Context of Community Healthcare and Nursing - Essay Example

Context of Community Health Care and Nursing Community Children’s Nursing 1. Introduction Community children’s nursing practice is about childcare from birth and throughout childhood. Nursing sick children requires specialised nursing qualification as many believes that children have special needs and therefore needs nurses with special skills. The primary objective of many community children’s services includes parental support and the avoidance of hospitalisation for children. However, like any other programmes in health care, children’s nursing services are not free of inconsistencies that give rise to confusion. We therefore need to research and explore the concept of community children’s nursing service. This paper will discuss the origin of community children’s nursing practice and regulation. We will also include some the issue in home care, childhood, and other community health services. 2. Community Children’s Nursing Community children’s nursing has been adopted to take in an assortment of different terms which have beforehand been used such as paediatric community nurse, paediatric home care nurse, paediatric hospital-at-home nurse, children’s home care nurse and many others. All of these titles relate essentially to the same area of nursing practice. In UK, a community children’s nurse is a registered nurse who has completed a programme of education in community nursing leading to registration with the United Kingdom Central Council for Nursing, Midwifery, and Health Visiting. The nurse focus of work is primarily those children requiring treatment and care for acute and chronic ill health in a home setting (Littlewood 1999). 2.1 Community Children’s Nursing Practice and Regulation The practice of community children’s nursing is concerned with the provision of care to children from birth, during childhood and adolescence and sometimes into young adulthood. There is prevalent acceptance of the view that nurses who possess a registers children’s nurse qualification should undertake the nursing of sick children. Many believes that if community children’s nursing care is to be advanced as a true alternative to hospital care then the children must be afforded the same rights as children who received care in hospital. Consequently, since the children have special needs, which require special skills, nursing in the community also requires special skills (Taylor 1999). The employment of qualified children’s nurses in the community according to Cook (2000) began in the 1950s, and developed in response to government reports emphasizing the importance of keeping children in their own homes for treatment whenever possible. Thus, the roles of community children’s nurses are to provide nursing care, support, information and resources to sick children and their families in settings outside of acute hospitals. A vital part of the delivery of these elements of the role is the need to sustain and nurture the relationship between the child and its parents or other carers. Community children’s nurses also act as an information and teaching resource for the community nurses (p.34). Having qualified children’s nurses working in the community allows children needing complex, specialized treatment, monitoring, or care to be maintained at homes, and allows them to be discharged earlier from hospital when they have bee admitted. In order to provide this service, a number of different schemes have been set up using different models. Specialist community children’s nurses may work as an individual in a multidisciplinary primary health care team. Teams of community children’s nurses have been set up in some areas where there is large demand like the inner cities. In an ‘inreach’ schemes, community-based children’s nurses maintain some responsibility for and contact with children during short periods of hospital admission. In an ‘outreach’ schemes, hospital-based paediatric nurses provide technical support to children in their own homes when complex treatments or equipment are in use. Some community children’s nurses are highly specialised, focusing solely on particular conditions such as cystic fibrosis, diabetes, asthma, or cancer (Cook 2000). 2.2 Issues in Home Care It should be appreciated that home care may cause problems for some children and their families. Although children who have day care avoid the traumatic effects of hospitalisation, they can become fearful at home if their parents are anxious about home care and are not confident in their own caring abilities. There is evidence that parents can cope better with children’s impending death if they can care for them at home, but not all parents feel able to take on this responsibility. Siblings of children cared for at home sometimes suffer because of reduces attention to their needs. Although these problems cannot be ignored, they can be overcome by the careful assessment of families before discharge by an experienced children’s nurse. A community children’s nurse who will be used to working in partnership with parents, can also be alert for signs that home care is becoming too stressful for the family. Although there is little research to show the benefits of a community children’s care nurse service, some found the home care for children with chronic illness was effective in improving the satisfaction of the family with care and the child’s psychological adjustment. It also reduced maternal stress. A community children’s nurse service in Southampton for instance, reduced patient stay by 3.2 days, increased patient turnover, reduced waiting lists and save 215, 000 a year (Moules et. al. 1998:374). 2.3 Childhood and Community Health Services The concept of childhood is socially constructed and it is essentially a creation of the 20th century where children were considered not ready to participate in adult life at this age. For this reason, they need education and special treatment (Basford and Slevin 2003). The aims of many community children’s service include parental support and the avoidance of hospitalisation for children by preventing admission or enabling early discharge. The early services were set up to provide community care for children with acute illnesses who would provide community care for children with acute illnesses who would otherwise bet admitted to hospital. However, the number of children now being discharged from hospital with long-term needs is increasing, and their care and support is beginning to form a considerable portion of the community children’s nurse caseload (Moules 1998). However, community children’s nursing services are fragmented and anomalies continue to exist that give rise to confusion. For instance, Watkins et. al. (2003) explains that in the United Kingdom there are six different models of services in operation. Moreover, 50% of the UK has access to a service with only a minimal number able to offer 24-hour access. These variations have occurred essentially because current legislation regarding the care of sick children differs between hospital and community settings (p.272). In Nottingham, the philosophy of children’s nursing reflects the view that the best place for a sick child to be cared for is in his/her own home, by his/her family. Children are therefore nursed at home whenever possible and/ or discharges home at the earliest conceivable time. In order to achieve this goal, an effective, and appropriately skills community nursing team has developed to support the family in delivering care at home. The provision of a paediatric community nursing or now known in general as community children’s nursing service enables children to be discharges home much earlier and in some instances prevents the initial admission to hospital. The philosophy is to maintain the integrity of the family unit, promote care by the family, and enable the family to maintain its independence. This approach also recognizes the importance of family relationships and other social factors, which are relevant to the individual child. The emphasis is upon teaching the parents and the family, health education and the provision of long-term support, guidance and advice, as well as specialist nursing intervention. Preparation for discharge begins on admission, at which time the name nurse or primary nurse assesses the child and family has needs and plans their immediate and long-term care. Essentially, it is this nurse’s responsibility to make the initial contact with community nurse well in advance of child’s potential discharge and then continue to liaise with and assist in preparing the child and family for continuing treatment or care at home. During this pre-discharge period, the community children’s nurse meets frequently with the child, parents, and family on the ward. This enables the nurse to not only develop a friendship and form an allegiance, but also to become the key figure in the process that is involved in preparing for the continuation of treatment or care at home (Smith 1995). On the lighter side, community children’s nurses, who work collaboratively with other members of the primary health care term, undertake much care of asthma management work. According to Kerr (2000), the gaps in service provision encountered by families with children discharged from hospital services and the role of the community children’s nurse serves to fill this gap by providing continuity of care with primary and secondary services whist advising, teaching, and supporting children and their families in their own home. The health promotion role of the community children’s nurse works effectively in preventing children with chronic conditions such as diabetes and asthma from repeated hospital admission, decreases time lost from school and optimises normal childhood activity. The community children’s nurse understands the developmental needs of children and the impact of child development and maturation upon health status and receptiveness of health promotion. In this way, an infrastructure is developed which empower even very young children to gain competence in their self-management aims. It is acknowledged however that not all children will want to take on the responsibilities and obligations involved in self-management programmes and their right to negotiate their involvement and to opt in and out of partnership arrangements must be respected (p.120). 2.4 Quality of Health Services for Children The need to involve children as service uses in all aspects of health care is receiving much professional support. It is clear that future services will be increasingly needs led and a crucial point for consideration by all involved must be how to involved children and young people in commissioning activity. It is through such activities that individuals can exercise their rights to be involved in health provision and be more involved in the decision-making process. However, the ways in which children can become involved in a meaningful activities rather than being involved as ‘token gestures’ remain to be explored. Particular attention needs to be given to the challengers presented by involving children who have mental health or learning difficulties, or children from ethnic minority groups, groups of children who are most likely to be under presented in any consumer activity yet may be regular service users. In preparing guidelines for commissioners and providers of children’s services, Hogg (1996) according to Kerr (2000) suggests that ‘standards developed with children, young people and their families are often the best indication of quality and provides useful audit checklist to help this process’ (p.121). 3. Conclusion Community children’s nursing definitely helps children and families by filling the gaps in the service provision when children were discharged from hospital services. Aside from providing continuity of care, community-based nurses’ helps advice, teach, and support children and their families in their own home. Their roles in promoting health in the community effectively prevents children with chronic conditions from repeated admission thus reducing time lost from school and enhances normal childhood activity. 4. 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