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Children access their GP service for minor illness and injury and follow up medical reviews for more chronic; sometimes, specialist conditions. Health Visitors will also see young children in the surgery. For example, they hold clinics to monitor the growth of children and administer immunisations.

Think about:
Is your GP service child friendly?
How could a GP service encourage children and young people to give feedback on the care they receive?

Adolescent girls are more likely to access their GP surgery than their male counterparts, as they their needs change for example: options for contraception.

Applications such as 'eConsults' were launched during the COVID 19 pandemic to allow the public to continue accessing their primary healthcare service, whilst keeping patients at home as much as possible (due to lockdown restrictions). When these applications were initially launched, adolescents they were not able to complete their own application - as the form stated you must be 18 years old to do this. This created a barrier to young people (<18years) accessing primary care and therefore put their health and wellbeing at risk. This was clearly problematic for young people who did not feel comfortable disclosing health concerns to their care giver/responsible adult.

Think about:

In this scenario, which Rights were not being upheld?

How do you think young people felt when they were unable to independently access primary care through eConsults?

Health and social inequalities - What social barriers might some families encounter that could prevent them accessing the 'eConsults' application?

How would you advise the GP surgery to accommodate for these families?

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All registered healthcare professionals have a legal duty to...

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All registered healthcare professionals have a legal duty to...

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ensure that children's rights are upheld and protected in whatever setting they access healthcare.

This learning package aims to help you revisit children's rights and apply them to nursing care in diverse healthcare environments. You will be prompted throughout with subheadings like 'Think about' or 'Look up' to add depth to your learning and draw upon your experience from previous placements.

The content of this package is applicable to all children's nurses and also to allied healthcare professionals who care for children and young people (CYP).

Please remember to scroll across the screen as you make your way through the package. There are seven columns in total. To maximise your educational benefit of this package please click on the three dots to the right hand side of each section and select 'Expand Post'.

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Aims:

To revisit children's rights.

To provide an overview of how nurses in diverse environments work with CYP and their families to prioritise their rights.

Learning Outcomes:
On completion of this learning package, student will be able to:

Demonstrate knowledge of children's rights.

Identify how processes in various diverse environments are put in place to safeguard children's rights.

Describe the effects that can be had on CYP when their rights are not met.

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Clinical Investigations Units (CIU) see CYP who are clinically stable enough to receive outpatient care (do not require an inpatient bed) but need urgent medical and nursing interventions or investigations.

A few examples of the reasons CYP may attend are:

fasting bloods

allergy testing

regular intravenous infusions for metabolic conditions or crohns disease

sleep studies

Think about:

CIU assists in releasing bed capacity in hospitals. By providing care in an outpatient setting, how does this service support children's rights to access education?

How does this service support children with disabilities to live a full life with dignity?

What kind of unnecessary harm does this service prevent children from experiencing - in terms of preventing the need for admission into an inpatient bed?

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We will look at four, diverse, healthcare environments that children have access to in this Padlet. These are:

Community Based

Ambulatory Care

Inpatient Care

Emergency Care

Please continue to column 2) 'What rights do children have?'

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In 1990 the UK signed up to the UNCRC to improve the lawful protection of children.

A number of children's rights, as stated by UNCRC are listed below...

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This is stated specifically for children who have disabilities

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Right to express their feelings and concerns in all matters that affect them

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Right to express their feelings and concerns in all matters that affect them

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Right to a standard of living that meets their physical and social needs

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Right to a standard of living that meets their physical and social needs

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One child's home environment will vary from another. Examples of diverse places of residence for children and young people could include:

One-bedroom flat

Women's prison

Three-bedroom house

Women's refuge

Mobile home - travelling families

All children, in any living situation, should have access to a Health Visitor (HV). HVs provide holistic support and advice to families.

Think about:

How do Health Visitors promote and safeguard the following children's rights in the home setting...

1. Best Possible Health?

2. Right to a standard of living that meets their physical and social needs?

3. Protected from Harm?

Providing community-based healthcare to children from travelling families can be challenging, as they may move around the country frequently and therefore are less likely to receive continuity of care from the same professionals.

