There is strong evidence to suggest that the start of an infant’s life determines the foundation of all future learning, behaviour, and health (Centre on the Developing Child, 2007). Studies in neuroscience confirm that the first five years last a lifetime and that the best brain development occurs when children are cared for within nurturing relationships (Winter, 2010). Further, the start of life is especially important for many aspects of good health and wellbeing in later adulthood (Wadsworth & Kuh, 2011). Nurturing early childhood experiences are known to build the foundation for a skilled workforce, a responsible community, and a thriving economy (Centre on the Developing Child, 2007). In Australia, maternal, child and family health nurses (MCaFHNs) are the primary workforce tasked with provision of primary health care services to support parents to optimise their children’s growth and development potential (Schmied et al., 2014; Rossiter et al., 2017).
The Commonwealth of Australia is comprised of six states and two territories. Each jurisdiction has developed well child, health care independently, with differing scope of maternal, child and family health nursing practice, differing educational requirements and resultant quality measures (Kruske & Grant, 2012). As such, there is no consistent definition of MCaFHN practice in Australia and a lack of research that explicitly or comprehensively describes the role of the MCaFHN (Fraser, Grant, & Mannix, 2016). This presentation showcases research that attends to this gap by developing evidence informed standards for MCaFHN practice in Australia.
Methods:
Undertaken in three stages, the research used Puddy and Wilkins’ (2011) continuum of evidence effectiveness to frame the research design. This enabled explicit inclusion of experiential and contextual evidence alongside the best available research evidence. Ethical approvals were received from Flinders University in South Australia and Griffith University in Queensland. The research was funded by Maternal, Child and Family Health Nurses Australia, competitive grant funding from Flinders University and industry funding from Gymbaroo Australia.
In stage one, all existing state and territory standards and competency documents (N=8) were thematically analysed into 19 categories. These were then synthesised further into five domains, each with three to four practice categories. A workshop was held with a national panel of industry and academic experts. Here, the draft was critiqued to incorporate findings from a review of the international literature (Fraser, Grant, & Mannix, 2014) and reconstructed in relation to the contemporary contexts of the panels’ experience. This resulted in re-clustering the findings into four domains each with between two and five statements incorporating between three and 11 practice cues.
This draft was distributed for broad consultation with industry, consumers and key stakeholders via a qualitative online survey in stage two. The resultant 452 full responses were analysed and results incorporated into a final draft. The final draft included seven standards each with between six and 27, cues. Stage three saw the draft distributed widely to Australian maternal, child and family health nurses as a modified Delhi survey.
Results:
The final survey resulted in 170 full responses in the first round of the Delphi survey with an average of 97.8% agreement. Where a 75% rate of agreement results in acceptance of a statement in Delphi survey technique (Keeny, McKenna, & Hasson 2011), 97.8% agreement in the first round attests to the rigor of the study design. We attribute this to iterative stages of consultation and knowledge generation with wide ranging participant groups of industry, consumers and key stakeholders.
Conclusion:
The National Standards of Practice for Maternal, Child and Family Health Nurses in Australia (Grant, Mitchell, & Cuthbertson, 2017) are now being incorporated into education and practice across Australia. Linking explicitly to the Registered Nurse (RN) Standards of Practice (NMBA, 2016), they provide a much needed framework for RNs transitioning through advanced practice to Nurse Practitioner roles. Further, they enable jurisdictional service providers and educators to benchmark quality and safety for maternal child and family health nursing across Australia.