Annex B : Acute care (children’s high dependency unit)

Annexe B: Nursing procedures

Procedures for assessing people’s needs for person-centred care

2.1 Take, record and interpret vital signs manually and via technological devices

2.12 Undertake, respond to and interpret neurological observations and assessments

Alexis used the Paediatric Early Warning Score (PEWS) chart to assess, record and monitor Freddie’s vital signs. This tool supports early recognition of deterioration and escalation of care. The use of a nationally standardised PEWS chart ensured consistency in monitoring and communication across services, particularly when liaising with specialist paediatric neurology teams in another hospital.

Alexis recognised the importance of identifying normal and abnormal findings within Freddie’s observations and escalated any concerns to her practice supervisor to support safe and timely clinical decision-making.

Alexis also undertook neurological observations using the Glasgow Coma Scale (GCS) to assess Freddie’s level of consciousness and identify any signs of deterioration following his suspected head injury.

During handover, Alexis participated in completing a joint set of neurological observations with the incoming nurse. This supported consistency, reduced the risk of misinterpretation, and ensured continuity and safety of care.

Procedures for meeting needs for mobility and safety

7.1 Observe and use evidence-based risk assessment tools to determine need for support and intervention to optimise mobility and safety, and to identify and manage risk of falls

7.2 Use a range of contemporary moving and handling techniques and mobility aids

Alexis participated in safe manual handling practices when transferring Freddie for his MRI scan. This required clear team communication and coordinated movement to ensure that all staff were aware of their roles and that the transfer was completed safely, particularly due to the suspected head injury.

Alexis contributed to ongoing risk assessments throughout the shift, recognising that Freddie’s condition and mobility were improving. Risk assessments were updated to reflect his current ability, supporting safe progression of mobility.

Alexis supported Freddie to gradually increase his independence, including mobilising short distances and using a commode within his bed space. She recognised when additional support, such as a wheelchair, may be required and ensured repositioning needs were met while he was in bed.

Procedural competencies for medicines administration and optimisation

11.1 Carry out initial and continued assessments of people receiving care and their ability to self-administer their own medications

11.2 Recognise the various procedural routes under which medicines can be prescribed, supplied, dispensed and administered; and the laws, policies, regulations and guidance that underpin them

Freddie was using a Patient Controlled Analgesia (PCA) device to administer morphine, allowing him to manage his own pain relief within safe prescribed limits. Alexis demonstrated understanding of how the PCA functioned and the importance of monitoring its use.

Alexis regularly assessed Freddie’s pain using a pain scale and discussed this with him to ensure that his pain was effectively managed. She observed how PCA usage data was reviewed with her practice supervisor to monitor frequency of use and inform clinical decision-making.

Alexis recognised the importance of ensuring that medication prescriptions remained appropriate and contributed to discussions with the team regarding pain management, liaising with medical staff where required.

Learning opportunities in your area

Understanding the 6Cs in practice

Students are encouraged to develop an understanding of the 6Cs of nursing (Care, Compassion, Competence, Communication, Courage and Commitment) and reflect on how these underpin everyday practice.

Within this clinical area, students have opportunities to observe and demonstrate the 6Cs through:

• Delivering person-centred care that prioritises the needs, safety and dignity of the child and family
• Using compassionate and age-appropriate communication to support understanding and reduce anxiety
• Developing competence in clinical skills such as observations, assessments and documentation
• Demonstrating courage by asking questions, seeking clarification and escalating concerns appropriately
• Showing commitment to learning through reflection, feedback and engagement with the multidisciplinary team

Students should reflect on how they have applied the 6Cs within their own practice, for example when communicating with children and families, supporting decision-making, or contributing to safe care delivery.

Clinical assessment opportunities (Aligned to Platform 3)

The high dependency environment provides a wide range of opportunities for students to develop skills in clinical assessment and care planning.

Students may be involved in:

• Undertaking A-E (Airway, Breathing, Circulation, Disability, Exposure) assessments
• Monitoring and interpreting vital signs using tools such as PEWS
• Completing neurological observations, including use of the Glasgow Coma Scale
• Participating in pain assessment using age-appropriate tools
• Contributing to risk assessments and identifying changes in patient condition
• These experiences support students to develop their ability to gather, interpret and use clinical information to inform person-centred care planning and recognise deterioration.

Discharge and transition of care (Aligned to Platform 7)

Students have opportunities to observe and contribute to the processes involved in discharge planning and transition of care.

This may include:

• Participating in multidisciplinary team discussions regarding discharge planning
• Observing how care is stepped down from high dependency to lower levels of care
• Understanding the role of discharge summaries and communication with primary care (e.g. GP)
• Liaising with community services such as school nurses or specialist teams
• Supporting education for children and families regarding ongoing care and recovery

These experiences enable students to understand the importance of coordinated care, continuity and safe transitions between services

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