Child care: a nursing perspective

Alba Brugués

Do all professionals working in primary care develop their professional skills adequately? My answer is no, and I believe that the paediatric service of primary care is one of the services in which there is more room to rethink the model of care. To make it easier, I will explain the model of childhood health (this is how I like to express it) that we have been developing for some years at the Can Bou Health Center (CASAP). A model that is gradually becoming known and extended to other primary care centres and which has been presented to national and European congresses and has received great interest on the part of managers and experts in paediatrics and who, at the moment, is offering specific training for those who want to a change orientation of the care of children and their families in primary care.

In the first place, two basic conceptual pillars must be highlighted:

1. In the nursing profession, the basic training axis is based on the promotion of health and the prevention of disease. When we talk about the Healthy Child Program, it’s obvious that the professional best prepared for this activity is the nurse.
2. In organizations where professionals develop their skills to the fullest, they are more motivated and have more capacity for resolution at a team and organizational level; a model described by Clayton Christensen in his article: “Disruptions of Health Care Professions".

With these two premises I will expose some of the cores of the model change:

1. The nurse as a health reference consolidates for the paediatric population, especially oriented to the promotion of health and the prevention of diseases, in which the paediatrician and the family doctor become consultants in those cases where the nurse determines it.

2. The paediatrician and the family doctor allocate more space in their agendas to devote time to the diagnosis and treatment of children who require it. Specific queries have been created for childhood asthma, cryotherapy, dermatoscopy and allergies.

3. Own support material has been developed:

a) Infant Nurse Care Guide. A document created by the CASAP paediatric team that aims to support the activity carried out by the nurses during the follow-up and development visits of the child, in which the following values ​​are appreciated:

• Family care based on the model of Virginia Henderson fourteen needs.
• The physical examination by means of a colour facilitator (semaphore); in green colour, it’s determined which physical signs explored are normal for age or don’t require supplementary studies; in yellow, what physical signs are pathological or potentially pathological and have to be checked with the doctor or monitored in future reviews, and, in red, what will have to be assessed with the doctor and immediately referred to the specialized service for diagnosis.
• The warning signs of psychomotor development that must be taken into account according to age from the Llevant table.
• Immunizations.
• The prescriptions and recommendations that must be delivered to the patient.

b) Guide to nursing interventions in health problems. Infancy, in which situations or demands of health problems in children have been prioritized. In this guide we have identified eighteen situations of possible autonomous resolution by the nurse and seventeen possible emergency interventions in which the resolution will be shared with the doctor.

At the same time, an exclusive agenda has been created for the demand management of nurses from 5:00 to 8:00 p.m.

4. Community health programs and group activities provided in the agendas have been increased regularly and periodically.

a) Welcome to the newborn. It’s a type of group visit during the first month of the baby's life in which experiences and knowledge are shared with a dozen families, a nurse and an educator from the municipal nursery school.

b) Group visit of six months. It’s a visit also in group format that eliminates the individual visit of the six months. In this session, two nurses give health education related to age-specific changes. The session is developed interactively and at the end an individualized physical examination is carried out.

c) Newborn space. Every two weeks a nurse participates in a session with a group of parents in the municipal nursery school, together with the educator, to discuss health education issues and share doubts and experiences of newborns and their families.

d) Breastfeeding support group. Group consultation and open one day a week.

e) Young consultation. Talks and exhibitions at the demand of those interested in the centre of young people in the city regarding issues related to drugs, sexuality, self-esteem, etc.

f) Health and School Program, at the request of several social networks and with their support, unilateral information is given and the possibility of consulting in a private environment is offered, apart from the on-demand interventions in the schools.

5. The promotion of research facilitates that the most motivated professionals can devote working time to research.

Diagram of the evolution of the model, from where we started to where we are now:

However, although the population is very satisfied with this service, it should be evaluated frequently if this approach which is very directed towards self-care, achieves the expected results and we can definitely turn the program around to get more autonomous adults and avoid dependent children and families being chronically healthy.