Integrating community childrens nursing in urgent and emergency care: a qualitative comparison of two teams in North West England Full Text
BMC Pediatrics, 07/17/2012
Kyle RG et al. – Integration of Community Children's Nursing Teams (CCNTs) at multiple points in the urgent care system is required in order to provide an alternative to inappropriate emergency department (ED) attendances and emergency admission. The principal enablers and barriers are both aspects of normative integration, which involves shared understanding of the contribution of CCNTs and trusting relationships between practitioners.Methods
- Comparative case studies were conducted of two CCNTs serving Primary Care Trusts in North West England.
- Twenty-two health professionals including CCNT managers and staff; paediatricians; nurses; children's ward, ED and OAU staff; commissioners of children's services; GPs and primary care staff were interviewed between June 2009 and February 2010.
- Qualitative data were analysed thematically using the Framework approach.
- Barriers to integration included paediatricians' perceived lack of ownership of the CCNT, poor communication between consultants and community children's nurses (CCNs), and weak personal relationships.
- This prevented early referral to the CCNT as an alternative to hospital care.
- Enablers of integration included co-location and rotation of CCNs through urgent care settings including OAUs and EDs.
- This enabled nurses to develop skills, make decisions about referral to home care and gain the confidence of referring clinicians.