In this week’s ‘EBN Blog’ Associate Editor Kerry Gaskin @GaskinKerry will introduce our theme for September 2024 – ‘Children are our future – Challenges influencing the future of nursing care of CYP’.

Over the next five weeks, EBN will present a series of blogs and journal content relating to global challenges facing children and Children and Young People’s (CYP) Nursing. This will include an EBN Resources Page and an upcoming Editorial (October edition) by Danielle Edge, Lecturer in Child Health Nursing @danniedge and Professor Kerry Gaskin, EBN Associate Editor. The blogs will consider factors influencing children’s rights, CYP nurse education, cultural humility in CYP nurses, global delivery of paediatric intensive care, child and adolescent mental health (CAMH) and palliative care services.

Why is this theme important? Almost a third (28%) of the world’s population are CYP under the age of 18 years¹. Globally the health and wellbeing of CYP are being affected by a variety of factors including the Coronavirus (COVID-19) pandemic, conflict and climate change. Findings from an international survey exploring child health professionals’ experiences regarding climate change was published on 21^st August 2024, by the Royal College of Paediatrics and Child Health. The survey found that clinicians are already experiencing the impact of climate change within the health service; with ‘CYP being exposed to heat, poor outdoor air quality, household air pollution and increased prevalence of infectious diseases’². RCPCH Officer for Climate Change, Dr Helena Clements, said “Children have fundamental human rights to clean air, safe water, sanitation, affordable and nutritious food, and shelter, yet millions of children in the UK and globally do not have access to these critical health determinants”².

Health inequalities have been high on the policy agenda for some time^3-4; the Marmot review^5-6 identified ‘giving every child the best start in life’ as one of five priority areas. The unprecedented rise in infant mortality in England over the last decade has disproportionately affected the poorest areas of the country⁷. In the year ending March 2023, the West Midlands had the highest child death rate, and this was highest for children of Black or Black British ethnicity (56.6 per 100,000 population) and Asian or Asian British ethnicity (50.8 per 100,000 population)⁸.

As CYP nurses we are uniquely positioned to influence the future of child health in the UK and globally, by understanding and addressing complex and inter-related social determinants within our practice, research, policy documents and the educational curriculum. Additionally, as Professor Lucy Bray, Edge Hill University indicates and will be exploring in her blog, ‘we need to work with CYP (particularly those often less heard) to challenge accepted practice and exclusion’ and  ‘professionals and institutions need to acknowledge their competencies and rights within day-to-day practice – revisiting that it is the little things which can make a big difference, maintaining humanity within services under pressure’.

Health services were clearly under huge pressure during the COVID-19 pandemic, for example, resulting in redeployment of CYP nurses and health visitors to work in adult wards and intensive care units⁹, negatively impacting service provision for CYP and their families. Furthermore, evidence is emerging of the intense impact of the pandemic on the mental health and wellbeing of children and parents¹⁰. The influence of the pandemic and other challenges on CAMH will be considered in the upcoming blog by Rebecca Reynolds and Yasmin Smith, Senior Lecturers at the University of Plymouth. Healthcare professionals must be alert to the potential consequences of declining mental health and further research is required exploring the long-term impact of the pandemic on both parents and children^11.  The new government must prioritise the rebuilding of essential services such as Health Visiting and School Nursing^12.

Whilst paediatric intensive care has also been affected by the pandemic, other local, national and international factors are influencing the provision of intensive care globally. Data from Save the Children¹³ indicates that in 2022, 2,985 children were killed across 24 countries and almost 200 million children were living in the world’s most deadly war zones; this was the highest number in more than ten years and exacerbated by the war in Ukraine. In these war-torn countries the need for intensive care has escalated at a time when provision of services has been catastrophically affected by damage caused to health care facilities. In the UK, major tragic incidents such as the Manchester Arena bombing in 2017¹⁴ and stabbings affecting children, require care provision for CYP and their families in the most difficult circumstances¹⁵. Professor Lyvonne Tume, Edge Hill University, Professor Joseph Manning, University of Leicester and Dr Julie Menzies, Bristol Children’s Hospital will explore challenges for paediatric intensive care nurses in their upcoming blog. Whilst key factors influencing palliative and end of life care will be considered by Gilda Davis, Senior Lecturer in Children’s Nursing at the University of Worcester.

