Central Coast - Enhancing Paediatric Emergency Nursing
A substantial change to the provision of paediatric care at Wyong Emergency Department has been achieved through the commissioning of a temporary position of Paediatric Liaison Nurse (Clinical Nurse Specialist) to work in collaboration with Wyong Emergency Department staff and increased availability of a paediatric Clinical Nurse Educator. It was guided by the principles of equity, access and quality and aimed to:
- enhance the interface between acute and community paediatric services in the Wyong local government area
- increase existing knowledge and provide opportunities for clinical skills development in paediatric emergency nursing
- facilitate an increased awareness of primary health care issues, such
as:
- immunisation
- child protection
- asthma education
- breast feeding and
- early intervention referrals
- review and provide follow-up phone contact for families who may not wait for assessment
- increase links with community supports for families, such as Child and Family Health Nurse referral
The paediatric liaison nurse was:
- a resource person for nursing and medical staff in Wyong ED
- available for clinical education and inservices addressing paediatric issues
- able to assist with the development of resources in accordance with NSW Health Clinical Practice Guidelines
- a participant in quality projects such as phone call follow-up for families who do not wait for assessment
- able to chart review and identify potential follow-up care
Some of the achievements of the Paediatric Liaison Nurse were:
- Daily assistance with direct care
- Assisting with clinical procedures
- Providing staff and parent education
- Advocacy of evidence based practice and policy driven management
- Average of seven patients consulted per shift
- Accreditation of six staff members to administer nitrous oxide conscious sedation and continued promotion of more staff accreditations
- Promoted and educated staff to attend nasopharyngeal aspirates on patients to be admitted with bronchiolitis
- Targeting of new nurse graduates and junior staff on the differences
in treating children compared to adults, with handouts being given and
emphasis placed on:
- physical differences
- fluid management and calculation
- drug dosages and calculations
- management of common paediatric problems
- Participation in projects on:
- gastroenteritis
- asthma
- paediatric resuscitation trolley review
- buffering of local anaesthetic
The impact of the roles on clinical skills development was evaluated by a Paediatric Nursing Confidence Scale survey in August 2003, which was sent to all staff in the Wyong Emergency Department. Some of the results were:
- 100% of staff with less than 5 years experience felt more confident in their overall ability to manage a paediatric patient
- 76% of staff agreed or highly agreed that their confidence in managing gastroenteritis in children had increased
- 81% of staff agreed or highly agreed that their confidence had increased in the management of children with both asthma and bronchiolitis
The survey conclusively suggests an overwhelming positive increase in the staff's knowledge and confidence in providing care to children and their families, as a direct result of the presence of the Paediatric Liaison Nurse in Wyong Emergency department. Therefore the objectives of this project have been funded for a further 2 year period and will be replaced by a similar role of Paediatric Emergency Liaison CNC.