Chapter 5: Interprofessional working with children and young people

ANSWERS TO ACTIVITY 5.1: REFLECTIVE PRACTICE

Watch the short video by clicking on the link on the website to hear an overview of the five stages of team development identified by Tuckman and think about how you can apply them to your Practice Learning Placement.

www.mindtools.com/pages/article/newLDR_86.htm

Five stages of team formation: 

1st stage – Forming: an early stage of team formation where people can be positive, anxious, polite, uncertain or excited.  Roles and responsibilities are not yet clear. This stage can take some time as people become familiar with each other and their strengths and limitations.

2nd stage – Storming: people are beginning to get to know each other and start pushing against boundaries which can lead to conflict as roles or working styles have the potential to ‘clash’.  This is often where teams fail to join together if responsibilities are unclear or people feel a lack of support particularly when dealing with lots of change.

3rd stage – Norming: team members know each other better and being to respect people’s differences.  There’s a stronger emphasis on the ‘team goals’ and appreciation of everyone’s strengths with an ability to constructively criticise activities and outputs.  In this stage there is always the potential to revert back to stage 2 as new challenges appear.

4th stage – Performing: the team works well and is comfortable with each other.  Work can be delegated easily and the team works well together towards a common goal.

5th stage – Adjourning: this occurs when small project work groups have been disbanded upon completion of specific tasks.  The teams separate which can cause anxiety depending upon the outcome.

ANSWERS TO ACTIVITY 5.2: CRITICAL THINKING

  • Imagine you are a young person in hospital having just been diagnosed with diabetes.  Why do you need professionals to work together?

Answer: To facilitate safe management of the condition and provide information and advice across statutory services, e.g. education for school staff, GP and primary care staff.  Newly diagnosed patients need to understand the underlying pathophysiology of their condition and learn to recognise and manage the emergence of symptoms. Earlier treatment lead to better outcomes.  Acute and community/specialist staff need to share information across services to provide support, deliver care, refer to specialists, reduce anxiety, and provide training and education to children and young people, families and those services involved with them.

  • Now imagine you are a parent of a child at home with complex needs – consider and note down why you need community services to work together.

Answer: To prevent services and care becoming fragmented and stressful through duplicated roles and poor communication.  Services need to provide a professional to co-ordinate care via a key worker, lead professional or care co-ordinator whose role is to liaise with other services, professionals and practitioners to reduce anxiety, prevent unnecessary financial outlay, organise care delivery and empower children and families to regain control.  Families often have a number of children in the family to consider and provide equal support to, which can often be difficult when one of the children has complex needs.  Services need to work together to support the child’s life journey across social care, education and health services with the support of the third sector to ensure maximum potential is reached through a variety of social, financial, physical and emotional support inputs.

ANSWERS TO SAFEGUARDING STOP POINT 5.1

Think about the challenges mentioned above and consider your duty of confidentiality regarding patient care.  Note down what you need to be aware of during joined working in terms of data sharing processes as a children’s nurse. Can you think of any legislation that might help inform this?

Challenges

Shared record-keeping; sharing confidential information across agencies; establishment of a key worker to co-ordinate care; working between regulated and non-regulated services; assessing and maintaining quality of care; assessing and managing risk

Your duty of confidentiality

NMC Code (2015) – Professional standards which nurses and midwives must uphold to promote safe and effective care. 

Duty of confidentiality refers to the need to act in the best interest of the patient and respect their right to confidentiality. 

The need to gain consent prior to sharing any information – awareness of different forms of consent – implicit and explicit.  Have a look at the Department of Health’s document (2001) Seeking Consent: Working with Children. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.go...@en/documents/digitalasset/dh_4067204.pdf

Share necessary information with other agencies only when the interest of safety overrides the need for confidentiality.

Ensure patients are suitably informed through information sharing in language which they understand.

Helpful legislation? 

Children’s Act (2004); Children and Young people (Scotland) Act (2014); Mental Capacity Act (2005); Adults with Incapacity Act (Scotland) (2000); Mental Health (Care and Treatment) (Scotland) Act 2003.

ANSWERS TO WHAT’S THE EVIDENCE? 5.1

Access the Report of the UK Children’s Commissioners (2015) by clicking on the link below:

www.childrenscommissioner.gov.uk/sites/default/files/publications/Report%20to%20the%20UNCRC.pdf

Explore the section relating to children with disabilities and identify key recommendations in relation to service delivery, care planning and transition.

Children with disabilities – key recommendations: Recognise the importance of early, integrated support for children with complex needs and their families enabling them to remain within their family and community wherever possible; ensure children’s wishes and interests are listened to and acted upon in important decisions about their support and future; increase availability of service provision for children and young people with complex needs and expanding life expectancy; improve transition services to a) prevent children waiting too long for appropriate packages of care to be put in place, b) explain the process more fully and in an accessible way which they understand, c) prevent children being treated in inappropriate places such as adult wards and d) start the transition planning process early.

ANSWERS TO WHAT’S THE EVIDENCE? 5.2

Transition guidelines for children using health or social services (NICE, 2016) refer to the importance of using the philosophy of empowerment to embed person-centred approaches within healthcare. 

Use the link below to explore the benefits of empowerment for families and identify the key principles of PCP: www.nice.org.uk/guidance/ng43

NICE transition guidelines – benefits of empowerment and principles of PCP

Involve young people and carers in service delivery; treat the young person as an equal partner; support the young person to make decisions; agree goals and address outcomes with the young person; managers in health and social care should work together involving young people and families; help the young person to identify their named key-worker to co-ordinate care and provide support.

ANSWERS TO CASE STUDY 5.1: HAMISH

Hamish was 18 with a diagnosis of autism and complex physical disability and wanted to go to college when he left his complex needs school.  He had yearly transition meetings at school with his parent/guardian, ASL teacher (and head teacher), Skills Development Scotland (SDS) representative (careers service) and duty (un-allocated) social worker.

Hamish's SDS worker supported him to apply for appropriate courses, and to make his own choices. The school supported Hamish to attend various taster sessions at the college so that he could feel more secure and familiar with the environment once he'd left school. The social worker ensured the plan was appropriate and all agencies involved were meeting their obligations, whilst gathering various pieces of information to ensure the correct support could be put in place.

Hamish was then allocated a social worker from the local Transition Team who would be responsible for, and oversee, his transition. Hamish's social worker completed the adult assessment form and secured funding for transport to and from college where he attended a supported course.  He attended college for two years, after which he wanted to move onto day support. His social worker was again allocated to update the previous assessment and seek the funds for day support.  Funding was agreed and Hamish's mum decided she would like to manage a direct payment on her son's behalf, under the principles of self-directed support.

  • Think about Hamish’s story and identify key areas of concern for him, his family and professionals involved.  What are the challenges and benefits for Hamish? What might your role as a children’s nurse be in this process?

Key areas of concern

Hamish’s wishes for future life choices; leaving the supportive and secure school environment to transition into the adult world of further study and employment; gaining access to suitable courses which interest him; agreeing funding to develop day care support.

Challenges and benefits for Hamish

Challenges – ensuring his voice is heard and his wishes are incorporated into his next ‘life chapter’; accessing the physical college environment; accessing and studying a course of his choice; integrating into a new college/education system and establishing new social contacts, friends and support; being fully supported to achieve his aims and ambitions and ensuring that the environment is fully accessible to his needs; the College and adult learning environment being fully equipped to understand what Hamish requires to be effectively supported; ensuring he is on the right benefits and has input from both health and allied health professionals as required; understanding choice and being fully informed about what is available; stepping into and understanding his rights as a young adult.

Benefits – feeling empowered as part of the decision-making process; having the support of the SDS representative and a transition social worker with whom he can establish a working relationship; having the support of the same social worker when moving from college to day care; having his mum to manage the direct payment funding aspects of his care package to ensure his views are listened to and acted upon.

Your role as a child health nurse

Being part of the multi-agency team involved in the transition process engaging with staff in the school setting.  This role could be as a care co-ordinator or lead professional being directed by the named person who has legal responsibility for the successful outcomes focused process from the education setting.  There is also a role with child health nurses to ensure that Hamish is transitioning well into adult services where appropriate in the wider healthcare environment.

Key nursing skills required are those of effective communication, active listening, prioritisation, planning, and directing the handover of nursing care related information to the key worker responsible for taking forward the transition process into the adult setting.  Additional aspects of your role – working under the NMC Code (NMC, 2015) to ensure documentation and care records are completed effectively and efficiently, employing skills of communication and negotiation with Hamish and his family to ensure they are fully aware of your role within the handover process and ensuring you have knowledge of the local transition process and associated best practice policy/guidance. Key nursing skills in this setting will also involve understanding of, and compliance with, other professional systems and working in partnership with other professionals from the different sectors.