engaging patients and their families in practice change and
TRANSCRIPT
Professor Tanya McCance & Ms Rosie Kelly
Background Information The project is a collaboration
between UTS (lead researcher Professor Val Wilson co-joint appointment with Sydney Children’s Hospitals Network) & University of Ulster (lead researcher Professor Tanya McCance)
This study is being conducted in collaboration with children’s hospitals and children’s units in general hospitals across a number of countries in Europe and Australia with 12 organisations involved (across 20 wards/units)
A core set of 8 KPIs have been developed from primary research undertaken by Tanya McCance at the University of Ulster
Participants from the
Australian sites
Workshop 29/30th Jan
2013
KPIs for Nursing and Midwifery KPI 1: Consistent delivery of nursing/midwifery care against identified need
KPI 2: Patient’s confidence in the knowledge and skills of the nurse/midwife
KPI 3: Patient’s sense of safety whilst under the care of the nurse/midwife
KPI 4: Patient involvement in decisions made about their nursing/midwifery care
KPI 5: Time spent by nurses/midwives with the patient
KPI 6: Respect from the nurse/midwife for patient’s preference and choice
KPI 7: Nurse’s/midwife’s support for patients to care for themselves where appropriate
KPI 8: Nurse’s/midwife’s understanding of what is important to the patient
(McCance et al 2012)
Person-centred Nursing Framework
(McCormack & McCance 2010)
PERSON-CENTRED PROCESSESConsistent delivery of nursing/midwifery care against identified needTime spent by nurses/midwives with the patient
Working with patient’s beliefs and valuesKnowing what is important to the patientRespect for patient’s preference and choice
Sharing decision makingPatient involvement in decisions made about his/her care
Providing holistic careSupport of patients to care for themselves, where appropriatePatient’s sense of safety whilst under the care of the nurse/midwife
ATTRIBUTES OF THE NURSEProfessionally competentPatient’s confidence in the knowledge and skills of the nurse/midwife
Measurement Framework
The framework for measurement utilises a range of data collection methods
The measurement framework comprises three key data sources
i. obtaining user feedback (patient survey & patient/family stories)
ii. observations of practiceiii. reviewing the patient records against
identified goalsiv. Speaking with staff
Project Aim
To explore the utility of these KPIs and related measurement framework in
supporting the development of person-centred practice across a range of services
provided to sick children.
European Sites
Hans Christian Andersen Children's Hospital, Odense, Denmark
Temple Street Children's University Hospital, Dublin, Ireland
Great Ormond Street Hospital, London, England, UK
East Kent, England, UKRoyal Belfast Hospital for Sick Children, Belfast,
Northern Ireland UKSouth Eastern Trust, Northern Ireland UK
Australian Sites
Princess Margaret Hospital for Children, Perth
Northern Sydney Local Health District Nepean Blue Mountains Local Health
District The Women's and Children's Hospital,
Adelaide The Sydney Children’s Hospital’s Network
Project Plan
Stage 2: Implementation of the KPIs and measurement framework
1 2 3 4 5 6 7 8 9 10
Survey Survey Survey Survey Survey Survey
Survey Observation
Analysis
Feedback
Stories
Stories
Transcribe
Analysis
Document
• Survey: distributed to all patients on discharge (over 7 weeks)
• Stories: 3 family stories over 1 week and 3 patient stories over 1 week
• Documentation: review patient record in conjunction with asking staff about patient goals (10 reviews over 1 week)
• Observation: monitoring nursing presence in a specified bay over a 30 minute time period (3 over 1 week)
Outcomes for SE Trust (1)
KPI 8: Did you feel the nurses understood the things that were important to your child during their time in hospital?
Parent’s comment:
Maybe they could have told the parents a wee bit more about the arrangements for staying overnight. Because you’re sitting there you don’t really know whether to get into your jammies or not or is there a bathroom for the mummies that we can use. Nobody really said anything to us so we weren’t sure, so maybe that was the only thing .
Outcomes for SE Trust (2)
KPI 5: Did you feel that the nurses had enough time to give the care which your child needed?
Patient Satisfaction survey
Parent’s comments:They had time for them, you know, they spent time with them and got them whatever they needed. And if the buzzer went they were there.
Outcomes for SE Trust (3)
KPI 4 : Did you feel the nurses involved you in the decisions made about your/your child’s care?
Child’s comments:I felt really included in every decision that there was to make, because they made me fell like I was the adolescent and they treated me like I was the person going through, like I was able to make the decisions and it gives you a sense of independence and I really like that.
Action Plan
Issue Relationship to KPI
Action Required
Person Responsible & Date for Completion
Current documentation does not:1.Facilitate easy identification of parent daily priorities of care to their hopes/wishes. 2.Clearly identify area for nurses to record daily patient priorities
KPI 4 patient’s involvement in decision makingKPI 8 understanding of what is important to the patient
Review of current nursing documentation is already underway
Rosie Kelly and pediatric ward sisters/deputy sisters
There is no agreed standard written information leaflet/ welcome to booklet for the children’s unit.
KPI 6 Respect for patient preference and choice KPI 8 understanding of what is important to the patient
The development of ‘Welcome to the children and young person’s unit at the Ulster Hospital’ booklet
Craig Ward staff
Our experience
Staff engagement through regular feedback is keyTime consuming to embed in practiceLearning new skills around data collection and analysis
made us a bit anxious to start withAction planning is a bonus because it gave us focusPublicising our results for parents and kids to see is
important
OutcomesExample 2: Comparison of six wards in one organisation
KPI 1: Consistent delivery of nursing care against identified need Patient Satisfaction Survey“Did you feel that the care your child needed was delivered each day regardless of which nurses were on duty?”
KPI 5: Time spent by nurses with the patient
Observations of Practice: Based on observations carried out at differing times of the day
Outcomes
Example 4: Benchmarking across all participating sites
KPI 1: Consistent delivery of nursing care against identified need
Chart Review
Novelty of the projectMeasuring the impact of nursing on the experience of
patients and their familiesInvolving nurses in evaluating and making changes to
their own practice as a result of engaging with the research process
Implementing processes that support the use of evidence to inform practice and knowledge translation in action
Developing capacity in research through engagement of local facilitators
Creating active research collaborations that can influence the local, national and international healthcare agenda.
Further Information
Professor Tanya McCanceInstitute of Nursing and Health ResearchUniversity of UlsterE: [email protected]
Ms Rosie KellyPaediatric Unit South Eastern Trust E: [email protected]
Patricia Coulter BHSCT E: [email protected]