Canadian Paediatric Nursing Standards:

Standardizing High Quality Nursing Care for Children in Canada

2016 CAPHC Nursing Leadership Breakfast Session

B. Fleming-Carroll, L. Rudden, F. So, K. Breen-Reid, M. McAllister, P. Hubley, M. Ballantyne

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Objectives:

• Explore children’s healthcare needs unique to Canada

• Describe the development process of Canadian paediatric nursing standards

• Share the Paediatric Nursing Standards• Building next steps for knowledge translation

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Children VS Elders

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2016 UNICEF Report: Child Well-being

https://youtu.be/CioMdBRF1RA

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Key Health Concerns for Canadian Children

• Mental health• Obesity• Poverty• Indigenous Health• New Immigrant Health• Childhood Disability & Complex

Care• Chronic Health Conditions

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A Call to Action

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Harnessing our Strengths• Champion and advocate for children’s health issues• Care for children and their families as a unit• Focus on health promotion, illness prevention, curative & rehab. of the child• Working in many different settings• Many contacts with child & family members over time• Strength-based approach to care• Delivery of developmentally appropriate care• Focus on optimal functioning• Integrate scientific theory related to child health• Understanding of ethical, moral and legal problems unique to children• Breadth of knowledge related growth and development • Integration of Anticipatory guidance & health coaching• Frontline to vulnerable populations• Navigator/coordinator-understands the system• Collaborator with teams/sectors to provide best care

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Why Standards?• Direction for professional

paediatric nursing education and practice

• Framework for the evaluation of this specialized practice.

• Measurable standards define the nursing profession’s accountability to the public and the practice outcomes for which they are responsible.

(Adapted from American Nursing Association [ANA])

“There will always be some interest more immediate than protecting the well-being of children. There will never be one more important.”

- UNICEF REPORT CARD 2010

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The Journey- “Just the beginning”

• Develop a set of outcome oriented standards for paediatric nursing that will guide practice across the country and enable children and families to receive a consistent level of high quality care no matter where they are in Canada

• To grow the value of specialty training for nurses who practice in paediatric settings

• To grow the value paediatric nursing as a viable specialty area

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What We Are Building Upon: • Children’s Rights

– UN “Rights of the Child”– WHO

• Paediatric Nursing Standards– US (2008)– UK (2013)– Australia (2006)

• Canada• Canadian Nurses Association (CNA)• Canadian Association of Paediatric Nurses (CAPN)• Paediatric Intensive Care Nursing (CNA)• Provincial/Territorial standards

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Development of the Canadian Paediatric Nursing Standards

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Think Tank: October 2014

• Established interest and need• Developed core steering committee• Literature review and status report• Process map

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Obtaining perspective: Delphi process

Draft 1 Standards

Developed 5 Paediatric Nursing Standards to reflect:- Setting/environment- Focus of nursing- Patient populations - Understanding of terms - Glossary

E-Delphi Survey Round 1

Engaged >100 Canadian Nurses- Refinement- Understanding- Context- Refine Glossary

E-Delphi Survey Round 2

Engaged >80 Nurses from all provinces/territories- Further refinement- Feedback concerning application, communication

Review, Steering Committee Ratification

Ensure agreement across standardsConsistent languageReliabilityValidity

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Summit – September 11-12, 2015

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Vision• Paediatric Nurses are a powerful collective force that helps

ensure that all children and families in Canada have equitable access to highest quality pediatric care regardless of their circumstances.

• Paediatric Nursing Standards are leveraged to prepare the best paediatric nurses in the world and they are integrated into the practice of any nurse who works with children, youth and families in all settings and through key transitions.

• Children, youth and families are healthier, safer and more able to reach their full potential as a result of our leadership in evidence based: policy development, advocacy, health promotion, early detection and family centred care.

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Outcome Oriented Standards Exploration

Proficiency / Competencies

Always Events

Desired Outcomes

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Hybrid Delphi Process

• Initial Round: Expert Consensus Summit• Round 1 & 2: e-Delphi

Recruitment:1) Snowball method2) Direct contact

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E-Questionnaire Development

• Approved as a Quality Improvement project• Use of RedCAP©

• Rated each component with a 4 point scale (5 domains, Always events, competencies)

• Qualitative field to ask for clarifications & additions

• Instruction package and glossary of terms

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Data Analysis

• Set limits for agreement– Greater than 80% for domains– Greater than 65% for sub-points

• Small sub-group from steering committee reviewed the feedback and scoring

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e-Delphi Scoring

• Round 1– Greater than 80% for domains– Greater than 70% for sub-points

• Round 2– Greater than 97.5% agreement for domains– Greater than 92% agreement for sub-points

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Revisions

• Terms/key words were stream-lined to ensure consistency in language

• Repeated concepts were combined or eliminated

• Additional sub-points were accepted based on participant consensus

• Revisions & additions to glossary to ensure clarification

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Who responded?

