Hunter - Paediatric Rural Outreach CNC
This position was initially commenced as a 12-month pilot position in August 2002.
Prior to the establishment and appointment of this position each area health service within the Northern Child Health Network reviewed their child health and service development needs. Due to the varying degrees of isolation and socioeconomic factors in some communities, their service needs differed. However, common throughout all areas was the need to enhance and improve the education and professional support of and to nurses.
It is well documented that nurses who care for children and their families require specialist knowledge and skills (NSW Health Guidelines for the Hospitalisation of Children 1998, p.13). Additionally, in the 2002 Senate Community Affairs Reference Committee Report on the Inquiry into Nursing: The Patient Profession Time For Action, (2002, pp.188-189, 170), it points out that nurses who are expected to work across both adult and children's health services believe they are unable to cope with the demands of specialist paediatric care and this practice environment affects their job satisfaction. In addition, this document also identifies rural and remote nurses as the recipients of 'fragmentation of development in education and training'.
It is with this background that the Paediatric Rural Outreach CNC position was proposed and established. The position was an initiative of three networking partners of the Northern Child Health Network: Hunter, Mid North Coast and New England Area Health Services. Consequently, the position was established to provide a paediatric resource and consultancy service for nurses working in child health and paediatric acute care settings throughout the Upper and Lower Hunter, Mid North Coast and New England Areas, a geographical area of 144,000 square kilometres. In addition, the role aimed to provide education and training to enhance best practice by developing continuing education programs, facilitating clinical secondments of nurses throughout the network and developing train the trainer workshops.
During September, October and November 2002 the incumbent,
undertook an education needs
analysis 
(pdf 268K) across the three area health services, to identify and determine
the felt and normative need of nurses employed to care for children and
their families. This was necessary to plan and develop relevant continuing
education initiatives and provide appropriate resources and support. Hospital
sites with different classifications and thus different facilities for
children and their families were surveyed. An 80% return rate was achieved
with a coverage rate across the network of 52%. As a result of the needs
analysis findings an education plan was developed and training implemented
throughout the network.
The objectives of this position were:
- To enhance the competence and confidence of nurses who provide care to children and their families in rural areas throughout the network by facilitating and providing education and training and promoting professional development
- To encourage and promote collaboration, networking, information sharing and peer support of nurses within the network
- Dissemination of and education relating to clinical practice guidelines and other paediatric resource material
- To establish and maintain ongoing consultation and negotiation with key stakeholders to maintain communication links
Achievements:
Examples of education initiatives, resources, clinical service and consultancy that have been undertaken, conducted and/or developed from July 2003 - July 2005 include:
- NSW Health Department Paediatric Clinical Practice Guidelines : Significant involvement with pilot sites throughout the network to role out clinical practice guidelines. This includes providing education and team support to achieve desired goals and facilitating the local adaptation of the guidelines in all sites and the development of local clinical tools and resources.
- 20 Paediatric Advanced Life Support one-day Workshops conducted with Debbie Andrews of NETS at numerous locations throughout the network. 247 participants attended. Participants included Enrolled Nurses, Registered Nurses, Ambulance Officers and General Practitioners.
- Five combined Adult, Paediatric and Trauma Emergency Care Workshops were conducted in Hunter Rural Hospitals. These workshops were developed and presented in conjunction with the Rural Critical Care CNC and Trauma CNC from Hunter New England Health.
- The workshops were scenario based and were attended by Enrolled Nurses and Registered Nurses. 68 participants attended.
- Seven scenario based Resuscitation Workshops for General Practitioner's and Nurses were conducted in conjunction with the Rural Critical Care CNC. These workshops were conducted at Hunter New England Health rural sites. With 39 GP's and 12 RN's attending.
- A four-hour Paediatric Resuscitation Workshop for Staff Specialists, VMOs, Residents and Registrars at Kaleidoscope/John Hunter Children's Hospital has been co-developed and is co-presented. The workshops commenced in January 2004, six workshops have been conducted with 27 medical officers attending.
- Monthly Paediatric Telehealth Education sessions from John Hunter Children's Hospital, and teleconferenced to sites throughout the Northern Child Health Network. More than 324 participants have attended these sessions.
