Children and Young People's Nursing

Principles for Practice, Second Edition

Alyson M. Davies, Ruth E. Davies, Alyson M. Davies, Ruth E. Davies

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781498734356
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Underpinned by a rights-based approach, this essential text critically analyses the theory and practice of children and young people's nursing from several perspectives - public health, acute and community based care, education and research. Chapters address the clinical, legal, ethical, political and professional issues and controversies which impact on the care delivered to children, young people and their families both nationally and internationally. This new edition continues to promote reflection and critical thinking about the practice of children's nursing and professional development.

PART 1

CHILDREN AND YOUNG PEOPLE’S HEALTHCARE IN CONTEXT

A Rights-Based Approach

1 The right for children and young people to participate in their own healthcare

Jill John and Richard Griffith

2 Safeguarding and child protection

Catherine Powell

3 The use of restraint in children and young people’s nursing

Sally Hore

1

The right for children and young people to participate in their own healthcare

JILL JOHN and RICHARD GRIFFITH

Introduction

Historical overview of childhood and children’s rights

How far have we come?

Legal rights

Legal issues in relation to protection and sexual activity

So where are we now?

From policy to practice

What more can we do?

How does the UN committee think we are faring?

Conclusion

References

OVERVIEW

This chapter examines the evidence for children and young people’s right to participate in their own healthcare. It begins with a historical overview of children’s rights and legislation and then examines the evidence by exploring the following questions:

∎ How far have we come?

∎ Where are we now?

∎ What more can we do?

Case law examples and evidence-based research are examined and examples of frameworks and excellent practice from healthcare and associated allied professions are provided.

INTRODUCTION

There is a growing acceptance in the UK and elsewhere that children and young people should participate more in making decisions about issues that affect them. Increased children and young people’s participation has been fuelled by a convergence of new and developing ideas from quite different perspectives, such as the growing children’s rights agenda and the new sociology of childhood.

The key benchmark for children’s rights is the 1989 United Nations Convention on the Rights of the Child (UNCRC) that the UK ratified in 1991. It is the most extensively ratified human rights treaty in history and was the culmination of six decades of work with Somalia and North America, the only UN member countries to opt out of the charter. The UNCRC provides a framework for the development of national policies and laws to protect the rights of children and young people throughout the world, and is considered by many as being instrumental in the development of more child-friendly policies in Britain (O’Halloran 1999). The main weakness of the convention, however, is that there is no direct method of formal enforcement, and governments are merely directed to undertake all appropriate methods available to them to implement the rights. Member states had to report back to the UN initially 2 years after their ratification and implementation and then every subsequent 5 years, although occasionally the response from the UN committee exceeds this timescale.

Until recently, it has been difficult to reconcile differences between historically held beliefs about children and young people’s inability to make decisions and findings from research that contradict these assumptions (Alderson 2007). Children and young people’s participation in healthcare decisions is heavily influenced by such assumptions, in particular an identified need for adult guidance and the need to reduce attempts to reason or listen to their views (Flatman 2002; Alderson 2007). The notion of working with children, young people and families in the involvement of their care (physical and otherwise), including the decision-making process, would have been seen as totally inappropriate as little as 30 years ago, when parents and other family members were seen as amateurs who frequently got in the way of professionals trying to do their job (Darbyshire 1994). Indeed the first UK report to the UN committee appeared to reflect a protectionist ideology supporting the view that young children are unable to make decisions themselves, with the emphasis being on parents as the consumers of healthcare which could be argued both marginalizes and objectifies children and young people (Fulton 1996).

HISTORICAL OVERVIEW OF CHILDHOOD AND CHILDREN’S RIGHTS

Until the nineteenth century and the increase of industrialization it could be argued that the notion of childhood was largely an invention (Boyden 1991, cited in James et al. 1999). Rates of fertility and mortality were high owing to the spread of deadly and untreatable infectious disease, including typhoid and cholera. Families therefore had many children because a high percentage of children died under the age of 1 and many more did not live beyond 5 years. It is difficult for historians and others to calculate infant mortality rates as births were not registered until 1837; however, church records before this time showed that funerals always exceeded baptisms. Aries (1962) identified that medieval European children were not segregated from adults and therefore were not thought to require any special needs and frequently were dressed in adult clothing. Aries (1962, p. 48), continuing in his studies, eventually described childhood as ‘a nightmare from which we have only recently begun to awaken’. Indeed the further back in history one goes, the more evidence there is of a lower level of child care, including an increased likelihood of children not only being killed but also abandoned, beaten, terrorized and sexually abused by those who were supposed to care for them (deMause 1974, cited in Mayall 1994).

