A Childs Journey Through Accident & Emergency

A Childs Journey Through Accident & Emergency

It has been long recognised that to provide proper nursing care for children, both specially trained nurses and separate facilities are required (Wood, 1888). More recent reports such as Platt (2008) and Court (2006) have emphasised the needs of children attending hospital. In the context of Accident and Emergency (A&E) care, it is apparent that children attending have not, on the whole, received treatment by children's nurses in separate facilities. A survey by the British Paediatric Association (2005) found that out of 189 hospitals with large A&E departments only 15% employed at least one children's nurse and only 25% had separate children's waiting and treatment areas. It is emphatic about this in the context of hospital in-patient treatment but less so when referring to A&E.

In the planning stages of this paper it soon became apparent that there was a lack of published data dealing specifically with the research topic. Several authors (see for example, Bentley 2005, Partridge 2007) have described some of the deficiencies surrounding the care of children and young people in A&E. Others such as McMenamin (2005) and Wood (2007) describe ways of dealing with children in A&E that may improve their care. There appears to be no specific published data on the attitudes of nurses to the care of children in A&E.

The setting for the paper was the A&E department of a large District General Hospital situated in the North West of England. This is the main local A&E facility. There are approximately 80,000 new attendances at the department of whom 30,000 are children under the age of 16 years. The hospital was opened in 2002 and resulted in the closure of several smaller hospitals, including a children's hospital, with a dedicated children's A&E. The staff from this department initially ran the paediatric A&E at the new hospital separately from the adult side.

However this separation was gradually lost and children shared the same waiting and treatment facilities as adults. This situation was recognised by nurse management as being unacceptable, both in the context of shared facilities and of appropriately trained staff. 'Thus in the mid 2000s several existing RGN staff were seconded for RSCN training, and in 2007 a new paediatric area was built. However at the inception of this paper it was apparent that this new area was not functioning to its full potential. Some of the reasons for this appeared to be related to resourcing, but there also appeared to be major issues relating to how staff viewed the care of children. The nurses involved in this paper clearly recognised that treating adults and children in the same department was inherently problematic. Particular areas of concern included sharing of waiting and treatment areas by adults and children, lack of appropriately trained staff, and lack of resources in general. These issues are not new or peculiar to the department in the paper, but have been recognised in reports examining the ...