Developing a Service for Children with Tracheostomies: The Alder Hey Experience

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Developing a Service for Children with
TracheostomiesThe Alder Hey Experience

• Alison Flynn
• RGN, RSCN Dip Child and Adult Health
• BA (Hons)
• Jan Rowlands
• RGN, RSCN Dip in Child Health
• ENB A50

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History.

• Two ward areas.
• No structure to training.
• Cultural change.
• Some communities no paediatric nursing teams.
  (Eaton 2000)

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Tracheostomy trends and developments

• Increasingly more common (Wilson 2005).
• Clinical indications /evolutions .
• Approx 60 children at present.
• High profile.

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Community nursing team

• Developed1992.
• Provides a service for Liverpool.
• SLA with South Sefton PCT.
• Generic team.
• Support child and families.
• Offer specialised nursing care.

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ENT tracheostomy service

• ENT Nurse Specialist role developed 2003.
• Provided an improved service .
• Working group for tracheostomy care .

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Coming together(Austin et al 2006)
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Leadership in nursing.

• High profile .
• Challenging .
• Adaptablecombine elements of theories to create
  electic models (Murphy 2001).
• Our roles were pivotal to service provision for
  children with tracheostomies .

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Qualities of a transformational leader

• Influence (Sellgrens et al 2006).
• Shared Vision .
• Power/Empowerment (Murphy 2005).
• Feedback .

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Five fundamental aims (Jooste 2004)

• Inspiring a shared vision.
• Enabling others to act.
• Challenging the process.
• Modelling the way
• Encouraging the heart.

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Objective

• To provide a high quality service for children
  with tracheostomies by successfully complementing
  the child's and their families care together with
  training, education and research.

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Family centred care

• Recognizing that the family is the constant in
  the child's life.
• Facilitating family/professional collaboration at
  all levels of service delivery (Law et al 2005)
• Culturally competent and responsive to
  individual needs

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Development of competencies

• Encouraged participation.
• Training packages developed.
• Standardsevidence based
• Policy for caring for a child with a
  tracheostomy
• Review three years.

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Tracheostomy training days

• No formal in house training .
• Training needs analysis.
• Getting support from managers.
• Initially running bi-annually.

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Format of the training day

• Covers all aspects trachesotomy care.
• Operation .
• Paediatric scenarios
• Practical sessions.
• Trachesotomy pathway.
• Discharge planning.

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Popularity

• Running once a month in house
• External study days
• Developed high standards evidence based care.
• Promoted collaborative working .

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New innovations

• Valuing the parents .
• User participation (DH 2006).
• Sharing information.
• Running training days.
• Accountability (Dimond 2005).
• Develop our own DVD.
• Separate packages.

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Parents Day
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Parents Day
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Educational commitment

• Training in schools -(Smith et al 2003).
• Majority of children attend main stream school .
• Partnership agreements developed.
• Packages of care.
• Key workers.

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Our Circle of Influence
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George Clooney
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Our Children
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Any Questions .
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References

• Austin L Luker K Martin R (2006) Clinical Nurse
  Specialists and the practice of community nurses
  Journal of Advanced Nursing Vol 54 Issue 5 pgs
  542-550.
• Eaton N (2000) Childrens Community Nursing
  Services models of care delivery a review of
  the literature Journal of Advanced Nursing
  Vol 32 Issue 1 pgs 49-56.

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References

• Department of Health (2006) Our health, our
  care, our say a new direction for community
  services London DH.
• Dimond B (2005) Legal Aspects of Nursing Fourth
  Edition London Pearson Longman.
• Jooste K (2004) Leadership a new perspective
  Journal of Nursing Management No 12 pgs 217-223.

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References

• Law M Teplicky R King S King G Kertroy M Moning T
  Rosenbaum P Burke-Gaffney J (2005) Family
  centred caremoving ideas into practice
  ChildCare, Health and Development Vol 31 No 6
  pgs 633-642.
• Murphy L (2005) Transformational Leadership a
  cascading chain reaction Journal of Nursing
  Management No 13 pgs 128-136.

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References

• Murphy W (2001) Leadership and community
  childrens nurses Paediatric Nursing Vol 13 No
  10 pgs 36-40.
• Sellgren S Ekval G Tomson G (2006) Leadership
  styles in nursing management preferred and
  perceived Journal of Nursing Management No 14
  pgs 348-355.

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References

• Smith J C Williams J Gibbin K P (2003) Children
  with a tracheostomy experience of their carers
  in school Child Care, Health and Development
  Vol 29 No 4 pgs 291-296.
• Wilson M (2005) Tracheostomy management
  Paediatric Nursing Vol 17 No 3 pgs 38-43.