Children’s Nursing in the Community – Care Closer to Home
The first of NMBI’s Summer Series events was hosted by the School of Nursing at University College Cork and focused on the theme Children’s Nursing in the Community – Care Closer to Home.
President of the Nursing and Midwifery Board of Ireland (NMBI), Essene Cassidy welcomed all attendees.
NMBI Director of Education, Policy and Standards, Carolyn Donohoe, presented NMBI demographics to the audience. Particularly striking was the gender imbalance within Children’s Nursing and the geographical distribution of children’s nurses within Ireland. On 1 June 2022, there were 4,982 nurses on the children’s division of the register. Of these, 3,371 are currently practising in the area. The majority of these are female, with only 78 male children’s nurses. The disparity between the genders is high in the children’s division.
UCC Head of School of Nursing and Midwifery, Professor Josephine Hegarty, presented the college’s strategic direction to the audience, particularly within the health context. She highlighted the great shifts in healthcare over the last 70 years and that the future will focus on the community and the home as the primary location of care.
“The future of health care is moving from curative to preventative, and we need to be preparing our nursing graduates for same,” she said.
Rosemarie Sheehan, Assistant Director of Nursing at Children’s Health Ireland, chaired the panel discussion. Each panellist had experience of children’s nursing from a different perspective.
Cora O’Leary, a Clinical Practice Specialist from Resilience Care (which provides advanced community care) spoke about her experience as a children’s community nurse and how she qualified as a children’s nurse in the UK. She was keen to highlight that during her training as a children’s nurse most of her placements occurred in the community. She believes that this prepared her to work with children who have complex healthcare needs and their families in their homes.
Eilín Ní Mhurchú, a Liaison Nurse Manager at the Jack and Jill Foundation, said that when nurses care for a child in the community it is not just the child who is cared for, but also the entire family unit. Some of the children that she looks after have complex, life-limiting conditions and there is an enormous pressure on a family to undertake care. Children’s nurses look at the many elements within the home, said Eilín.
Tyrone Horne, a Clinical Nurse Co-ordinator for Children with Life Limiting Conditions in Cork and Kerry, discussed the delivery of palliative care to children in their homes. He highlighted the importance of ongoing education for nurses working in these environments so that they may learn new skills. He spoke particularly highly of a course he undertook that helped him with delivering difficult news to patients and families.
Martin Foy, parent of Roisín who has a rare and complex condition, gave an insightful talk on the impact of children’s nurses on the life of his daughter. He was highly complimentary of the holistic care provided for Roisín and the family unit. The Jack and Jill Foundation provides care at home for Roisín. Her trips to hospital have reduced in duration throughout the years, partly due to the care and support provided by children’s nurses in the community.
Aisling Glavin, a Clinical Nurse Manager 2 at Puffin Ward in Cork University Hospital emphasised the importance of not placing too many expectations on families. The spectrum of conditions and implications of same are very broad, she said. Children’s nurses work in close collaboration with a range of professionals to provide care. Aisling spoke about how enabling a child to remain home for their care is so important and children’s nurses need to be highly adaptable. By remaining alert and implementing subtle changes in a child’s care, nurses can ensure that care at home remains feasible, she added.
Claire Hayes, a Lecturer Practitioner at the School of Nursing and Midwifery, UCC, spoke of the commitment of students on the integrated course. She acknowledged the difficulty of facilitating placements in the community and the preceptorship model that would be required to enable it. She particularly enjoys teaching students communication skills and preparing them to empower families to assist in the care for children with complex needs. Claire also highlighted the importance of research within children’s nursing.
Marieke Buckley, a fourth-year intern of the Children’s and Integrated programme has just embarked on her final nine-month internship at Cork University Hospital. She said graduates are not ready or prepared to work in the community. She emphasised the need to review the possibility of community placements throughout the programme, adding: “You can’t be it, if you can’t see it.”
Olga Buckley has been an Advance Nurse Practitioner with the Paediatric Oncology Outreach Nursing Service (POONS) for the last 20 years. She highlighted the vastness of Cork as a county and that the border becomes fluid at times when a child in neighbouring counties need care. Olga strongly advocates for parents and believes in helping them to understand what is going on with their child’s care so that they can make informed choices. She said that the healthcare of children is evolving all the time and the importance of educating nurses cannot be underestimated.
Is there a need for an integrated programme, can there just be a children’s nurse qualification?
The panel answered a resounding ‘yes’ to the need for an integrated programme. As the role of a children’s nurse involves the care of the family unit, it is vital that there are dual qualified nurses. Integrated nurses are a valuable resource and provide unique care. Martin Foy highlighted the importance of children’s nurses being able to provide care for children into adolescence and early adulthood, this ensures continuity and the maintenance of a relationship between the nurse, child and family that could have begun in the first weeks of a child’s life.
Can there be a move to placements in the community?
A fundamental review of undergraduate education is in the early stages and the possibility of placements in the community will be reviewed with great importance. NMBI and UCC agreed that community placements are important and should be considered as a possibility.
Can there be a further emphasis on data collection and utilise the data in workforce planning?
The collection and sharing of data is a key area for NMBI under the current strategy. There is also extensive work underway in the HSE in relation to data collection and analysis.
Can there be a drive to promote nursing and midwifery as a career choice?
NMBI are currently considering the many routes to nursing and hope to make nursing and midwifery more accessible as a career.
NMBI CEO, Sheila McClelland brought the event to a close by reiterating the key points from the night. The three ‘C’s’ as they refer to Children’s nursing –
Communication – educating nurses to hone their communication skills with the many stakeholders engaged in the care of a child, but particularly with their parents and family unit.
Complexity – considering the complexity of providing care for a child at home and how that complexity is ever evolving.
Community – the move to care in the community is important and one that must be considered carefully in terms of preparing graduates for work.
Ms McClelland thanked all those who had attended the event and expressed the gratitude of NMBI to UCC for hosting the discussion and to all those who had taken part.