Purpose and Aim:
To assess the knowledge and skills required to undertake clinical consultations of children and young people as an autonomous practitioner in a minor injuries setting.
LEARNING OUTCOMES ASSESSMENT CRITERIA
The learner will: The learner can:
1. Understand the legal and professional frameworks for working with children and young people as an autonomous
practitioner in a minor injuries setting.
1.1 Explain how the scope of practice for working with children and young people as an autonomous practitioner in a minor injuries setting is:
defined
limited
indemnified.
1.2 Outline the impact of legislation specific to children and young people in Wales on the work of an autonomous practitioner in a minor injuries setting.
1.3 Explain the responsibilities of an autonomous practitioner for judgements relating to:
mental capacity
consent
confidentiality
complaints
errors
safeguarding
sexual exploitation.
1.4 Analyse the responsibilities of an autonomous practitioner for:
communication
team working
the safety of children and young people
personal behaviour and the behaviour of others.
1.5 Critically analyse a range of professional dilemmas in autonomous practice.
2. Understand the role of the autonomous practitioner in clinical decision making when working with children.
2.1 Critically examine the process of clinical decision making.
2.2 Give examples of how statistical methodology is used in clinical decision making.
2.3 Explain a range of assessment tools used to support clinical decision making when working with children and young people in a minor injuries setting.
2.4 Identify sources of professional support for working with children and young people in a minor injuries settings.
3. Understand how to place the needs of children and young people at the centre of care.
3.1 Critically examine strategies that can be used to place the needs of children and young people the centre of care.
3.2 Explain how to implement risk management strategies for
children and young people patients who fall outside the scope of a minor injuries setting.
4. Be able to evaluate clinical consultation practice when working with children and
4.1 Critically examine the quality of clinical consultations with
children and young people undertaken as an autonomous
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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young people as an autonomous practitioner in a minor injuries setting.
practitioner working in a minor injuries setting.
4.2 Use evidence from clinical consultations with children and young people to contribute to the evaluation and quality improvement of autonomous practice undertaken by a minor injuries team or unit.
Assessment Methods:
There is no assessment information available for this unit. Assessments used should be fit for purpose for the unit and learners, and generate evidence of achievement for all the assessment criteria.
Assessment Information:
For standardisation purposes, assessment of this unit must be conducted using the Emergency Nurse/Paramedic Development Programme for Autonomously Managing Minor Injuries, commissioned by the Chief Executive Officers of University Health Boards Wales.
Scope of practice for working with Children and young people as an autonomous practitioner in a minor injuries setting must include reference to the following frameworks:
professional
legal
ethical
pharmaceutical.
Legislation specific to children and young people in Wales must include:
Social Services and Well-being (Wales) Act 2014
United Nations Convention on the Rights of the Child (UNCRC)
Rights of Children and Young Persons (Wales) Measure 2011.
A range of professional dilemmas must include:
conflict
looked after children and young people and those in shared care
special circumstances
problems with referrals
disputed diagnosis
unprofessional behaviour.
A range of assessment tools should include nationally recognised tools such as:
Wong Baker and other pain assessment tools
Glasgow Coma scores for infants and adults
Ottawa Ankle and Knee assessment
Lund Browder burns assessment
Canadian C Spine
Rule of Nines for burns
RCEM DVT
NICE head injury guidelines
Fraser guidelines and may include other tools.
Sources of professional support should include:
current clinical practice literature
other healthcare professionals
current legislation
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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professional advice.
Strategies that can be used to place the needs of children and young people at the centre of care must include reference to:
both children and young people
children and young people deemed vulnerable by virtue of illness and/or ability
children and young people with protected characteristics (as defined by the Human Rights Act).
AC 3.2 Must include reference to both children and young people.
