Child health nursing placement settings

Health visiting teams may consist of:

• health visitors
• community public health nurses
• community nursery nurses
• family health workers
• and community clerical officers. 

They work in partnership with local GP practices and children’s centre staff. They visit families in their own homes, facilitate community based groups and run clinics in health centres and community settings. 

Health visitors are in a unique position to deliver government policies in relation to the public health agenda, working in partnership with families, education, social care and other allied professionals to assess for health needs and facilitate early intervention. They are ideally placed to provide ongoing support, playing a key role in bringing together relevant local services to help families with continuing complex needs, for example where a child has a long-term condition.

Health visitors offer Universal core services to all families with children under five years old and targeted support to families with additional needs such as post-natal depression, substance misuse, domestic abuse, teenage parents and those living in disadvantaged circumstances. This way of working is set out by the Healthy Child Programme (Department of Health, 2009) and the 4-5-6 Model of Health Visiting (Department of Health, 2015). 

Health visitors work in partnership with families and communities to improve access, experience and outcomes and to reduce health inequalities. They consider individual community needs including asylum seekers, travelling communities, religious and culturally diverse groups.

The school nursing service delivers the universal healthy child programme 5 - 19 to improve health outcomes for the school aged population. The team works in partnership with children, young people and their families as well as other professionals and agencies to ensure that children's health needs are being met and supported within their school and local community The healthy child programme is aimed at children, young people and families to focus on early intervention and prevention. Therefore, the school nursing service aims to:

• Immunise children to protect against disease and infection
  
• Provide health education
  
• Promote healthy lifestyles
  
• Provide drop-in sessions
  
• Work with agencies to safeguard children from harm
  
• Complete school entry screening
  
• Complete growth measurements for reception and year 6 children for the National Child Measurement Programme, and offering advice and support
  
• Undertake comprehensive health assessments which can be completed at home, in school or within a clinic setting.
  
• They are able to offer confidential health advice and support on all aspects of children's development.

Specialist schools provide education for students with special education needs. The schools utilise a variety of teaching methods to meet the individual needs of children and are flexible in their approach to allow for any additional needs. Common special needs catered for within the schools are:

• learning disabilities
• communication disorders
• emotional and behavioural disorders
• physical disabilities such as Cerebral palsy and Muscular Dystrophy. 

Pupils with such specialist needs benefit greatly from the additional educational services offered within the specialist schools. Pupils will also have access to other health and social care professionals within the school such as nurses, physiotherapists and speech and language specialists.

The skills you will develop during a placement with the special school will vary greatly depending on the nature of the school you visit and can range from communication skills and behaviour management to care of a child with a feeding tube or requiring long-term ventilation. The special schools are very different to placements you will be familiar with and will provide a unique opportunity to develop your confidence in caring for children and young people with additional and complex health and social care needs.

Children’s hospices offer respite and short breaks to families with a child or young person who has a life threatening or life limiting condition, this means that the child or young person is unlikely to survive into adulthood. The hospice also provides emergency symptom management, where distressing symptoms will be managed by experts in paediatric palliative care, as well as end of life care and bereavement support. Children and young people with a life limiting or life threatening condition, such as Cerebral Palsy, Muscular Dystrophy, cancer, leukaemia as well as some other rare conditions, are referred to the children’s hospice at time of diagnosis and will remain under the care of the hospice until death or transition to adult services.

The children’s hospice is often perceived as a sad place for those who have not visited, however, it is often a place of smiles and laughter while the expert health and social care staff work hard to make special memories for the short and precious lives of the children and young people under their care.

The skills you will learn at the hospice include communication, tube feeding, administration of medicines, symptom management, end of life care among many, many more.

Respite and short break units offer short breaks to families with a child or young person who has a disability or additional health need. Many of the respite units you will visit are small bungalows which can house around 4-8 children or young people at any one time. Children who are referred to respite units will have additional health needs of some sort and of varying degrees. Caring for such children r young people at home often places an enormous strain on the family unit, short break units offer some respite from this. Children who access these services can often have very complex health and social care needs and require constant supervision throughout the day and night.

