Children and Young People's Nursing at a Glance E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Wiley Series on Cognitive Dynamic Systems
- Sprache: Englisch
Children and Young People’s Nursing at a Glance, is the perfect companion for study and revision for pre-registration children’s nursing students from the publishers of the market-leading at a Glance series. Divided into seven sections it explores assessment and screening, working with families, the newborn infant, the developing child, child health policy, nursing the sick child and young person and chronic and life-limiting conditions.
This comprehensive book is an invaluable resource for pre-registration nursing students as well as newly qualified nurses wanting to consolidate and expand their knowledge of children and young people’s nursing.
- Breaks down complex aspects of child health care in an accessible and un-intimidating way
- The perfect revision and consolidation textbook
- Linked closely with the NMC standards for pre-registration nursing education, and the essential skills clusters framework
- Highly visual colour presentation, with approximately 130 illustrations
- Includes boxes, summary boxes, key points and recommendations for practice to improve the learning experience
- Supported by a companion website featuring over 500 interactive multiple choice questions (www.ataglanceseries.com/nursing/children)
- Available in a range of digital formats - perfect for 'on the go' study and revision
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Seitenzahl: 647
Veröffentlichungsjahr: 2018
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Table of Contents
Cover
Preface
References
Part 1: Assessment and screening
1 Assessment of the child
Interviewing – history taking
Observation – subjective data
Measuring – objective data
Summary
2 SBAR framework
Inter-professional working
Communication barriers
When using SBAR tool the practitioner should aim to:
3 The nursing process
What is nursing theory?
What is the nursing process?
Planning care
Summary
4 Nursing models
Nursing models used in children and young people’s nursing
How nursing models can be used in practice
Summary
5 The care plan
Assessment
What to assess
Planning
Implementation
Evaluation
Documentation
6 Record keeping
What constitutes a patient record?
CIA mnemonic
Ensuring good record keeping
What colour ink should nurses use when making records?
All nurses should follow the no ELBOW rule when making notes
Problems faced by nurses in keeping records
How long should records for children be kept?
Summary
7 Engagement and participation of children and young people
What are the practical hints and tips that can assist in achieving effective engagement and participation of children and young people?
What to avoid
8 Observation of the well child
9 Observation of the sick child
Introduction
The importance of observation
Child, young person and family-centred care
10 Septic screening
What is sepsis?
Stabilization of the infant or child
Blood tests
Urine
Stool sample
Chest X-ray
Lumbar puncture for CSF sample
Swabs
Consent
11 Advanced physical assessment
Airway
Breathing
Circulation
Disability
Exposure
12 Developmental assessment
Assessment
Genetics and nature versus nurture
Developmental milestones
Developmental delay
Implications for practice
13 Paediatric Early Warning Score
Calculating the Paediatric Early Warning Score
Limitations
14 Paediatric critical care
Recognition and management of the seriously ill child
15 Understanding investigations
Radiology
Sampling of cerebrospinal fluid
Blood samples
Sputum samples
Gastric washings
Nasopharyngeal aspirate
Per nasal swabs
Urine samples
Biopsy
16 Understanding blood gas analysis
pH
Buffers
Respiration
Base deficit
Renal tubular secretion
Anion gap
Sampling
17 Understanding blood chemistry
Electrolytes
Kidney function
Liver function
Acid–base balance
18 Understanding pathology specimen collection
Important principles when collecting specimens
Obtaining blood samples
Urine collection
Stool specimens
Transporting specimens
19 Understanding X-rays
How do X-rays work?
What is radiation?
The importance of staying still
Other types of imaging
20 Pulse oximetry
The pulse oximeter
The pulse oximeter probe
Indications for use and clinical application
Limitations of pulse oximetry
21 Central venous devices
Types of CVAD
Accessing CVADs
Care of CVADs
Complications
22 Tracheostomy care
Stoma and skin care
Suctioning
Humidification
Tube changes
Safety
Communication
Feeding
Complications
23 Infant resuscitation
Unresponsive – shout for help!
Open airway
Not breathing normally?
Rescue breaths
24 Young person resuscitation
Safe to approach
Stimulate
Shout
Airway
Breathing
Circulation
Definitive care
25 Resuscitation drugs
Adrenaline
Amiodarone
Atropine
Adenosine
Glucose
26 Emergency care
Nursing competency
The unwell baby
Common presentations in preschool children
Common presentations in school-aged children
Common presentations in adolescents
Safeguarding
Part 2: Working with families
27 Partnership
Effective partnership
Partnership and the multidisciplinary team
Parental stress and partnership
Mothers and fathers
Parental needs
Communication
28 Family centred care
What is family?
Models that facilitate a family centred approach to care
Advantages of family centred care
Challenges of family centred care
Summary
29 Family health promotion
What is important to the family?
Challenges to family health promotion
30 Communicating with children
Factors influencing communication
31 Hospital play
What constitutes hospital play?
Effects of a hospital admission
Role of the hospital play specialist
Stages of hospital preparation
32 Role of the community children’s nurse
Prevalence of chronic illness in childhood
Benefits of home care for children with a chronic illness
Role of the community children’s nurse
33 Collaboration with schools
34 Family information leaflets
Writing patient information leaflets
Consider the content and style of the leaflet
Use the 10 principles of clear writing
Consider the order of the information in your leaflet
Producing the leaflet
35 Safeguarding
From Maria Colwell (1973) to Peter Connolly (2007)
Munro Report
36 Fabricated or induced illness
37 Gaining consent or assent
38 Clinical holding
Considerations
Pre-holding considerations
Care during clinical holding
Post-holding considerations
39 Breaking bad or significant news
Preparing to break bad news
Supporting the family when bad news is given
After the bad news has been broken
40 Care of the dying child
Quality care for the dying child and family
Physical needs
Psychosocial needs
Spiritual needs
41 Dealing with aggression
What is aggression?
What causes aggression?