Central to this theme is the perennial review of pre-registration nurse education; whether we need fields of practice¹⁶ or should revert to generalist nurse education¹⁷. The blogs will undoubtedly create discussion around curriculum content related to the key challenges highlighted through this series. The EBN resources page provides links to previous journal content as well as additional contemporary resources, such as the national project, Fit4CYP¹⁸ which aims to establish how the structure and content of pre-registration educational programmes influence the readiness for practice of newly qualified children’s nurses Fit for Children and Young People project (Fit4CYP) – University of Plymouth. Integral to the educational preparation of nurses caring for CYP and their families is developing cultural humility through decolonisation of the curriculum. This will be explored in more depth in an upcoming blog Laura Maguire, Kathryn Sethi, Emma Tonks and Waheeda Zaman, CYP Nursing Lecturers at Birmingham City University.

References

1. United Nations (2024) World Population Prospects, available at: World Population Prospects – Population Division – United Nations [accessed 18/7/24]
2. RCPCH (2024) Changing climate already impacting the way healthcare professionals work around the world, available at: https://www.rcpch.ac.uk/news-events/news/changing-climate-already-impacting-way-healthcare-professionals-work-around-world [accessed 23/8/24]
3. NHS England (2019) The NHS Long Term Plan. NHS, www.longtermplan.nhs.uk
4. Public Health England (2019) Place-based approaches for reducing health inequalities: foreword and executive summary. PHE, www.gov.uk/government/publications/health-inequalities-place-based-approaches-to-reduce-inequalities/place-based-approaches-for-reducing-health-inequalities-foreword-and-executive-summary
5. Marmot, M. (2010) Fair society, healthy lives: the Marmot Review: strategic review of health inequalities in England post-2010. ISBN 9780956487001
6. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. (2020) Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity, available at: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on [accessed 20/2/24]
7. Taylor-Robinson D, Lai ETC, Wickham S, et al. (2019) Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000–2017: time trend analysis. BMJ Open, 9:e029424. doi:10.1136/ bmjopen-2019-029424
8. National Child Mortality database (2023) Child Death Review Data Release: Year ending 31 March 2023, https://www.ncmd.info/publications/child-death-data-2023/ [accessed 20/2/24]
9. Mallory J et al (2021) Covid -19 pandemic redeployment of paediatric cardiac nurse specialists to adult intensive care units – could we do it? Available at: https://blogs.bmj.com/ebn/2021/10/03/covid-19-pandemic-redeployment-of-paediatric-cardiac-nurse-specialists-to-adult-intensive-care-units-could-we-do-it/ [accessed 23/8/24]
10. Hamilton D (2020) Impact of COVID-19 on Children and Families, available at https://blogs.bmj.com/ebn/2020/10/25/impact-of-covid-19-on-children-and-families/ [accessed 23/8/24]
11. Gaskin, K. L., Hope, L., & Lewis, A. (2024). “It Shook My Whole Parenting Plan”: Parents’ Experiences of Being at Home with Their Newborn Baby During the COVID-19 Pandemic. Comprehensive Child and Adolescent Nursing, 1–17. https://doi.org/10.1080/24694193.2024.2389415
12. NHS Providers (2024) The Forgotten Generation: Shaping better services for children and young people, available at: https://nhsproviders.org/forgotten-generation-shaping-better-services-for-children-and-young-people [accessed 18/7/24]
13. Save the Children (2024) The 10 most dangerous countries for children living in conflict, available at: https://www.savethechildren.org/us/charity-stories/worst-conflict-affected-countries-to-be-a-child [accessed 17/7/24]
14. Craigie RJ et al (2020) Manchester Arena bombing: lessons learnt from a mass casualty incident BMJ Mil Health 2020;166:72-75.
15. RCPCH (2024) RCPCH responds to major incident in Southport, available at: https://www.rcpch.ac.uk/news-events/news/rcpch-responds-major-incident-southport [accessed 23/8/24]
16. Barrett D (2016) available at: Fields of nursing: do we need them, what should they be and when should nurses choose theirs? – Evidence-Based Nursing blog (bmj.com)
17. Purssell E, Sagoo R (2023) Children’s nursing: is it time to rethink field-specific training? Nursing Children and Young People32(2): 12.
18. Carey M et al (2024) Fit4CYP, available at: Fit for Children and Young People project (Fit4CYP) – University of Plymouth.[accessed 20/2/24]