nursing and midwifery strategy draft version 6 march … and midwifery...draft version 6 strategy...
TRANSCRIPT
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 1
Draft Version
Strategy for Nursing and
Midwifery in Northern
Ireland
March 2015
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 2
Prologue (or message from CNO)
A Partnership for Care. Northern Ireland Strategy for Nursing and Midwifery. 2010 – 2015. (2010) comes to an end in 2015. I would like to thank all nurses and midwives across all levels, organisations and sectors for supporting the achievement of the objectives contained within that important document.
The completion of A Partnership for Care provides a new opportunity at a significant time for health and social care services in Northern Ireland. Nurses and midwives are at the forefront of service delivery and are well placed to influence and participate in future direction. It was with that in view that I commissioned the production of this new Strategy.
This Strategy is the result of engagement with the nursing and midwifery professions, members of the public (including patients, service users and carers) and wider family of nursing and midwifery. It is the translation of what these individuals expressed as important to the professions for the next five years to deliver safe, effective, person-centred care in whatever care setting nurses and midwives are.
The strategy presented is the product of a process involving several drafts through which emerging themes from ongoing engagement clearly reflected a holistic approach to nursing practice. Further development of the themes demonstrated an alignment to the Person Centred Practice framework (McCormack and McCance, 2010), the model which has been used to subsequently to construct the strategy.
This document represents the work of a number of groups and individuals who progressed development through:
• A regional workshop attended by nurses, midwives, members of the public (including patients, service users and carers) and the wider nursing and midwifery family
• Meetings convened for a small Task and Finish Group to draft the initial document • Consultation with members of the public who had attended the regional workshop • Wide consultation within Health and Social Care, independent and voluntary sector
organisations.
Acknowledgements and thanks....
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 3
Nursing and Midwifery Strategy 2015 - 2020
What is a Strategy?
A strategy is simply a plan of action designed to achieve an overall goal or aim. This will often be in a context of uncertainty, working with available knowledge and reasonable prediction of eventual outcomes.
The Future of Nursing and Midwifery in Northern Ireland?
In order to outline the future direction for nurses and midwives and the actions they need to take to achieve the goals set within a strategy, it is important to think about what the future might look like.
In Northern Ireland, service provision in the next ten to twenty years is likely to be impacted by factors such as: health and care policy, increased patient and public expectations, new medicines and technologies, demographic trends, available care workforce, changing lifestyles and factors indirectly affecting health and care; poverty, environmental and world economy developments. Lifestyle choices and other social and economic influences have,
over the last number of years resulted in a rise of ill health related to, for example: obesity, smoking and harmful drinking.
The vision of Transforming Your Care was built on a desire to reduce variations in accessibility and service provision for patients and service users, ensuring that every person in Northern Ireland has access to safe effective person-centred care, positioned as close to their own homes as possible.
The services within which nurses and midwives and staff aligned to the family of nursing will inevitably continue to change, within a setting of increasing need and challenging resources. Fundamental to the delivery of safe effective care, is the underpinning values of the professions, grounded in the desire to remain person-centred in care approaches.
Underpinning Values of Nursing and Midwifery
There is one area which will remain constant in the midst of anticipated change. The underpinning values of nursing and midwifery are the principles and beliefs that guide the choices and daily practices of individuals and are relevant to any system, care setting or career structure which nurses and midwives may find themselves in. These principles are embodied within the Nursing and Midwifery Council: The Code: Professional standards of practice and behaviour for nurses and midwives (2015). For the purpose of this strategy, nursing and midwifery is expressed as an intellectual, physical, emotional and moral process underpinned by the following values;
treating people1 with caring and compassion, with dignity and respect and with equality and impartiality
and the following principles;
acting in partnership and collaboration with people and colleagues in the interests of the highest quality of care
providing leadership to ensure safe and effective care maintaining ongoing competence throughout their working career
1 Throughout the strategy document the word ‘people’ or ‘person’ refers to all individuals receiving care and treatment and their families and carers within any health and social care setting, or organisation engaged in
care provision, such as the independent and voluntary sectors. This includes: women, children, adults, and those people with mental health needs or learning disabilities.
