getting it right for children and young people

CLINICAL PROFESSIONAL RESOURCE

Getting it Right for Children and Young PeopleSelf assessment tool for general practice nurses and other first contact settings providing care for children and young people

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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 [email protected]

Evaluation

The authors would value any feedback you have about this publication. Please contact [email protected] 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.

This publication is due for review in December 2020. To provide feedback on its contents or on your experience of using the publication, please email [email protected]

AcknowledgementsProject 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 HBDr 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 AdvisorProfessor Dave Clarke, Chair RCN Children and Young People’s Acute Care Forum Steering Com-mittee, Foundation Professor of Nursing, College of Medicine, Biological Sciences and Psychology Centre for Medicine, LeicesterKathryn Yates, RCN Professional Lead Primary, Community and Integrated careLouise Lidbury, Primary Care and Independent Sector Adviser, RCN WalesFiona Smith, RCN Professional Lead Children and Young People’s Nursing

ROYAL COLLEGE OF NURSING

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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) 14

6. Practical skills self assessment 15

7. Health promotion, minor illness and injuries 16

8. Environment of care 17

9. Useful websites and resources 19

10. References 21

Contents

GETTING IT RIGHT FOR CHILDREN/YOUNG PEOPLE AGED 0 – 16 YEARS

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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 self-assessment 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.


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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.

• 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.

• 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.


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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.


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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

Name of practitioner: Date:

NMC number:

Name of mentor: Role of mentor:


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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:

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.

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.


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5. Core competence 1

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.

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


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NMC Code reference



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.

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.


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NMC Code reference



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.


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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


NMC Code reference



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.


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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


NMC Code reference



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.


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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


NMC Code reference



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.


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6. Practical skills and knowledge self-assessmentDepending 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 knowledgeCompetent (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:InfantChildYoung person

Awareness of sepsis pathway and treatment:InfantChildYoung person

Treatment of anaphylaxis:InfantChildYoung person

Treatment of choking:Infant ChildYoung person

Treatment of fitting:Infant ChildYoung person

Resuscitation skills:InfantChildYoung person

First aid treatment:Burn/scaldsHead injurySoft tissueBone injury


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7. Health promotion, minor illness and injuries

Practical skill and knowledgeCompetent (expert, can

teach others)

Require support

Novice (need development)

Review date

Preliminary advice and support:ToiletingEczemaHead lice/threadwormColic/Oesophageal refluxSquints/speech developmentAdvice on immunisationInfant feeding (inc. breastfeeding)WeaningSleepBehaviour issuesTransition

Signposting and referral:Youth offending team abbreviations may not be understood locally or by the practice teamYouth offending servicesProbation servicesLAC/CLA Care leavers nurseLocal counselling servicesChild and Adolescent Mental Health Services (CAMHS)Health board wellbeing servicesSexual health servicesDrug and alcohol servicesHealth visitorAsylum seekers supportSchool nursing servicesSocial servicesSafeguarding 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 growthPubertyChildhood obesityEating disorders

Medicine management for children:OralInhaledEye/earInjectedBuccalPer rectum (PR)Topical


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Ensure provision and policies for: Y/N Action plan Review date

Privacy/dignityAdvocacyChoiceConsent and confidentialityChaperoningInterpretation in a language when required.Baby changing facilitiesBreastfeeding facilities

Recognise child safeguarding concernsPhysical (including neglect, fabricated or induced illness)Sexual (including non-consensual relationships)Behavioural and emotional abuse and neglectDomestic violence and abuse

Children and young people with special needs/disabilitiesAccess to advocacy servicesAppropriate access to all areas within the practiceAccess to toilet and changing facilitiesAppropriate manual handling equipmentand techniquesAppropriate communication aidsAdvice for specialist services eg, epilepsy, feeding, speech and language therapy

Health and safetyAdequate hand hygiene facilities Disposal facilities for nappies/padsSafe storage of medication, lotions, needles and syringesHazards – sharps bins, electrical socket covers, equipmentPolicy for cleaning and decontamination of equipment and toysPolicy for safe holding of CYP for procedures

Play and distractionPromote a child friendly environmentProvide age appropriate toys, games, books that can be easily de-contaminatedKnowledge of distraction techniques Preparation for procedures

8. Environment of care


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Ensure provision and policies for: Y/N Action plan Review date

Information and displaysChildlineYouth and counselling servicesMental health and wellbeing informationDrug and alcohol informationBullying and staying safe onlineFamily break up informationBereavement and lossGender identity and pubertyProvision of health promotion materials seasonally eg, sun-safe, fireworksAccident prevention informationHealthy eatingYoung carersYouth groupsSexual health and welfareContraceptionHealth and wellbeingComplaintsConsentCommon childhood illnessesDirectory 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.


