Getting it right for children
and young people
A self-assessment tool for practice nurses
Acknowledgements
This publication has been produced by the Royal College of Nursing and the Royal College of General
Practitioners with support from the Department of Health and Department for Education and Skills. They
would like to thank the following for their contribution and support:
CPHVA
Royal College of Midwives
Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN
© 2006 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of
the Publishers or a licence permitting restricted copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London
W1T 4LP. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover
other than that in which it is published, without the prior consent of the Publishers.
Foreword
In 2004 my predecessor, Sarah Mullally, published the Chief Nursing Officer’s review of the
nursing, midwifery and health visiting contribution to vulnerable children and young people.
This review, which forms part of the cross-Government Every Child Matters: Change for Children
programme, identifies changes in practice that are needed to improve the outcomes for the most
vulnerable children and young people in our society.
In particular, the CNO review recognises that children and young people are the highest users of
general practice. It notes that this setting provides valuable opportunities for identifying and
acting on behalf of children at risk and delivering health improvement and parenting messages.
However, the review also highlights concerns about practice nurses’ ability to undertake such
work. Strengthening practice nurse competencies to work with children and young people was
seen as a priority and a number of recommendations are made. These include developing
competencies for nurses working with children and young people in general practice and
out-of-hours services. A self-assessment tool was proposed to help nurses to work with their
practice colleagues and clinical supervisors to identify their existing skills and any gaps that
need to be addressed.
The Department of Health and the Department for Education and Skills have supported the
Royal College of Nursing, Royal College of General Practitioners and other key professional
organisations in producing such a tool. I am delighted to commend this document to you as a
means of improving practice in working with all children and young people and helping to ensure
better outcomes for the most vulnerable.
Christine Beasley, Chief Nursing Officer (England),
Department of Health, London, April 2006
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Supporting statement from RCGP
and RCN presidents
The Chief Nursing Officer’s review clearly recognised that children and young people are high
users of general practice services. The recent white paper Our health, our care, our say stresses
the importance of care as close as possible to home, with new and enhanced roles for
practitioners working within general practice and other primary care settings.
We are delighted to commend this resource to practice nurses, and urge general practitioners and
others to assist colleagues to use this tool as part of their continuing professional development.
The checklist aims to improve the care of children and young people, by enabling individuals and
teams of practice nurses to develop additional knowledge and skills.
We would like to thank the Department of Health and Department for Education and Skills for
their support in developing this checklist.
Dr Roger Neighbour FRCGP
RCGP President
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Sylvia Denton CBE FRCN
RCN President
Getting it right for children and
young people
A self-assessment tool for practice nurses
Introduction
Making sure that practice nurses are able to meet the health needs of babies, children and young people is
critically important. A pre-school child will attend their GP practice about six times every year and school-aged
children two or three times a year (DH, 2003; DH, 2004). Practice nurses may be the most easily accessible
first point of contact a child and family has with the health service, and general practice provides valuable
opportunities for identifying and acting on behalf of children at risk and for delivering parenting messages.
Such opportunities are likely to be found where staff are confident in assessing the needs of children, young
people and their families, and where informal day to day contact promotes team working and early discussion
of children who may be of cause for concern.
Registered nurses, midwives and health visitors must abide by the requirements of the Nursing and Midwifery
Council Code of professional conduct (NMC, 2004), which states that each practitioner is accountable for his
or her practice. Although there are a number of highly skilled practice nurses and nurse practitioners with a
children’s nursing qualification working in general practice and other first contact services, many nurses in
these settings will not have had an opportunity to undertake any specific training in the care of children and
young people. In seeking to improve service provision, the Chief Nursing Officer’s review of the nursing,
midwifery and health visiting contribution to vulnerable children and young people (DH, 2004) recommended
the development of a best practice ‘self-assessment tool’ to help nurses to work with their colleagues and
clinical supervisor to identify their existing skills in caring for children and young people, and any gaps that
need to be addressed.
The following scenarios may help you to decide whether this self-assessment tool is for you:
• you are giving an immunisation and a mother asks you about the best age to start the baby on ‘solids’
• a mother arrives in the surgery saying that her toddler has bumped his head and asks if you think he needs
to go to the emergency department
• you are concerned about a three-month-old baby who has a bruise on his arm
• you are unsure what advice to give to a 15-year-old who has asked you about contraception
• a three-year-old is very difficult to understand and you wonder if you should suggest contact with the
health visitor
• a media campaign has alerted you to the problem of child abuse and you are surprised that you have not
come across this in your practice
• you think a 13-year-old is a bit quiet and wonder if they might be depressed.
About the tool
This self-assessment toolkit is divided into two parts. Part One links to the Common core of skills and
knowledge for the children’s workforce (DfES, 2005), which outlines a common set of skills and knowledge
that has been designed for use by everyone working with children and young people. Part Two highlights the
key clinical skills and knowledge required to address the needs of children and young people presenting with
acute illness and injury, as well as the environment for care.
We recommend that you complete the tool, and discuss plans for updating and developing practice in the
care of children and young people with your line manager and clinical supervisor. You could also use the
tool within your team, perhaps as part of a focus on the quality of care of children and young people in
your care setting.