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 4
delegating care appropriately within the family of nursing and midwifery being open and honest if something goes wrong with care provided
being accountable for actions
It is these underpinning values and principles that attract and retain nurses and midwives. Situations can arise where these values come into conflict with pressures of work and this is cited as a reason by some for leaving the profession. One of the outcomes of this strategy must ensure that such values and principles continue to be embedded in the future nursing and midwifery family.
What is the Vision?
The vision of the strategy is a clear statement of the future of services, care and practice reflected from the desires of nurses and midwives in the region of Northern Ireland.
The three Strategic Themes, each of which contains Strategic Objectives, define how the professions in Northern Ireland might bring about the vision practically. Each organisation or employer of nurses and midwives will translate these objectives, and demonstrate compliance across all fields of practice, over the next five years to the Chief Nursing Officer.
Strategy Concept
The conceptual model which the strategy is built upon is the Person Centred Practice Framework (McCormack and McCance, 2010). This model comprises four constructs:
• prerequisites which focus on the attributes of the nurse
• the care environment which focuses on the context in which care is delivered
• person centred processes which focus on delivering care through a range of activities
• expected outcomes which are the results of effective person centred nursing or midwifery.
The relationship between the constructs of the framework is indicated by the pictorial representation, figure 1 right, that being to reach the centre of the framework, the
Figure 1: Person Centred Practice Framework
Insert vision statement here
prerequisites must first be considered, then the care environment, which is necessary in providing effective care through achievement of outcomes acknowledged that there are relationships within, and across constructs.
Strategy Framework
Figure 2, below, pictorially represents the centred outcomes are achieved through a combination of objectives, some of which overlap with each other.
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015
Figure 2: Strategy Framework
prerequisites must first be considered, then the care environment, which is necessary in providing effective care through the care processes. This ordering ultimately leads to the achievement of outcomes – the central component of the framework. It is also acknowledged that there are relationships within, and across constructs.
represents the framework of the strategy, indicating that person centred outcomes are achieved through a combination of objectives, some of which overlap
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 5
prerequisites must first be considered, then the care environment, which is necessary in the care processes. This ordering ultimately leads to the the central component of the framework. It is also
of the strategy, indicating that person centred outcomes are achieved through a combination of objectives, some of which overlap
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 6
Strategic Aim:
In the next five years Nursing and Midwifery leaders and organisations
employing nurses and midwives in Northern Ireland should:
• Develop a competent and flexible nursing and midwifery workforce
• Prepare nurses and midwives to lead in a changing health care system
• Update the career pathway to reflect the expansion of nursing and
midwifery roles
• Support nurses and midwives to innovate person centred practice
developments
The attributes of a nurse or midwife are the pre-requisites that each individual nurse or midwife needs, to contribute to the provision of safe, effective, person centred care. This includes the need to:
• be professionally competent • have effective interpersonal
skills
• be committed to the job • be a reflective practitioner
who is aware of self
• be aware of individual values and beliefs.
McCormack and McCance (2010)
Attributes of the Nurse or Midwife
Moving towards 2020, the acquisition of enhanced
knowledge and skills through the development of new
roles to meet the needs of people will support the
delivery of person-centred care across a diverse range
of settings and changing services. Nurses and
midwives, working within the multidisciplinary team,
must be able to articulate their professional
accountabilities within the changing environments of
care that they find themselves in.
The expansion of roles and responsibilities for nurses
and midwives, particularly in the area of enhanced
management of Long Term Conditions, dementia and
palliative care needs will require registrants to be at
the forefront of leading change. Nurses and midwives
should have the knowledge and skills, therefore, to
lead innovation in practice, thus requiring employing
organisations to develop and foster supportive learning
cultures.
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 7
Attributes of the Nurse or Midwife
Theme Objective Measures of Success Professional accountability for professional practice
Nurses and midwives will be enabled to articulate the value of nursing and midwifery from ward to board.
Nurses and midwives will be encouraged to engage in constructive critical reflection on practice, enhancing self-awareness.
Nurses and midwives will be enabled to revalidate in accordance with the requirements of the Nursing and Midwifery Council.