Emotional or impulsive aggression
Triggers of aggression
De-escalating physical aggression
42 Minimizing the effects of hospitalization
The experience of hospitalization
Interventions and adverse experiences of hospital
Interventions to alleviate the impact of hospitalization
43 Transition
Challenges to transitioning to home
Assessing needs for discharge to home
Specific needs
Integrated care pathway
Part 3: The newborn infant
44 Fetal development
Pre-embryonic development
Embryonic development
Fetal development
Fetal circulation
Adaptation at birth
45 Neonatal examination
46 Neonatal screening tests
Neonatal screening programmes
Sample collection and analysis
Conditions commonly screened
47 The premature baby
Causes of prematurity
Outcome
48 Neonatal transport
Planning a transport
49 Jaundice and hyperbilirubinaemia
Physiology of bilirubin
Hyperbilirubinaemia
Causes
Investigations of jaundice
Management of jaundice
Phototherapy
Care of a baby having phototherapy
50 Congenital heart disease
Pathophysiology
Diagnosis
Common conditions
Management of cardiac disease
Follow-up and prognosis
51 Neonatal resuscitation
Preparation and readiness
Keep infants warm: avoid heat loss
Initial assessment at birth
Follow ABC approach
Drugs
Babies needing specialist neonatal care
Parents, communication, record keeping
52 Incubator/Babytherm care
Heat balance
Heat loss
Four mechanisms of heat transfer
Incubator and Babytherm management and care
Weaning from an incubator or Babytherm
53 Sudden infant death syndrome
Definition
Incidence
Measures in place to reduce the risk
Advice to parents to help reduce the risks
Smoking
Part 4: The developing child
54 Nutrition in childhood
Importance of good nutritional assessment
Nutrition in the under-fives
Nutrition in school aged children
Nutrition in young people aged 12+
55 Breastfeeding
56 Bottle feeding
Types of infant formula
Preparing infant formula
57 Feed calculations
58 Percentile charts
Definition
Background
Potential triggers
59 Child development: 0–5 years
60 Child development: 5–16 years
61 Age-appropriate behaviours
Growth
Development
Age-inappropriate behaviours
62 Common behavioural problems of childhood
Common emotional and behavioural problems
Crying babies and colic
Feeding problems
Sleeping problems
Temper tantrums
Unwanted or aggressive behaviour
63 Adolescent development
Physical development
Brain development and changes in cognition (thinking)
Identity
Changing social relationships
Young people as service users
64 Child health promotion
What is child health promotion?
Do children’s nurses need to promote health?
Involving children
Ethics
Evaluation
Where is health promoted to children?
65 Immunity and immunization
Immunity
How immunizations work
Population immunity
Safe immunization
Immunization controversies
66 Childhood immunizations
Immunizations given at 2, 3 and 4 months
Immunizations given at 12–13 months
Immunizations given at 3 years 4 months or soon after
Immunizations given to girls at 12–13 years
Immunizations given to teenagers aged 13–18 years
Other immunzations available
Common problems
Treatment
When not to immunize
Part 5: Child heath policy
67 Child health policy
68 The rights of children in hospital
69 The NHS Change Model
Application of the NHS Change Model to innovation in children’s services
70 Young person policy
How can the ‘You’re Welcome’ criteria help nurses improve health care for young people?
How can nurses self-review their compliance to the ‘You’re Welcome’ standards?
71 Child disability policy
Part 6: Nursing the sick child and young person
72 Pain assessment
Self-report tools
Behavioural cues
Physiological cues
73 Pain management
Why managing pain in children is important
Summary of current guidelines
What does pain management involve?
Pharmacological interventions
Physical and psychological interventions
74 Preoperative preparation
Preadmission clinic
Hospital admission
Effects of hospitalization
Informed consent
Patient safety and risk management
Fasting guidelines
75 Postoperative care
Community perspective
76 Pressure area care
Categories of pressure ulcers
77 Managing fluid balance
Distribution of body fluids
Mechanisms of fluid balance
Management of the child with fluid imbalance
Oral fluid requirements
Intravenous fluid requirements
78 Administering medication
Contemporary issues
Involving the child, young person and family
Medicines safety
Calculation formula
Units of measurement
Calculating IV fluid rates
79 Drug calculations
Numeracy
Nursing and Midwifery Council
Skills
Estimation
Using a calculator
Checking the dose
Recommendations for practice
80 Enteral and nasogastric feeding
Enteral feeding
Nasogastric feeding
Orogastric feeding
Gastrostomy feeding
81 The feverish child
Fever
Thermoregulation
Physiology
Clinical assessment
Management
82 Infectious childhood diseases
83 Assessing infectious diseases
What is infectious disease?
Infectious agents
Epidemiology
Portal of entry
Source
Symptomatology
Disease course
Site of infection
Virulence factors
Treatment and protection
84 Prevention of infection
Context and definition
Prevention and control of infection
Specific pathogens
Actions to control transmission of infections
Hand hygiene
85 Hyponatraemia and its prevention
Movement of body fluid and electrolytes
Sodium
What is hyponatraemia?
Management of the child with hyponatraemia
Preventing hyponatraemia
86 Thermal injuries
Incidence
Priorities (Figure 86.1)
Total body surface area
Assessment tools
Burns
Compartment syndrome
Scalds
87 Childhood fractures
Types of closed fractures
The healing process
Management
Complications
88 Plaster care
Reasons for application
Preparation of the child
Applying the cast
Potential problems
89 Traction care
What is traction?
Why is traction used?
Types of traction
Care of the traction
General care considerations
90 Neurovascular observations
Compartment syndrome
Neurovascular observations
Further considerations of neurovascular observations
91 Neurological problems
Cerebral palsy
Headache
Stroke
Seizures
Neuromuscular or neuropathic conditions
92 Brain injury and coma
Physiology
Coma
93 Seizures
Causes of seizures
Epilepsy
Nursing care
Further investigations
Treatment
Follow-up care
94 Meningitis
Common causes
Prevention
Assessment
Planning care
Diagnosis
Management of bacterial meningitis
Potential complications
95 Septicaemia
Definition
Other terms
Management principles
Maximize oxygen delivery
Reduce oxygen demand
Optimize cardiac output
General considerations
96 Respiratory problems
Respiratory assessment
Bronchiolitis
Upper airway obstruction
Respiratory infections
Common respiratory interventions
97 Asthma
Asthma
Psychosocial impact of asthma
Role of Asthma UK
Treatment and management
Review
Emergency management
98 CPAP and BiPAP
Respiratory failure
Continuous positive airway pressure and bi-level positive airway pressure
Further considerations
99 Cardiovascular assessment and shock
Cardiac output
100 Inflammatory bowel disease
IBD and children
Diagnostic tools
Considerations for children and families diagnosed with IBD
101 Gastro-oesophageal reflux
What is reflux?
What causes reflux?
How is reflux diagnosed?
Treatments for GOR and GORD
Do infants grow out of GOR?
102 Coeliac disease
What causes coeliac disease?
Who should be tested for coeliac disease?
How is coeliac disease diagnosed?
How is coeliac disease treated?