Clinical consultations with children and young people must include evidence relating to:
consultations with both children and young people
communication and consultation skills, including barriers to communication
history taking (including mental health issues)
risk assessment (including the assessment of non-mobile children, and sexual exploitation)
physical examination skills
the assessment of pain
the use of bio-clinical data such as physiological measurements, POCT, INR, pregnancy testing, BM, urinalysis
the use of radiological data
gathering evidence for differential diagnosis
clarifying and evidencing a diagnosis
the planning and initiating of treatment
using medication
prescribing treatments and/or management
report and statement writing
forensic aspects
risk management
referral to other healthcare settings and agencies
health education and aftercare.
AC 4.1 Evidence must:
be cross referenced to cases in the clinical portfolio
include the clinical assessment of both children and young people
include all areas of minor injuries: lower and upper limbs, knee, hip, back, shoulder, head and neck, chest, wounds, burns, eye, ear, mouth and throat, bites and stings, mental health, inoculation
include evaluation of the use of professional and legal frameworks, and assessment tools
include an audit of clinical practice
include feedback from children and young people, and/or their families/carers, or from supervisor(s) and/or team members.
AC 4.2 Evidence might include:
minutes from team meetings
narrative explanations
case studies
audit
quality improvement planning.
If not specifically stated in the assessment information, a plural statement in any assessment criteria means a minimum of two.
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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To meet standards for clinical governance, organisational liability, professional and regulatory requirements, all new units containing assessments that are competence based and are for learners who are employed in, or volunteering in, health and social care, clinical care or childcare settings:
learners must have completed any mandatory H&S training or education required for their job role
context-specific health and safety must be explicitly stated WITHIN individual units.
Other Mappings:
NOS EUSC 34, EUSC 36EUSC 21.
Code 2015.
RCEM: CC12, CC6, CC1, CC2, CC3, CAP23, CC16, CC4, CC5, CC17, CC18 CC19, CC21, CC22, CC24, CC34, CAP 33, CAP 20, HAP 18, HAP 19, C3AP2A, C3AP2B, CAP38, HAP34, HAP11, CAP30, CAP13, HAP30, PAP6, PAP15, PAP16, PAP17.
Assessor Requirements:
Registered practitioners with a minimum of two years experience of working in minor injuries settings as:
an emergency nurse/paramedic/advanced care practitioner
Consultant nurse or
Consultants in emergency medicine.
© 2016 Agored Cymru
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Child Specific
Children are not little adults and are often more likely to be at risk of environmental hazards and subsequent injury because of their unique activity patterns, behaviour, physiological differences (EPA 2015). As a consequence the practitioners will need to enhance their knowledge base and modify their consultation and assessment skills to be able to appropriately manage children and adolescents. The following additional competencies are required to specifically meet the needs of this group of patients.
Competency All of these are applicable across the age ranges: > 1 year, paediatric, adolescent,
adult and older person
Learning Outcome
For a broad range of patients presenting with minor injury complaints, the EP will:
1. Quickly build a
therapeutic relationship with children, young people and their parents/guardians thus demonstrating effective communication skills &
ability to ensure consent is lawful
Create a climate of mutual trust and establishes partnerships with children, young people, parents and guardians.
Be responsive to the age and ability of the child to enable psychological care in response to the injury and experience of attending an emergency unit.
Demonstrates ability to determine Fraser competence in children/adolescents to ensure that consent needs are met
Recognises & understands why children & adolescents are not able to decline treatments
Know and respect the legal framework and ethical issues relating to children in the ED including consent and confidentiality
Be aware of the different developmental stages of children and their assessment
Know that some of the presenting symptoms could be manifestations of non- accidental injury (NAI)
2. Be proficient in taking in a systematic, problem focused history to enable a differential diagnosis
Be able to interact with children of different stages of development to elicit the history and undertake a careful, sensitive and flexible examination
Recognizes and acts on common red flags for paediatric injuries
Consider multiple re-attendances and if these are a safeguarding concern 3. Be adept in undertaking
a physical examination in a toddler, child and adolescent
Demonstrate a detailed knowledge of the variance of anatomy & physiology between an adult, adolescent and child
Demonstrate ability to modify clinical examinations to minimise distress and enable timely diagnosis to be made.
