Changes in children's nursing services in the United Kingdom in recent years have focused on the need for adequate and efficient services to be provided in the interests of the child. Early discharge is now the norm and children are often sent home in an earlier recovery stage than adults with comparable conditions. Whilst the contributions of paediatric community nursing services have gone some way to providing specialist nursing care for children and their families in their own homes, the majority of children are discharged home without such support being available. This may place an overwhelming responsibility of caring for a recovering child onto parents. The purpose of the qualitative research reported in this paper was to identify any gaps in nursing services for acutely sick children and their families following discharge, and to suggest ways to improve integration and communication between hospital and primary care to facilitate a 'seamless web of care' for families. Families were surveyed following discharge (n=164) and interviews carried out with those experiencing problems (n=20). General practitioners were also surveyed for their opinion as key contributors of primary care. Findings revealed the isolation felt by parents following discharge, with their need for information about a child's illness and expected recovery, and for reassurance and specific advice through some means of support, which was clearly not being met. The perceived benefit of continuity of care was a common theme, with both parents and professionals acknowledging the importance of closer liaison between hospital and primary health care services. This study is valuable in providing preliminary qualitative information regarding the gaps in children's nursing services and how these can be overcome by using our present resources more imaginatively, in order to ensure the delivery of cost-effective and quality health care services in the best interests of local need.

Medical students at the University of Sheffield have, in the past, spent time on children's wards as part of their clinical rotation in paediatrics. This has largely been seen as a means of increasing their understanding of the role of nurses in order to facilitate professional relationships. Literature would tend to support this view and identifies that closer cooperation and joint training might alleviate some of the differences and divisions between the two professional groups. In order to enhance this experience, a collaborative proposal between the Medical and Nursing Schools and the Sheffield Children's Hospital was put forward that involved each medical student having one ‘nursing day’, during which they would be ‘buddied’ by a senior nursing student in the placement area. This would involve the medical student shadowing and working alongside the nursing student to experience the realities of nursing practice and maximize opportunities for shared learning. As part of the day a joint seminar, facilitated by nursing lecturers, is held in the afternoon on topics relevant to all professional groups working with children to facilitate reflection, discussion and shared learning. It is clear from observing these seminars and from the evaluations of both medical and nursing students that adopting this interprofessional approach to learning is successful in terms of: mutual respect; understanding each others’ roles; enhanced medical experience of the medical student and ability to practice basic care skills, and student nurses developing their teaching and mentoring skills in practice Follow‐up contact with the students involved has revealed that by spending time together in this way, ongoing contact during the remaining clinical rotation was enhanced as the relationship was continued. Ongoing developments have seen cross‐boundary sessions, which involve medical students coming along to the School of Nursing and sharing in lectures delivered by medical staff. Initiatives such as these, by working across professional boundaries, can only be beneficial in providing truly holistic care to the child and family.

Problem-based learning (PBL) continues to be a feature of many nursing programmes and has been the subject of a number of empirical studies. This study explored the experience of PBL of a group of registered nurses undertaking a 1 year children's nursing programme. Focus group interviews at the end of the programme and 6 months post-qualification captured the student's perceptions of how they experienced learning to be a children's nurse on this type of programme and subsequently the impact it had had on them on their return to practice.Themes identified by the focus groups centred on the transitions students have to make to this type of learning and the need to let go of previous education expectations. Adapting to the PBL process led to a range of strategies being employed by the group to cope with the new demand, resulting in largely negative perceptions of PBL on programme completion. The second focus group allowed the group time to reflect on their experience and the impact of it on their role and presented a positive balanced view of their experience. This included increased confidence, assertiveness, being more questioning of practice and likely to search for and use evidence to underpin practice than before this PBL programme.This research demonstrates the need to provide more initial preparation at the start of programmes to support the transition to PBL and provide ongoing mechanisms for listening and responding to student concerns about the PBL process. For those considering PBL in the future, blended approaches rather than curricula wholly delivered by PBL may be more suited to shorter programmes of study. However, the overall message from this research indicates that although the students experienced difficulties in the process, the outcome did in fact meet their needs in the longer term.

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