103 Appendicitis
Principles of care
Preoperative care
Postoperative care
104 Constipation
The constipated child
Management of the child with functional constipation and faecal impaction
Drugs used in constipation
Disimpaction
Patient education
Maintenance therapy
105 Renal problems
Kidney function in children
Kidney structure
Structural renal disorders
Acquired renal disorders in childhood
Renal tract infection
Acute renal injury (failure)
End-stage renal damage (chronic renal failure)
Renal replacement therapy
Kidney transplantation
Tumours
Renal injury
Tests used in renal disorders
106 Haematological problems
Easy bruising
Petechial rash
Thrombocytopenia with absent radii (TAR)
Fanconi’s anaemia
Purpura fulminans
Hermansky–Pudlack syndrome
Haemophilia
Dactylitis
Facial appearance in β-thalassaemia major
107 Musculoskeletal problems
Developmental dysplasia of the hip
Congenital talipes equinovarus
Scoliosis
Slipped upper femoral epiphysis
Perthes’ disease
108 Reproductive and sexual problems
Structural abnormalities
Developmental issues
109 Skin conditions
Assessing the child with a rash
110 Atopic eczema
Diagnosis
Assessment
Part 7: Chronic and life-limiting conditions
111 Living with chronic illness
Definitions
Impact on the child and family
Child and young person first and foremost
112 Cystic fibrosis management
Detection of CF
Common problems and management
Impact on family
113 Juvenile idiopathic arthritis
Management
114 Epilepsy
Seizures
Generalized seizures
Partial seizures
Treatment
Status epilepticus
115 Childhood cancer
Nurse as supporter
Nurse as physical care provider
Nurse as teacher and educator
Nurse as team player
Summary
116 Cleft lip and palate
Cleft services
Support and management
Common problems and their management
Syndromes
Reparative surgery for lip and palate
Postoperative care
117 Diabetes
Complications and associated conditions
Treatment
Psychological and social issues
118 Diabetes management
Insulin regimens
Insulin types
Insulin administration
Nutrition
Physical activity
Illness management
119 Childhood obesity
Causes of childhood obesity
Current statistics
National Child Measurement Programme
Health risks
What can be done?
Change4Life
120 Eating disorders
What are eating disorders?
Who is affected by eating disorders?
Causes of eating disorders
Treatment
121 Mental health problems
What is a mental health problem?
Types of services
Types of mental health problems
Recognizing problems
122 Self-harm in childhood
What is self-harm?
What causes self-harming behaviour?
Management and treatment
123 What is a learning disability?
124 Autistic spectrum disorder
What is autistic spectrum disorder?
Autism
Causes
Brain differences
Triad of impairment
Supporting children with ASD
125 Communicating with the child who has a learning disability
126 Positive behavioural support
What is positive behavioural support?
127 Atrioventricular septal defect in children with learning disability
Symptoms
Treatment
Follow-up advice
128 Genetic conditions: Down’s syndrome
Genetics
Phenotype features
Diagnosis
Specific medical problems in Down’s syndrome
Prognosis
129 Other genetic conditions
Phenylketonuria
Duchenne muscular dystrophy
References and further reading
Index
End User License Agreement
List of Tables
3 The nursing process
Table 3.1 Websites providing further information on a range of nursing models
19 Understanding X-rays
Table 19.1 Procedures and X-ray doses
47 The premature baby
Table 47.1 The premature baby
Table 47.2 Regardless of level of care or unit required, all premature babies should be kept ‘PINK, WARM and SWEET’ and the ‘PARENTS TOO’
54 Nutrition in childhood
Table 54.1 Calorie intake for children
56 Bottle feeding
Table 56.1 Whey and casein-based formulas
Table 56.2 Daily fluid or feed requirements
59 Child development: 0–5 years
Table 59.1 Patterns of development
Table 59.2 Dental development
Table 59.3 Essential developmental milestones
72 Pain assessment
Table 72.1 Physiological signs used to assess pain
73 Pain management
Table 73.1 Consequences of unrelieved pain
81 The feverish child
Table 81.1 Thermoregulatory responses
82 Infectious childhood diseases
Table 82.1 Childhood infections
List of Illustrations
1 Assessment of the child
Figure 1.1 Assessment of the child
2 SBAR framework
Figure 2.1 SBAR framework
Figure 2.2 Simulated scenario using the SBAR tool
3 The nursing process
Figure 3.1 Planning care using the nursing process and nursing models
4 Nursing models
Figure 4.1 How to implement nursing models into practice
Figure 4.2 Suggested activities
5 The care plan
Figure 5.1 Care plan framework
Figure 5.2 Common care planning problems
Figure 5.3 Example – care plan
6 Record keeping
Figure 6.1 Record keeping
7 Engagement and participation of children and young people
Figure 7.1 Use of graphic facilitation to capture what children, young people and families want from health services
Figure 7.2 Some ideas as to how children and young people can engage and participate in health services
8 Observation of the well child
Figure 8.1 Assessment
9 Observation of the sick child
Figure 9.1 Observation
Figure 9.2 Things to consider when a child or young person is in distress
10 Septic screening
Figure 10.1 Septic screening
11 Advanced physical assessment
Figure 11.1 Rapid clinical assessment of a seriously ill child will identify any potential respiratory, cardiovascular or neurological failures
12 Developmental assessment
Figure 12.1 Development assessment
13 Paediatric Early Warning Score
Figure 13.1 Paediatric early warning scores are a systematic tool designed to detect early deterioration in children
15 Understanding investigations
Figure 15.1 Understanding investigations
16 Understanding blood gas analysis
Figure 16.1 Blood gas analysis
18 Understanding pathology specimen collection
Figure 18.1 Principles of pathology specimen collection
19 Understanding X-rays
Figure 19.1 How an X-ray is performed
Figure 19.2 Types of X-ray
20 Pulse oximetry
Figure 20.1 Pulse oximetry
21 Central venous devices
Figure 21.1 Advantages and disadvantages of central venous access devices (CVADs)
Figure 21.2 Advantages and disadvantages of each CVAD
Figure 21.3 Implantable ports
Figure 21.4 Tunnelled device
22 Tracheostomy care
Figure 22.1 Principles of tracheostomy care
23 Infant resuscitation
Figure 23.1 Paediatric Life Support Algorithm
Figure 23.2 Correct neutral position of head for successful airway management
24 Young person resuscitation
Figure 24.1 Advanced Paediatric Life Support Algorithm
25 Resuscitation drugs
Figure 25.1 Uses and doses of resuscitation drugs
26 Emergency care
Figure 26.1 Common reasons why parents bring babies to an emergency department
27 Partnership
Figure 27.1 Effective partnership
28 Family centred care
Figure 28.1 Principles of family centred care
Figure 28.2 Successful implementation of family centred care (FCC)
29 Family health promotion
Figure 29.1 Family health promotion
30 Communicating with children
Figure 30.1 Aspects to consider when communicating with children