The status of children and childhood as it evolved was marked by the absence of practically all civil rights, with no philosophical or legal recognition to self-determination; this rendered children virtually powerless, having little or no control over their own lives, which many consider a marked characteristic of slavery (Verhellen 1996). For example, early Roman law allowed a father to literally have the power of life or death over a child and this power was frequently upheld. The overwhelming power a father had in law was gradually removed during the nineteenth century by Talfourd’s Act, the Custody of Infants Act 1839 and the Matrimonial Causes Act 1857. Yet, children were still seen to be in the custody of their parents, who retained considerable power over them. For example, parents could demand that a child in care be handed back when he or she was old enough to earn a wage (Barnardo v McHugh [1891]).

However, the twentieth century brought changes in family life associated with both industrial and urban expansion; childhood was gradually seen as a separate period of human life and children became central figures within the family (Boyden 1991, cited in James et al. 1999). Hygiene and public health were a defining feature of ‘modern childhood’, alongside the development of compulsory education. Impressive improvements were made in both the UK and other developed countries in the areas of health and physical development of children owing to higher standards of living and advances in sanitation and nutrition. Because of this, children have been attributed with certain qualities or disabilities and interest in them has grown considerably. However, socioeconomic inequalities in health still exist in developed societies today, including the UK, and sadly some of these have changed little in recent years. Public Health Wales (2012) indicates a clear link between poor social and economic circumstances and the health and well-being that may be lifelong.

KEY POINT

It has taken centuries to recognize children as important beings in their own right.

REFLECTION POINT

Why do you think that it has taken centuries to recognize children as important beings in their own right? Take a few moments to think of two reasons why children held little importance within the family before the twentieth century.

HOW FAR HAVE WE COME?

Some consider that current-day perception of childhood has changed little and is essentially a preparation for ‘adulthood’, with a particular onus on guiding, educating, developing and sustaining the physical and moral well-being of children and young people through social institutions that include the family, school, health and welfare agencies. All too frequently, however, these agencies speak for children and young people on the basis that they are incapable of thinking ‘like adults’ until a certain developmental age is reached (Alderson 2007).

This view of regarding children and young people as ‘future adults’ instead of ‘current or present persons’ leads to the knowledge and beliefs of children and young people being either disregarded as irrelevant or totally ignored as a means of understanding their actions, concerns and needs (James and Prout 1990; Mayall 1996). There is an unquestionably growing counterview to this among both academics and professionals, in that children and young people are social actors in themselves and not just subjects of social processes and structures (James and Prout 1990). The emerging sociology of childhood indicates the importance of children and young people actively constructing their own lives by, for example, participating in and negotiating their own healthcare, education and social welfare by utilizing skills that often go unrecognized (Mayall 2002). However, the approaches adopted for children’s rights and adults’ beliefs regarding this concept in the UK undoubtedly have their origins in the evolution of the child and childhood with an indication that this history continues to influence current attitudes toward children and young people in society and contemporary healthcare practice (Lowden 2002).

Overall, the 54 articles in the convention can be broadly divided into three types of rights:

1. Provision

2. Protection

3. Participation

With participation regarded as the younger sibling of provision and protection it has been identified by the UN Committee on the Rights of the Child as a central underlying principle which must be considered in respect of all other rights; however, it is also one of the provisions sadly most widely violated and disregarded in every sphere of children’s lives (Shier 2001).

PROVISION

Article 24 of the UN convention indicates that children and young people have the right to

[the] highest attainable standard of health and to the facilities for the treatment of illness and rehabilitation of health.

The first named concern in the article is

… to diminish infant and child mortality.

Children and young people’s right to good healthcare is enshrined in various UK policy, law and public documents, including, most importantly, the UNCRC and the 1989 and 2004 Children Acts. Alderson (2002) indicates that Article 24 of the convention balances local with global attainment and indicates how inspirational some children’s rights are. She argues that children and young people’s right to be healthy is often unrealistic and unattainable, although the convention clearly indicates the right to every type of healthcare available to them within their own culture. This is unquestionably variable and inequitable even in the UK where we have free health care at the point of delivery let alone worldwide in countries that have no identified healthcare systems.

AREA OF CONCERN IN THE UK

Inequalities in health in the UK have been identified for more than 30 years in both research and policy. They are link...

Table of contents

• Cover
• halfTitle Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• Preface
• Acknowledgements
• Contributors
• Part 1 Children and Young People’s Healthcare in Context: A Rights-Based Approach
• Part 2 Family-Centred Care in Practice: Being Inclusive
• Part 3 Care Delivery Across a Range of Settings
• Part 4 Developing a Professional Children and Young People’s Nurse
• Index