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Professional, medical and nursingwww.wales.nhs.uk/governance-emanuel/opendoc/265373

Resuscitationwww.resus.org.uk

Disabilityhttps://councilfordisabledchildren.org.uk

Getting it right for Every Child (GIRFEC) Scotlandwww.gov.scot/topics/people/Young-People/gettingitright

Medicines Management Paediatric Care Online (PCO) www.rcpch.ac.uk/improving-child-health/quality-improvement-and-clinical-audit/paediatric-care-online/paediatric-care

Meds-IQ www.rcpch.ac.uk/improving-child-health/quality-improvement-and-clinical-audit/meds-iq-sharing-qi-resources-paediatric

Public healthwww.rcpch.ac.uk/improving-child-health/public-health/public-health

www.gov.uk/government/publicactions/the-complete-routine-immunisation-schedule

http://webarchive-nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@eh/documents/digitalasset/dh_4096999.pdf

www.nhs.uk/Livewell/dentalhealth/Pages/Careofkidsteeth.aspx

www.noo.org.uk/NOO_about_obesity/child_obesity

www.eric.org.uk

Mental and emotional welfarewww.youngminds.org.uk/about/our_campaigns/transitions?gclid=CMCQI5HKstECFCVcz0wodMw0KOg

Suicide Prevention Strategies UKwww.gov.uk/government/publications/suicide-prevention-strategy-for-england

www.gov.scot/Publications/2013/12/7616

www.wales.nhs.uk/sitesplus/888/page/69971

www.stampoutsuicide.org.uk/locational-info/northern-ireland

Bullying and cyber welfarewww.bullying.co.uk/cyberbullying

Sepsis recognition and managementhttp://sepsistrust.org

Pain in children – guidelineswww2.rcn.org.uk/_data/assets/pdf_file/0004/269185/003542.pdf

Consentwww.nhs.uk/Conditions/consent-to-treatment/Pages/Children-under-16.aspx

Child protectionwww.gov.uk/government/publications/working-together-to-safeguard-children--2

www.gov.uk/government/publications/multi-agency-statutory-guidance-on-female-genital-mutilation

Advocacy, empowerment and support for children and young people Children’s Commissioner Englandwww.childrenscommissioner.gov.uk

9. Useful websites and resources


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Children’s Commissioner Northern Irelandwww.niccy.org.uk

Children’s Commissioner Scotland www.cypcs.org.uk/about/commissioner/role

Children’s Commissioner Waleswww.childcomwales.org.uk

Children’s rightswww.unicef.org.uk/what-we-do/un-convention-child-rights/?gclid=CJG-h__NstECFRONGwodknkCbQ&sissr=1

www.fixers.org.uk

www.rcpch.ac.uk/improving-child-health/us-voice-children-young-people-and-families/us-voice-children-young-people-an

Playhttp://nahps.org.uk/index.php?page=faqs

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 2010-2015. UK: RCGP.


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10. ReferencesECPAT. (1991, December). United Nations Conventions on the Right of the Child. Available at: http://new.ecpat.org.uk/content/united-nations-convention-rights-child (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: www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmccode.pdf (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: www.umsts.org/umst/uploaded/Regulation%20of%20Paediatric%20Nurses%20in%20Europe%202015_1.pdf (accessed 10 October 2017)

Royal College of General Practitioners (2010) RCGP Child Health Strategy 2010-2015, London: RCGP. Available at: www.rcgp.org.uk (accessed 10 October 2017)

Royal College of Nursing (2012) Core competencies for nursing children and young people, London: RCN. Available at: www.rcn.org.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: www.rcn.org.uk/publications (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: www.rcn.org.uk/publications (accessed 10 October 2017)

Welsh Government (2015) Health and Care Standards, Cardiff: NHS Wales. Available at: www.wales.nhs.uk/governance-emanual/opendoc/265373 (accessed 10 October 2017)

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December 2017Publication code: 006 507

getting it right for children and young people

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