Think about:

How can children's community nurses ensure that children of travelling families receive the best possible healthcare?

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Outpatients is often used by CYP who are generally well or have stable health but require an outpatient referral to a medical/surgical specialist or regular follow-up by inpatient Consultants.

Think about:
How does an Outpatient department or clinic support the patient's right to information about their healthcare?

Right to be protected from harm and right to best possible health...
Outpatient nursing staff, specialist nurses and treating Consultants at attentive to episodes of care whereby the patient 'did not attend' for their appointment(s). Recurring failure to engage with services can be an indication of a safeguarding issue. In such circumstances, all of the healthcare professionals listed above have a duty to inform the safeguarding team and/or contact social services directly.

Effective information sharing between professionals is essential for earliest identification and assessment with prompt implementation of service provision necessary to meet the needs of the child.

Think about:

How does a safeguarding referral support the child's right? You may want to consider which rights this process is protecting.

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CYP have a vast range of reasons for requiring inpatient admissions. All patients will have their own specific needs that need to be identified and met by nursing staff. We will now discuss a few rights that affect inpatient care and the negative impacts associated with it.

Many basic human rights are, of course, applicable to children, as well as those listed by UNCRC.

The World health Organisation (WHO) state that access:

'to pain management is a fundamental human right'.

Think about:
Pain is a complex concept but as a CYP nurse, how would you advocate for your patient's pain needs to uphold their human right stated above?

The inpatient admission of a patient can put them at risk of hospital-acquired infections as well as negative implications on their emotional psychological and social health.

The WHO states that:

'children have the right to enjoyment of the highest attainable standard of health'.

Think about:
What can be put in place by nursing staff in order to minimise negative inpatient-associated affects on the health and wellbeing of CYP? ie. infection control, family centered care etc.

How could a CYP ward nurse ensure that patients with long-term admissions continue to have access to their right to education?

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It is widely known that intensive care settings are perceived as being very alien and frightening to CYP and their families. This is contributed by being surround by numerous machines which make unfamiliar noises and flashing lights, twenty-four hours of the day.

The need for admission to an intensive care unit can be the result of an emergency or planned post-operative care, for example. Similar to the previous section on 'inpatient wards', intensive care poses challenges to critically unwell patients.

Think about:
In terms of tissue viability, how will you protect your critically unwell patient from unnecessary harm?

In intensive care settings, visiting privileges are limited.
With this in mind, how do you support the CYP's right to not be separated from their parents against their will?

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Think about:
You are an intensive care CYP nurse. How would you fulfill the needs of this infant in their right to play and rest whilst critically unwell?

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Generally, accessing a CED is an unplanned/non-scheduled event. Over recent years there is overwhelming evidence to show that the number of CYP presenting to CED with mental health problems has risen substantially.

Caring for mentally disturbed or distressed adolescents in CED can be a complex matter. This patient group may be at risk to themselves or (rarely) to other patients.

Think about:
You are a CED nurse caring for an adolescent with erratic behaviour caused by a mental health disorder. How can you protect the patient from harming themselves?

(consider the following: staff needed to maintain level of supervision the patient requires, who is on hand at the hospital to aid in security matters? Who would you escalate your concerns to? CAMHS? Where would you ideally nurse your patient?)

It is commonplace for nursing staff to search the belongings of a patient who has self-harmed or plans to harm themselves. As the nurse, how could you carry this out whilst upholding the patients rights?

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Particularly for children who have experienced a brain injury through ill health or trauma; rehabilitation is vital to help them begin to resume normal daily activities. The affects of rehabilitation therapy differs between individual patients. This care can be required on a long-term basis in order to retrain the nerve pathways and muscles involved to function as best as possible.

Think about:

How does neuro-rehabilitation promote C&YPs right to a full life with dignity?
How does rehabilitation promote children's right to life?

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World Health Organisation. 2020. Guidelines on the management of chronic pain in children. Available at: Guidelines on the management of chronic pain in children (who.int) [Accessed: 19 August 2021].

