Paediatric nursing
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Most of the issues around children and pain have been identified and yet children's pain continues to be poorly managed. This review aims to take a fresh look at this topic through the use of family nursing theory and children's policy and rights perspectives. Family nursing and children's policy have a valuable contribution to make to assessment issues; nurse education needs to combine family-centred care concepts and children's rights in the teaching of pain management.
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Recent reports suggest that emergency departments in England are some way from achieving universal provision of specific facilities for children and young people staffed by practitioners with appropriate qualifications. In 1998, 74 per cent of emergency departments employed children's nurses, but only 8 per cent employed them in sufficient numbers to provide 24-hour cover (Smith 1998). ⋯ There has been an increase in the numbers of children's nurses employed in general emergency departments but the numbers are still too low to comply with policy requirements. Managers should ensure that the skills of children's nurses are used to the full, and ENPs need to consider legal and accountability issues if they are asked to assess and treat children without having accessed appropriate training.
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In the rare circumstance when a child is resuscitated there is great debate over whether to allow parents and relatives to remain present. Research reveals both positive and negative family responses to witnessing a resuscitation attempt and the rights and needs of the child/young person must be considered. Staff are generally positive about the benefits of witnessed resuscitation but report a lack of knowledge and skills in supporting the presence of relatives. Scenarios used in resuscitation training need to include the presence of family members and local policies should be developed based on the available evidence.
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An audit to evaluate a protocol for the management of children and young people presenting with self-harm was undertaken at Calderdale and Huddersfield NHS Trust. The objectives were to review current practice and to identify strengths and challenges. The audit showed that most staff were aware of the written procedure for obtaining a specialist assessment by the child and adolescent mental health services (CAMHS), but that feedback was inconsistent and there was a need for improved communication between health professionals.