- Relevant Policy, Procedures and Pathways have been developed as the
need was identified. Policies for the Upper/Lower Hunter and HNE Health
Area Emergency Services that have been developed and ratified include:
- 'Admission of Infants and Children and Transfer to a Higher Level Care Facility'
- 'Pain Management Guidelines for Infants and Children in the Emergency Department'
- 'Acute Management of Young Children and Infants with Gastroenteritis'
- 'Paediatric Oxygen Therapy'
- 'Intraosseous Infusion Emergency Resuscitation in Children'
- 'Midazolam Sedation in Children'
- 1:1000 Adrenaline via Nebuliser for Croup'
- Asthma Clinical Practice Guideline Pathway: Rural and Regional/Tertiary Versions
- Gastroenteritis Clinical Practice Guideline Pathway: Rural and Regional/Tertiary Versions
- Fever in Children under 3 years Clinical Practice Guideline Pathway: Rural and Regional/Tertiary Versions
- Trial of Oral Fluid Form Clinical Practice Guideline Tool
- Paediatric Triage Tool
- Paediatric Fever poster
Eight other pathways are currently at the draft and trial stage of development and implementation.
All policies, procedures, pathways are made available to all rural partners.
- Co authored a paper , which has been published in the Australian Journal of Advanced Nursing 2005 Vol 23, 1. This paper discusses a completed collaborative research project with UNE, Armidale Hospital Children's Ward and John Hunter Children's Hospital around family-centred care practices in clinical practice.
- Member of the organising committee for the annual Kaleidoscope/John Hunter Children's Hospital Paediatric Nursing Seminar. This conference was held in Newcastle in November 2003 and 2004. The conference theme in 2004 was 'A view through the Kaleidoscope'. A diverse range of oral and poster presentations were presented.
- Invited Paediatric Nursing Representative on Area and State-wide Committee/Working Parties ie CAMHSNet Eating Disorder Guidelines Working Party, Hunter New England Health No CPR Guidelines Working Party, Three Children's Hospitals Fact Sheet review and development committee (Kaleidoscope arm).
- Successful submissions to Nurse Initiatives Funding to run annual Rural Paediatric Nurse Education programs. Programs conducted, 2003, 2004, and 2005 for rural nurses in the Hunter Sector of Hunter New England Health; 45 nurses have attended these programs in 2004-05 (2003 numbers not included).
- Chairperson of the NSW Paediatric Network CNC Group. An example of a current project of this group is the development of a Paediatric Companion Document to the nurse initiated 'NSW Rural Emergency Clinical Guidelines for Adults.' When completed these nurse-initiated guidelines for Paediatric Emergency Care will be utilised in rural emergency departments state-wide and incorporated into the First Line Emergency Care Course (FLECC) program core competencies (currently at final draft stage).
- Worked collaboratively with the Rural Division of GPs and Hunter Urban Division of GPs to present the Paediatric component of the 2005 Family Medical Practice Registrar Orientation . Three sessions were conducted at Cessnock, Scone and Nelson Bay Polyclinic in January and February 2005, with 20 participants. Also an education workshop for GP Practice Nurses was conducted in June 2005 with 15 practice nurses attending.
- Facilitated the clinical secondment of nurses from rural and regional hospitals to Kaleidoscope JHCH and JHH Paediatric Emergency Department for clinical placement. 12 participants have undertaken this program.
- Currently developing the paediatric component of the new Hunter New England Health Basic and Advanced Life Support Program. An initiative of Hunter New England Health Critical Care Services.
Quality Initiatives:
- Introduced the use of portable disposable head boxes for high flow oxygen delivery to infants up to 12 kg in rural emergency departments throughout Hunter New England Health, Hunter sector. This involved working collaboratively with the manufacturer to develop a user-friendly connection for Rural Emergency Departments and trialling of the prototype connection.
- Co-development and implementation of a Medical Emergency Criteria Plan for Cessnock and Kurri Kurri Hospitals.
- Paediatric Clinical Practice Guideline Pilot site implementation and pathway/tool development.
- Collaborated with colleague to make quality award submission for Hunter New England Health Quality Awards 2005: "Implementing Paediatric Emergency Department Clinical Practice Tools for Gastroenteritis, Fever and Asthma: a collaborative approach"
Major outcome:
NSW Health have recognised the invaluable work of the Outreach CNCs and are now recurrently funding these positions across NSW.