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Overview

In these guidelines, the World Health Organization (WHO) provides evidence-informed recommendations for the management of chronic pain in children. The recommendations are based on the most current, high-quality scientific evidence, and were formulated following processes and using methods that meet the highest international standards for guideline development. The recommendations in this guideline are based on systematic reviews of the evidence on benefits, harms, acceptability and feasibility, as well as on equity and resource considerations. The recommendations were formulated by the Guideline Development Group, consisting of individuals with diverse expertise and experiences and with global representation.

The purpose of this guideline is to assist WHO Member States and their partners in developing and implementing national and local policies, regulations, pain management protocols and best practices. It will help countries balance concerns about ensuring access to appropriate therapies for pain relief with the harms arising from misuse of medications and other potential adverse effects of interventions for pain management.

These guidelines focus on physical, psychological and pharmacological interventions for the management of primary and secondary chronic pain in children 0 to 19 years of age.

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Guidelines on the management of chronic pain in children

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In these guidelines, the World Health Organization (WHO) provides evidence-informed recommendations for the management of chronic pain in children. The recommendations are based on the most current, high-quality scientific evidence, and were formulated following processes and using methods that meet the highest international standards for guideline development.

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Unicef. 1989. The United Nations Convention on the Rights of the Child. Available at: https://www.unicef.org.uk/what-we-do/un-convention-child-rights/ [Accessed: 10 August 2021].

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What is the UN Convention?

The UN Convention on the Rights of the Child (UNCRC) is the basis of all of our work. It is the most complete statement of children's rights ever produced and is the most widely-ratified international human rights treaty in history.

What makes the UN Convention so special?

The Convention has 54 articles that cover all aspects of a child's life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights "without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status" (Article 2).

The Convention must be seen as a whole: all the rights are linked and no right is more important than another. The right to relax and play (Article 31) and the right to freedom of expression (Article 13) have equal importance as the right to be safe from violence (Article 19) and the right to education (Article 28).

We are the only organisation working for children recognised by the Convention.

The Convention is also the most widely ratified human rights treaty in the world. All UN member states except for the United States have ratified the Convention. The Convention came into force in the UK in 1992.

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UN Convention on the Rights of the Child - UNICEF UK

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The United Nations Convention on the Rights of the Child (UNCRC) is the basis for all of UNICEF's work and upholds children's rights all over the world.

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Look up HEADSS assessment (few sources listed under references).

When a health professional is seeing and treating adolescents/young people, a HEADSS assessment should be completed. This can be done formally or informally. This assessment can be completed with the patient in the absence of their carer(s). Maintaining their privacy and dignity in this way means that this is often the best way to capture the most accurate and truthful answers.

Think about:
How does the HEADSS assessment screen for potential child abduction - including human trafficking?

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Jessie May is a charity funded company who employs children's nurses to care for CYP with complex, life-limiting conditions. For many of these children, their care often becomes palliative. This service provides specialist respite care for families and supportive care for the children's specific needs at home. The children's nurses are also trained to broach the topic of death with the family and advocate for the child and their family when the time comes for end of life care.

Think about:

How might this service support the following rights of children:

Right to a full life with dignity?

Right to play?

Right to an identity?

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Her Majesty's Government. 2018. Working Together to Safeguard Children: a guide to inter-agency working to safeguard and promote the welfare of children. Available at: Working Together to Safeguard Children 2018 (publishing.service.gov.uk) [Accessed: 19 August 2021].

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Royal College of Paediatrics and Child Health. 2020. Child Protection Evidence: systematic review on bruising. Cardiff. RCPCH

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Nursing and Midwifery Council. 2015. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 3rd ed. UK.

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Royal Cornwall Hospitals NHS Trust. 2019. Adolescents Screening Assessment Tool Clinical Guideline. Available at: https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Paediatrics/AdolescentHEADSSScreeningAssessmentToolClinicalGuideline.pdf [Accessed: 11 August 2021].

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Sullivan, K. Samarendra, H. Malbon, K. Orteu, D. 2019. P8 Adolescent psychosocial history using headss in a tertiary paediatric emergency department. BMJ Paediatrics Open 3. doi:10.1136/bmjpo-2019-RCPCH-SAHM.16.

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Right to not be separated from their parents against their will, unless it is in their best interests

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Right to not be separated from their parents against their will, unless it is in their best interests