carers) your first concern, treating them as individuals and respecting their dignity.

2 Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community.

3 Provide a high standard of practice and care at all times.

4 Be open and honest, act with integrity and uphold the reputation of your profession.

MAKE THE CARE OF PEOPLE YOUR FIRST CONCERN, TREATING THEM AS INDIVIDUALS AND RESPECTING THEIR DIGNITY

The NMC Code instructs all nurses to treat people as individuals. It is therefore crucial that you must treat all children, young people and their families or carers as individuals and respect their dignity. The concept of the maintenance of dignity is now pivotal to the practice of good nursing practice.^2,3

A report by the chief nursing officer for England⁴ has highlighted some problems with the provision of single-sex accommodation in some hospitals.⁵ This primarily applies to adult patients, because following guidance from the National service framework for children, young people and maternity services⁶ segregation by age is a more important issue than segregation by gender, especially for young people. However, it is important to stress that some young people and indeed children may also want to be able to choose between being in a single- or a mixed-sex environment.

To achieve the NMC code related to dignity, the children’s nurse must always consider aspects of dignity which are sometimes difficult to achieve in some older hospitals. For example, in order to maintain child patient dignity, consider the provision of toilet and bathroom facilities (for children and carers). This is especially pertinent for carers who may be rooming in with their sick children. Good children’s units have appointed family care coordinators to help manage such aspects of the family admission. Undoubtedly the care of children and young people and their families is improved by respecting their wishes and dignity. Importantly, children’s nurses should reflect on the work of Rylance,⁷ who interviewed the parents of 300 hospitalised children and ascertained that dignity, privacy and, significantly, confidentiality were badly valued on children’s wards As far as the NMC code is concerned children, young people and their carers should have the same rights to these principles of dignity as adult patients. The Code states that you must not discriminate in any way against those in your care. Remember children have enshrined rights! Reed et al.⁸ have highlighted the complex issue of promoting child dignity, comparing it with that of the older adult where the nurse has to care for the patient who may, in the case of the head-injured or older patient, no longer be the same person they once were, versus the sick child who is developing into a person who is yet to reach their full potential. The healthcare professionals who deliver care to children and young people in healthcare environments including the home therefore need to act in such a way that they respect the dignity of the child throughout their temporal lifespan for both the present and future human being.

Essence of care,⁹ which importantly also applies to children’s nursing, identifies nine key areas of care that have been identified by patients as needing attention, including privacy and dignity, which are now firmly re-established at the forefront of nursing. Importantly, if your own unit has no specific age-related divisions, close attention must be paid to privacy and dignity in the wider context of gender, ethnicity and developmental age and with due regard to that aspect of the code which instructs you not to discriminate in any way against those in your care.

Importantly the NMC Code also asks that nurses treat all people kindly and considerately and the NMC Code significantly asks you to act as an advocate for those families in your care. The advocacy role of children’s and young people’s nurses should be manifest by adhering to the NMC Code, which asks nurses to help families’ access to relevant information and support. In Chapter 38 Battrick and Glasper outline how children’s nurses can harness a variety of media formats to support the spoken word. Helping families navigate the labyrinth of information in the real and virtual world is a skill all children’s nurses must harness.

The NMC Code asks each children’s nurse to respect children’s, young people’s and families’ right to confidentiality. Importantly the NMC Code states that you must ensure that people are informed about how and why information is shared by those who will be providing their care. Only in safeguarding situations can a children’s nurse not promise confidentiality (see Chapter 3). Hence the NMC Code states that you must disclose information if you believe someone (a child) may be at risk of harm. Significantly, student nurses are monitored and cautioned by their universities not to disclose information about a child or a family inadvertently in, for example, case study or other assignments. Additionally, any conversations or discussions about families must remain within the clinical domain and never disclosed in a public forum of any description (for example discussions about particular family cases by students on the bus to class). In small communities this could be catastrophic for some families.

The growth of web-based networking sites such as ‘Facebook’ can place children’s nurses in a difficult and potentially compromising position as photographs of them, for example in a clinical domain, may inadvertently show other children in the clinical domain, thus breaching their right to confidentiality. The Association of Chief Children’s Nurses (accnuk.org) is specifically advising children’s nurses to politely decline any invitation to join a family’s Facebook pages. Furthermore children’s nurses are asked to monitor how mobile phones are used by families in clinical domains, not because of the telephone usage but rather because of the photographic cameras they contain. Photographs taken with mobile phone digital cameras may inadvertently show other children and again may breach their right to confidentiality, exacerbated if placed on a networking web site

Practice tip

Using ward funds buy some cheap pay as you go mobile phones without cameras and allow children and their families to use these in safe mobile phone havens

The NMC Code asks each nurse to work in collaboration with children, young people and their carers. Furthermore, the NMC Code asks each nurse to listen to children and families in their care and respond to their concerns and preferences. This involves listening to their needs at each stage in the healthcare journey and responding to their concerns and preferences. The NMC Code specifically asks (children’s) nurses to support families in self-caring activities to improve and maintain their health. In contemporary society where a range of emerging health issues such as type 2 diabetes linked to rising levels of childhood obesity are prevalent, this aspect of the code is of paramount importance. Thus the health promotion and advocacy role of the children’s nurse is enshrined in regulatory protocol. In light of this the NMC Code asks that the nurse recognise the contribution that people (children and their families) make to their own care and wellbeing. The overarching principle of family-centered care, which is the mantra of children’s nursing, is entirely congruent with this aspect of the code. Additionally, the NMC Code emphasises the need for nurses to make arrangements to meet families’ language a...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Contributors
• Foreword
• Preface
• How to use this book and website
• 1 Key concepts in undertaking clinical procedures with children and young people
• 2 Clinical holding of children and young people
• 3 Safeguarding children and young people
• 4 Communicating with children, young people and their families
• 5 Promoting family health in contemporary healthcare
• 6 Planning and assessing the care of children and young people
• 7 Play provision for children in hospital
• 8 Manual handling for children and young people’s nursing
• 9 Assessment and vital signs: A comprehensive review
• 10 Medicines administration
• 11 Undertaking emergency life support
• 12 Caring for personal hygiene needs
• 13 Providing optimum nutrition and hydration
• 14 Promoting children’s continence
• 15 Delivering pre- and postoperative care
• 16 Elimination: non-invasive renal care
• 17 Pain assessment and management
• 18 Administration of blood and blood products
• 19 Skin health care
• 20 The management of the child with an allergy
• 21 Non-invasive respiratory therapy
• 22 Tracheostomy care
• 23 Caring for the child requiring long-term ventilation
• 24 Invasive monitoring
• 25 Invasive respiratory therapy
• 26 Invasive cardiovascular support
• 27 Caring for children suffering from burn injuries
• 28 Transporting and transferring sick children and young people
• 29 Neonatal care
• 30 Managing children and young people with mental health problems
• 31 Developing child oncology skills
• 32 Orthopaedic skills
• 33 Care of the child with spinal injury
• 34 Venesection, cannulation and the care of children requiring infusions
• 35 Caring for children with life-threatening and life-limiting conditions
• 36 Emotional aspects of end of life care
• 37 Developing your skills as a mentor. A guide for newly qualified practitioners
• 38 Providing and delivering information to children and their families
• Index