The skills you will develop during a placement within a respite or short break provision will vary greatly depending upon the children or young people resident at the time of your placement. Skills learned can range from communication and behaviour management to administration of medicines and tube feeds to very complex health needs such as care of a child with an artificial airway requiring long-term ventilation.

Community children’s nurses are children’s nurses with qualifications or experience in the community setting. They work closely with children’s wards, health visitors, midwives and GP’s. They visit families in their own homes where children have extra health needs such as long-term conditions, disability or sometimes following an acute illness or surgery. Some community children’s nurses are focused on a speciality such as diabetes or oncology whilst others offer a more generic service. Community children’s nurses provide clinical care or supervise parents and families giving care. They provide ongoing support to the child and family, playing a key role in bringing together relevant local services to help families with continuing complex needs.

These placements normally allow you to experience both environments emphasis will be focused on surgical interventions and post-surgery protocols. There should be ample opportunity to observe surgery, with local, spinal and general anaesthesia. Pain and nausea control are priorities in the recovery setting and of course patients come for surgery with varying levels of fitness, so existing conditions need consideration making assessment the major skill in this setting.

Skills that can developed in this placement setting include:

• Knowledge of the anatomy
  
• Use of anaesthesia and pain control
  
• Vital sign assessment
  
• Use of various monitoring tools such as ABCDE
  
• Post-operative recovery assessment and monitoring
  
• Interprofessional communication

Placement opportunities including: Children’s High Dependency (HDU), Emergency Department, Children’s Theatres, Neonatal-Intensive Care (NICU).

Critical and emergency care placements include the assessment and management of the critically ill neonate or child requiring acute or emergency care. Patients within these environments will require more comprehensive care and constant monitoring than would be available on a ward. Assessment skills are paramount in this setting and learning will be enhanced of all assessment tools and frameworks to augment clinical decision-making.

Skills that can developed in this placement setting include:

• Vital signs
  
• ABCDE assessment
  
• Recognition of the seriously ill child
  
• Care of the neonate
  
• Understanding of Advanced Paediatric Life Support relevant pathways
  
• Documentation of relevant pathways (i.e. sepsis / pain / fluid balance)
  
• MDT communication and interprofessional working
  
• SBAR / handover to other staff

Such as emergency department paediatric specific and combined adult and paediatric departments.

A placement in an emergency area, other areas involves priority treatment for possible life threatening illness / injury, although you will observe the staff dealing with emergencies daily, this setting is also where you can enhance observation and assessment skills. Using the tools available to assess a patient’s status and then the handing over of that information in an appropriate manner to other health care professionals.

All emergency departments in the south west peninsula have paediatric specialist nurses working within them, you should be assigned a paediatric nurse for the duration of your placement. Please expect to have exposure to children, young people and adults.

Skills that can developed in this placement setting include:

• Triage and assessment
  
• ABCDE assessment tools
  
• Glasgow Coma Scale
  
• History taking
  
• Vital signs, pain assessment and monitoring of patients conditions
  
• Communication
  
• SBAR systematic handover
  
• Wound closure, sling application, dressings and splints
  
• ECG recording
  
• Basic and advanced life support processes
  

• Head injury,
  
• Trauma and paediatric emergencies
  
• Minor injuries including wounds and orthopaedic injuries
  
• Child protection and domestic violence
  
• Drug and substance misuse
  
• Mental ill-health

Examples of surgical procedures: ENT, Urology, Dermatology and Orthopaedic

Skills that can be developed in this area:

• Pre-operative preparation of children and young people including play and distraction.
  
• Post-operative care, vital signs, A-E Assessment.
  
• Clinical decision making.
  
• Skills to recognise the deteriorating child or young person.
  
• Communication, information sharing and health promotion.
  
• Medicine management and pain relief.

Examples of medical conditions: Respiratory, cardiac and gastrointestinal, also caring for children and young people with chronic/long term conditions.

Skills that can be developed in this area:

• Communicating with the child and family.
  
• Aspects of infant care.
  
• Care planning and onward treatment.
  
• Vital signs and the assessment of the sick child.
  
• Understanding investigations and the implications of results on changing treatments.
  
• Nutrition, hydration and elimination needs of infants, children and young people.