How_to_Work_with_Carers

Advice for nurses working with children and young people This information was updated May 2008. For further information, please contact advice@nmc-uk.org Introduction This information has been developed by the NMC in conjunction with children and young people, parents and other carers, nurses and other staff. It is relevant to all nurses and midwives seeking to develop their practice in order to respond sensitively and appropriately to the needs of children and young people. In developing this advice, children and young people, parents and other carers, nurses and other staff who care for children and young people participated in a series of workshops across the UK to identify: What should a child or young person expect from a nurse caring for them' What should a nurse caring for children and young people be' What should a nurse caring for children and young people do' The findings are incorporated in this document. The NMC recognises that the provision of contemporary healthcare to children and young people is strongly influenced by Government policy drivers across the four countries of the UK and by significant advances in knowledge and technological capability, which result in new interventions and changing public expectation. Because the field of children’s and young people’s healthcare is developing rapidly and is challenging traditional boundaries of professional groups, ethical frameworks, models of service delivery and public expectation, nurses need additional advice in order to interpret The code: Standards for conduct, performance and ethics for nurses and midwives (2008) (the code) appropriately within this context. The NMC recognises that safe, effective and appropriate children’s nursing involves more than just the application of theory to practice. It involves an awareness and application of self, a motivation to build trusting relationships with children and young people and with their parents, and active consideration of the rights of children as set out in the 1989 United Nations Convention on the Rights of the Child. Nurses working with children and young people have the needs and rights of the child, independent of their parents as their focus but also recognise and acknowledge the needs of parents and their right to parent their child. This creates a tension in respect of enabling the child to exercise their rights, for example, keeping the child/young person’s confidence and enabling them to take decisions where it is appropriate to do so. This is in part governed by legislation around consent and the circumstances in which a child or young person can consent for themselves. Nurses working with children and young people have an absolute duty to safeguard and protect children and young people from harm, and this can mean breaking confidences by sharing information in order to protect, and dealing with the very difficult situations that can arise as a result. This advice is designed to support the development of nurses working with children and young people so that they can be effective in the application of their self-awareness, as well as effective in applying their knowledge and skills. It provides a framework for best practice and offers an added support to the interpretation of the code. It should be read in conjunction with the code and with the Values for integrated work with children and young people. This document should also help employers and education providers to develop and implement systems that can support best practice and develop reflective, emotionally competent practitioners. The advice recognises and embraces the values and needs of children and young people and of their parents, as identified by them throughout the drafting of this document, and aims to further safeguard the health and wellbeing of the public by addressing the necessary application of self-awareness in effective children’s nursing. A note on terminology For the purposes of this document the term parents encompasses parents and other legal carers. The term family encompasses parents, siblings, grandparents and other relatives as well as other people who have significance for the child or young person, including friends, neighbours etc. The NMC code: Standards of conduct, performance and ethics for nurses and midwives The advice in this document is based on the following four principles set out clearly within the code "Make the care of people your first concern, treating them as individuals and respecting their dignity" "Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community" "Provide a high standard of practice and care at all times" "Be open and honest, act with integrity and uphold the reputation of your profession" The advice has been developed by the NMC in conjunction with children, young people, parents, carers, nurses and others who work with children to guide nurses as they seek to continually develop their practice in order to meet the needs of children and young people. What can a child or young person expect from a nurse caring for them' “Be the best you can be.” (child participant at Edinburgh roadshow, 2006) Children’s nurses have specialist training to care for children. They are educated in children’s physical, cognitive and emotional development and take account of children’s developmental stages in these areas in their practice. They know that the needs of children and young people change over time and that they develop the skills and abilities to become increasingly involved in their care. Children’s nurses also know that communication in all forms is vital to enable this to happen and to reduce fear and anxiety for the child/young person and for their parents. Nurses working with children and young people should be confident and competent in providing the fundamental aspects of care. This gives