Opinion In tests carried out with a variety of syringe sizes, Corpak MedSystems states in its frequently asked questions section online that it is unlikely that a person would be able to exert sufficient pressure on a syringe to burst a feeding tube. If a tube is clogged, the person exerting force by pushing and pulling it would realise that there is an obstruction and stop before the tube burst or collapsed. As nurses and carers looking after families of children requiring long-term gastrostomy feeding, we cannot underestimate the feeling of empowerment parents experience when they choose blended diet – being able to meet one of their child’s basic need enables them to regain control. Imagine being able to make, bake and blend your child’s birthday cake. Does the level of support provided to these families become like other care services, dependent on which area of the country they live? Perhaps as nurses we should be considering how, after careful assessment, feeding a child blended food would have a negative effect on nursing practice. At Little Bridge House and two other hospices that are part of Children’s Hospice South West we support a group of families who have chosen blended diet and individualised their children’s diet to make it their own. We have shown that with careful consideration, risk assessment and communication with local dietitians it is possible to develop practical guidelines that support and replicate care for those who choose to use blended food at home. References British Dietetics Association(2014) BDA Policy Statement. Use of Liquidised Food with Enteral Feeding Tubes. tinyurl.com/oy56fwb Brown S (2014) Blended food for enteral feeding via a gastrostomy. Nursing Children and Young People. 26, 9, 16-20. Kennedy D et al (2015) How would you want to feed your child? Dietetics Today. February, 40. Klek S et al (2011) Commercial enteral formulas and nutrition support teams improve the outcome of home enteral tube feeding. Journal of Parenteral and Enteral Nutrition. 35, 3, 380-385. National Institute for Health and Care Excellence (2012) CG139. Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care. tinyurl.com/cbz6679 National Institute for Health and Care Excellence (2014) Infection. Evidence Update September 2014. Evidence Update 64. tinyurl.com/nwenoy9

Suzanne Brown is a children’s nurse on the care team care, Children’s Hospice South West, Fremington, Devon NURSING CHILDREN AND YOUNG PEOPLE

Letter Employers need to join the 21st century The profession and qualifications ascribed to children’s nurses have altered with time, reflecting changes in children’s health and their place in society. Before amendments to nurse education in the 1990s, children’s nurses were entered on the Register for Sick Children (RSCN), emphasising care of sick rather than well children. Subsequent registration and university-based education has reflected illness prevention, health promotion and understanding that young people are not children. Hence, there are now separate degrees in children’s nursing, child nursing and children’s and young people’s nursing. Any connotations to sickness have therefore been removed from current RN(Child) registration.

Reflecting these developments, in 2011 this journal changed its name from Paediatric Nursing to Nursing Children and Young People. It is concerning, therefore, to see job advertisements inviting ‘paediatric’ nurses to apply for a range of positions across acute, tertiary, voluntary, private and community settings. This medicalised term is outdated and does little to reflect 21st century nursing professionalism. It is incumbent on us, as children’s nurses, to influence employing organisations to better reflect current professional practices by adopting terms such as children’s nurses rather than paediatric nurses in their advertisements. Jane Hunt, senior lecturer children’s and young people’s nursing, Bournemouth University

Starting out

A case that made me stronger I WILL never forget a young patient I looked after when I began my job as a staff nurse on the children’s intensive care unit (CICU). The child suffered a spontaneous bleed on the brain and was left with extensive neurological defects. The extent of the damage was uncertain at that point but the prognosis was that the child’s future would be bleak. When I heard about this story, my immediate thoughts were about the child’s parents and the devastation the situation had brought on their family. It must have been shocking for them because the child had been healthy but was so ill now. Their whole lives changed in an instant and they had no control over this. I remember feeling unsure about what to say to the family and how to interact with them. I wondered how I or anyone could possibly help to ease the pain and sorrow they now felt. This child’s case had a significant effect on me because it made me doubt my decision to work as a nurse in CICU. I even rang my mother and told her that I was going to leave my

job and return to Ireland. I realised how emotionally challenging it was going to be for me to nurse children with complex medical conditions in such a highly pressured clinical environment. That day I doubted my abilities to cope and carry out the necessary nursing duties to the best of my ability. This was because I have never taken care of patients in the most critical phase of their illness before. Thankfully, I am still in a supernumerary period and I do not yet have the responsibility of caring for patients at an independent level. This has given me time to reflect on my experiences, learn from them and transform any negative thoughts or feelings about my new job into positive ones. I know I will have experiences in future that will make me doubt my abilities as a nurse. That is only natural. However, I am grateful for the opportunity to be starting out my career in the CICU. I intend to make sure that it will be a positive and fulfilling experience at all times. Lisa Kirwan is a staff nurse at Great Ormond Street Hospital for Children in London July 2015 | Volume 27 | Number 6 15

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Employers need to join the 21st century.

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