AlbertaBritish ColumbiaManitobaNew BrunswickNfld & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Total 90 nurses

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Who responded?Hospital

Staff Development

College/University

Management

Community/Home Care

Clinic/medical office

Rehabilitation

Other

Public Health

Outpost

Research

Government

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ResultsRoun

ds# Agreed to Participate

# Actual Participation

# Completed Questionnaire

in Full

% Completed

1 128 84 78 61

2 135 85 77 57

STANDARDS• Over 97.5%

endorsement

ALWAYS EVENTS• Over 92%

endorsement

COMPETENCIES• Over 92%

endorsement

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5 Domains of Paediatric Nursing

Core Standards:Nursing Process

Safety / ReliabilityQualityEthics

ResearchEducation

2. Advocating for Equitable Access and the Rights of Children and their

Family

1. Supporting and partnering with the

child and their family

3. Delivering Developmentally Appropriate Care

4. Facilitating a child and family friendly

environment

5. Enabling Successful Transitions

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Standard I: Supporting and partnering with the child and their familyPaediatric Nurses partner with the child and their family to achieve their optimal level of health and well-being leading to resilient families and healthy communities.

The Paediatric Nurse ALWAYS:• Establishes an intentional therapeutic relationship with the child and

family• Respects the child and family in goal setting and decision making• Collects and uses information from the child and family context to

inform care• Communicates with child and family as partners in care • Advocates for optimal use of resources to support the child and family• Recognizes and fosters the parenting role to support child well-being

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Standard II: Advocating for Equitable Access and the Rights of Children and their FamilyPaediatric Nurses demonstrate and mobilize their understanding of the social determinants and other systemic factors that impact child health.

The Paediatric Nurse ALWAYS:• Completes a comprehensive assessment (beyond physical

assessment) through an advocacy lens considering Social Determinants of Health and child well-being

• Facilitates an appropriate environment to perform assessment and intervention considering privacy and confidentiality

• Build capacity in the child and their family to self-advocate• Engages in a community of practice or network that focuses on

paediatric nursing practice and knowledge and resources for children and families

• Supports the child and family to navigate the health care system

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Standard III: Delivering Developmentally Appropriate CarePaediatric Nurses perform assessment based on growth and development and deliver paediatric-specific care.

The Paediatric Nurse ALWAYS:• Demonstrates knowledge of typical development and variation from typical• Demonstrates knowledge of safety risks relevant to developmental stage• Provides anticipatory guidance and coaching on typical development and safety

related to the developmental stage of the child and family• Performs safety assessment at point of care to minimize risk and harm with

developmental stage• Incorporates developmentally appropriate play and/or recreational activities into

care• Performs age and developmentally appropriate bio-psychosocial assessment• Uses developmentally appropriate strategies when preparing for and performing

interventions• Considers development that is influenced by ethnicity, spirituality and culture

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Standard IV: Creating a Child & Family Friendly Environment

Paediatric Nurses play an essential role in creating a child and family friendly environment that welcomes families and promotes hope and healing. It is understood that the environment changes as the child grows and is influenced by multiple factors including but not exclusive to psychological, spiritual, and social.

The Paediatric Nurse ALWAYS:• Completes a child and family assessment• Demonstrates cultural competency and humility in all child and family interactions• Engages the child and family in all care decisions and plan of care in a respectful

non-judgmental, culturally safe manner• Shares information relevant to plan of care and collaborates with and amongst

circle of care providers• Recognizes and fosters family strengths and supports • Uses strategies to support and foster resiliency• Demonstrates caring and compassion to both child and family

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Standard V: Enabling Successful Transitions

Paediatric Nurses support the child and family through healthcare transitions to maximize their well-being. This may include, but is not limited to, hand-off between healthcare providers, admission and discharge, and facility transfer (such a from paediatric to adult care institutions)

The Paediatric Nurse ALWAYS:• Uses effective communication strategies at all transitions in care• Engages in planning of health education and coaching at all transitions• Provides health education and information to optimize transition of the child and

family• Assesses readiness and supports safe transition• Anticipates resources to support transitions in care• Plays an active role in facilitating effective transition

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Small Group Work

In table groups identify opportunities and activities that integrate the new standards within your assigned sector.1. Paediatric Tertiary/Quaternary Hospitals 2. Community Hospitals3. Community & Public Health Organizations4. University & College nursing Programs5. Research 6. Government & Professional Associations

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Canadian Assocoation of Paediatric Nurses (CAPN)

• Official membership with CNA• Obtained domain name paednurse.ca • Establish an Interim Executive for CAPN• First Executive meeting to be organized Nov.

2016• Establish Roadmap including website

development & membership, toolkits for standards implementation

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Thank you to our supporters

• Think Tank & Summit participants• Delphi responders• Financial supporters: