Think about the nursing environment in which you work. How appropriate is it for the children and young people you care for? How could you change the environment to help improve engagement and the child or young person’s experience of care? Is your service information material suitable for all children and young people?

Answer: This is not always easy to get right. As illustrated in his experience of A&E, Thomas, aged 16, told researchers he would be unhappy to be treated in an environment where there was ‘fluffy rabbits, geese and fairy princesses’, whereas in the same study Jessica described how these might help younger children feel welcome (McKenzie et al., 2010).

By stepping into the child or young person’s shoes you begin to see the world as they do. You develop insight into why it may be important to consider the gender of the nurse who supports them, or why privacy is so important to some young people. This insight enables you to plan the environment as much as you can and reminds us not to ask any potentially sensitive questions in a busy reception, waiting area or ward environment where this could easily be overheard.

To help provide an age appropriate environment you might want to consult the Department of Health’s ‘You’re Welcome’ quality standards, which offer guidance on creating young people friendly health services (Department of Health, 2011). 

Reference

Department of Health. (2011) You’re Welcome:  Quality criteria for young people friendly health services. Available at:  www.gov.uk/government/uploads/system/uploads/attachment_data/file/216350/dh_127632.pdf (last accessed 8 October 2016).

Think about the developmental needs of the child or young person in your care. Are they old enough to understand concepts such as self-esteem, confidence or stress? Do they have particular needs which mean that you need to adapt your health promotion or illness intervention strategies? To what extent can the child or young person you are nursing self-sooth and manage their own care needs? To what extent do you need to involve their parents or carers? How will you get the right balance?

Answer: The dependency needs of children and young people vary considerably, and age is just one factor that affects this. Illness or disability can increase dependency temporarily or permanently. So too can fear or anxiety have a bearing on a child or young person’s dependency – both on their parents or carers and on you as a nurse. It is therefore important that you can gain some baseline understanding of a child or young person’s level of independence in order to evaluate what level of dependency may be required.  For example, the average 2–3 year old toddler is likely to require some level of assistance with toileting and dressing and will be quite happy to discuss this, whereas an 11–12 years old would be horrified at the prospect of being helped with these private tasks. An awareness of developmental norms is as important as an awareness of the health-related needs that affect dependence and independence.

Imagine the child or young person arriving at the Accident and Emergency (A&E) department following self-harm or coming into hospital for surgery. They may be distressed, confused or frightened, and the way in which you engage and respond to them will influence their engagement and experience of healthcare for better or worse. What can you do to help ensure that the child or young person experiences you as compassionate and caring?

Answer: When supporting the child or young people who has self-harmed it is important not to use language that may leave the young person feeling blamed or not taken seriously. Phrases like attention seeking often make the young person feel like they are wasting your time and you will be unlikely to engage them. Equally important is validating what they have to say. Young people who have self-harmed are often upset, angry or confused and what you say and do will communicate whether you ‘get it’ or not. 

There is evidence that children’s subjective experience of events may differ significantly from those of adults (Livesley and Long, 2013). Try stepping into the child or young person’s shoes. How might they be feeling and what might they be thinking?  What can you say, do or give them to read that might put their mind at ease? What support might their parents need?

Answer: McKenzie et al. (2010) remind us just how important it is to consider the perspectives of children and adolescents, which are likely to differ according to their age. In their study Rebecca commented that nurses were ‘really nice’ because they didn’t treat older adolescents like babies which helped with her need for independence as a teenager. Rebecca’s view illustrates the need to constantly revisit how the children or young person may be feeling, and to check they have understood what is happening in relation to their care.

Reference

McKenzie, S., Norrish, S., Parker, L. and Frampton, I. (2010). Consulting with young people about healthcare. Part I: experience of the hospital environment. Paediatric Health, 4(2), 157–166

You are a school nurse and Leanne has sent you a note saying that something is making her unhappy. You are aware that Leanne is a private girl and is rarely seen around school without Kirsty who is an equally quiet and reserved girl. You have also noticed that Leanne appears to have lost some weight and is generally looking tired and preoccupied.

• How should you prepare for meeting Leanne?
• What happens if you try to discuss her note but she refuses to open up?
• What are your professional obligations as a nurse?
• Are you concerned about Leanne’s safety or welfare or can you help her feel better by talking things through or accessing further help for her?
• Can you keep the discussion private or should you inform Leanne’s parents? Should you suggest that she might want to bring Kirsty with her?

Answer: After discussing different ways to respond to Leanne’s note you decide to write back. You choose this method for a number of reasons. First, this mirrors the approach that Leanne took to engage you and this may reflect the communication style she is most comfortable with. Second, you feel it is important that Leanne understands the parameters of what you are able to do in your role and consider that she may need time to reflect on this to trust you and feel safe to share what is on her mind.   Finally, you suggest that she may wish to bring a friend to see you, but point out that you would prefer that the meeting was held in private.

Discussing the limits of confidentiality may help set the scene for a positive therapeutic relationship to form where Leanne feels safe and able to trust you, but at the same time understands what you can and cannot keep private. This can be a precarious process. Too much reassurance about confidentiality ahead of hearing what Leanne has to say may give her a false sense of security which the nurse may later be duty bound to break. Too little reassurance may leave Leanne feeling uncertain about whether the nurse can be trusted.