Nurses and midwives will be supported to challenge unacceptable standards, and raise concerns through appropriate mechanisms.
Evidence of the value of the nursing and midwifery contribution Evidence of an efficient system of revalidation Evidence of appropriate support to raise and escalate concerns.
Leadership for quality improvement in practice.
Nurses and midwives will be developed, facilitated and encouraged to lead quality improvement within health and social care.
Nurses and midwives will identify and lead on opportunities to innovate and develop person centred cultures.
Nurses and midwives will demonstrate the impact of quality improvements on resources.
Nurses and midwives will share quality improvement work with other colleagues, regionally, nationally and internationally.
Nurses and midwives will receive recognition for engaging in innovation, service/quality improvement or practice development approaches.
Evidence of innovation leading to quality improvement Evidence of a culture of continuous quality improvement
Education and learning for personal and professional development
Education and learning programmes for nurses and midwives will be commissioned within a robust framework based on the needs of the people they care for.
Nurses and midwives will work in environments that support a culture of learning and development.
Nurses and midwives will be supported to enhance their confidence, competence and resilience to practice.
Evidence of confident and competent practitioners
Research and development to build a knowledge base for practice
Nurses and midwives will be supported to engage in research and development activity within care settings.
Education and training opportunities are provided to continue to build capacity for research and development within the nursing and midwifery workforce.
Nurses and midwives will share research and development outputs regionally, nationally and internationally.
Evidence of research capacity within the workforce Research outputs that demonstrate contribution to the nursing and midwifery evidence base
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 8
The care environment focuses on the context in which care is delivered and includes the need for:
• skill mix with the appropriate knowledge and skills
• shared decision-making systems
• productive staff relationships
• supportive organisations systems
• potential for innovation and risk taking
• appropriate physical care environments that balance aesthetics and function
• effective staff relationships linked to the sharing of power.
McCormack and McCance (2010)
Strategic Aim:
In the next five years Nursing and Midwifery leaders and organisations
employing nurses and midwives in Northern Ireland should:
• Enable service development through nurses and midwives that supports
independence, maximising health and wellbeing for the people of
Northern Ireland
• Measure, produce and use evidence that leads to positive outcomes for
people
• Ensure the right staff, are in the right place, in the right numbers
• Partner with agencies, organisations, professions and the public to
innovate services, to improve safety, quality and experience outcomes
for people.
Care Environment
Nurses and midwives should enable services to
promote health and wellbeing so that, for example:
children get the best start in life; the risk of
dementia is reduced through tackling lifestyle risks,
and individual independence is maintained,
amongst other regional health goals. Thus care
provision will continue to be under review and
innovative ways of working applied to nursing
practice to enable an effective transition to a
health and wellbeing approach to service provision.
This will also require that nurses and midwives are
appropriately skilled, for the right care
environment, in the right numbers to provide safe,
effective, person-centred care.
As information and technology systems advance
and increasingly enhance the opportunity to
provide timely, safer, more effective care, nurses
and midwives should be prepared to interact with,
lead on and influence growth in this area. This will
require the skills of the professions to be developed
specifically related to technology.
The culture of health and care organisations is pivotal to providing services which are safe,
high quality and promote a positive personal experience. Nurses and midwives occupy roles
which can lead in the integration of best evidence and improvement science within the
multi-professional teams they work in. It is necessary that nurses and midwives are
supported to work collaboratively with their colleagues to build organisational cultures that
are safety and quality conscious, remaining focused on the person receiving care.
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 9
Care Environment
Theme Objective Measures of Success Supportive technology for health and wellbeing
Nurses and midwives will develop skills to engage with current and emerging technologies to support healthcare.
Nurses and midwives will be at the forefront of technological innovation, influencing and guiding future advances for people.
Evidence of integration of technology within nursing and midwifery practice
Workforce planning to support person centred practice
Nurses and midwives will be supported to plan their careers taking account of the need for succession planning.
Nursing and midwifery staffing levels are calculated using a recognised or validated tool to support evidence based approaches.
New roles for nurses and midwives are developed using a robust evidence base linked to improving safety, quality and experience outcomes for people.