31 Hospital play
Figure 31.1 Hospital play
32 Role of the community children’s nurse
Figure 32.1 Role of the community children’s nurse
33 Collaboration with schools
Figure 33.1 Hints and tips when engaging with schools and colleges
34 Family information leaflets
Figure 34.1 Developing family information leaflets
35 Safeguarding
Figure 35.1 Timeline of legislation and guidance on legislation
Figure 35.2 Events surrounding safeguarding legislation
38 Clinical holding
Figure 38.1 Holding a child in a supportive manner
39 Breaking bad or significant news
Figure 39.1 Factors influencing the process of breaking bad or significant news
40 Care of the dying child
Figure 40.1 Care of the dying child
41 Dealing with aggression
Figure 41.1 Features of physiological, psychological, physical and social aggression
42 Minimizing the effects of hospitalization
Figure 42.1 Challenges of hospitalization
43 Transition
Figure 43.1 Care issues for consideration when the family with a child with complex care needs are transitioning from the acute hospital setting to home
44 Fetal development
Figure 44.1 Fetal circulation
45 Neonatal examination
Figure 45.1 Examination of the neonate
46 Neonatal screening tests
Figure 46.1 Neonatal screening tests
47 The premature baby
Figure 47.1 Characteristics of the premature baby
48 Neonatal transport
Figure 48.1 Road transport
Figure 48.2 Air transport
Figure 48.3 Sea King helicopter
49 Jaundice and hyperbilirubinaemia
Figure 49.1 A baby nursed under a phototherapy unit with support rolls and eye covers
50 Congenital heart disease
Figure 50.1 Examination of the neonate
51 Neonatal resuscitation
Figure 51.1 Head position, the key to airway management
Figure 51.2 Correct size and position of face mask
Figure 51.3 Mask ventilation via T-piece
Figure 51.4 Apply pressure to lower third of the sternum
52 Incubator/Babytherm care
Figure 52.1 Comparison of babytherm and incubator
53 Sudden infant death syndrome
Figure 53.1 Sudden infant death syndrome
54 Nutrition in childhood
Figure 54.1 Nutritional assessment
Figure 54.2 The importance of good nutrition
55 Breastfeeding
Figure 55.1 Choosing to breastfeed
Figure 55.2 Advice on breastfeeding
56 Bottle feeding
Figure 56.1 Examples of specialized milks
Figure 56.2 Safe preparation of powdered infant formula
57 Feed calculations
Figure 57.1 Feed calculations
58 Percentile charts
Figure 58.1 Measuring head circumferences
Figure 58.2 Measuring weight
Figure 58.3 Measuring height
59 Child development: 0–5 years
Figure 59.1 Gross motor development
Figure 59.2 Fine motor development
Figure 59.3 Speech and language
Figure 59.4 Social development
60 Child development: 5–16 years
Figure 60.1 Child development 5–16 years
Figure 60.2 Growth rates for girls and boys
Figure 60.3 Chain of hormonal events in puberty
Figure 60.4 Sequence and range of sexual development in puberty
61 Age-appropriate behaviours
Figure 61.1 Age appropriate behaviour
62 Common behavioural problems of childhood
Figure 62.1 Behaviour problems and strategies
Figure 62.2 What you need from your evaluation
63 Adolescent development
Figure 63.1 Who am I and how am I ?
64 Child health promotion
Figure 64.1 What is health promotion?
Figure 64.2 Approaches to health promotion
Figure 64.3 Promoting health to children
65 Immunity and immunization
Figure 65.1 Immunization
Figure 65.2 Safe administration of vaccinations
66 Childhood immunizations
Figure 66.1 Immunization schedule for children 2 months to 18 years
67 Child health policy
Figure 67.1 Current UK Child health policies for health and social care
68 The rights of children in hospital
Figure 68.1 Ensuring the rights of children in hospital
69 The NHS Change Model
Figure 69.1 The NHS Change Model
70 Young person policy
Figure 70.1 Child health policy is the cornerstone of improvements in child health
71 Child disability policy
Figure 71.1 Policies and guidance documents for disabled children and young people and those with complex health needs
Figure 71.2 Child health policy for improving standards of care for children with disabilities and those with complex health needs
72 Pain assessment
Figure 72.1 Factors affecting a child’s behaviour when in pain
Figure 72.2 Key steps in pain assessment
Figure 72.3 Three approaches to assessing pain
Figure 72.4 Self-report tools
Figure 72.5 Some of the more commonly used and well-validated pain assessment tools
73 Pain management
Figure 73.1 The stages of pain management
Figure 73.2 The three P’s of pain management
Figure 73.3 Interventions
Figure 73.4 The WHO two-step approach to pain management
74 Preoperative preparation
Figure 74.1 Preoperative preparation
Figure 74.2 Preoperative checklist
75 Postoperative care
Figure 75.1 Phases of postoperative care
Figure 75.2 Stages of wound healing
76 Pressure area care
Figure 76.1 Development of pressure ulcers
Figure 76.2 Some common sites for pressure ulcers
77 Managing fluid balance
Figure 77.1 Common causes of fluid imbalance
Figure 77.2 What you need from your evaluation
78 Administering medication
Figure 78.1 Medication procedure
79 Drug calculations
Figure 79.1 Principles of drug calculations
80 Enteral and nasogastric feeding
Figure 80.1 Troubleshooting nasogastric tube placement
Figure 80.2 Administering a bolus feed
Figure 80.3 Administering a continuous feed
Figure 80.4 Administering medication
81 The feverish child
Figure 81.2 The fever cycle
Figure 81.3 The tie course of a typical febrile episode
83 Assessing infectious diseases
Figure 83.1 Assessing infectious diseases flow chart
84 Prevention of infection
Figure 84.1 Five moments for hand hygiene
Figure 84.2 How to wash your hands
85 Hyponatraemia and its prevention
Figure 85.1 The effects of hyponatraemia and hypernatraemia on the cell
86 Thermal injuries
Figure 86.1 The SAFE approach
Figure 86.2 Lund and Bowden assessment tool
Figure 86.3 Classification, assessment, management and complications
Figure 86.4 Zones of injury
87 Childhood fractures
Figure 87.1 Common sites of childhood fractures
88 Plaster care
Figure 88.1 Removal of synthetic cast using an oscillating plaster saw
Figure 88.2 Application of cast
Figure 88.3 Completed cast
89 Traction care
Figure 89.1 Fixed traction
Figure 89.2 Types of balanced traction
90 Neurovascular observations
Figure 90.1 Position of pulse points
Figure 90.2 Pain assessment
91 Neurological problems
Figure 91.1 The ICF framework
92 Brain injury and coma
Fig 92.1 CT scan demonstrating Extradural Haematoma (EDH)
93 Seizures
Figure 93.1 First aid care for a child having a convulsion
Figure 93.2 Types of seizure
94 Meningitis
Figure 94.1 Recognizing symptoms in babies and young children
Figure 94.2 Recognizing symptoms in young people
Figure 94.3 Signs of acute raised intracranial pressure
Figure 94.4 Tumbler test for septicaemia
95 Septicaemia
Figure 95.1 Signs of septicaemia
96 Respiratory problems
Figure 96.1 Assessment of the child with a respiratory problem
97 Asthma
Figure 97.1 What is asthma?