confidence to the child/young person and to their parents. This confidence and competence is underpinned by knowledge and practical ability in the areas of child development; communication with children, young people and their families; play and entertainment; and family and other social systems important in the lives of children and young people. Competence and confidence in clinical skills are also important for children, young people and their parents. Nurses working with children and young people should be mindful of the additional distress that some procedures can cause at different stages of the child/young person’s development, especially where the nurse is learning and appears fearful herself. Moreover, nurses working with children and young people need to be able to provide support and education to children, young people and their families in order to enable them to understand what needs to be done and why, to make decisions about their treatment options and to be able to contribute meaningfully to their own care. Principles Principle 1: Make the care of children, young people and their parents your first concern, treating them as individuals and respecting their dignity Principle 2: Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community Principle 3: Provide a high standard of practice and care at all times Principle 4: Be open and honest, act with integrity and uphold the reputation of your profession Principle 1: Make the care of children, young people and their parents your first concern, treating them as individuals and respecting their dignity 1.1. Treat people as individuals Introduce yourself and your role to the child/young person and their parents. Get to know the child/young person and their parents as individuals – accept that all families are different. Work in such a way as to ensure that children’s and young people’s rights are protected and asserted. Use your knowledge and expertise to communicate directly with children and young people; listen and respond appropriately to what they say themselves. Plan your care to build in time for personal contact – be friendly, professional and compassionate. Be attentive to the needs of children and young people and make time for interventions – don’t rush. Be prepared to be flexible and patient. Acknowledge the role of siblings, other family members and friends in the lives of children and young people and the effect that illness or disability may have on them. Work positively with siblings and friends for the benefit of the child/young person. Act in ways that recognise and acknowledge the expressed beliefs or choices of children, young people and their parents – don’t be judgemental. Provide information for parents about how they can meet their personal needs (for example where they can eat cheaply when their child is in hospital; where they can meet other parents whose children have similar health needs; who in their local community can provide support and other services to assist) and what is expected of them in relation to their child’s care. 1.2. Respect confidentiality Work within the legal frameworks of the country in which you are working to hold and share information, being mindful of your duty to protect children and young people from harm and to co-operate with other members of the team in order to provide safe and effective care. Share information that is required for safe practice and to safeguard children and young people in a sensitive and proportionate manner. Work with children and young people to assist them in talking openly to others and sharing their own information. Where consent to share information is not given, you must decide and justify your decision to share the information or to withhold it. Seek advice from your manager or experts in the field when you are unsure whether to share information. Ask the child/young person how they want you to communicate sensitive information. When using technology such as mobile phones and email to communicate with children and young people, you need to balance the benefits against the risk of breach of confidentiality. You should follow guidance, policy and legislation in doing this. 1.3. Collaborate with those in your care Recognise the knowledge and skill held by parents and by the child/young person in relation to their child and their illness, disability or treatments. Work in partnership with parents (and others where appropriate) to enable them to be involved when they wish to in all aspects of the child/young person’s care through. Take steps to identify and overcome any barriers to understanding, whether this is the result of verbal language, disability, stage of development and understanding or anxiety. 1.4. Ensure you gain consent Ensure your practice is within the legal frameworks for consent and capacity for the country in which you are working. Empower children and young people and their parents through providing information and giving them time for making decisions. Respect the rights of children and young people and of their parents within the legal frameworks. Explain honestly what needs to be done and why, and whether there are any choices to be made. If there are choices, help children and young people to make decisions using play and other appropriate means of communication. Where there is a disagreement between the child/young person and their parents, or between parents, use clinical governance frameworks to seek advice on how to resolve the situation before the intervention or course of treatment begins. Document the content of all discussions, any disagreements and the action you have taken to resolve this and the outcome. Give information as early as possible, be prepared to repeat this and to discuss any concerns – consent must be voluntary and without coercion. Check that the child/young person and their parent / carer understand the information they have been given. Be prepared to explain complex concepts which are not understood and document the discussions. Ask questions of other members of the team on behalf of children, young people or their parents where they are not able to do this themselves. 