Sue Dunlop March 2009

Future options in community children's nursing education

Aims of presentation

To raise awareness of:• the decline of 'traditional' educational

courses • the need for continual profession

development • innovative approaches to learning • your role as mentors

Education Learning Skills Attitudes Competencies Knowing and Understanding Analysing and evaluating Developing intellectual flexibility Capabilities Teaching

Definitions

Children's community nursing:

• Providing nursing assessment, care, and support for children and young people (and their families) in a range of out-of-hospital settings, with the aim of responding to local need, preventing hospital admission and facilitating early discharge

• Teaching- support workers, non-qualified carers, junior staff-teaching complex interventions, utilising technical equipment , teaching young people to navigate adult health care systems and self-management

• Planning and providing services within a variety of models of care; especially working within multi-agency children’s community teams

• Providing consultative roles for the patient and wider team• Challenging, influencing and using local and national policy to

enhance service provision (DH, 2009)

The decline of the 'traditional' educational course

• The picture throughout the United Kingdom

• The inadequate ‘workforce planning’ models

• The NMC focus on the SCPHN course-longer, more competencies different standards for mentors

• The failure of the NMC to modernise the SPQ

NMC Standards (2001)Clinical nursing practice

22.1 assess, plan, provide and evaluate specialist clinical nursing care to meet

care needs of acutely and chronically ill children at home and

22.2 assess, diagnose and treat specific diseases in accordance with agreed

medical/nursing protocols.

Care and programme management

22.3 initiate and contribute to strategies designed to promote and improve health

and prevent diseases in children, their families and community;

22.4 initiate action to identify and minimise risk to children and ensure child

protection and safety and

22.5 initiate management of potential or actual physical or psychological abuse of

children and potentially violent situations and settings.

Modernising SPQ programmes

“The Welsh Assembly Government will work with the NMC and higher education institutions to modernise the community SPQ programme, and develop flexible modules that prepare nurses for specialist and advanced roles in the community” (WAG, 2009)

The decline of the 'traditional' educational course

Cost-

“Economics is concerned with the best allocation of scarce resources to competing

activities-in health it means choosing the investment option that gives the greatest

health benefits for patients at the least cost”

(Maynard, 2009:12)

The need for continual profession development To keep abreast of:•The local and national political environment•-need political astuteness •-need to understand the barriers and boundaries,

local culture and group norms•-need to challenge, contribute to and use policy•-need to network, influence, market and sell

children’s community nursing and advocate for

children and young people (using UNCRC) in

an adult-centric environment

Policy

Policy concerned with service re-design Wanless Reviews-Designed for Life & One Wales-Dzari A High Quality Workforce and role re-design and workforce planning

Policy concerned with children and young people-the English and Welsh NSF, Every Child Matters, Palliative care, Rights to Action, participation and advocacy, transition and continuing care

Policy concerned with nursing-Realising our potential, developing Advanced Nursing Practice, skills for health, knowledge and skills frameworks and modernising nursing careers- different emphasis in all four countries

The need for continual profession development

To keep abreast of: • The current and emerging evidence base-need to be able to think critically-need to be able to solve complex problems-

advanced decision making -need to be able to influence others to take on

board new ways of working: -patient journeys-care pathways-managed clinical

networks, skills rather than badges or grades, whole systems approaches to services and care, planning rather than commissioning.

The need for continual profession development

To keep abreast of:• The changing nature of ‘childhood’ and the bigger picture-need to see beyond ‘sick’ children-need to be aware of changing trends in child health-public

health issues-the political links between health and social problems and an inequitable society

-need to be conversant with the participation and hearing the child’s voice agenda, the engaging with children through research agenda, the style and approach required to enable young people to take responsibility for their health-skills such as motivational interviewing and behavioural change techniques .

The need for continual professional development (CPD)

• NMC news (October 2008)-the NMC are looking at a risk-based approach to revalidation in response to the government white paper- Trust, assurance and safety: The regulation of health professionals (DH, 2007).

• A non-medical revalidation group will develop principles that will identify what evidence you need to provide to demonstrate that you are fit to practise and that you have undertaken CPD

Innovative approaches to learning

• Action learning ( on the job) – stretch and develop you through projects-directly relevant to the job.  Learning activity contributes to the organisation.  Provides wider organisation understanding.  Widely regarded as a key ingredient of leadership and management development.

