This study has identified the knowledge, skills and attitudes required by qualified nurses who care\ud for children in Accident and Emergency (A and E) following trauma. These requirements were\ud then compared with the current attributes of such nurses.\ud The researchm ethodologyw as carriedo ut in three phasesa fter an extensives urveyo f the relevant\ud literature. The identification of the level of knowledge, skill and attitudes required for best practice\ud was achieved by the first phase: a Delphi study, being a structured approach to collecting the\ud opinions of a panel of qualifieda nd experiencedc hildren's nurses.T he actualk nowledge,s kills\ud and attitudes that nurses have and apply in practice were identified by the second and third phases\ud of the research.R egisteredn ursesc aring for children in three A and E units were surveyedb y\ud questionnairew hilst further dataw as obtainedb y nine sessionso f participant observationi n three\ud A and E units.\ud Ile three sets of results have been compared and contrasted with each other and with the review\ud of the literature and this triangulation approach has led to a number of key findings. The care\ud needs of traurnatised children are different from those of adults; at present the majority of\ud children are not cared for by nurses with the necessary competence or within an appropriate\ud environment. Children need holistic care, not just the treatment of their medical injury.\ud ibis study has uncovered a specific education and training challenge, because most of the\ud registered nurses in this survey who do care for traumatiscd children think they arc competent in\ud that specific and distinct role, although the observations showed that this is not always the case.\ud Such nurses should be trained in both paediatric and A and E nursing skills. Tl-ýs can and should\ud be achievedb y personaliseda nd flexible courses.\ud The recommendationsa rising from the key outcomesh ave been made separatelyto educationa nd\ud training providers, to the nurses themselves and finally to the health care policy makers and\ud managers who control the clinical environment for the A and E nursing of children's care. 11c\ud recommendations to the education and training providers arc specific to the content of the\ud curricula for training nurses who care for children and to the structure of the corresponding\ud courses. Adult-trained nurses, however expert in that context, are recommended to seek the advice\ud of their child-traincd colleaguesw ho care for children. Managersa rc recommendedt o benchmark\ud the physical environment, culture and practices of their A and E Units against those in the\ud Children's hospital. Iley are also recommended to work with education and training providers to\ud support three different models of continuous professional development; models which reflect the\ud different backgrounds and initial levels of compctcncc of nurses who care for children.\ud The researchers uggeststh at, if theser ecommendationsa re actedu pon, then nursesc aring for children\ud wiH be better educated and in turn the practices of caring for traumatiscd chUdrcn in A and E wiU\ud also improve, and wiU better meet the needs of both the children and their families
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