Evidence of career progression Evidence of maintenance appropriate staffing levels
Positive relationships for a positive care experience
Nurses and midwives will develop opportunities to work across professional and disciplinary boundaries to reach improved safety, quality and experience outcomes for people.
Nurses and midwives will partner with other members of the multi-professional team to build positive working environments.
Evidence of collaborative working across professional boundaries
Leadership for changing service delivery models
Nurses and midwives will be supported to recognise and evidence service need.
Nurses and midwives will respond proactively to develop innovative approaches to changing service delivery.
Nurses and midwives will be lead on the coordination of care across professional boundaries for people.
Evidence of the nursing and midwifery contribution in the development in new models of care
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 10
Person centred processes focus
on delivering care through a
range of activities that
operationalise person-centred
nursing and include:
• working with the beliefs and
values of the service user
• connecting with service users
through engagement
• shared decision making
• providing treatment and care
that is holistic
• recognising the uniqueness
and value of the individual.
McCormack and McCance (2010)
Strategic Aim:
In the next five years Nursing and Midwifery leaders and organisations
employing nurses and midwives in Northern Ireland should:
• Work with staff, and people to provide a positive care experience
• Support nurses and midwives to integrate the voice of people into
practice innovation
• Support nurses and midwives to lead the development of a culture of
quality and safety
• Support nurses and midwives to partner with a range of professions to
provide person-centred care.
Person Centred Processes
A high quality health service exhibits safety, quality
and patient experience which ultimately happen
when a caring culture, professional commitment
and strong leadership are combined to serve
people. The underpinning professional values of
nursing and midwifery should continue to be
integrated into any service they provide. In the
next five years as services change and develop,
nurses and midwives must partner, therefore,
with people, to transition through this time of
redesign.
It is important that people are listened to by the
professions to guide innovation in service models
and ensure that person-centred practice is
developed to enhance individual health and
wellbeing enablement. This will include the
availability of services closer to the person’s
home, where safety and quality remain central to
care provision.
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 11
Person Centred Processes
Theme Objective Measures of Success Securing the voice of person
Nurses and midwives will be supported to develop skills in meaningful engagement with people.
Nurses and midwives will use feedback provided by people in the development of nursing and midwifery services/practice.
Nurses and midwives will influence the development of innovative approaches to effectively include the voice of the person.
Evidence of engagement with people
Partnering with people
Nurses and midwives will actively seek to understand the needs of people to ensure a positive care experience.
Nurses and midwives will support people to actively participate in decisions which will be reflected in person centred plans of care.
Nurses and midwives will encourage people to actively seek healthy lifestyle choices.
Nurses and midwives actively seek to reduce inequality and improve access to the services they provide.
Nurses and midwives will develop skills to enable them to engage in courageous conversations with people.
Evidence of a positive care experience
Delivering safe and effective care
Nurses and midwives will develop positive relationships with people that will ensure a sense of safety.
Nurses and midwives have tools and resources which are appropriate to the care setting to identify and manage risks for people.
Nurses and midwives will monitor aspects of practice and use the information to develop appropriate actions to improve the care experience.
Nurses and midwives will work in partnership with other professionals to develop an embedded culture of quality and safety.
Evidence of safe and effective care
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 12
Person Centred Outcomes: Implementing and Monitoring the Strategy
[Title] Nursing and Midwifery Strategy 2015 - 2020, defines how the nurses and midwives
in Northern Ireland might bring about the vision for the professions in a practical way
through the strategic aims, themes and objectives. Each organisation or employer of nurses
and midwives will demonstrate translation of these objectives, and compliance across all
fields of practice, over the next five years to the Chief Nursing Officer.
It is of importance, therefore, in order to determine whether or not the objectives are being
achieved, the nursing and midwifery professions should develop skills and be supported via
appropriate systems and infrastructure to describe, measure and publish relevant
comparable measurements for activity. From these measurements, practice and ultimately
nursing and midwifery care and treatment can be improved, taking into account the views
of, and involving people.