98 CPAP and BiPAP
Figure 98.1 Causes of respiratory failure
Figure 98.2 Causes of respiratory distress
Figure 98.3 CPAP/BiPAP mask
Figure 98.4 Non-invasive ventilator
99 Cardiovascular assessment and shock
Figure 99.1 Cardiovascular assessment
100 Inflammatory bowel disease
Figure 100.1 Main inflammatory bowel diseases
Figure 100.2 Signs and symptoms of inflammatory bowel disease
Figure 100.3 Treatments for inflammatory bowel disease
101 Gastro-oesophageal reflux
Figure 101.1 Gastro-oesophageal reflux
102 Coeliac disease
Figure 102.1 What causes coeliac disease?
Figure 102.2 Common symptoms
Figure 102.3 The Crossed Grain symbol
Figure 102.4 Medical treatments
Figure 102.5 Normal villi and damaged villi in coeliac disease
103 Appendicitis
Figure 103.1 Signs and symptoms of appendicitis
Figure 103.2 History and assessment
Figure 103.3 Key observations and investigations
104 Constipation
Figure 104.1 Differential diagnosis of chronic constipation
Figure 104.2 Diagnostic criteria for constipation
Figure 104.3 Chronic constipation
Figure 104.4 (a) A three-pronged approach is needed to manage functional constipation (b) Managing constipation
105 Renal problems
Figure 105.1 Renal problems
106 Haematological problems
Figure 106.1 Easy bruising
Figure 106.2 Petechial rash
Figure 106.3 Thrombocytopenia with absent radii (TAR)
Figure 106.4 Fanconi’s anaemia
Figure 106.5 Purpura fulminans
Figure 106.6 Hermansky–Pudlack syndrome
Figure 106.7 Haemophilia
Figure 106.8 Dactylitis
Figure 106.9 Facial appearance in β-thalassaemia major
107 Musculoskeletal problems
Figure 107.1 Congenital talipes equinovarus (CTEV). Also known as club feet
Figure 107.2 Ponseti casting. Note separate leg plaster used for each leg
Figure 107.3 Denis Browne boots
Figure 107.4 Pavlik harness
108 Reproductive and sexual problems
Figure 108.1 Issues of sexual identity
Figure 108.2 Checking the testes
109 Skin conditions
Figure 109.1 Children’s concerns about the reaction of others to their skin conditions
Figure 109.2 Macule
Figure 109.3 Papule
Figure 109.4 Plaque
Figure 109.5 Wheal
Figure 109.6 Vesicle
Figure 109.7 Pustule
Figure 109.8 Crust
Figure 109.9 Lichenification
110 Atopic eczema
Figure 110.1 Eczema can impact on the patient’s quality of life
Figures 110.2 and 110.3 In some ethnic groups, atopic eczema can affect the extensor surfaces rather than the flexures, and discoid or follicular patterns may be more common
Figure 110.4 Facial eczema is common in infants
Figure 110.5 Flexural involvement
Figure 110.6 Eczema on extensor surface of arms
Figure 110.7 Discoid or follicular pattern of eczema
Figure 110.8 Eczema can cause lichenification
Figure 110.9 Weeping and crusting may be signs of infection
Figure 110.10 Assessing severity of eczema
Figure 110.11 Management of eczema
111 Living with chronic illness
Figure 111.1 Family challenges
Figure 111.2 Emotion and problem focused coping strategies
Figure 111.3 Role of the children’s nurse
112 Cystic fibrosis management
Figure 112.1 Features of cystic fibrosis
Figure 112.2 Professionals involved
113 Juvenile idiopathic arthritis
Figure 113.1 Juvenile idiopathic arthritis
114 Epilepsy
Figure 114.1 Features of epilepsy
115 Childhood cancer
Figure 115.1 Childhood cancer
116 Cleft lip and palate
Figure 116.1 Cleft lip and palate
117 Diabetes
Figure 117.1 Type 1 Diabetes
118 Diabetes management
Figure 118.1 Diabetes management
119 Childhood obesity
Figure 119.1 Childhood obesity
120 Eating disorders
Figure 120.1 Eating issues
121 Mental health problems
Figure 121.1 Mental health problems
122 Self-harm in childhood
Figure 122.1 Methods of self-harm
124 Autistic spectrum disorder
Figure 124.1 The triad impairments model –
Lorna Wing
125 Communicating with the child who has a learning disability
Figure 125.1 Communication with children who have additional support needs: It’s not that difficult
Figure 125.2 Whatever the communication system adopted by the child with a learning disability your responsibility lies in ensuring you listen with your whole self
126 Positive behavioural support
Figure 126.1 Challenging behaviour
127 Atrioventricular septal defect in children with learning disability
Figure 127.1 Atrioventricular septal defect
128 Genetic conditions: Down’s syndrome
Figure 128.1 Down’s syndrome – dymorphic features
Figure 128.2 Specific medical problems that occur more frequently in people with Down’s syndrome
129 Other genetic conditions
Figure 129.1 Main areas of muscle weakness affected Duchenne muscular dystrophy
Figure 129.2 Phenylketonuria (PKU)
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e1
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Children and Young People’s Nursing at a Glance
Edited by
Alan Glasper
Professor of Children’s and Young People’s NursingFaculty of Health SciencesUniversity of SouthamptonSouthampton, UK
Jane Coad
Professor in Children and Family NursingFaculty of Health and Life SciencesCoventry UniversityCoventry, UK
Jim Richardson
Senior Lecturer at the School of NursingFaculty of Health, Social Care and EducationKingston University London and St George’sUniversity of LondonLondon, UK
Series Editor: Ian Peate
This edition first published 2015 © 2015 by John Wiley & Sons, Ltd.
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Library of Congress Cataloging-in-Publication Data
Glasper, Edward Alan, author.
Children and young people’s nursing at a glance / Alan Glasper, Jane Coad, Jim Richardson.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-51628-7 (pbk.)
I. Coad, Jane, author. II. Richardson, Jim, 1957– author. III. Title.
[DNLM: 1. Pediatric Nursing–methods–Handbooks. 2. Adolescent. 3. Child.
