Chapter 1

GETTING STARTED

Who’s who?

There are many different people on the children’s ward, some of whom have jobs unique to dealing with children. This can be a little daunting at first if you’re not sure what they all do and means that you have a lot of names to learn. However, having such a large and varied team means that collectively, you can provide much better care for your patients and their families and you can learn a lot from your colleagues’ expertise. Understanding a little bit about what everyone in the team does will allow you to make the best use of their skills. The list below gives a brief description of some of the roles within the team. They are listed in alphabetical order for ease of reference.

Breastfeeding advisor

Many breastfeeding supporters are mothers who have trained to provide breastfeeding advice on a voluntary basis. They have a wealth of knowledge and tips and are able to provide support to mothers who are having difficulty establishing breastfeeding.

Child protection nurse

By law, each hospital or community trust must have a named nurse and a named doctor who are responsible for child protection. Child protection nurses are extremely knowledgeable and are a very useful first port of call for advice if you have any concerns about a child’s welfare. They attend child protection and psychosocial meetings and will often provide training on child protection to other members of staff.

Clinical support worker

Sometimes also known as therapy helper or therapy assistant. Their role is to work alongside, and under the supervision of, allied health professionals (such as physiotherapists and occupational therapists) and help with therapy sessions by preparing equipment, getting the patient ready before the session and providing an extra pair of hands during therapy sessions.

Dietitian

The dietition can give advice on feeding and nutrition, including advising about parenteral nutrition regimes or dietary supplements. They are crucial in the management of patients with eating disorders and can advise on monitoring for refeeding syndrome. They can also provide advice to children with food allergies.

Health visitor

Health visitors work in the community but you may come across them in the hospital at psychosocial meetings or when you are working in community paediatrics. Their work is varied but mostly involves going to visit families in their own homes. Health visitors routinely visit all new parents to provide any necessary advice or support in caring for their new baby. During these first few visits, they assess the level of support the parents need and decide how much longer they need to continue working with that family or if they need to refer on to other specialist services. They also play a vital role in supporting vulnerable children and families and are trained in recognising signs of abuse and neglect in children. They may be the first to raise concerns about the welfare of a child due to the valuable insight they gain from visiting families in their own homes.

Healthcare assistant

This is often abbreviated to HCA and HCAs are sometimes also known as auxiliary nurses or nurse auxiliaries. Their role is to work alongside nurses and midwives to provide them with support in their work. They will always be working under the supervision of a registered nurse or midwife. Duties involve things like helping with washing and dressing, meals, making beds and taking observations. The experience of healthcare assistants can vary a lot. Some may be working as a HCA whilst studying to become a registered nurse whilst others may have little or no medical knowledge. It is important to understand that the role and training level of healthcare assistants differ significantly from those of nurses (they are unable to dispense medications, for example).

Midwife

Midwifes have a varied role as they are involved in the care of pregnant women antenatally, the safety of mother and baby during labour and delivery, and the care of mother and baby in the early postnatal period. They are able to offer advice to mothers about feeding, supported by the breastfeeding advisor for women who need additional support. Some midwives are also trained to perform newborn baby checks.

Nursery assistant

Nursery assistants need no specific childcare qualifications but will assist nursery nurses in their work and under supervision. They can still provide very useful support to children by engaging them in play and distracting them from procedures but will not be able to help with more specialist work such as explaining diagnoses through play in the same way as a play specialist or nursery nurse would be able to.

Nursery nurse

Nursery nurses have many similar roles to the hospital play specialists but will often also work in community settings. In order to be a nursery nurse, they will have a childcare qualification but will not have trained to as high a level as a play specialist (who undergoes additional training). They may work alongside play specialists.

Occupational therapist

The role of the occupational therapist (also called an OT) is to help children to be able to do all the things that any child of their age could do. Essentially, their role involves assessing any physical or psychiatric IMPAIRMENT that the child may have and providing practical solutions to minimise the extent to which this impairment becomes a DISABILITY. This might mean making adaptations to the child’s home or providing them with equipment or tools to help them to complete tasks.

Orthoptist

Orthoptists work within the ophthalmology team to help diagnose, investigate and treat problems with eye movements, such as squints (strabismus). Some are also involved in vision screening for children in community health centres and schools.

Pharmacist

The ward pharmacist is an enormously useful source of information so make good use of them. They will be able to advise you on the latest research on certain medications, the most effective preparations to use and possible side-effects to be aware of, and can help you with difficult prescriptions. They also check all the drug charts and may spot mistakes you have made in your prescriptions. Try not to take this as a criticism but instead be grateful that they have pointed it out to you so that you have the chance to correct it and try to learn from their advice. They are also very useful for communicating with families and GPs to establish exactly which regular medications a child takes and to discuss changes to medications with parents.

Pharmacy technician

Pharmacy technicians work closely with pharmacists to assemble, label and dispense medications. They check the stock of medications on the ward and expiry dates of medications. They are sometimes also involved in checking and recording the medications patients are taking and talking with families about how to use their medicines safely at home. They may not have the same depth of knowledge as pharmacists for helping with queries about prescriptions.

Physician assistant

Only present in a handful of paediatric centres but an incredibly valuable resource (count yourself very lucky if you have them at your hospital). They are trained to support doctors in the medical management of patients and can often perform blood tests and insert cannulas, check blood results, write discharge summaries and order investigations. As they take on some similar roles to junior doctors (but tend to be in the same post for longer), they become experts on the ins and outs of how the hospital works and can be vital to the smooth running of the department. There will be individual variation between what they are trained and comfortable doing so avoid making assumptions and ask.

Physiotherapist

Physiotherapists are highly trained and probably have a much better knowledge of working anatomy than you do. Physiotherapists help children with balance and mobility problems through exercises, manual therapy and provision of mobility aids (such as frames or wheelchairs). They can help with postural problems for children with spinal deformity, prevent joint contractures and also provide chest physiotherapy (for example, to help children with pneumonia to clear mucus from their airways).

Play specialist

Play specialists are experts in child development and age-appropriate play and will have had to study for several different qualifications (including a degree) in order to work as a hospital play specialist. They are crucial in helping to distract children whilst you are performing procedures and can help with the explanation of diagnoses and treatments to children through engaging them in play. They can also provide support to siblings and contribute to clinical decisions based on the child’s behaviour that they have observed whilst playing.

Psychologist

Child psychologists may specialise in either clinical or educational psychology. A clinical psychologist will be involved in the management of children with mental health problems such as anxiety and depression, those struggling to adjust to their physical illness or children with behavioural problems or issues with family relationships. Educational psychologists are more likely to work in a community setting. They aim to enhance the child’s learning ability through helping them with their emotional problems or learning difficulties...