Getting it Right for Children and Young People

Transcription

1 Getting it Right for Children and Young People Self assessment tool for general practice nurses and other first contact settings providing care for children and young people CLINICAL PROFESSIONAL RESOURCE

2 Acknowledgements Project Team This publication was first published in April 2006 in partnership with the Royal College of General Practitioners with support from the Department of Health and Department for Education and Skills, CPHVA and the Royal College of Midwives. The RCN would like to thank members of the RCN Children and Young People s Acute Care Forum and Continuing and Community Care Forum for revising this publication. Particularly: Eirlys Thomas, RCN Children and Young People s Acute Care Forum Steering Committee Member, Head of Nursing Children Services ABMU HB Dr Patricia McNeilly, RCN Children and Young People s Continuing and Community Care Forum Steering Committee Member, Lecturer (Education) Orla McAlinden, RCN Children and Young People s Continuing and Community Care Forum Steering Committee Member, CQC Specialist Advisor Professor Dave Clarke, Chair RCN Children and Young People s Acute Care Forum Steering Committee, Foundation Professor of Nursing, College of Medicine, Biological Sciences and Psychology Centre for Medicine, Leicester Kathryn Yates, RCN Professional Lead Primary, Community and Integrated care Louise Lidbury, Primary Care and Independent Sector Adviser, RCN Wales Fiona Smith, RCN Professional Lead Children and Young People s Nursing This publication is due for review in December To provide feedback on its contents or on your experience of using the publication, please publications.feedback@rcn.org.uk Publication This is an RCN practice guidance. Practice guidance are evidence-based consensus documents, used to guide decisions about appropriate care of an individual, family or population in a specific context. Description Ensuring that all those caring for children and young people are able to meet their needs is essential. This toolkit will support nurses working out of hospital settings in providing care to children and young people. Publication date: December 2017 Review date: December 2020 The Nine Quality Standards This publication has met the nine quality standards of the quality framework for RCN professional publications. For more information, or to request further details on how the nine quality standards have been met in relation to this particular professional publication, please contact publicationsfeedback@rcn.org.uk Evaluation The authors would value any feedback you have about this publication. Please contact publicationsfeedback@rcn.org.uk clearly stating which publication you are commenting on. RCN Legal Disclaimer This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in each country and outside the UK. The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this website information and guidance. Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN 2017 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers. 2

3 ROYAL COLLEGE OF NURSING Contents 1. Introduction 5 2. Principles 5 3. About the tool 6 4. The Code 8 5. Core competence 1 (Professional values and the role of the nurse) 9 Core competence 2 (Nursing practice and clinical decision making) 10 Core competence 3 (Knowledge and cognitive) 12 Core competence 4 (Communication, interpersonal and technology) 13 Core competence 5 (Leadership, management and teamworking) Practical skills self assessment Health promotion, minor illness and injuries Environment of care Useful websites and resources References 21 3

4 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 1. Introduction Ensuring that all those caring for children and young people (CYP) are able to meet their needs is essential. The GP, general practice nurse (GPN) and registered nurses in first contact services ie, walk in-centres/out-of-hours provision may well be the first point of contact for families around health care issues. General practices provide valuable opportunities for identifying issues and acting in the best interest of children and young people. General practice is at the forefront of primary health care in the UK and nurses, along with their colleagues from the multi-disciplinary team, are expected to deliver an ever increasing and often complex range of services for the practice population. In response to this, the practice team has expanded and developed in order to meet the needs of service users, including children, young people and their families. Similarly, the nursing team has evolved in recent years and may include health care assistants (HCAs), assistant practitioners (APs), as well as general practice nurses (GPNs), nurse practitioner (NPs) and advanced nurse practitioner (ANP) roles (RCN, 2014a). Although there are a number of highly skilled GPNs, NPs and ANPs with a registered children s nursing qualification, in general practice the majority will not have had the opportunity to undertake specific education and training in the care of children and young people. The aim of this selfassessment tool is to assist registered nurses working in general practice and out of hospital settings to review their existing knowledge and skills, identify their training needs and further develop their practice in discussion with their clinical supervisor. This toolkit will support registered nurses working out of hospital settings in providing care to children and young people GPNs are part of the wider multidisciplinary team, have an important role to play in promoting, sustaining and improving the health and wellbeing of children and young people in their care. It is estimated that children and young people represent 25% of the general practice population and pre-school children may visit around six times a year (Royal College of General Practitioners, 2010). The lives of children and young people in the UK have become ever more complex, an increasing number are living with long-term and complex conditions and childhood poverty and social inequality continues to have implications for their health and wellbeing (British Medical Association, 2016, RCN Briefing Paper Inequalities Experienced by Children across the UK, June 2016). Nurses working within general practice may be the most easily accessible first point of contact that a child and family has with the health service. General practice provides valuable opportunities for early intervention, family support and recognising when children are at risk. In addition to meeting the physical needs of children with acute, long-term and complex conditions they are well placed to promote mental health and emotional wellbeing and to prevent mental ill health in the longer term (RCN, 2014b). Such opportunities are likely to be found where staff have the underpinning knowledge and skills and are confident and competent in the assessment of children and young people and in the planning, delivery and evaluation of interventions to meet their needs. This toolkit can be used to support both the care provided by nurses, to children and young people and nurses continued professional development through revalidation. 4

