Our continuing professional development (CPD) articles are designed to assist with your nursing skills and practice.
Research and advances in technology have enabled children and young people with life-limiting conditions to live longer. To maintain their well-being and quality of life many of these children usually require some form of intravenous access for treatment. Children’s nurses should have the skills and training to ensure they are competent to practise using totally implanted central venous access devices such as portacaths (ports). This article addresses the care and management of these ports in children and the wide variation in practice that exists in the UK, and makes recommendations for practice.
This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in healthcare. This article introduces the Me first model and explores how it can be applied in clinical practice.
This article gives an overview of migraine in children. It outlines the epidemiology of the condition and describes presentation with headache and other symptoms and linked conditions. It aims to raise awareness of the diagnosis of migraine and its impact on children and young people, their families and school life. The author also describes methods of diagnosis and management, and the importance of recognising and of avoiding medication overuse.
Complementary feeding is an important developmental milestone in children and occurs at a formative time for the development of healthy eating habits that can continue into later childhood and beyond. The timing of weaning has been a controversial subject and recommendations in the UK differ from those in Europe. In the UK and New Zealand, baby-led weaning is becoming increasingly popular. The importance of responsive feeding is highlighted to make parents aware of a baby’s cues indicating hunger or fullness. There have also been advances in the science of immunology that deem the early introduction of allergens to be a preventive strategy for food allergies. This article discusses the nutritional requirements for infants and reviews the foods that should be introduced and avoided. Guidelines are changing all the time, so nurses must keep up to date with current research to be able to offer advice to parents of infants.
Nocturnal enuresis – or bed-wetting – is one of the most common chronic conditions of childhood. It has a significant effect on the quality of life of affected children and their families and is associated with several comorbidities, some of which resolve on successful treatment. The causes of this troublesome condition are explored and the principles of assessment and treatment are discussed with reference to National Institute for Health and Care Excellence guidance as well as research. Response to treatment resistance is considered and appropriate onward referral discussed.
Suctioning to clear airway secretions is an important part of the nursing care for children with respiratory conditions. While the principles of safe suctioning are known widely, they are not closely adhered to. The adverse effects of suctioning can easily be overlooked to the detriment of the patient. Careful risk assessment and patient observation are needed to ensure that suctioning is performed only when necessary and the risks to the patient are minimised.
Part two of this article focuses on the care and management of infants and children who are seriously ill and who have lost so much fluid that they have entered a state of shock. The pathophysiology of shock is reviewed and the types and stages of shock are considered. The challenges of identifying shock are explored and the management of fluid resuscitation with colloids rather than crystalloids is analysed. An overview of the complex management of a young person in shock is provided using a case history format. The article offers the opportunity to extend readers’ knowledge of some of the special tests that may be required to support the diagnosis of shock and provides an overview of the expected results.
Fluid requirements differ between infants and children. It is important for children’s nurses to understand the principles of fluid mechanics and apply this understanding to ensure each child’s state of hydration, and thereby preserve their safety and well-being. This two-part article aims to introduce the concept of fluid balance and electrolytes to children’s nursing students, help them identify what is normal and what is not, and provide guidance on what actions should be taken when problems occur. It may also be useful for registered nurses to use for revalidation.
Primary ciliary dyskinesia (PCD) is a rare, genetic disorder of the motile cilia characterised by chronic lung disease, nasal and sinus disease, chronic ear infections with glue ear leading to possible hearing impairment, and subfertility. Half of patients have organ laterality defects. Despite symptoms being present from birth, PCD remains underdiagnosed. Early diagnosis and symptom management may reduce morbidity, improve quality of life and ensure children are adequately supported to meet their full potential. This article seeks to raise awareness of PCD in children’s nurses who are well placed to identify children for referral to the national PCD diagnostic service. It examines the clinical characteristics of the disease along with the complexities and limitations of diagnostic testing. In addition, it explores the management of children with PCD within the national PCD management service for children.
In April 2016 the Nursing and Midwifery Council introduced revalidation for all nurses and midwives. It was designed to demonstrate a registrant’s ability to practise safely and effectively throughout their career and thereby improve patient and public protection. Children’s nurses should be aware of their renewal (revalidation) date to prepare their portfolio in good time. The portfolio must include evidence of 450 hours of practice, 35 hours of continuing professional development, five examples of feedback on practice and five written reflective accounts. Revalidation was tested in 19 pilot sites across the UK including Aneurin Bevan University Health Board (ABUHB) – the overall experience of the children’s nurses from ABUHB who participated in the pilot was positive. Children’s nurses have been supported in revalidation through learning from shared examples of portfolio entries. Advice from ABUHB pilot participants to children’s nurses includes getting organised, recording information regularly in their portfolio and the reassurance that revalidation is not difficult.
Serious bacterial and viral infections occurring in early infancy are important factors affecting morbidity and mortality. Recognition of sepsis by healthcare professionals is vital and allows initiation of appropriate early treatment which can be life-saving and improve outcomes for these infants greatly. This article outlines the leading causes of sepsis, for example, group B Streptococcus (GBS), Escherichia coli and herpes simplex virus. We discuss the non-specific ways in which an infant with a serious infection may present to health professionals and highlight crucial features to look for in the history and during examination of an unwell infant, and these include ‘red-flag’ signs and symptoms that should be carefully elicited. A systematic approach for the management of an infant with suspected sepsis based on up-to-date evidence and the National Institute for Health and Care Excellence ( NICE 2012 ) recommendations are discussed. Implications for nursing practice are also included, with a summary of sepsis in early infancy to aid the continued professional development of nurses working with young children in clinical settings.
This is part 2 of an article exploring the endocrinopathies associated with cancer treatments, a growing area of care. More than 80% of all childhood cancers are treatable and the number of survivors of childhood cancer is increasing, but up to two thirds of these children reportedly present with significant health problems resulting from their treatments and about 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment, and its implications for their current and future health. It focuses on the specific endocrine risks to survivors of childhood cancer following treatment with chemotherapy and radiotherapy. This is the final article in a series that has illustrated the breadth of work undertaken by nurse specialists in endocrinology and oncology.