1.5. Maintain clear professional boundaries Build relationships with children and young people that are based on trust and respect. Act in a professional manner and maintain professional boundaries in your relationships with children, young people and their parents. This means being clear about your role as a nurse and saying ‘no’ to their requests for personal support outside your contract of employment. Seek advice from your supervisor or manager if you are in any doubt about where the professional boundaries are or if your feel you have crossed those boundaries. back to top Principle 2: Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community 2.1. Share information with your colleagues Provide verbal and written information to other members of the team in order to enable them to care safely and effectively for the child/young person Communicate with colleagues in the care setting and with the child/young person and their parents about your plan of care. You have a duty to safeguard and promote the welfare of children and young people at all times. 2.2. Work effectively as part of a team Understand and be proud of your role as a children’s nurse. Understand and respect the roles of others members of the team. Collaborate and work in partnership with others to provide holistic care for the individual child or young person. This includes working with parents and the child/young person and with members of other professional groups and sectors. 2.3. Delegate effectively Where you need to delegate aspects of care to others, you are responsible for ensuring that they have the necessary knowledge and skills, and you remain accountable for their care if they are not a registered professional. 2.4. Manage risk Work with others to identify potential risks to children and young people and generate strategies to manage these risks, recognising and acknowledging that risk-taking is a normal part of development which enables children and young people to learn strategies for assessing and managing risk themselves as they grow and develop. Ensure that the physical environment is appropriate for children, young people and their families, and highlight safety concerns where you are not able to take immediate action to remove, reduce or manage the risk Ensure that essential standards for environmental safety and clinical practice are maintained and take appropriate action when these fall below agreed levels. Report, reflect on and learn from adverse events and near misses. Work flexibly to ensure safe levels of cover and appropriate skill mix for the level of activity and dependency. Use resources effectively and efficiently in order to provide the best possible care within limited resources. This includes prioritising care and contributing to the development and implementation of more effective and efficient ways of working. back to top Principle 3: Provide a high standard of practice and care at all times 3.1. Use the best available evidence Ensure that your nursing interventions are based on evidence or best practice principles. Ensure that best practice principles are applied in relation to involving children in research, involving the organisation’s research governance lead where there are concerns about the research study. 3.2. Keep your knowledge and skills up to date Ensure that you remain competent to perform the range of nursing interventions required for the children and young people in your care within the parameters of the role in which you are employed. Take steps to acquire new knowledge and skills to meet the needs of children and young people as interventions and roles develop and change over time. Use reflective practice, supervision, work-place and other forms of learning to maintain and enhance your skills and knowledge. Use performance review processes to identify appropriate formal learning opportunities such as further training and education programmes to enhance your practice and your professional development. Be conscious of the impact on children and young people of tentative, nervous attempts to learn new skills and wherever possible, make appropriate opportunities to gain competence before practising on a child. Maintain knowledge of local voluntary and statutory organisations which can offer support to children, young people and their families and seek to make connections. Use knowledge of children’s development and how this impacts on anatomy, physiology, understanding, physical development to underpin your practice and to assess the physical, emotional and psychological risks posed to children, young people and their family as a consequence of the child/young person’s illness, disability or being in a care setting. Ensure that you are appropriately trained and competent in respect of the knowledge and skills required to deliver all aspects of care, in particular those deemed of higher risk such as the administration of medicines and invasive interventions. back to top Principle 4: Be open and honest, act with integrity and uphold the reputation of your profession 4.1. Act with integrity Take account of your own behaviour and attitudes and the effect this has on relationships with children, young people and their parents. Be open, honest and consistent in your interactions with children, young people and their parents, and with colleagues. 4.2. Deal with problems Challenge others in the team who do not hold the child/young person’s interests as central, and who may put their professional aspirations above the needs of the child/young person.