4. Infant. 5. Nursing Assessment–methods–Handbooks. WY 49]
RJ245
618.92’00231–dc23
2014005233
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: Paediatric ECG. LIFE IN VIEW/SCIENCE PHOTO LIBRARY
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1 2015
Preface
The education of children’s and young people’s nurses remains a foremost challenge for those wishing to ensure the accuracy and safety of the evidence base for practice. As long ago as 1952, Twistington-Higgins in his book written to commemorate the first 100 years of The Hospital For Sick Children, Great Ormond Street, London, UK, reiterates one of the original aims of the hospital dated 1852, which was: ‘To disseminate among all classes of the community but chiefly among the poor a better acquaintance with the management of infants and children during illness by employing it [The Hospital] as a school for the education of women in the special duties of children’s nursing’.
That initial aim of one of the early children’s hospitals resonates with contemporary children’s and young people’s nursing and Catherine Jane Wood, one of the early matrons of The Great Ormond Street children’s hospital left a tangible legacy of the importance of educating children’s and young people’s nurses in stating that ‘Sick children require special nursing and sick children’s nurses require special training’ (Wood 1888). In recognition of that laudable aim this new and exciting at a Glance book has been written by experienced practitioners and educators in a common quest to capture the complexities delivering nursing practice based on best evidence.
All children’s and young people’s nurses share a single espirt de corps which unites them with their colleagues worldwide and although this book is primarily reflective of children’s and young people’s nursing in the United Kingdom, others will find it an invaluable guide to the delivery of evidence-based nursing care.
Although the prime focus of the book is to illuminate best clinical practice, my fellow editors and I hope that the format of the at a Glance series will provide quick and easy access to important care delivery information packaged in an engaging and informative style. This book will be of interest to undergraduate student nurses and existing registrants wishing to remind themselves of the complexities of children’s and young people’s nursing which encompasses care delivery across the lifespan of the child from birth through to the emergence of the young person and future adult. In the pages of this book you will find concise information to help you deliver that care to this wide and disparate client group that makes up the landscape of contemporary childhood.
For those students wishing to test their knowledge and understanding of the content there is a comprehensive bank of multiple choice questions on the companion website.
This book could not have been completed without the organizational expertise and help of Brenda Nash. My fellow editors and I are in her debt.
Alan Glasper
References
Twistington-Higgins T. (1952) Great Ormond Street 1852–1952. Watford: Odhams Press Ltd.
Wood CJ. (1888) The training of nurses for sick children. Nursing Record December 6, 507–510.
Contributors
Owen ArthursConsultant Paediatric RadiologistGreat Ormond Street Hospital for ChildrenLondon, UK
Justine BarksbyLecturer in Learning Disability NursingSchool of Health SciencesUniversity of NottinghamNottingham, UK
Nicola BarnesNurse Practitioner for Complex EpilepsyGreat Ormond Street HospitalLondon, UK
Cathryn BattrickMatronSouthampton Children’s HospitalSouthampton, UK
Marie Bodycombe-JamesSenior LecturerSpecialist Community Public Health NursingSwansea UniversitySwansea, UK
Margaret BourkeAdolescent Mental Health NurseSt Patrick’s Mental Health ServicesSt Patrick’s University HospitalDublin, Ireland
Maria BrennerLecturer and Programme Co-ordinatorCollege of Health SciencesUniversity College DublinDublin, Ireland
Anne BrocklesbySenior Lecturer in Child NursingCanterbury Christ Church UniversityKent, UK
Mark BroomAcademic Manager Family CareFaculty of Life Sciences and EducationUniversity of South WalesPontypridd, UK
Pauline CardwellLecturer (Education)School of Nursing and MidwiferyQueen’s UniversityBelfast, Northern Ireland
Carol ChamleyCarol ChamleySenior lecturerChildren and Young People’s Nursing/Nurse ResearcherCoventry UniversityCoventry, UK
Collette ClaySenior Lecturer in MidwiferyFaculty of Health and Life SciencesCoventry UniversityCoventry, UK
Jane CoadProfessor in Children and Family NursingFaculty of Health and Life SciencesCoventry UniversityCoventry, UK
Andrea CockettHead of DepartmentChild and Adolescent NursingKing’s College LondonLondon, UK
Angela ColeClinical Nurse Specialist for Children and Young Adults with IBDBarts Health NHS TrustLondon, UK
Sarah CorkhillLecturer in Children’s nursingSchool of Nursing and MidwiferyKeele UniversityKeele, UK
Doris CorkinSenior Lecturer (Education)School of Nursing and MidwiferyQueen’s UniversityBelfast, Northern Ireland
Mick CullenPaediatric Gastroenterology Nurse SpecialistSouthampton Children’s HospitalSouthampton, UK
Jeanette DavidPaediatric Clinical Skills Specialist Resuscitation Officer – Paediatric LeadGloucestershire Hospitals NHS Foundation Trust UKCheltenham, UK
Maggie DuckettMidwifery LecturerSouthampton University Clinical Nurse SpecialistSolent Sexual Health ServicesSouthampton, UK
Kath EvansHead of Patient ExperienceNursing DirectorateNHS England
Filippo FestiniProfessor of Paediatric NursingDepartment of Health SciencesUniversity of Florence, Italy
Siobhan FitzgeraldClinical Nurse Specialist Airway ManagementOur Lady’s Children’s Hospital CrumlinDublin, Ireland
Ellie ForbesMatron for Child HealthSouth Devon Healthcare NHS Foundation TrustTorquay, UK
Elizabeth GillespieTeam LeaderCommunity Children’s Nursing TeamSouthbank Child Development CentreGlasgow, UK
Alan GlasperProfessor of Children’s and Young People’s NursingFaculty of Health SciencesUniversity of SouthamptonSouthampton, UK
Elizabeth Gormley-FlemingSenior Lecturer Children’s NursingUniversity of HertfordshireHatfield, UK
Karen GrantEducation and Practice LeadSouthampton Children’s HospitalSouthampton, UK
Jennifer GrehanLecturer and CPD co-ordinator (Diagnostic Imaging)School of Medicine and Medical ScienceUniversity College DublinDublin, Ireland
Karen GriffithsSenior Lecturern Children’s NursingFaculty of Health SciencesStaffordshire UniversityStoke-on-Trent, UK