3
4
Other key contacts
Children’s community nurse/team
Link midwife
Link health visitor
Named nurse for child protection
Clinical supervisor (for children and
young people)
PCT children’s lead
Name of practitioner:
Name
Date:
Contact details
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The skills and knowledge highlighted in this
section cover the physical, intellectual,
linguistic, social and emotional growth and
development of children and young people,
and encourages the development of your
ability to recognise concerns and provide or
signpost additional sources of information
and advice.
Child and young person
development
The skills and knowledge highlighted in this
section will help you to communicate
effectively with children and young people.
This includes developing your skills of
listening, explaining, building empathy,
consultation and negotiation, and awareness
of issues such as confidentiality, ethics and
respect.
Effective communication and
engagement
Comments/action plan
The Common Core of Skills and Knowledge (DfES, 2005) is a tool that will help
you to focus on your individual training and practice development needs in
relation to your work with children and young people. It is suggested that you
access the document and consider your current level of skills and knowledge
in each of the six areas of expertise. Then you can work with your supervisor
to develop an action plan to ensure that you are confident and competent in
any areas that need development.
Review date
See: www.everychildmatters.gov.uk for an electronic version of the document
and for links to other new tools and processes that are being developed to
support better outcomes for children and young people.
Part 1: Common Core of Skills and Knowledge
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The skills and knowledge highlighted in this
section will help you to be confident in your
own practice and enhance your ability in
seeking and responding to the knowledge and
input others can make in delivering the best
outcomes for children.
Multi-agency working
The skills and knowledge highlighted in this
section will help you to recognise and
understand the impact of transitions in the
lives of children, young people and the need
for reassurance, advice and support for
parents and carers at this time.
Supporting transitions
The skills and knowledge highlighted in this
section encourage an awareness of your
own role and responsibilities in safeguarding
and promoting the welfare of children and
young people, including understanding
national guidance and local procedures,
knowing when to involve others and where
to get advice and support. This should be
updated annually.
Safeguarding and promoting the
welfare of the child
Comments/action plan
Review date
7
The skills and knowledge highlighted in this
section recognise that timely information
sharing is an essential part of helping to
deliver better services to children, young
people and their families. This includes an
understanding of respect issues and
legislation surrounding the control and
confidentiality of information.
Sharing information
Comments/action plan
Review date
8
- clinical signs of dehydration:
• infant
• child
• adolescent
Basic clinical assessment
including:
• infant
• child
• adolescent
Signs that may indicate an unwell:
• newborn infant
• six-month-old infant
• one-year-old
• five-year-old
• ten-year-old
• 15-year-old
Normal parameters for vital signs:
Key skills and knowledge
Tick
Comments/action plan
Review date
If you do not have the relevant skills to address the particular need, you
should be aware of where to gain advice or who to refer to; this may include
other team members such as general practitioners, nurse practitioners, health
visitors and school nurses. The CNO Review recommends that all nurses
working with children and young people have access to support and
supervision from a qualified children’s nurse and this may mean accessing a
professional from the wider local workforce.
Recognising and responding to an acutely ill/injured child
During routine visits you can promote healthy options and identify health
issues which, if treated early, can reduce lifelong effects and in some cases
save a child’s life. We recognise that clinical knowledge and skills will vary
according to your prior learning and practical experience. We also recognise
that roles may differ according to the needs of the practice. You can work with
your supervisor to highlight the aspects of care delivery that are pertinent to
your role.
Part 2: key clinical skills and knowledge
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• burns/scalds
• head injury
• soft tissue injury
• bone injury.
First aid:
(updated annually)
• infant
• child
• adolescent
Resuscitation skills:
• infant
• child
• adolescent
Treatment of a fitting child:
• infant
• child
• adolescent
Treatment of choking:
• infant
• child
• adolescent
Treatment of anaphylaxis:
- basic respiratory assessment:
• infant
• child
• adolescent
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Immunisation schedule and
contraindications
Recognition of common child
and adolescent illnesses and
infestations
• youth counselling
• teenage sexual health services
• drug and alcohol services
• child and adolescent mental health services
• health visitor
• school nurse
• community children’s nurse
• Connexions
• children’s social care.
Signposting and referral to:
• infant feeding
• weaning
• sleep
• behaviour problems
• transitions.
Preliminary advice and support:
Key skills and knowledge
Tick
Health promotion, minor illness and injuries
Comments/action plan
Review date
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• physical (including neglect, fabricated or
induced illness)
• sexual (including non-consensual
relationships)
• behavioural and emotional abuse and
neglect
• domestic violence.
Assessment and referral for possible
child protection concerns:
• oral
• inhaled
• eye/ear
• injected
• buccal
• per rectum (PR)
• topical.
Administration of medicines in
childhood:
• recognition of failure to thrive/faltering
growth
• puberty
• childhood obesity
• eating disorders.
Normal parameters for height and
weight:
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• hand-washing for staff, CYP and
parents/carers
• disposal of soiled nappies/pads
• safe storage of medication, lotions, needles,
syringes
• hazards – sharps bins, electrical socket
covers, equipment
• Control of Substances Hazardous to Health
Regulations (COSHH) policy
• cleaning and decontamination/disposal of
toys, books and furniture.