Be aware of the different developmental stages of children and their assessment
Know that some of the presenting symptoms could be manifestations of non- accidental injury (NAI)
Uses common calculators to enhance assessment and decision making in children e.g. PEWS
Demonstrate understanding and ability of altering examination techniques to meet the needs of children e.g. otoscope, visual acuity testing
4. Select and appropriately refer patients for radiographic images
Recognises the ionising radiation risk to children and the stochastic effect.
Recognises common sites for referred pain and how this may influence requesting radiographs.
5. Correctly interpret radiographic images
Demonstrates understanding of variance of bone anatomy on child’s xrays,
Demonstrates understanding of the variance of interpreting children’s xrays and uses recognised tools appropriately e.g. CRITOL
Recognises common fractures in children which are at variance from adult e.g.
bowing fractures, Salter Harris 6. Be able to make the
correct diagnosis
Use applied knowledge of anatomy, physiology and pattern recognition in children to analyse and interpret the history, mechanism of injury, signs & symptoms, physical examination findings and diagnostic information to develop appropriate
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 52 differential diagnosis and finally a diagnosis.
Demonstrates understanding that the interpretation of tests is age dependant e.g.
radiology 7. Effectively determine,
manage and deliver treatments
Demonstrates ability to gain child’s trust to be able to undertake treatments e.g.
trephining nails, removal of embedded ear-rings, casting, wound management
Demonstrates understanding of immunisations schedules and uses them appropriately
8. Assess and manage the patients’ pain effectively
demonstrates ability to use pain assessment tools specific to children
safely administers pain relief to children
recognises other methods of pain relief and uses them appropriately e.g. distraction 9. Effectively determine
and develop a plan for further care & initiate appropriate follow up
Provides appropriate advice to children, parents & guardians on how to manage their injury following discharge, this includes when to seek help
Demonstrates understanding of what follow up children require
Be able to identify those patients needing urgent specialist attention
Anaphylaxis
The EP will identify the child suffering from anaphylaxis and implement appropriate interventions and treatment Assessment Methods Knowledge Understand presentation and management of anaphylaxis in children AA, C, Mi, L Skills Be able to institute appropriate management for anaphylaxis (APLS
guideline)
Know when to ask for help
AA, C, Mi, D, L
Concerning presentations [RCEM PAP6]
The EP will be able to identify and assess children with safeguarding issues, and refer appropriately. The EP will hold an up to date level 3 training certificate in Safeguarding Children
Assessment
Methods Knowledge
Understand the types of issues and terminology to describe safeguarding concerns, e.g.
physical/sexual/emotional and neglect C, Mi
Know the range of conditions presenting as a symptom of NAI or psychological distress, e.g. deliberate self-harm, aggression or risk- taking behaviour, recurrent abdominal pain, headaches or faints, recurrent attendances in young children, bullying, truancy
C, Mi
To understand the roles of agencies/systems in safeguarding children e.g. Social services, Police, child protection units, domestic violence units/agencies, SureStart, Health Visitors, School, voluntary sector (e.g. drug and alcohol support).
C, Mi
To understand the safeguarding needs of children involved in domestic violence situations, trafficking,
sexual exploitation, asylum seeker, traveller children C, Mi
Have an understanding of the local documentation regarding the reporting and referral of safe guarding
concerns C, Mi
Physical abuse
Understand the signs of physical abuse C, Mi
Understand the signs of common injury that may mimic physical abuse C, Mi
Understand the common fractures seen in physical abuse C, Mi
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Be able to recognise patterns of injury or illness which might suggest NAI C, Mi Sexual abuse
Understand the ways in which children might reveal sexual abuse C, Mi
Understand and recognise the signs and symptoms of sexual abuse C, Mi
Understand the importance of seeking help from experienced colleagues in the assessment of
children where NAI might be an issue C, Mi
Understands the signs of sexual exploitation & grooming C, Mi
Neglect
Understand the ways in which children may present with neglect and be able to identify children
in need C, Mi, L
Skills
Reliably picks up clues which should give rise to concern
Ability to translate recommendations into appropriate actions on a case by case basis and follow local guidelines
Can engage children appropriately in their own decisions and protects the best interests of the child at all times
Can engage with parents appropriately
Be able to initiate safeguarding children procedures as per local Policy if sexual abuse, physical
abuse or neglect is suspected E,AA, C, Mi,
Be able to refer to the appropriate agencies if safeguarding issues are suspected.