• Shadowing – learning from someone who is experienced and good at what they do – by watching them in action-excellent means of sharing tacit knowledge, re-enforcing standards and good practice

• Visioning/scenario planning – engaging in structured discussion and debate with others regarding the potential future direction of the organisation or scenarios that might occur, and identifying appropriate strategies in response-a ‘safe’ way of exploring new strategies and testing innovative ideas.  Participants will be able to share and learn from each other’s experience.

• Secondment – gaining experience of a more senior or new role through temporary assignment to that role-develops breadth of experience, knowledge and skills. Learning of direct relevance to the role. A good way to assess further development needs.

Innovative approaches to learning

• Self managed learning- reflecting on learning needs-tailoring learning to knowledge/skills deficits

• Seminars and conferences latest techniques/theories, networking

• Personal developmental courses (HR) – formal structured events-part of a workforce and people management strategy.

• Accredited courses- traditional and blended-learning, solid theoretical perspective, credits, links service to HEI’s, opportunities for teaching and curriculum development (Investors in people direct, 2008)

METI: PediaSim

Your role as mentors

• Coaching – critically reflecting with another person on what can be learnt from work-based experiences, including what can be learnt about one’s own strengths and weaknesses and new or better ways of tackling issues in the future.

• Mentoring – seeking advice, support and ultimately being assessed by a more senior/experienced colleague

Your role as mentors • Myall et al., (2008)-Mentorship is pivotal to students'

clinical experiences and is instrumental in preparing them for their role as confident and competent practitioners.

• Moseley and Davies (2008) -(i) Mentors had a positive attitude towards their role and enjoyed it. (ii) When looking at what caused mentors difficulty, in addition to the commonly discussed dimensions of organisational constraints (workload, skill mix) and interpersonal factors, there was clearly an additional cognitive one. Knowledge, not just personality, mattered. Therefore, mentors and those who train them could pay more attention to cognitive components of the role, even if that meant laying a lesser stress on the interpersonal ones.

Your role as a mentor

• Acknowledge your equal status in educating and preparing nurses to nurse

• If they do not do so, encourage your local HEI to run conferences for mentors, up dates and mentor of the year awards

• Ensure you are fully compliant and conversant with the latest teaching and assessing standards (NMC, 2008)

Mandatory Standards for Mentors and Mentorship

“Nurses… who make judgments about whether a student has achieved the

required standards of proficiency for safe and effective practice must:

A- be on the same part or sub-part of the register as that which the student is intending to

enter….

B- have developed their own knowledge, skills and competency beyond that of registration

through CPD – either formal or experiential learning – as appropriate to their support role;

C -hold professional qualifications at an appropriate level to support and assess the students

they mentor i.e. professional qualifications equal to, or at a higher level than, the

students they are supporting and assessing and;

D- have been prepared for their role to support and assess learning and met NMC defined

outcomes. Also, that such outcomes have been achieved in practice and, where relevant, in

academic settings, including abilities to support inter-professional learning.” (NMC 2008

p16)

Finally-the take home message

• Advocate not only for children but for your right for CPD and education

• Advocate to be able to meet children’s needs by:

• Understanding, analysing and challenging politics and policy,

• Finding and using the current evidence base,

• Utilising relevant theories and

• Thereby be able to realise your full potential so you develop and grow personally and professionally, and make a real contribution to the health of our nations most important resource-our young

Thank you for listening

References • Department of Health (2007) Trust, assurance and safety:

The regulation of health professionals . (DH, 2007). • Department of Health (2009) Children’s community teams.

Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4867921

• Investors in people direct (2008) Innovative approaches to learning. Available at: http://www.investorsinpeopledirect.co.uk:92/articles/innovative-approaches-to-learning-and-development.aspx

• Maynard A (2009) On time of trouble. HSJ. Intelligence. 2009 5th January

References

• Myall, M; Levett-Jones, T and Lathlean, J (2008) Mentorship in contemporary practice: the experiences of nursing students and practice mentors. Journal of Clinical Nursing. Volume 17, Number 14, July 2008 , pp. 1834-1842

• Moseley, L G and  Davies, M(2008) What do mentors find difficult? Journal of Clinical Nursing. Volume 17, Number 12, June 2008 , pp. 1627-1634

• Nursing and Midwifery Council (2001)Standards for Specialist Education and practice. NMC London

References

• Nursing and Midwifery Council (2008) Revalidation in practice. NMC News October 2008. NMC. London

• Nursing and Midwifery Council (2008). Standards to support learning and assessment in practice. NMC. London.

• Welsh Assembly Government (2009) A community nursing strategy for Wales. Consultation document. WAG. Cardiff.