UNIQUENESS OF NURSING - CHILDREN'S BRANCH
The Children's branch of nursing is relatively new, in 1959 The Minster of Heath first recommended that children have the right to be nursed by specially trained, qualified staff who understood children's individual needs but it wasn't until 1988 dedicated training courses were set up to provide nurses with the specific skills and knowledge to nurse children whose physical, physiological and social needs are different to that of adults (Hubbard & Trig 2000).
Sick children's rights have only recently been acknowledged despite children making up 25% of the population. But now many reports and policies are aimed at improving children's services and recent statute law has given children increased rights (Hubbard et al). The Children's Act (1989 & 2004) highlights children's rights; Every Child Matters endorses working in partnership with other organisations to ensure children are safeguarded and receive the best care available and The National Service Framework (NSF) 2004) outlines a vision to provide a high quality child centred care for both children and their parents. These policies give direction today and will shape the future of children's nursing. Nurses need to understand how they apply and what implications there might be when caring for children. So for example, one of the most common reasons for children being admitted to hospital is due to injury from accidents, however if the injuries cannot be explained and physical or mental child abuse is suspected, the nurse will have a duty under these guidelines to work with other agencies and professionals such as the Child Protection Services (Hubbard et al).
Children's nurses work with children from birth up to 18 years old in many settings from special baby care units to adolescent services (Chambers and Licence 2005). They need to understand the effect age and development has on a child's health and how the delivery of treatment and care will need to be modified accordingly. This will differ considerably from a newborn baby to an adolescent. For example when giving medicine, the drug will need to be available in a form which can be easily administered, and take into consideration, the weight and development of the child (Robertson & South 2006). The age and development of a child will influence ability to cooperate with procedures; a young child may become bored, tired or hungry and their capability to concentrate may be limited and procedures may therefore take more than one attempt (Robertson et al).
Children's nurses work in both hospital and primary care settings such as schools, GP's surgeries and in the community. Children's nurses specialise in many areas, a few examples are; intensive care, child protection, cancer, diabetes, pediatric emergencies, infections, neonatal problems, burns and plastics, respiratory, cardiac or skin disorders (Robertson et al).
Children's nursing is very much centred on the family (NMC 2008), Hincliffe, Schober & Norman advocate nurses should provide a safe, secure and comfortable environment and form good relationships with both the child and their family. The NSF (2004) state nurses should support both children and their families to make decisions regarding treatment and care options. Hubbard and Trig agree and convey the family is central to the child's wellbeing, and whilst respecting and promoting the rights of a child the needs and views of the parents should be incorporated wherever possible during the treatment and care of children. This may sometimes result in conflicting situations and the NMC (2008) imply the importance of understanding the personal, socio-economic and cultural influences surrounding a child's welfare.
Lansdown, Waterston and Baum (1996) suggest children's nurses should avoid jargon, use age appropriate language and in a child friendly way give children information they need in order for them to make informed decisions. Hubbard and Trig agree and suggests that play is used to communicate with a sick child, with the aid of toys, diagrams, picture books, photos and videos applicable to the child's age and cognitive levels to clarify images and gain trust and understanding. For example in order to alleviate fears for a child who has a needle phobia, the injection technique could be demonstrated with the aid of an orange.
Consent is an area where conflict may arise; English common law is vague about the age of consent to medical treatment (Alderson 1990). According to Dimond (1996) Children under16 can give valid consent to treatment if they are considered to be Gillick competent. If they refuse to give consent, parents may give consent against the child's wishes, if the benefits outweigh the risks, for example a child who is suffering with cancer, refuses chemotherapy (Chambers et al). Generally consent for young children is given by the family, but parents might have difficulty giving consent for someone other than themselves. In line with the Children's 1989 Act, children's nurses should ensure children are not cohersed into giving or refusing consent and their views should be taken account of where possible following the Fraser guidelines in respect of consent and confidentiality (Dimond 1996). Under the family reform Act of 1969 children over the age of 16 can give or refuse consent, unless they lack capacity, for example in emergency situations (Dimond 1996).
Reducing costs for the government is key and one of their main priorities is to increase primary care for children in their own homes and reduce hospital admissions. In addition it is believed that care in the home is better for both children and their families, primary care was first recommended in the Platt Report (1958). The Royal College of Nursing (2003) still maintain the best care is provided by pediatric community nurses. Therefore, increasingly children are being cared at home by their parents supported by the community children's nurse (NMC 2008) whose role is to provide guidance, care and to teach parents the skills necessary to provide care for their child, for instance administration nutritional requirements via a nasogastric tube (Hubbard et al).