5 ROYAL COLLEGE OF NURSING 2. Principles A number of core principles underpin this toolkit. Current government policy for children and young people across the UK is outcomes focused and based on a whole-child approach. Such an approach, encompassing health, social care and education, needs to be adopted by GPNs and other registered nurses who care for children and young people in the context of their own families and communities. Partnership working with children, young people and families should remain central to all care. Article 12 of the United Nations Convention on the Rights of the Child (1991), ratified in the UK, states that children have the right to express their views in all matters affecting them, the views of the child being given due weight in accordance with the age and maturity of the child. Such an approach is pivotal in the practice setting where children should, over time, be empowered to take control over their own health as they mature and develop. An individualised approach, whilst valuing equality and diversity is paramount. Additional consideration should be given to children, young people and families living in special circumstances (such as asylum seekers, those in temporary accommodation, looked after children or children of substance misuse parents, such as drugs and alcohol). Co-ordinated, multi-professional, multi-agency care is paramount to promoting, sustaining and improving the health and wellbeing, outcomes and life chances of children and young people. Practice should be reflective, up to date and evidence-based and should take into account ongoing referral pathways, audit and evaluation of the outcomes. Children and young people should also be involved in service evaluation and forward planning. Health promotion and early intervention, while building resilience is key to keeping children and young people safe and well. The safety of the child is paramount. Building rapport and relationships with children and young people as well as their parents/carers should underpin all aspects of their care. Recognising and reporting signs of a child in need, a child suffering from neglect or a child suffering abuse are fundamental aspects of the role of the GPN and other registered nurses working in out of hospital settings. 5

6 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 3. About the tool According to the Health and Care Standards Framework (2014), every person has the right to receive excellent quality care. As a result, all health care workers should maintain and develop competences in order to reach their full potential. As a registered nurse you are expected to provide evidence that you are maintaining essential competences and updating your knowledge and skills. As an NMC registrant, you are expected to keep your knowledge and skills up to date, take part in educational and professional development activities that aim to maintain and develop your competence and improve your performance (NMC Code, 2015). The portfolio is designed as a self-assessment tool for you as a registered nurse who cares for children/young people to provide evidence and demonstrate how you are developing/maintain core competencies and provides you with the opportunity to identify whether further training and development is required. It enables you to see clearly what you do well and which areas you could be safer and more effective in. This aligns with the domains of your code of conduct enabling you to demonstrate how you prioritise people, practise effectively, preserve safety and promote professionalism and trust. This document supports the personal appraisal development review (PADR) and revalidation process and demonstrates performance against Knowledge and Skills Framework (KSF). The competences have been written with reference to NMC competences for children s nurses, RCN core competences for children and young people (2012) and Paediatric Nurse Education in Europe (PNAE, 2015). This toolkit will help you focus on your individual training and practice development needs in relation to working with infants, children and young people. It is suggested that you access the document and consider your current level of knowledge and skills in each of the areas. You can then work with your supervisor who could for example be a community children s nurse to develop an action plan to ensure that you are confident and competent in any of the areas that need development. 6

7 ROYAL COLLEGE OF NURSING Name of practitioner: Date: NMC number: Name of mentor: Role of mentor: Name of nurse practitioner Contact details Lead for children/young people Clinical mentor Link midwife Link health visitor Lead for safeguarding Local emergency centre for CYP Link community children s nursing team Other key contacts eg, paediatric assessment units Clinical supervisor 7

