Improving Developmental Care Provided by Patient Care Assistants to Prevent Developmental Regression during Acute Hospital Admission

Background: As healthcare rapidly changes, organizations large and small are adapting the structure of their inpatient and outpatient service areas in order to provide quality care in a more efficient manner while maintaining high levels of patient/family satisfaction. A change in the care delivery model in a children’s hospital incorporated the use of PCAs in partnership with a registered nurse to ensure all staff were working to their highest capabilities. Subsequently a gap was identified in the PCAs orientation and educational preparation. There was a lack of knowledge and application of developmentally appropriate pediatric care. This project was a quality and safety improvement project concentrated on developing a new educational offering for PCAs centering on developmentally appropriate pediatric care. The new offering was developed by a multidisciplinary team including a Pediatric Nurse Practioner, Clinical Nurse Specialist, Clinical Educator, Clinical Manager, Registered Nurse, PCA, Child Life Specialist, and a Patient and Family Experience Coordinator.   The offering was presented in small segments, over a two (2) hour time frame using a variety of teaching methods.

Methods: Through the Maternal Child Health Nurse Leadership Academy (MCHLA) sponsored by Sigma Theta Tau International and program sponsor Johnson & Johnson, I participated in a triad team guided leadership academy and mentorship program over an 18 month period to procure and refine leadership skills in a maternal child healthcare setting. Guided by the Faculty Mentor; the Leadership Mentor and Scholar shadowed the Kouzes and Posner’s leadership practices to form and guide a multidisciplinary team in the development of a new educational offering for patient care assistants (PCAs) focusing on developmentally appropriate pediatric care. Delivery of the content will be carried out through electronic learning modules and classroom setting education which includes case studies and hands on competencies.  Success of the new educational offering will be measured through methods of competence and confidence questionnaires which will be administered in a pre-test and post-test fashion.  

Results: Results thus far in the project consist of creation of an updated developmentally appropriate pediatric care educational offering. This included a thorough assessment of the existing electronic learning modules accompanied by updating of content and literacy levels; the creation and validation of pre and post confidence and competence scales used to measure the success of the curriculum; and administration of the pre confidence and competence scales to 15 PCAs. The project timeline includes plans to present the educational offering in July, 2015. Post questionnaire administration and evaluation will occur in September and October, 2015. It is anticipated that by November, 2015, 15 PCAs will have completed the new educational offering and the post-test on confidence and competence.  Following data analysis any needed changes will be made to the presentation and it then will be assimilated into the orientation curriculum of all future PCAs.

Conclusions: Regressive developmental behaviors frequently accompany the hospitalization of children. To minimize these regressions, or lack of attainment of appropriate developmental milestones, all care givers must be knowledgeable about anticipated “normal” development in children.  Since the PCA has become an integral part of the nursing care delivery team they must be provided with adequate information and guidance to provide such care and/or seek additional assistance. This project presented information deemed essential by a team of experienced child health care providers, presented the material using dynamic and diverse methods, and anticipates changes to be documented in the analysis of pre/post testing and improved patient satisfaction.