Sheila HayesClinical Nurse Specialist Airway ManagementOur Lady’s Children’s Hospital CrumlinDublin, Ireland
Melissa HeywoodClinical Nurse ConsultantVictorian Paediatric Palliative Care ProgramThe Royal Children’s HospitalMelbourne, Australia
Dean-David HolyoakeSenior Lecturer in Child and Adolescent Mental HealthUniversity of WolverhamptonWolverhampton, UK
Kate HowardDeputy Director of NursingAHP’s and QualityNorthamptonshire Healthcare NHSFoundation TrustNorthampton, UK
Frances HowlinLecturer in Children’s NursingSchool of Nursing, Midwifery, and Health SystemsUniversity College DublinDublin, Ireland
Elaine HuntingdonSenior Lecturer in Children’s NursingLiverpool John Moores UniversityLiverpool, UK
Emma InnessSenior Lecturer in Children’s Nursing; Advanced NursePractitioner in Paediatric RheumatologyOxford Brookes UniversityOxford, UK
Lucille Kelsall-KnightSenior Lecturer in Children’s NursingUniversity of WolverhamptonWolverhampton, UK
Janet KelseyAssociate Professor Health Studies (Paediatric)Plymouth UniversityPlymouth, UK
Olivet KewleySenior Lecturer in Child NursingLiverpool John Moores UniversityLiverpool, UK
Kate KhairNurse Consultant HaemophiliaGreat Ormond Street HospitalLondon, UK
Kate KnightSenior Lecturer Children’s NursingLiverpool John Moores UniversityLiverpool, UK
Narinder KularNurse Consultant Paediatrics Complex CareShropshire Community Health NHS TrustBridgnorth, UK
Karine LatterLead Nurse Specialist Cleft Lip and PalateNottingham University HospitalNottingham Children’s HospitalNottingham, UK
Helen LavertyHealth LecturerLearning Disability NursingUniversity of NottinghamNottingham, UK
Sandra LawtonNurse Consultant DermatologyNottingham Children’s HospitalNottingham University Hospitals NHS TrustNottingham, UK
Angela LedshamLecturer/Practitioner PICUUniversity Hospital Southampton NHS Foundation TrustSouthampton UniversitySouthampton, UK
Gayle Le MoineSenior Lecturer in Child NursingCanterbury Christ Church UniversityCanterbury, UK
Stella LovellSenior Lecturer in Child NursingCanterbury Christ Church UniversityCanterbury, UK
Lindy MayNurse Consultant Paediatric NeurosurgeryGreat Ormond Street HospitalUniversity College LondonLondon, UK
Orla McAlindenLecturer in Children and Young People’s NursingSchool of Nursing and MidwiferyQueen’s University BelfastNorthern IrelandBT9 7BL
Isobel McDermottSenior Lecturer in MidwiferyFaculty of Health and Life SciencesCoventry UniversityCoventry, UK
Patricia McNeillyLecturerSchool of Nursing and MidwiferyQueen’s UniversityBelfast, Northern Ireland
Nick MedforthProfessional Lead: Child Health and CareFaculty of Health and Applied Social SciencesLiverpool John Moores UniversityLiverpool, UK
Victoria MooreStaff NurseChildren’s Haematology UnitRoyal Belfast Hospital for Sick ChildrenBelfast, Northern Ireland
Colman NoctorAdvanced Nurse PractitionerSt Patrick’s Mental Health ServicesSt Patrick’s University HospitalDublin, Ireland
Sharon NurseSenior Teaching Fellow, MidwiferyQueen’s UniversityBelfast, Northern Ireland
Patricia O’HaraSister, Children’s wardAntrim HospitalAntrim, Northern Ireland
Theresa PengellySenior Lecturer in Children and Young People’s NursingCoventry UniversityCoventry, UK
Vanessa PlaresPractice Educator for Newly Registered NursesNursing and Non-Medical Education TeamGreat Ormond Street Hospital NHS Foundation TrustLondon, UK
Elisabeth PodsiadlySenior Lecturer (Neonatal Nursing) Faculty of Health, SocialCare and EducationKingston University and St. George’sUniversity of LondonLondon, UK
Jayne PriceAssociate Professor (Children’s Nursing)Faculty of Health, Social Care and EducationKingston University and St George’s, University of LondonLondon, UK
Lavinia RaesideAdvanced Neonatal Nurse PractitionerNICU, RHSC YorkhillGlasgow/Southern General HospitalSouthampt Glasgow, UK
Sarah ReedLecturer in Children’s and Young People’s NursingUniversity of SouthamptonSouthampton, UK
Gail ReochSenior Lecturer in Children’s NursingUniversity of NorthamptonNorthampton, UK
Jim RichardsonSenior Lecturer at the School of NursingFaculty of Health, Social Care and EducationKingston University London and St George’sUniversity of LondonLondon, UK
Sheila RobertsSenior Lecturer Children’s NursingUniversity of HertfordshireHatfield, UK
Angela RyanNurse TutorCentre of Children’s Nurse EducationDublin, Ireland
Sarah SantoClinical Nurse ManagerNorth West and North Wales Paediatric Transport ServiceWarrington, UK
Suzanne SeabraSenior Lecturer, Children’s NursingFaculty of Health SciencesStaffordshire UniversityStoke-on-Trent, UK
Sally ShearerDirector of Nursing and Governance for ChildrenBarts Health NHS TrustLondon, UK
Sarah SteadSenior Lecturer in Child NursingCanterbury Christ Church UniversityCanterbury, UK
Nicola StevensPaediatric Diabetes Specialist NurseNorthampton General Hospital; University of NorthamptonNorthampton, UK
Kathryn SummersSenior Lecturer in Child NursingCanterbury Christ Church UniversityCanterbury, UK
Catherine SwailesPaediatric and Neonatal Clinical FacilitatorMilton Keynes Hospital NHS Foundation TrustSenior Lecturer in Children’s NursingUniversity of BedfordshireBedfordshire, UK
John ThainSenior Lecturer in Children’s NursingInstitute of Health ProfessionsFaculty of Education, Health and WellbeingUniversity of WolverhamptonWolverhampton, UK
Angela ThompsonGastro/IBD Nurse Specialist for Children and Young AdultsBarts Health NHS TrustThe Royal London HospitalLondon, UK
Gillian TurnerSenior Lecturer in Specialist Community Public HealthNursingLiverpool John Moores UniversityLiverpool, UK
Alison TwycrossHead of Department for Children’s Nursing andReader in Children’s Pain ManagementEditor: Evidence Based NursingDepartment of Children’s NursingLondon South Bank UniversityLondon, UK
Katy WeaverHealth Play SpecialistRoyal Alexandra Children’s HospitalBrighton, UK
Lisa WhitingPrincipal Lecturer and Professional LeadChildren’s NursingUniversity of HertfordshireHatfield, UK
Jane WillockSenior Lecturer (Child Health) Faculty of Life Sciences andEducation University of South WalesPontypridd, UK
Nicola WilsonPractice EducatorNeurosciencesGreat Ormond Street Hospital for ChildrenLondon, UK
Mark WoodsSenior Lecturer Clinical SkillsLiverpool John Moores UniversityLiverpool, UK
Matthew NorridgeLecturer Practitioner in Paediatric Intensive CareKings College LondonLondon, UK
How to use your revision guide
Features contained within your revision guide
Each topic is presented in a double-page spread with clear, easy-to-follow diagrams supported by succinct explanatory text.
