Chapter 14
Person-centred health services for children
Val Wilson1 ,2 & Annette Solman2
1Sydney Children’s Hospitals Network, Sydney, Australia
2University of Technology Sydney, Australia
Introduction
The concept of person-centred practice provides nurses with a framework for undertsanding the complexity of the health-care setting. It is applicable across differing care contexts (from acute care to rehabilitation to care within the home), and flexible enough to take into account the needs of patients of all ages. At its heart is the need for those who work in such contexts to focus on delivery of care that achieves outcomes that benefit the patient, their family and themselves. Providing such care not only nurtures the patient and supports the family, but also ensures staff invest in creating care cultures that result in improved well-being for all. The creation of effective person-centred cultures is neither easy or straightforward; it requires a common vision and goals, strategic planning, systematic approaches, supportive leadership, tenacity and dedication. In this chapter we will be sharing with you how one organsiation has developed Person-Centred Paediatric Practice as the foundation for nursing.
The practice setting
The Sydney Children’s Hospitals Network (SCHN) was formed in 2010 with the amalgamation of two major paediatric hospitals (The Sydney Children’s Hospital in Randwick and The Children’s Hospital at Westmead) and includes Bear Cottage (hospice), NSW Newborn and Paediatric Emergency Transport Services (NETS), NSW Pregnancy and Newborn Services Network (PSN) and the Children’s Court Clinic (Box 1). The creation of the SCHN was a result of a Special Commission of Inquiry into Acute Care Services in NSW Public hospitals (Garling 2008).
Box 14.1 Demographic information about the Sydney Children’s Hospitals Network (SCHN)
- Largest paediatric health-care organisation in Australia.
- Provides quaternery and tertiary level services.
- Over 92,000 presentations to emergency.*
- Provided over 138,000 bed days, discharging more than 50,705 patients* (more than half are younger than 5 years.)
- Over 5000 staff with a largely RN workforce.
- Provides undergraduate placements for 22 universities.
* 2013/2014 data.
Prior to the amalgamation, practice development stratieges were being used to inform and support changes in both hospitals, with each hospital having a Practice Development Unit.
Models of care
The bedrock of paediatric nursing practice is the family-centred care (FCC) model (Hutchfield 1999). This model advocates a partnership approach where staff work alongside parents, taking into account that parents are strong advocates and have a unique undertsanding of their child and are therefore able to provide key information about how best to deliver care for their child. It also acknowledges that parents and indeed patients have the right to be involved in care delivery and be part of the decision-making process. Nurses have strongly held beliefs that they not only advocate for FCC, they consistently deliver this in practice everyday (Lewis et al. 2007). While nursing staff in this study (Lewis et al. 2007) could clearly articulate the principles of FCC and espouse their incorporation into everyday practice, it was evident that this was not happening consistently. This was influenced at times by what Casey (1995) describes as ‘nurse-centred led care’, where parents are either excluded (through lack of communication) or given permission to be part of care. The findings from the study led to a number of initiatives being undertaken that supported improvements in practice and enhanced the experience of childen, families and staff. (Hooke et al. 2008).
Developing the nursing vision
Whilst it was vital that we kept FCC principles at the heart of nursing practice there was a need to extend this to incorporate a more inclusive approach that took into account the needs of the child, the family and staff. Nurses across the organisation (undertaken at The Children’s Hospital at Westmead prior to the amalgamation) were invited in 2008 to participate in a series of workshops to develop the nursing vision (Collaboration). It was important that all nursing staff felt they had a role in contributing to the vision and that their perspectives were valued (Inclusion). This was followed by a period of consultation, and after some months the nursing vision was endorsed by nursing groups across the organisation in early 2009 (Participatory). The philosophical approach to this work not only incorporated the CIP principles; it also supported working alongside and developing together, rather than working on people to get them to support the ideas put forward by a few staff. The framework (Figure 14.1) incorporates the principles of FCC and extends these to reflect the more inclusive nature of ‘persons’, in other words. It was about everyone in the care setting – patients, families and staff. It was important that staff were clear that to nurture, care and support the patient and family they needed to also nurture, care and support one another.
Figure 14.1 (a) Providing person-centred care. (b) The Person-centred Nursing Framework. Source: The Children’s Hospital at Westmead (2009).
You can see in this vision a strong correlation between the principles and the person-centred framework (McCormack & McCance 2010); for example, being a responsible and effective team member relates to developed interpersonal skills (prerequisites) and effective staff relationships (the care environment). There was the need to plan, implement and evaluate programmes of work that would support the realisation of this vision in everyday practice.
Once the vision was endorsed it was launched and every ward/unit received a laminated poster to display the vision. The six principles were highlighted in practice using a number of different approaches such as:
- Discussed during orientation of all nurses new to the organsation.
- Written into role descriptions and used to support/inform the recruitment process and staff appraisals.
- Used in staff meetings to discuss practice issues and support improvements.
- A reflective/education tool; i.e. ‘How are you using evidence to support your practice?’
Person-centred aims and goals
A vital aspect of the work undertaken since the launch of the vision was the need to strategise and prioritise the aims and goals we hoped to achieve for patients, families, staff and the organisation. The person-centred vision and framework provided key inspiration in strategic planning and endorsement of programmes of work. This ensured that development initiatives were focused on prerequistes, the care environment and the care processes in order to achieve person-centred otucomes. Table 14.1 provides some examples of the development work and the outcomes achieved.
Table 14.1 Examples of initiatives supporting the development of Person-Centred Practice (PCP)
| Initiative | Component(s) from the PCP framework | Outcomes | |
| PR | Clinical Nurse Educator (CNE) Development Program Evidence-based programme to support CNEs to move beyond being seen as ‘expert givers of knowledge’ to become facilitators of work-based learning Programme run over 8 months (2/3 hours per month) | Clarity of values and beliefs Developed interpersonal skills Knowing self | Programme is now in its 5th year. Evaluation reports that CNEs have increased confidence and satisfaction in their role. Past participants now co-faciltiate the programme |
| CE | Let Someone Know – improving patients’ and families’ experiences through focusing on Clinical Bedside Handover and Multidisciplinary Ward Rounds using a Patient Journey Board (PJB) | Effective staff relationships Power sharing The physical environment | 90% of multidisciplinary staff felt that the PJB has improved and streamlined communication. Observations revealed a more effective and timely handover, with an overall reduction of 20 minutes |
| CP | HeartBeads programme started by a few nurses was aimed at positively acknowledging what children go through as part of their stay in hospital by rewarding them with a bead for every procedure they endure. Parents were involved from the start, e.g. helping decide the types of bead and for what procedures. Each set of beads is unique to the individual child. The programme has grown since 2008 and is now embedded in practice | Working with patients’ values and beliefs Having sympathetic presence Engagement |