Each strategic theme has aligned associated measures of success, through which achievement of the theme might be demonstrated. The next section of this document sets out an evaluation strategy, which outlines the range of methods through which that evidence might be collected.
It is expected that a baseline level of achievement against the strategy objectives will be measured at the point of implementation in each organisation through the evaluative methods and again at a number of milestone stages within the five year period that the strategy spans.
Implementation will be monitored by the Safety, Quality and Experience Sub Group of the statutory committee: Central Nursing and Midwifery Advisory Committee (CNMAC). A subsequent report will be offered by the Chair of this Sub group to CNMAC for review and action at each milestone stage.
[insert para related to time frame for milestones once agreed by CNMAC]
[Insert diagram of accountability processes up to CNMAC]
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 13
Evaluating the Strategy
This section of the document sets out an evaluation strategy, which outlines the range of methods through which that evidence might be collected.
It is expected that a baseline level of achievement against the strategy objectives will be measured at the point of implementation in each organisation through the evaluative methods and again at a number of milestone stages within the five year period that the strategy spans.
[insert para related to time frame for milestones once agreed by CNMAC]
[Insert table of themes and related evaluative methods]
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 14
References
Belfast Health and Social Care Trust (2009). Nursing and Midwifery Strategy
Department for Health, Social Services and Public Safety. (2004). A Healthier Future: A
Twenty Year Vision for Health and Wellbeing in Northern Ireland. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety, Scottish Executive, Welsh
Assembly Government, Department of Health. (2006). Modernising Nursing Careers: Setting
the Direction. London, DoH.
Department for Health, Social Services and Public Safety. (2008). Improving the Patient and
Client Experience. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety. (2009). Delivering the Bamford
Vision. Reponses of the NI Executive to the Bamford Review of Mental Health and Learning
Disability Action Plan 2009-2011. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety, Scottish Executive, Welsh
Assembly Government, Department of Health. (2010). Midwifery 2020. Delivering
Expectations. London, DoH.
Department for Health, Social Services and Public Safety. (2011). Transforming Your Care: A
Review of Health and Social Care in Northern Ireland. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety. (2011). Quality 20:20. A 10 year
Strategy to Protect and Improve Health and Social Care in Northern Ireland. Belfast,
DHSSPSNI.
Department for Health, Social Services and Public Safety. (2011). Promoting Good Nutrition.
A Strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-
2016. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety. (2012). A Strategy for Maternity
Care in Northern Ireland 2012-2018. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety, Scottish Executive, Welsh
Assembly Government, Department of Health. (2012). Strengthening the Commitment, the
report of the UK Modernising Learning Disabilities Nursing Review. Edinburgh, Scottish
Executive.
Department for Health, Social Services and Public Safety. (2012). Fit and Well – Changing
Lives 2012-2022. Belfast, DHSSPSNI.
Department for Health, Social Services and Public Safety. (2014). Delivering Care: Nurse
Staffing in Northern Ireland. Belfast, DHSSPSNI.
Health and Social Care Board (2014). E-health and Care Strategy for Northern Ireland:
Improving health and wealth through the use of information and communication technology
(Consultation document). Belfast, HSCB.
McCormack B. and McCance, T. (2010). Person-centred Nursing: Theory and Practice. Oxford, Wiley-Blackwell.
Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 15
Northern Health and Social Care Trust (2013). Quest for Excellence – Our Promises, Nursing
and Midwifery Strategy 2013-2016. Available for download at:
http://www.northerntrust.hscni.net/about/2111.htm
Nursing and Midwifery Council (NMC, 2014). Revalidation for nurses, midwives and specialist
community public health nurses. Information available at: http://www.nmc-uk.org/Nurses-
and-midwives/Revalidation/
Nursing and Midwifery Council (2015). The Code: Professional standards of practice and
behaviour for nurses and midwives. London, NMC.
South Eastern Health and Social Care Trust. (2013). Nursing and Midwifery Strategy
Southern Health and Social Care Trust. (2009). A Strategy for Nursing and Midwifery.
Available for download at:
http://www.southerntrust.hscni.net/pdf/A_Strategy_for_Nursing_and_Midwifery_2009-
14.pdf