8 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 4. The NMC Code of Practice The Code presents the professional standards that all nurses and midwives must uphold in order to be registered to practise. It was developed to reflect the changing roles and expectations of nurses and midwives, and reinforce our professionalism. The Code is structured around four themes and should be central to your everyday practice: There are 22 health care standards that are grouped into seven themes. You will need to refer to the Health and Care Standards document and identify how your practice reflects these standards. This document reflects the Paediatric Nurse Education in Europe (PNAE) core competences. Included in this framework, are the domains in which registered nurses are required to practice regardless of the area they work in. Prioritise people Practise effectively Preserve safety Promote professionalism and trust Together they signify good nursing practice. As part of your self assessment you will need to identify how the competence statements reflect the Code. The Health and Care Standards and Health and Social care standards Scotland, have been designed so that they can be implemented in all health services; they establish a basis for improving the quality and safety of health care services by providing a framework which can be used in identifying strengths and highlighting areas for improvement. 8

9 ROYAL COLLEGE OF NURSING 5. Core competence 1 Professional values and the role of the nurse: (NMC Domain 1, Professional values) KSF dimensions and levels: Personal and people development level 3, Quality level 2 Competence statement: NMC Code reference Statement of evidence Health and care standards Practice within professional, ethical regulatory and legal codes recognising and responding to moral/ethical dilemmas and issues concerning infants, children and young people, have an understanding of relevant legislation relating to information sharing and safeguarding children and young people. Practices in a holistic manner promoting individualised patient care, using a family centred approach, ensuring that the protection, rights, wishes and beliefs of children and young people are upheld with reference to the children s charter. Promotes the health and wellbeing of infants, children and young people. Understands and promotes the role, responsibilities and functions of the registered nurse caring for children and young people within health care, inter-agency and inter-disciplinary environments. Work in partnership with children and their families/carers and other agencies to tailor clinical and care needs within home and community settings. 9

10 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 5. Core competence 2 Nursing practice and clinical decision-making (NMC Domain 3, Nursing practice and decision making) The registered nurse caring for children and young people within GP practices and first contact services should be able to deliver a multiplicity of clinical skills, drawing on a range of health care competences and advanced clinical decision making skills across a range of situations and environments for children and young people with acute, long-term, continuing and palliative care nursing needs, (RCN, 2014). KSF dimensions and level: Assessment and care planning to meet health and wellbeing need level 3, Equality and diversity level 2; Provision of care to meet health and wellbeing needs level 3, Interventions and treatment level 3. Competence statement: NMC Code reference Statement of evidence Health and care standards Undertake relevant comprehensive and systematic assessments using a child and family centred approach, acknowledging different stages in development and relevant physical, social, cultural, sexual, psychological, spiritual and environmental factors. Recognise and interpret signs of normal and changing health, ill-health, distress, development or disability. Critically question, evaluate, interpret a range of information and data sources to facilitate children and young people s choices and include parents/carers perspectives, to make sound clinical judgements to ensure nursing and clinical quality standards are achieved and practice is evidence based. 10

11 ROYAL COLLEGE OF NURSING Competence statement: NMC Code reference Statement of evidence Health and care standards Use a range of nursing skills, medical devices, interventions and activities to provide optimum care appropriately which maintains dignity, privacy and confidentiality for children and young people: patient monitoring, detection and intervention if condition improves/ deteriorates adhere to health and safety principles relating to manual handling, infection control and resuscitation procedures administer medication in accordance with policies and guidelines consider emotional, physical and personal care, including meeting the need for sleep an comfort, nutrition, personal hygiene to enable maintenance of the fundamentals of care inform, educate and facilitate learning regarding health needs recognise equality and diversity and demonstrate cultural competence facilitate and support transition from child centred services to adult orientated or from health to social care recognise and contribute to safeguarding children and young people, through taking appropriate and immediate actions, working in partnership in response to concerns that are consistent with legislation and relevant policies and procedures. 11

12 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 5. Core competence 3 Knowledge and cognitive (NMC Domain 3, nursing practice and decision making) KSF Dimensions and levels; Personal and people development level 3, Service improvement level 2, Interventions and treatments level 3 Competence statement: NMC Code reference Statement of evidence Health and care standards Apply relevant knowledge to nursing practice and the care of infants, children and young people, while promoting children s rights and advocacy including: knowledge on childhood developmental stages anatomy and physiology of children and young people policies relating to child safeguarding and children s rights problem solving and decision making utilise learnt knowledge within clinical practice to provide evidence-based nursing care to children and young people. 12

