Date of Award

2012

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

Faculty

Computing, Health and Science

First Advisor

Professor Cobie Rudd

Second Advisor

Professor Anne Wilkinson

Third Advisor

Dr Greg Maguire

Abstract

In Australia, specialist education in paediatrics is not a requirement for nurses caring for hospitalised children. Thus, nurses can work in paediatrics without any prior knowledge of the unique needs of children such as developmental stages or separation anxiety. As a consequence, there are some clinicians and authors who advocate that when children require health care, they should be cared for by nurses who are educated in, and understand the specific physical, psychological and social needs of children. Despite this, the evidence is lacking as to whether specialist nurse education affects the quality of care in paediatrics. This study investigates whether the quality of care that children and their families receive is different to when they are nursed by specialist paediatric nurses (SPNs) compared to nonspecialist paediatric Registered Nurses (NSPNs). SPNs are Registered Nurses who have undertaken specific or further education in paediatrics and NSPNS are Registered Nurses who have no specific or further education in paediatrics. This research was prompted by national policy changes in Registered Nurse (RN) education which shifted the focus from hospital-based training to the tertiary sector. There has not been a review of paediatric nurse education in Australia since these changes in 1994. Quality measures have been developed for the admission procedure as it is the most common clinical procedure performed in hospital on children. The quality measures were defined by the literature and a Delphi Panel of international paediatric nursing experts. The five stage methodology incorporated: (i) a desk analysis of the literature and policies regarding paediatric nursing and education to identify quality measures (QMs); (ii) development of QMs for the most common hospital procedure for children, the admission procedure; (iii) the development of a consensus definition of QMs using the Delphi method; (iv) observation of RNs using video during the admission of children to the hospital to test the proposed QMs and measure whether SPNs behaved differently to NSPNs; and (v) a follow-up on-line survey of all of the observed RNs regarding their perceptions of other factors influencing their practice. This research found that overall, SPNs meet the quality measures during the admission procedure significantly more often than NSPNs (p=0.009). When the QMs were analysed individually, the analysis showed a significant relationship between education and some of the QMs, but not in others where the relationship was not statistically different. This leads to the assumption that there are other factors than the level of specialist education which affect the quality of care such as prompts on admission forms and/ or the RNs‘ personal experiences. However, in the on-line survey of the sample, the RNs reported that tailored education has played a major role in their care delivery to children and their families. The findings of this research indicate that in Australia, the ‗comprehensive‘ nursing model, which leads to the qualification of RN, may not be the best model for delivering the highest quality of care to children and their families.

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