Children’s nursing has come a long way in 70 years

From partnering with parents to giving young patients a voice, caring for children has changed

From partnering with parents to giving young patients a voice, caring for children has changed

Picture: iStock

There have been a number of milestones in children’s nursing since the beginning of the NHS. By no means is this an exhaustive list, but it may serve as a reminder of some of the changes in policy and practice driven by the political landscape, such as, epidemiology, technological advances and alterations in the health profile of the population.

A prescription for play

Over time, underpinned by significant reports, there has been increasing recognition of the specific health needs and rights of children and young people. Arguably, the Platt Report, formerly called the Welfare of Sick Children in Hospital (1959), influenced the mindset of professionals. Supported by research it highlighted the detrimental effects of hospitalisation, the important role of parents and suggested alternatives to hospital care. Before this, stays were prolonged and professionals limited the times parents could visit because it was seen as harmful to the child’s routine.

‘Attention was given to reducing time in hospital’

As a consequence, their contribution to the physical care of their sick child was carefully controlled. Gradually, parents were given unrestricted access, became increasingly involved in care and decision making and attention was given to reducing time in hospital. Psychological needs were acknowledged with the employment of play specialists. There was a call to develop children’s community nursing services and a number of procedures to be carried out at home or within the day.  

Neonatal advances

Perhaps one of the most far-reaching changes, a combination of epidemiology, technology and innovation, is the survival of neonates at an ever-reducing gestational age. At the start of the NHS 70 years ago, the effect of this could not have been imagined. Once it became possible to prolong life the debates ranged from the ethics of intervention and the unintended consequences of care in the neonatal unit, to consideration of, and provision for, the implications of survival with a long-term disability or dependence on oxygen.       

Innovation in surgery, more sophisticated anaesthetics and intravenous therapy increased the possibilities for complex reconstructive surgery. There was also the safer management of more straightforward procedures and attention turned to the assessment and management of child and neonatal pain.

Dedicated to raising standards

The Report of the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984-1995 (2001) into the deaths of children, demonstrated the flaws in the governance of children’s services and the need for specific provision, standards and clinical pathways. There was emphasis on ensuring professionals had the appropriate knowledge and skills to care safely for children.

The National Service Framework for the care of Children and Young People and Maternity Services 2004 brought together previous reports and recommendations culminating in a ten-year plan to implement minimum quality standards for the care of children. Increasing this has been used as a template for commissioners of children’s services and feedback is being sought from children and young people as services are beginning to be shaped.

Training continues to evolve

Within the National Institute for Health and Care Excellence relating to children and young people, the mainstays of children’s nursing practice are provision of care in the community and working in partnership with parents.

Education has reflected these changes, especially the emergent recognition that children deserve to be cared for by individuals who have appropriate competencies. With Project 2000 came the first universal direct entry to children’s nursing. However, in 2018, despite numerous policy recommendations, some have called for a more generic training and the recent introduction of courses for the nursing associate brings with it no guarantee that they will be field specific. 

‘Feedback is being sought from children and young people’

One might argue that it is not the NHS that has championed the voice and needs of children, young people and their families, but a number of influential individuals and organisations who have been persistent in raising the profile of children, endeavouring to imprint the values of children’s nursing into NHS policy and practice.   

Further information

About the author

Annette Dearmun is consultant editor of Nursing Children and Young People

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