Key point boxes and red flag boxes draw your attention to important points.
Key point
The primary cause of cardiopulmonary arrest in young people is hypoxia. For this reason, if a young person is found unresponsive and not breathing the first action to be taken is for the rescuer to deliver five rescue breaths before seeking further help
Red flag
Effective ventilation and oxygenation may prevent a cardiac arrest from occurring in young people
The website icon indicates that you can find accompanying resources on the book’s companion website.
Section not available in this digital edition
Section not available in this digital edition
About the companion website
Part 1Assessment and screening
Chapters
1Assessment of the child2SBAR framework3The nursing process4Nursing models5The care plan6Record keeping7Engagement and participation of children and young people8Observation of the well child9Observation of the sick child10Septic screening11Advanced physical assessment12Developmental assessment13Paediatric Early Warning Score14Paediatric critical care15Understanding investigations16Understanding blood gas analysis17Understanding blood chemistry18Understanding pathology specimen collection19Understanding X-rays20Pulse oximetry21Central venous devices22Tracheostomy care23Infant resuscitation24Young person resuscitation25Resuscitation drugs26Emergency careDon’t forget to visit the companion website for this book at www.ataglanceseries.com/nursing/children where you will find over 500 interactive multiple-choice questions to supplement your learning.
1Assessment of the child
Figure 1.1Assessment of the child
Assessment is the collection of data, both subjective and objective, which aims to achieve a complete picture of the child’s health status. Good assessment is a combination of the interpretation of physical data with the information gained from observation of the child and family and from listening to them.
Interviewing – history taking
Gaining the trust of the child and family is an essential element in developing of an effective therapeutic relationship. Introducing yourself to the child and family with explanations of expected outcomes will put the child and family at ease. Age appropriate language should be used. Questions should be directed at both the child and parent. Young people should have an opportunity to talk in private if they wish. When taking a history, a structured approach should be used. This needs to include:
Presenting complaint
History of presenting complaint
Past medical history (birth and neonatal history in infants and young children), immunizations, illnesses and hospitalizations
Allergies
Current medication
Developmental history
Family history
Social history – nursery, school.
Observation – subjective data
Subjective data are what the child and parent say along with the visual information gained from the initial encounter with the child and family or while obtaining objective data (physical examination and recording of vital signs). This includes noting:
The colour of the child: are they pale, mottled, cyanosed, jaundiced, flushed
Behaviour: alert, crying, agitated, combative, lethargic, drowsy
Interaction with parents/carers/strangers
Interaction with environment, wanting to play or sleepy
Position: normal, floppy or stiff
The general appearance of the child: e.g. unkempt or clean
Obvious birthmarks, bruises or rashes
Dysmorphic features.
Measuring – objective data
All infants and children require a baseline physical assessment. This is a multifaceted process and some aspects are common to all children who require assessment of their health status. The physical assessment is concerned with the analysis and interpretation of data. Privacy and dignity should be maintained during this process. Consent should be obtained prior to undertaking a physical assessment.
Physical assessment includes:
Basic physical recordings of temperature, pulse rate, respiratory rate, oxygen saturation and blood pressure
Respiratory assessment, rate of breathing, depth of breathing, noise of breathing, presence of cough, chest movement, nasal flaring, use of other accessory muscles, child’s colour, ability to speak/feed, position of the child, peak flow and oxygen saturation level
Heart rate including pulse volume
Capillary refill time
Neurological status using Glasgow coma scale or AVPU
Level of hydration: obvious signs of dehydration include sunken anterior fontanelle, dull sunken eyes, dry oral mucosa, lethargy, weak cry, decreased urinary output
Weight
Height/length
Head circumference
Skin assessment using recognized pressure risk assessment tool
Urinalysis.
All findings need to be documented as they are a legal record of the nursing assessment, the foundation on which care is planned and the basis of communication with multidisciplinary team.
Summary
Assessment is a dynamic continuous process that needs to include the child’s and parentor carer’s perspectives. Observation is as essential as physical assessment and good communication skills are important.
2SBAR framework
Figure 2.1SBAR framework
Figure 2.2Simulated scenario using the SBAR tool
Inter-professional working
SBAR is a valuable communication tool when used either uniprofessionally or inter-professionally. For example during clinical placement the practice mentor may utilise this SBAR tool to provide feedback on the nursing student’s ability to prioritise using this flexible framework, when reporting on a patients’ condition and on their theoretical knowledge and problem-solving skills.
Additionally, effective understanding of collaboration and inter-professional working are essential elements within healthcare education and practice. During simulated inter-professional learning sessions, nursing and medical students are encouraged to reflect upon this situational briefing tool, which guides them to communicate important information in a predictable structure, when summoning senior nursing or medical help with a deteriorating child (Morrow 2012).
Communication barriers
The quality of communication between and with patients and healthcare professionals is a critical factor in establishing safe and effective care. Therefore, it is essential that everyone involved within the healthcare team communicates effectively, in order that maximum standards of care can be supported and achieved.
Within the healthcare environment practitioners need to be mindful of language and literacy barriers which may directly or indirectly affect the decision-making process and effectiveness of the communicated message. However, having clear shared goals, role awareness of individual professions and the ability to work independently within a team as well as working together should assist in removing these barriers.
When using SBAR tool the practitioner should aim to:
Communicate effectively
Identify priorities
Utilise decision-making strategies
Develop problem-solving skills
Be aware of language and literacy barriers.
3The nursing process
Figure 3.1Planning care using the nursing process and nursing models
Nursing has a theoretical base that has many elements including physiology, psychology, pathology, pharmacology and sociology. To deliver quality care to patients that is focused, safe and organized, it needs to be planned. Documenting the plan of care for a patient and its implementation ensures continuity of care and provides a legal document demonstrating that care has been delivered. Care can be organized using the nursing process and nursing models can help focus care to meet the specific needs of patients.
What is nursing theory?
Nursing theory is the cognitive knowledge and understanding that is used by practitioners to help them deliver the best possible care based on best evidence. Nursing theory is partly drawn from a range of interconnected subjects from the arts and sciences that can be applied to the practice of nursing (Colley 2003). This knowledge comes from experiential learning and research and is part of the rich tradition linked to the development of nursing. The importance of children’s and young people’s nurses delivering care that is underpinned by evidence-based theory is perhaps reflected in Nightingale’s famous pronouncement articulated in her notes for nursing ‘Children: they are affected by the same things [as adults] but much more quickly and seriously’ (Nightingale 1859: 72).
There are several models that are commonly used in the nursing of sick children and young people (Table 3.1
