1. Core Care Plan Project
Catherine
Daly

2. Background
In 2016, the ICHN Child and Family Health Interest Group undertook a project in the area of developing core care plans. Outcome = 36 Child, maternal and family health care plans developed.

3. Project
To implement and evaluate 36 core child maternal and family health care plans developed for PHN practice to safely support a safe, effective and quality child health core screening and surveillance service.

4. Rationale
By using a core care plan, it is envisaged that a bench mark exists for quality care, underpinned by evidence and research, thus supporting the delivery of best practice.

5. Approaches, models & frameworks explored
Methodology
Approaches, models & frameworks explored
The PARIHS framework (Promoting Action on Research Implementation in Health Services)
∴ Tool for evaluating the successful implementation of evidence into practice.

6. Underpinning assumption
According to PARIHS, successful change is based on the interaction between evidence, context and facilitation
It is a practical and pragmatic tool used by practitioners and researchers at the local level
It maps the interrelationships that exist.

7. Evidence
Defined as research, clinical experience, patient experience and local data/information (systematically collected and evaluated)
Support the ability to implement evidence effectively and understanding the multiple factors involved implementing such evidence in practice
Involves negotiation and developing a shared understanding about the benefits, disbenefits, risks, and advantages of the new over the old.

8. Context
The context concerns the environment in which the change is implemented and is divided into culture, leadership and evaluation.

9. Facilitation
Facilitation refers to processes aimed at implementing knowledge in a practical setting and requires a person (the facilitator) to assist the implementation in terms of aims, roles, skills and characteristic features.

10. Measuring the intervention
The PARIHS framework
Measuring the intervention
(core care plan)
Measuring the dependent variable directly involved based on the interaction between evidence, context and facilitation
Must work out a measurement strategy with the people responsible – PHNs decide what will represent ‘worth’ - continued use of core care plan
Evaluate the relative worth – is the core care plan fit for purpose – definition “success” and “failure” – modification.

11. 36 Core Care Plans
36 Core care plans

12. Roll out Three sites identified Link person identified in each site.
The PARIHS framework
Roll out
Three sites identified
Link person identified in each site.
Workshops to brief PHNs
Resource pack allocated with;
Information leaflet
Guideline for implementation
Consent Form
Core Care Plans
Evaluation Form.

13. Sample

15. Evidence Core Care Plan 1 - Jaundice at first postnatal visit Evidence
(DW)
Dublin West
(n=14)
(KWW)
Kildare/West Wicklow
(n=11)
(LO)
Laois/Offaly
(n=15)
Evidence
Site Q
Evidence
Yes % No DW
KWW LO 1.
Did you consider the care plan to be evidence based?
100 2.
Did this care plan support the delivery of safe care?
87 (13)
 13 (2) 3.
Did the content comprehensively address the Nursing Problem?
13 (2)

16. Context Core Care Plan 1 - Jaundice at first postnatal visit Evidence
(DW)
Dublin West
(n=14)
(KWW)
Kildare/West Wicklow
(n=11)
(LO)
Laois/Offaly
(n=15)
Context
Site Q
Context
Yes % No DW
KWW LO 4.
Did the care plan assist in the delivery of effective practice?
100
87 (13)
13 (2) 5.
Did the care plan support the achievement of nursing objectives? 6.
Do you envisage any risk in the implementation of this care plan?
20 (3)
80 (12)

17. Facilitation Core Care Plan 1 - Jaundice at first postnatal visit
Evidence
Core Care Plan 1 - Jaundice at first postnatal visit
(DW)
Dublin West
(n=14)
(KWW)
Kildare/West Wicklow
(n=11)
(LO)
Laois/Offaly
(n=15)
Facilitation
Site Q
Evidence
Yes % No DW
KWW LO 7.
Did you have the knowledge and skills to implement this care plan?
100 8.
Did the care plan support engagement with the child/mother/family? 9.
Do you envisage any consequences in implementing this care plan?
20 (3)
 100
80 (12)

18. Fit for Purpose Modifications Fit for Purpose Site Q Fit for Purpose
Yes %
No % DW
KWW LO
10.
In your opinion is this care plan fit for purpose
100
87 (13)
13 (2)
Modifications
Site Q
Modifications DW
KWW LO
TEXT

19. Fit for Purpose
Modifications
Needs to be more detailed in relation to assessing level of jaundice and follow up required. Exceptions LBW / SFR / Infections history / needs to be a priority of review.
Add specific guidance to mothers who are breast feeding as per NICE. Post-natal care up to 8 weeks after.
Under action plan instead of observing for signs of alertness, add “To refer to maternity hospital if increase in sleeping difficulty to feed. To add advising 3 hourly feeds until jaundice resolved. All PHN’s familiar with Kramer’s rule (non-midwives).

20. Modifications
“Observe for signs of alertness” if baby is lethargic importance of perhaps seeking medical attention if not alert, not feeding, sleepy or hard to arouse/wake. PHN’s may not be midwives or know “use of Kramer tool “however aids prompting to look up same.
If continue with Kramer’s rule as part of the care plan could we add a picture of the rule in practice to show mum? The picture could be on the back page of the jaundice care plan.
Small diagram of a baby for Kramer’s rule would be beneficial. Require training on Kramer’s rule. Common theme Kramer’s rule diagram of Kramer’s rule and training. 

21. Summary
22 Public Health Nurses participated 264 Evaluation forms were returned
Dublin West =DW Kildare/West Wicklow =KWW Laois/Offaly =LO

22. 17 Core Care Plans had ≥ 5 evaluation forms
deemed fit for purpose (with modifications)

24. Develop additional Core Care Plans
non-vaccinating parents
SALT
jaundice in pre-term infants
torticollis
older child not toilet trained at night
soiling
fussy eating for the older child
oral thrush
obesity
slow weight gain
support to the mother for child with disability
facial body spots from discharge
balanced nutritious food for infant planning to wean of milk
speech
cradle cap
communication milestones.

25. Recommendations
1. The findings to be returned to the Child & Family Health Interest Group to review the 17 Core Care Plans (≥ 5 evaluation forms returned, deemed fit for purpose) in terms of modification commentary
2. Each Core Care Plan adopted to be viewed as a live document with regular review and updates undertaken to incorporate new evidence and research into the detail to reflect best practice

26. Recommendations
3. Consultation to be undertaken with interested stakeholder to elicit their perspective and input into the findings
4. Due consideration to be given to the suggested development of additional Core Care Plans
5. In utilising Core Care Plans, it is imperative that practitioners use their clinical skills in assessing and delivering care, to ensure that no oversight occurs in meeting the ‘nursing problems’.

27. Thank
you