Background to the Research

• As part of the Chief Medical Officer's review of Hospital Services for the 'Acutely Ill Child' the Chief Nursing Officer commissioned a working group to examine the current evidence and position of nursing services for this group of children in NI.
  

Research Approach

• The working group consisted of representatives from community and hospital nursing, education and medicine. They examined provision in the areas of Nursing ill children in the community; Accident and Emergency Services; Paediatric Intensive Care and the role of the specialist children's nurse. This was achieved through the examination of contributions from a wide range of healthcare practitioners and through the exploration of data concerning healthcare in NI and Britain.
  

Main Findings

• A reduction in the number of days children spend in hospital and a drop in the child death rate has been achieved through advances in clinical practice, medicine and technology.
• In the majority of cases the care of children with complex needs takes place at home and this places major demands on family and professionals. In these cases the nurse is often the key professional in providing that care and support.
• Over the past 10 years the development of specific medical and nursing services for children in NI has not kept pace with recommendations that have emerged from numerous reports.
• Currently some services are fragmented in their organisations and are often delivered by staff who have limited specific knowledge or training in the care of children.
• The desire of government to extend the development of new roles for nurses working in acute and community services has major implications for workforce planning and the education and training of children's nurses.

Recommendations

Nursing Ill Children in the Community

• All children needing nursing interventions should have easy access to a Children's Community Nursing Service; this should be available 24 hours a day, 7 days a week.
• A model of service should be developed that supports the child and family in the home, links into secondary and tertiary care (when required), and builds on the integrated Health & Social Service in NI.

Accident & Emergency Children's Nursing

• Joint protocols should be developed between primary, secondary and tertiary care for the treatment of children. This should include how and in what circumstances children are transferred between units. Networks for sharing practice in the clinical management of acutely ill children should be developed.
• Appropriate nursing staff (Parts 8 & 15 of the UKCC Register RCN, PALS, APLS) should be available at all times, in all Accident and Emeregency departments. Skills should be maintained with ongoing training and education combined with rotation into and out of the tertiary centre.

Paediatric Intensive Care

• Nationally agreed standards for nursing staff should be implemented.
• Children should not be cared for in an intensive care unit which fails to meet the current standards, except for stabilisation and in unavoidable circumstances. The practice of providing intensive care for children within adult intensive care must stop.

Developing Nursing Roles

• All children should have appropriate access to a specialist nurse specific to their condition, e.g. asthma, diabetes, epilepsy and child/adolescent psychiatry.
• All Community Children's Nurses should hold an appropriate qualification.

Workforce, Planning, Education and Development

• Effective, robust workforce planning should be developed which will help Health and Social Services Trusts plan for future requirements, including education and training needs.
• The numbers of students entering pre-registration children's programmes must be kept under review in order to meet current service needs and future developments.