13 ROYAL COLLEGE OF NURSING 5. Core competence 4 Communication, interpersonal and technology (NMC Domain 2, Communication and interpersonal skills) KSF Dimension and level Communication level 3, Interventions and treatments level 3, Health, safety and security level 3, People management level 2 Competence statement: NMC Code reference Statement of evidence Health and care standards Communicate effectively and engage (with the use of technology as appropriate) with infants, children young people and their families, including those with communication and learning difficulties: listening and building empathy; summarising and explaining. Enable children, young people and their parents/carers to express their views and concerns whether emotional, social, psychological, spiritual or physical and respond appropriately: consulting and negotiating. Represent the child or young person s perspective appropriately and to act to promote safeguarding: demonstrating adherence to confidentiality and ethical codes relating to children and young people. Use a range of communication techniques to promote children and young people s wellbeing, including counselling skills, identification and management of challenging behaviour; recognition and intervention of stress, anxiety and depression; deploying and referring to sources of information and support. Report, document and refer care accurately using appropriate technologies, including taking action to safeguard and protect children and young people at risk of harm. Identify and respond proactively to situations, environments and individuals including within the health care setting, who may be harmful to children and young people. 13

14 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 5. Core competence 5 Leadership, management and teamworking (NMC Domain 4, Leadership management and teamworking) KSF Dimension and level People management level 1; Health, safety and security level 3 Competence statement: NMC Code reference Statement of evidence Health and care standards Appreciate that team working is crucial to facilitating children and young people s health and wellbeing, leading and co-ordinating team activity and delegating appropriately. Act as an advocate to ensure that when local policies and operational procedures are developed, these are in alignment with community clinical practices and environments. Work and operate assertively when necessary and communicate collaboratively with all team members, including other professionals and agencies, managing time and other resources effectively to ensure quality standards are achieved. Undertake risk assessments to actively promote the wellbeing, security and safety of children, young people and all those working within the environment of care, including themselves, knowing when and how to raise concerns, as well as what action to take if partner organisations fail to take appropriate responses. Present facts and judgements objectively, and challenge situations, using tools to critically evaluate and audit the care of children and young people according to relevant quality standards. Educate, facilitate, supervise learning and support students and care workers. 14

15 ROYAL COLLEGE OF NURSING 6. Practical skills and knowledge self-assessment Depending on the area where you work, you may feel that there are some skills you do well, while others need development. Here are some examples listed but you may wish to include examples of your own. Recognising and responding to an acutely ill/injured child Practical skill and knowledge Competent (expert, can teach others) Requires support Novice (need development) Review date Recognising normal parameters for vital signs: 0-1 year 1-5 years 5-12 years 12+ Basic clinical awareness assessment including recognition of the deteriorating infant, child and young person Clinical signs of dehydration: Infant Child Young person Awareness of sepsis pathway and treatment: Infant Child Young person Treatment of anaphylaxis: Infant Child Young person Treatment of choking: Infant Child Young person Treatment of fitting: Infant Child Young person Resuscitation skills: Infant Child Young person First aid treatment: Burn/scalds Head injury Soft tissue Bone injury 15

16 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS 7. Health promotion, minor illness and injuries Practical skill and knowledge Competent (expert, can teach others) Require support Novice (need development) Review date Preliminary advice and support: Toileting Eczema Head lice/threadworm Colic/Oesophageal reflux Squints/speech development Advice on immunisation Infant feeding (inc. breastfeeding) Weaning Sleep Behaviour issues Transition Signposting and referral: Youth offending team abbreviations may not be understood locally or by the practice team Youth offending services Probation services LAC/CLA Care leavers nurse Local counselling services Child and Adolescent Mental Health Services (CAMHS) Health board wellbeing services Sexual health services Drug and alcohol services Health visitor Asylum seekers support School nursing services Social services Safeguarding referrals Police (for FGM) Advocacy services Recognise common childhood and adolescent illnesses Immunisation schedules and contraindications Normal parameters for height and weight: Recognition of failure to thrive/ faltering growth Puberty Childhood obesity Eating disorders Medicine management for children: Oral Inhaled Eye/ear Injected Buccal Per rectum (PR) Topical 16

