Early pregnancy care

Clinical nurse specialist in early pregnancy care | The Royal College of Nursing

This document outlines the key skills and knowledge required to develop the role of the clinical nurse specialist in early pregnancy care.  It is intended to provide direction for commissioners and managers when creating roles to support best practice in local service provision for women and their families.

Full document: Clinical Nurse Specialist in Early Pregnancy Care

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National maternity and perinatal audit

The Healthcare Quality Improvement Partnership (HQIP) has published National Maternity and Perinatal Audit: Clinical report 2017.

This report identifies areas of good practice and opportunities for improvement in the care of women and babies in maternity services across Britain. The report recommends further improvements in the quality of maternity data so that more outcomes, such as proportion of births without intervention, can be measured accurately. This data will enable women, clinicians, commissioners and policy makers to evaluate care given locally and nationally and use it to drive further improvements in the quality of maternity services.

Additional links: HQIP press release  | Royal College of Midwives press release

Protection of Nurses Working with Children and Young People

Guidance to raise awareness among nurses and their managers of the complex issues surrounding safeguarding in the context of relationships between nurses and children and young people | RCN

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Image source: RCN

For the vast majority of nurses, harming those in their care, or even the possibility that another professional/colleague could, is the farthest thing from their minds. However, the RCN recognises that there are child abusers who target young people when they are at their most vulnerable. Abusers of children sometimes actively seek access to children by joining professions such as nursing, medicine, social work and teaching.

While in most identified cases, sexual abuse against children is carried out by men, it is important to recognise that women do it too. It is also important to keep things in perspective – the vast majority of nurses provide high standards in all aspects of caring for children and young people and protecting them from harm.

 

The role of nurses’ clinical impression in the first assessment of children at the emergency department

This study explores the diagnostic value and determinants of nurses’ clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED) | Archives of Disease in Childhood

Main outcome measures: Diagnostic accuracy of nurses’ clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses’ impression that a child appeared ill.

Results: Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses’ clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses’ impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours.

Conclusion: The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity.

Full reference: Zachariasse, J.M. et al. (2017)  The role of nurses’ clinical impression in the first assessment of children at the emergency department. Archives of Disease in Childhood. Published Online First: 10 June 2017

Protection of Nurses Working with Children and Young People

This guidance aims to raise awareness among nurses and their managers of the complex issues surrounding safeguarding in the context of relationships between nurses and children and young people.

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Image source: http://www.rcn.org.uk

In the publication, the Royal College of Nursing  include the age range of 0-18 (up to 25 years in line SEND reforms) in this definition and also advocate the need for special consideration in view of children and young people who may have a disability, or other need that affects their mental capacity to make decisions. This guidance concentrates on allegations of abuse made against staff such as smacking a child and inappropriate physical contact.

Click here to view this guidance.

Facilitators & barriers of palliative care in the neonatal unit

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Kilcullen, M. & Ireland, S. Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery. BMC Palliative Care | Published online: 11 May 2017

Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit.

Conclusions: This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

Read the full article here

Digital educational programme on nurses’ knowledge, confidence and attitudes in providing care for children and young people who have self-harmed

Manning, J.C. (2017) BMJ Open. 7:e014750.

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Objectives: (1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children’s nurses working with children and young people (CYP) admitted with self-harm.

(2) To explore the perceived impact, suitability and usefulness of the intervention.

Intervention: A digital educational intervention that had been co-produced with CYP service users, registered children’s nurses and academics.

Conclusions: The effect of the intervention is promising and demonstrates the potential it has in improving registered children’s nurse’s knowledge, confidence and attitudes. However, further testing is required to confirm this.

Read the full article here