The Oxford dictionary for nursing (McFerran, 2014) gives a definition of assessment as, the first stage of the nursing process in which nurses collect data about the patient’s health, using this data an effective care plan can be devised for this individual child. In 2017 the Royal College of Nursing (RCN) described assessment as being able to effectively evaluate an infant, child or young person condition using a broader process that involves listening, touch, visual observation, and communication. Every assessment performed needs to have a purpose (NSPCC, 2014) and that the practitioners are very clear as to why these assessments are being used and what they are wanting to achieve from these.
An important part of the assessment process is history taking of the patient, as it is important to be aware of any current or previous conditions and disability that may affect the results of these vital observations.
Physical examinations are mainly used when determining if a child or young person is unwell, additionally, it can be used when there are concerns in relation to the safeguarding of a child or young person. This could include cuts, bruises or rashes on the infant, child or young person’s body. It is important that these signs are spotted early rather than later to prevent the further abuse and neglect of the child but also so that there can be things put into place that may be able to help the family but mostly to help the child. The NSPCC (2014) discussed the importance of assessing an infant, child or young person’s circumstances, including their physical, social, emotional, intellectual and spiritual needs, being met and what, if anything, can be done to reduce the risk of underlying influences being unidentified allowing them the opportunity to have these needs met.
This is important as children can become very distressed from the assessments as they may have little understanding, or they are not completely aware of what is happening. It is important therefore that the child is involved in their care and aware if possible and they have the capacity to understand why they having these tests are being taken, this will help to settle the child, making sure that they are not getting too stressed or worried. Families should also be informed about the procedures that will be happening and why these assessments are going to be used. Having the parents aware can create a calming environment for the child instead of a stressful one, allowing the results of assessments such as PEWS and ABCDE to be accurate with the least interference from other factors.
The Paediatric Nursing Journal in 2008 stated that assessing and measuring vital signs can give important information about the health and well-being of a patient but also about ill-health. These vital observations can be recorded on a Paediatric Early Warning Scores chart (PEWS) this can show the clear trend that is occurring and as to whether there is a deterioration of the infant, child or young person’s health. The RCN (2017) explains that there is a systematic approach that needs to be taken when assessing, measuring and recording the vital signs of a patient, starting with the ABCDE approach to take an initial assessment of an unwell child, then to continue with the regular observations using the PEWS charts. Miranda, J.O.F. et al (2016) reviewed the use of Peadiatric Early Warning Scores (PEWS) and how effective they can be, Miranda explains how the key for survival and good prognosis of an ill child is the early recognition of the signs and symptoms of clinical deterioration of a child or young person. This allows the early intervention, meaning that these children and young people can get immediate medical attention. Castledine (2006) explained clearly when these vital signs should be recorded, this being arrival to the emergency department, admission onto the ward, at regular intervals during their stay and when having any procedure their vital signs will be recorded before, during and after the procedure. It is important that the vital observations are continuous for a child because they can deteriorate very quickly. The RCN (2017) also, however, explained that when assessing, monitoring and measuring the infant, child or young person’s vital signs their psychological needs also need to be recognised with the appropriate action taken. As this may become an influence on the results that you may receive and record. Vital signs can be affected by the anxiety or if the child is crying and upset, Bird, C. (2008) explains how measuring blood pressure for a child can be very difficult, saying that crying toddlers can have readings that are high and out of the normal ranges which are false. This can cause problems as these readings when placed on a PEWS chart may be in the areas that would raise alarms. The RCN (2017) has given clear guidance on abnormal results on the pews chart, explaining that crying and eating can affect the blood pressure measurements but that these should be noted on either the observation chart or in the nursing notes.
Using PEWS charts and assessment tools are a very effective way to assess a child’s health Murray (2015) explained how valuable of tool that the PEWS chart can be, looking at a case study of K.S. a night charge nurse and R.M. a four-year-old with a history of a 3-day fever and rash. K.S. became very concerned about this patient and the severity of the rash and when his vital signs were checked it was shown that he had a high heart rate and high blood pressure. However, the emergency department attending only placed this child in for the short-stay unit, K.S. was not convinced that this was the best option, K.S. being familiar with the PEWS system performed such on R.M. to which they scored a high on the risk for rapid deterioration. This information convinced the attending of the severity of this illness resulting in more tests which found a newly developed heart murmur and coronary aneurysms. In contrast to this Mok, W. et al (2015) held a study to find out attitudes towards vital signs monitoring and using these for early detection of clinical deterioration, the survey showed results such that the nurses he surveyed had a limited understanding of the key indicators of deterioration in a patient. A lot of the nurses in this study said that they looked for changes in the blood pressure to show a deterioration and less on the respiratory rate of the patient. Gold, D et al (2014) participated in a study to see if the PEWS chart was not only effective for intensive care admissions but also that is was effective in assessment within the emergency department.