Reliably documents concerns, conversations with other professionals and detailed descriptions or examination findings as appropriate.
Pain in children [RCEM PAP15]
The EP is able to evaluate pain in children and implement an appropriate and effective pain management plan and intervention
Assessment Methods
NMC:
Knowledge
Know how to assess pain in children and adolescents AA, C, Mi, L PS, A
Know the range of options to relieve pain – non-pharmacological and pharmacological - agents, routes of administration, dosage
C, Mi PS, A
Know how to select best option. C, Mi PS, A
Know the safe doses, side effects and toxicity of different agents C, Mi PS, A Skills
Be able to safely administer local anaesthetic blocks, oral analgesics and Entonox AA, C, Mi, L,
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
Page 54 Evidence and guidelines. [RCEM CC21]
It is the responsibility of each practitioners to ensure that they are aware of relevant developments in clinical care and also ensure that their practice conforms to the highest standards of practice possible. An awareness of the evidence base behind current practice and a need to audit one’s own practice is vital for the practitioner training in minor injuries care.
To progressively develop the ability to make the optimal use of current best evidence in making decisions about the care of patients
To progressively develop the ability to construct evidence-based guidelines in relation to medical practise
Knowledge Assessment
Methods
NMC:
Understand the application of research into practice C PE, R
Understand the advantages and disadvantages of different study methodologies (qualitative and quantitative)
C PE, R,E
Understand the principles of critical appraisal C PE, R,E
Understand levels of evidence and quality of evidence C PE, R,E
Understand the role and limitations of evidence in the development of clinical guidelines
C PE, R,E
Understand the advantages and disadvantages of guidelines C PE, R,E
Understand the processes that result in nationally applicable guidelines (e.g. NICE and SIGN)
C PE, R,E
Skills
Ability to search the medical literature including use of Athens, PubMed, CINHL, Medline, Cochrane reviews and the internet
C PE, R,E
Appraise retrieved evidence to address a clinical question and support clinical decisions made
C PE, R,E
Apply conclusions from critical appraisal into clinical care C PE, R,E
Behaviours
Keep up to date with national reviews and guidelines of practice (e.g. NICE and SIGN) C PE, R,E 6.2 Aim for best clinical practice (clinical effectiveness) at all times, responding to
evidence-based medicine
C, Mi PE, R,E 6.1 Recognise the occasional need to practise outside clinical guidelines C, Mi PS, A
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Audit [RCEM CC22]
To progressively develop the ability to perform an audit of clinical practice and to apply the findings appropriately
Knowledge Assessment
Methods
NMC Understand the different methods of obtaining data for audit including patient
feedback questionnaires, hospital sources and national reference data
AA, C PE, M
Understand the role of audit (developing patient care, risk management etc) AA, C PE, M
Understand the steps involved in completing the audit cycle AA, C PE, M
Skills
complete audit cycles AA, C PE, M
Behaviours
Recognise the need for audit in clinical practice to promote standard setting and quality assurance
AA, C PE, M
Level Descriptor 1
Contribute data to a local or national audit
Completes an audit in the department
2 Ensures patient experience questionnaires are completed for at least 20% of their own patients (see patient survey tool appendix 2)
3 Compare the results of an audit with criteria or standards to reach conclusions
Use the findings of an audit to develop and implement change
4 Lead a complete clinical audit cycle including development of conclusions, implementation of findings and re-audit to assess the effectiveness of the changes
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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