Safety and hygiene
• access
• communication and consent
• moving and handling techniques
• toilet/changing facilities.
CYP with disabilities/special needs
• advocacy
• choice
• consent and confidentiality
• chaperoning
• interpretation
• breast-feeding facilities
• nappy-changing facilities.
Privacy and dignity
Ensuring provision/policies for:
Environment for care
Tick
Comments/action plan
Review date
13
• provision of health promotion materials (for
example, sun-safe, accident prevention,
healthy eating)
• access to local children’s service directory
• self-help groups for children with chronic
illness and special needs.
Information and displays
• CYP friendly environment
• provision of suitable (for example, washable
and age-appropriate) play equipment, books
and furniture
• preparation for procedures – use of topical
local anaesthetic cream
• knowledge of distraction techniques and
provision (TV, video, light shows etc)
• permitted holding techniques.
Play and distraction
Resources
Sources of support and learning resources
The greatest support for undertaking self-assessment will come from within your team; whether that is in
supporting your learning or facilitating opportunities for study time, shadowing activities or more formal
training and updating opportunities.
You do not always have to attend a course to develop your knowledge and skills. You can enhance your
knowledge through e-learning, reading publications, reviewing evidence and speaking to experts.
We suggest you:
• Check out the publications and learning resources available from:
– Royal College of Nursing – www.rcn.org.uk or tel: 0845 772 6100
– Royal College of General Practitioners – www.rcgp.org.uk
– National Electronic Library for Child Health – www.nelh.nhs.uk
– Information on rare conditions – www.cafamily.org.uk
– Skills for Health – www.skillsforhealth.org.uk
• Make contact with local experts such as:
– children’s community nursing, school nursing and health visiting teams
– local children’s nurse specialists for child protection, asthma, diabetes and epilepsy
– the lead children’s nurse at your local children’s unit, primary care organisation and strategic health
authority, inviting them to speak/present a topic at one of your practice meetings/practice nurse meetings.
• Find out what is available from:
– the training department in your primary care organisation
– your local higher education institution.
This is not a comprehensive checklist but will enable you to consider your learning and personal development
needs. You should highlight these with your manager as part of your annual appraisal.
Annual updates
Every year you should ensure that you receive an update in child protection and basic life support skills for
infants, children and older children.
Date
Child protection
Basic life support
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Date
Date
Date
Date
Date
Date
References
Department for Education and Skills (2005) Common Core of Skills and Knowledge for the children’s
workforce, London: DfES.
Department of Health (2003) Getting the right start: the children’s national service framework for children,
young people and maternity services – emerging findings, London: DH.
Department of Health (2004a) The Chief Nursing Officer’s review of the nursing, midwifery and health visiting
contribution to vulnerable children and young people, London: DH.
Department of Health (2004b) The national service framework for children, young people and maternity
services, London: DH.
Nursing and Midwifery Council (2004) Code of professional conduct, London: NMC.
Other useful resources
Websites
• Skills for Health www.skillsforhealth.org.uk
• Royal College of Nursing: children and young people’s resources www.rcn.org.uk/cyp
• Information on children and young people’s policy www.everychildmatters
• Contact a family: Information on rare conditions www.cafamily.org.uk
Publications
• British Medical Association (2001) Consent, rights and choices in health care for children and young people,
London: BMJ Books.
• Department of Health (2001)
– Good practice in consent implementation guide
– Reference guide to consent for examination or treatment
– Seeking consent: working with people with learning disabilities
– Seeking consent: working with children and young people
– Consent what you have a right to expect:
– children and young people
– people with learning disabilities
– parents.
Copies available from www.dh.gov.uk/consent/index.htm
• Huband S and Trigg E (2000) Practices in children’s nursing: guidelines for hospital and community, London:
Churchill Livingstone.
• Royal College of General Practitioners & Brook (2000) Confidentiality and young people, improving
teenagers’ uptake of sexual and other health advice: A toolkit for general practice, primary care groups and
trusts, London: RCGP.
• Royal College of Nursing (2003) Restraining, holding still and containing children: guidance for good
practice, London: RCN.
• Royal College of Paediatrics and Child Health (2003) Bridging the gaps: health care for adolescents,
London: RCPCH.
• Sidey A and Widdas D (2005) Textbook of community children’s nursing, 2nd edition, Edinburgh: Elsevier.
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The RCN fully supports its members in raising concerns regarding the care of children and young people,
and the protection of their rights as individuals.
If you feel compromised – for example, if training provided by your employing organisation is inadequate
and you are not getting the help you need – contact RCN Direct on 0845 772 6100 or ring your local RCN
office. Contact numbers can be found in your RCN members’ handbook.
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The attached CD-Rom contains copies of some useful documents,
publications and weblinks which you may find helpful when using
this self-assessment tool.
April 2006
Published by the
Royal College of Nursing
20 Cavendish Square
London
W1G ORN
020 7409 3333
The RCN represents nurses and nursing, promotes
excellence in practice and shapes health policies.
Publication code 002 777
ISBN 1-904114-26-1