17 ROYAL COLLEGE OF NURSING 8. Environment of care Ensure provision and policies for: Y/N Action plan Review date Privacy/dignity Advocacy Choice Consent and confidentiality Chaperoning Interpretation in a language when required. Baby changing facilities Breastfeeding facilities Recognise child safeguarding concerns Physical (including neglect, fabricated or induced illness) Sexual (including non-consensual relationships) Behavioural and emotional abuse and neglect Domestic violence and abuse Children and young people with special needs/disabilities Access to advocacy services Appropriate access to all areas within the practice Access to toilet and changing facilities Appropriate manual handling equipmentand techniques Appropriate communication aids Advice for specialist services eg, epilepsy, feeding, speech and language therapy Health and safety Adequate hand hygiene facilities Disposal facilities for nappies/pads Safe storage of medication, lotions, needles and syringes Hazards sharps bins, electrical socket covers, equipment Policy for cleaning and decontamination of equipment and toys Policy for safe holding of CYP for procedures Play and distraction Promote a child friendly environment Provide age appropriate toys, games, books that can be easily de-contaminated Knowledge of distraction techniques Preparation for procedures 17

18 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS Ensure provision and policies for: Y/N Action plan Review date Information and displays Childline Youth and counselling services Mental health and wellbeing information Drug and alcohol information Bullying and staying safe online Family break up information Bereavement and loss Gender identity and puberty Provision of health promotion materials seasonally eg, sun-safe, fireworks Accident prevention information Healthy eating Young carers Youth groups Sexual health and welfare Contraception Health and wellbeing Complaints Consent Common childhood illnesses Directory of local child health services If you have identified you need development in some areas, ask yourself: Are these skills applicable for your current role? Are these skills essential for your current role? Are these skills something you would like to develop? If you have identified areas that are essential for your role or something you would like to develop, please discuss with your manager and educational lead how they can support you to achieve this. 18

19 ROYAL COLLEGE OF NURSING 9. Useful websites and resources Professional, medical and nursing opendoc/ Resuscitation Disability Getting it right for Every Child (GIRFEC) Scotland gettingitright Medicines Management Paediatric Care Online (PCO) quality-improvement-and-clinical-audit/ paediatric-care-online/paediatric-care Meds-IQ Public health uk/ / pdf Careofkidsteeth.aspx obesity Mental and emotional welfare transitions?gclid=cmcqi5hkstecfcvcz0wodm w0kog Suicide Prevention Strategies UK northern-ireland Bullying and cyber welfare Sepsis recognition and management Pain in children guidelines www2.rcn.org.uk/_data/assets/pdf_ file/0004/269185/ pdf Consent Pages/Children-under-16.aspx Child protection quality-improvement-and-clinical-audit/medsiq-sharing-qi-resources-paediatric Advocacy, empowerment and support for children and young people Children s Commissioner England

20 GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 16 YEARS Children s Commissioner Northern Ireland Children s Commissioner Scotland Children s Commissioner Wales Children s rights NstECFRONGwodknkCbQ&sissr=1 Play British Medical Association (2013) Growing up in the UK: Ensuring a healthy future for our children. UK: BMA Publications Unit. Royal College of General Practitioners (2010) RCGP child health strategy UK: RCGP. 20

21 ROYAL COLLEGE OF NURSING 10. References ECPAT. (1991, December). United Nations Conventions on the Right of the Child. Available at: (accessed 10 October 2017) Nursing and Midwifery Council (2015) The Code. Professional standards of practice and behaviour for nurses and midwives, London: NMC. Available at: uk/globalassets/sitedocuments/nmcpublications/nmccode.pdf (accessed 10 October 2017) Royal College of Nursing (2016) Inequalities experienced by children across the UK access the right care, at the right time, in the right place, London: RCN. Available at: publications (accessed 10 October 2017) Welsh Government (2015) Health and Care Standards, Cardiff: NHS Wales. Available at: opendoc/ (accessed 10 October 2017) Paediatric Nursing Associations (2015) Paediatric Nurse Education in Europe, from A Position Statement by the Paediatric Nursing Associations of Europe (PNAE). Available at: org/umst/uploaded/regulation%20of%20 Paediatric%20Nurses%20in%20Europe% _1.pdf (accessed 10 October 2017) Royal College of General Practitioners (2010) RCGP Child Health Strategy , London: RCGP. Available at: (accessed 10 October 2017) Royal College of Nursing (2012) Core competencies for nursing children and young people, London: RCN. Available at: uk/publications (accessed 10 October 2017) Royal College of Nursing (2014) Children and young people s mental health, every nurse s business, London : RCN. Available at: org.uk/publications (accessed 10 October 2017) 21

22 The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies RCN Online RCN Direct Published by the Royal College of Nursing 20 Cavendish Square London W1G 0RN December 2017 Publication code: