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The nursing activities and interventions important when caring for children in Accident and Emergency (A&E) Departments.

Student thesis: Doctoral ThesisDoctor of Philosophy

The aim of this study was to investigate the activities and interventions important when caring for children in A&E Departments. Background: Approximately three million children attend A&E Departments in the UK each year. However, there is an imbalance between those services provided by children’s A&E Departments and mixed A&E Departments resulting in most children having to attend the latter that are staffed primarily by non-paediatric specialists. Mixed A&E Departments focus primarily on the care of adult patients, with nurses less experienced in caring for acutely unwell or injured children. Furthermore, training and education pertaining to the care of children in A&E has yet to be formalised nationally which is not helped by the lack of evidence about what activities and interventions are important when caring for children in A&E Departments. Method: A sequential mixed method study comprising a three round Delphi survey followed by semi-structured interviews with service users and providers were conducted between July 2012 and June 2013. The purpose of using mixed methods was to identify views from clinicians and parents regarding the activities and interventions important when caring for children in A&E Departments, along with the factors that may enable or inhibit their undertaking. Results: Twenty-six activities and interventions were identified by the Delphi panelists creating an inventory that could be utilised to support the training and education of nurses working in both mixed and children’s A&E Departments. The study identified variable practice among RNs when assessing children in A&E Departments. Communication was considered the most important nursing activity among parents and was in contrast to RNs that reported the assessment and observation as the activities of most importance. Both RNs and parents shared equal experiences of the factors that enable and inhibit the undertaking of activities and interventions such as family centred care, the availability of a skilled nursing workforce and provision of a suitable environment for children that has facilities tailored to their specific needs. Conclusion: The findings of this research study illustrate that there is variable practice among RNs caring for children in A&E Departments that is not helped by an absence of training and education with respect to children’s A&E nursing. The study provides an inventory of activities and interventions to equip managers and clinicians with information that can be used for the training and education of nurses. Further, understanding the experiences of nurses and parents will strengthen the argument for family centred care to be adopted more favorably within A&E Departments, alongside commitment to providing a skilled nursing workforce and an environment that caters specifically for children and their families. Finally, understanding the enabling and inhibiting factors will aid clinicians when developing services for children and give them confidence when doing so.
Original languageEnglish
Awarding Institution
Award date2017


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