Author: Louise Wightman
Wightman, Louise, 2024 More than weighing babies: Quality and competence in the specialist practice of child and family health nursing, Flinders University, College of Nursing and Health Sciences
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Growth and development in infants and children lay the foundations for productive life trajectories into adulthood. Child and Family Health Nurses (CFHNs) in Australia are the primary workforce tasked with supporting families to promote optimal growth and development in infants and children from birth to five years. CFHNs’ work is distinctive because it is conducted in homes and community settings, is relational and is in the preventative health and early intervention domain. Many standards, frameworks, policies and guidelines govern the practice of CFHNs across Australia. There is no available empirical evidence of a transferable process of defining quality and competence in the practice of CFHNs compared to other nursing and midwifery roles. This study aimed to identify the elements of competence in the specialist practice of child and family health nursing to ensure quality care for children and families.
Focused ethnography, as the qualitative research methodology and a constructivist-interpretivist lens were used to explore the perspectives of CFHNs in health jurisdictions across all states and territories in Australia. Data were collected through online in-depth semi-structured interviews with sixty CFHNs, complemented by eighty-four organisational documents related to child and family health nursing practice.
The findings across settings suggest that there are challenges and inconsistencies in how CFHNs’ practice is identified and measured, where the focus is on service provision rather than a qualified and competent workforce. Current assessment of quality and competence relies on health organisations having task-focused skills assessments for initial employment of qualified CFHNs or a transition to practice programme for postgraduate students. It was found that opportunities to assess quality and competence in the ongoing practice of CFHNs presently exist. The approaches have individual merit, but their full benefit is not realised because these approaches are currently applied inconsistently or only in part across jurisdictions or settings. It is recommended for future practice that the use of reflective practice through clinical supervision, practice consultancies and peer or performance reviews be applied as an integrated approach in all settings, to enable the quality and competence of child and family health nursing practice to be comprehensively identified and measured.
The findings also suggest that transition to practice programmes offer valuable platforms for supporting inexperienced practitioners and cultivating a skilled workforce deeply rooted in providing early intervention and preventive care for children and families. A further recommendation for practice, therefore, is to establish the progressive implementation of transition to practice programmes across Australia for nurses who wish to qualify as CFHNs.
It is suggested that future research focuses on both recommendations for practice, that is, on an integrated approach to reflective practice and the extension of transition to practice programmes. Research focusing on the implementation and operation of these recommendations could evaluate their relevance and efficacy in providing a qualified and competent child and family health nursing workforce to care for children and their families.
This thesis contributes new knowledge to understanding the complexity involved in establishing quality and competence in the specialist practice of child and family health nursing. To promote optimal growth and development in infants and children from birth to five years, families rely on CFHNs who can provide quality and competent care.
Keywords: Child and family health nurses, quality clinical practice, competency in practice, focused ethnography, transition to practice prgrammes, reflective practice, clinical supervision, community nursing
Subject: Nursing thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Dr Julian Grant