Shape of Caring Review: Impact for Children’s Nursing Education


Alison Twycross (@alitwy), Editor and Jo Smith (@josmith175), Associate Editor of Evidence-Based Nursing will be leading this week’s ENB Twitter Chat (#ebnjc) on Wednesday 20th May between 8-9pm UK time focusing on the recently published Shape of Caring Review: Raising the Bar (2015) (available from: and the implications for the education of children’s nurses. We hope that as many children’s nurses as possible join us.

Participating in the Twitter Chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward:

  • Go to your Twitter account
  • Follow the discussion by searching for #ebnjc once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets
  • Add the EBN chat hash tag (#ebnjc) to your tweets to join in, this allows everyone taking part to view your contribution

The recommendations from Shape of Caring: Raising the Bar (2015) review of models of education and training for nurse registrants and healthcare assistants in England include:

  • Exploring the ‘2+1+1’ model of training: two year training focusing on the whole person (physical and mental health), one year in a chosen specialism, followed by a full years preceptorship.
  • That the one year specialisms would include adult, child, mental health, learning disability and community nursing.
  • Having a greater focus on mental health issue across all specialists.
  • Having a strong grounding in critical inquiry to foster an ability to engage in research and implement research findings into everyday practice.

What appears to be being suggested is a return to a generic nurse education with two years focusing on the whole person and, for children’s nurses, one year focusing on the care of children. What worries us about this proposal is that it could herald a return to an old style common foundation programme, where often curricula were primarily focused on meeting the physical health needs of adult patients. This is in part due to the fact that in many Schools of Nursing the number of children’s nursing students is much lower than for adult nursing. This has sometimes resulted in students needing to undertake additional sessions to apply knowledge to caring for children, young people and families. Given that the new community field of nursing recommended by the Shape of Caring review appears to be for adults we are concerned that the needs of children and young people will not be adequately addressed under the Shape of Caring proposals.

It is important to remember that the proposals in Shape of Caring: Raising the Bar (2015) are currently recommendations and so as children’s nurses we have the opportunity to make sure our voice is heard. The purpose of this week’s Twitter Chat is to debate some of the key issues. In preparing for the debate you might want to read the following:

  • Royal College of Nursing (2007) Preparing the Child Health Nurse – fit for the future. Available from:
  • Twycross, A. (2007) Modernising nursing careers: Implications for children’s nurses, Paediatric Nursing, 19(9): 39-40.

Both these documents present the argument for a children’s nurse fit for the future – a child health nurse. This nurse will be able to:

  • Care for children from 0-18 years with a physical illness and mental health issue
  • Care for children in the hospital and community
  • Care for children with a learning disability
  • Undertake health promotion activities with children, young people and families

This requires a child health nurse who is knowledgeable, skilled, and competent. The new child health nurse needs to have an understanding of and be knowledgeable about issues relevant to the care of children, young people and families including:

  • Family-centred care
  • Communicating with children of all ages and their families and how to engage in shared decision-making
  • Psychological theories of child development
  • Sociological theories of childhood
  • How children and young people’s anatomy and physiology differs from that of adults with different responses to therapeutic interventions across the age span
  • Children’s rights and balancing children’s right to participate in their health care decisions while ensuing the best interest of the child remain paramount
  • Ethical and legal guidance relevant to children of all ages
  • Pain assessment management for children aged 0-18 years
  • Safeguarding (child protection) polices
  • The public health agenda specific to children and young people

There are some areas where shared learning with other fields of nursing is appropriate such as: research methods and the skills to appraise and use the best available evidence underpinning care; health promotion and critical evaluation of the effectiveness of service and care delivery.

As children’s nurses we need to ensure that future nurse education equips the new child health nurse to meet the needs of children, young people and their families in an increasingly challenging health care environment with advancements in medical technology, changing disease profiles and the influence of lifestyle choices on health, and changing expectations. If we fail to ensure that we have an education system that equips the child health nurse for the future challenges we will be failing 22% of the population.

Questions to consider:

  1. How will the Shape of Caring recommendations impact on the education of children’s nurses and more importantly impact on the care provide to children, young people and families?
  2. Do you think a two year whole person approach followed by one year specialism will produce a child health nurse fit for purpose?
  3. How do you envisage the operationalization of the one year preceptorship?
  4. What is your vision for the child health nurse of the future?


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