10/05/2023.

 

We looked at the learning outcomes.

• To understand the primary difference between assessing children versus adult.
• To understand what is meant by assessing and what this entails.
• To understand the anatomical differences between adult and children.

We looked at the definition of assessment according to (Cambridge Dictionary, 2002). ‘The act of judging or deciding the amount, value, quality or importance of something, or the judgement or decision that is made’.

Children versus Adults:

We say children are not little adults.

Their health is more than absence of illness.

Children needs environment s which promote growth and development.

Adults must ensure that children are protected from environmental threats.

There are different types of assessments for children:

• Clinical
• Social and emotional.
• Physical development.
• Environment
• Family

Hospital setting assessment process guided by the great Ormand street manual of children’s practices (2012). The things to consider:

Age.

Gender

Cultural and religious beliefs,

Languages spoken,

Family history and medical history, and parental responsibility. For the assessment process, rapport – good communication skills are considered. That is verbal/nonverbal, interpreters are required, open and closed questions, clarify understanding.

The present history- the reason for attending, what are the main health concerns. What are the symptoms/pain depending on the age of the child. If younger the parent/guardian with supply this information.

The past medical history – may be relevant to take the birth history depending on the child’s age, the history of illnesses or the episodes if occurring. The current medication, any allergies. Updated Immunisation date.

The developmental aspect are speech and language, gross monitor, fine monitor, cognitive, social and emotional. The developmental norms – speech and language

Language – 18 month says approximately 20 words, 2 years say about 50 or more single word, to start to put 2-3 words together to make a sentence. 3 years uses up to 300 words, refer to things in the past, ask lots of questions – what? Why? Who?  4 years understands and say lots of words, longer sentences, and link them together, answer why? Questions. We looked at the developmental norms from 3 months up to 18 years.

Measuring Vital Signs – PEWS (Paediatric Early Warning System) in checking the vital signs of the children, we calculate the following: Heart Rate, Respiratory rate, Oxygen requirement, Saturations, Consciousness, Blood pressure, Capillary Refill Time, and skin colour. Theis will provide a score and a trend which is easily quantifiable as a red flag. The purpose to facilitate better communication between staff and to have a timely controlled management of care. Things to observe in measuring vital signs: normal respiration is a normal relaxed subconscious activity. Oxygen saturation is greater than 93%, pattern, effort and rate of breathing should be recorded, and the skin colour. In measuring their respiration for abnormal breathing: tachyaponea, retractions – subcostal, intercostal and tracheal tug, head bobbing, nasal flaring, apnea-pausing in breathing greater than 20 seconds and how the child positioning themselves.

Measuring the heart rate/pulse in children: always explain/show to the parent and child what you are about to do. Under 2’suse a stethoscope on the apex heartbeat and older children uses the radial pulse, ensure count for a full minute.

Measuring blood pressure, ensure the cuff size is correct (must cover 80-100% of the child circumference of the child’s arm but no more and there should be an overlap of the cuff), the cuff should be positioned over the artery, the dept of the bladder should not cover more than 2/3 of the upper area. Make sure the child is calm (sucking, crying, and eating can affect the reading).

Measuring the Capillary Refill Time (CRT): If using a finger, hand must be raised to the heart level. Compress for 5 seconds using forefinger, monitor time takes for the blood to return capillaries (normal skin colour) good perfusion if returns in less than 2 seconds.

Measuring the pain score: a valid pain assessment should be used, it should be age appropriate. This should be done on admission for a base line assessment, and accurate documentation should be done.

Measuring weight: to gain the accurate measurement on admission to calculate drugs. Ages 0-2 years should be weighed naked, 2 plus with minimal light clothing depending on the age.

At the end of everything, this should be recorded accurately. The clarity around the frequency, which observations needs recording, which limb was used for BP, the activity of the child when the observation was taken, and the consistence approach to how the result are documented.

 

KSB ADDRESSED.

K1: Understand the code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.

 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

 

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

 

K8: Understand how discriminatory behaviour is exhibited.

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical, and behavioural health, and well-being.

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours, and lifestyle choices to mental, physical, and behavioural health outcomes.

 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

K17: Understand commonly encountered mental, physical, behavioural, and cognitive health conditions as applied to delivery of care.

 

K18:  Understand and apply the principles and processes for making reasonable adjustments.

K19: Know how and when to escalate to the appropriate professional for expert help and advice.

K20: Know how people’s needs for safety, dignity, privacy, comfort, and sleep can be met.

 

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.

 

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity.

K24:  Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life.

 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.

 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.

K29: Understand the different ways by which medicines can be prescribed.

 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.

 

K36: Understand the roles of the different providers of health and care.

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services.

 

K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.

 

 

SKILLS:

 

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements.

S2: Keep complete, clear, accurate and timely records.

S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).

 

S17: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).

 

S18: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent.

 

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress, and reporting outcomes.

 

S23: Work in partnership with people, to encourage shared decision making, to support individuals, their families and carers to manage their own care when appropriate.

S25: Meet people’s needs for safety, dignity, privacy, comfort, and sleep.

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health.

 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity.

 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.

 

S30:  when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed.

 

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.

 

S35: Accurately undertake risk assessments, using contemporary assessment tools.

 

 

 

BEHAVIOUR:

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy, and preferences.

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.

B3: Be adaptable, reliable, and consistent, show discretion, resilience and self-awareness