Authors (including presenting author) :
Tam WSC, Ng CM, Chang BL
Affiliation :
Department of Paediatrics and Adolescent Medicine, Kwong Wah Hospital
Introduction :
Practice development approaches become more widely applied within the field of nursing since 1990s. “Practice development is a continuous process of improvement towards increases effectiveness in person centred care, through the enabling of nurses and healthcare teams to transform the culture and context of care. It is enabled and supported by facilitators committed to a systematic, rigorous continuous process of emancipatory change.”(McCormack et al.,1999). The key message of practice development is summed up by McCormack who propose that had been used in numerous ways to enhance clinical services, such as to increase quality and safety in healthcare within a unit, to develop shared values and services priorities and to improve communication within a healthcare team. (McCormack, 2010”; McCormack et al., 2013).
Based on the above conceptual ideas, we set up a commission training program in KWH Paediatric department. We prospect to improve patient care, clinical quality and service delivery outcome through a systematic changes by evidence based practice and knowledge translation. We are not only improving the clinical competence in nursing, but also develop the informatics skills in nurse leader.
Objectives :
Sharing good practice and developing workplace consensus to provide a high quality of nursing care.
Addressing the need to improve personnel’s behaviour and workplace culture.
Developing and well preparing more potential leadership and practice development facilitators.
Methodology :
As part of a routine quality assessment of training annually, we reviewed and prioritised the urgency of which area or practice we have to improve. During the period between 2Q of 2020 to 3Q of 2021, our project was covering the following topics:
• Care of PICC and PIVC
• Equipment update and review: defibrillator, breathing circuit
• Transportation bag and transportation care update
• Review and standardise the strapping method on medical devices: nasal gastric/transpyloric tube, ET tube and neobar
2 assigned APNs who is responsible for revise and update the clinical procedure/skill/knowledge according to EBP, HAHO guidelines and CDC’s recommendations, act as the practice development facilitators in our commission training program. After an updated clinical procedure/skill/knowledge transform into training materials, such as PPT & videos, they would deliver to all our nursing staffs via the classroom & zoom lecture. 2 more assigned RNs would be trained up to be the audit committee who participated in assessing the skill competency and knowledges understanding of all nursing staffs in our ward. They based on an audit form included a clear written nursing standard statement which have to be committed and achieved by all nursing staffs. The audit form is an important record that aids in verify the performance after the training.
Result & Outcome :
The familiar workplace training and education of evidence-based practices model was easy to adopt by our nursing staffs in this commission training program. It was successful on which all reflected from the evaluation and audit results. There are 29 out of 35 nursing staffs responded to the survey after 1.5 years of the program started. 69% of the staffs agreed the training program which increased their confident and knowledge in their daily nursing procedures. More than 60% of the responded staffs agreed the updated and standardised nursing practices which improved the patient care, and the communication among medical staffs. However, Seers et al., (2012) referred that the concept facilitation in practice development was the type of support practitioners need to change their attitudes, habits, skills, thinking and working ways. The importance of facilitation is furthermore highlighted by the practice development conceptual framework where authentic facilitation is illustrated as the strategy used to ensure collaboration, inclusion and participation during the transformation towards person-centred work culture (McCormack et al., 2013). It seems we can just met the criteria of clinical competence in nursing. Feeling of unassertive, doubtful and nervous at the beginning of the program, were feedback from four facilitators in-person interview. Both verbalised that they are lack of confidence and strategy to change the workplace culture, nursing staffs’ attitudes and their working ways. We have not yet well prepared our staffs to be practice development facilitators who are important to enable and support these stakeholders to do change holistically, and provide a systematic approach of effective and sustained changes in practice.
