nursing and midwifery strategy draft version 6 march … and midwifery...draft version 6 strategy...

Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015 1

Draft Version

Strategy for Nursing and

Midwifery in Northern

Ireland

March 2015


Prologue (or message from CNO)

A Partnership for Care. Northern Ireland Strategy for Nursing and Midwifery. 2010 – 2015. (2010) comes to an end in 2015. I would like to thank all nurses and midwives across all levels, organisations and sectors for supporting the achievement of the objectives contained within that important document.

The completion of A Partnership for Care provides a new opportunity at a significant time for health and social care services in Northern Ireland. Nurses and midwives are at the forefront of service delivery and are well placed to influence and participate in future direction. It was with that in view that I commissioned the production of this new Strategy.

This Strategy is the result of engagement with the nursing and midwifery professions, members of the public (including patients, service users and carers) and wider family of nursing and midwifery. It is the translation of what these individuals expressed as important to the professions for the next five years to deliver safe, effective, person-centred care in whatever care setting nurses and midwives are.

The strategy presented is the product of a process involving several drafts through which emerging themes from ongoing engagement clearly reflected a holistic approach to nursing practice. Further development of the themes demonstrated an alignment to the Person Centred Practice framework (McCormack and McCance, 2010), the model which has been used to subsequently to construct the strategy.

This document represents the work of a number of groups and individuals who progressed development through:

• A regional workshop attended by nurses, midwives, members of the public (including patients, service users and carers) and the wider nursing and midwifery family

• Meetings convened for a small Task and Finish Group to draft the initial document • Consultation with members of the public who had attended the regional workshop • Wide consultation within Health and Social Care, independent and voluntary sector

organisations.

Acknowledgements and thanks....


Nursing and Midwifery Strategy 2015 - 2020

What is a Strategy?

A strategy is simply a plan of action designed to achieve an overall goal or aim. This will often be in a context of uncertainty, working with available knowledge and reasonable prediction of eventual outcomes.

The Future of Nursing and Midwifery in Northern Ireland?

In order to outline the future direction for nurses and midwives and the actions they need to take to achieve the goals set within a strategy, it is important to think about what the future might look like.

In Northern Ireland, service provision in the next ten to twenty years is likely to be impacted by factors such as: health and care policy, increased patient and public expectations, new medicines and technologies, demographic trends, available care workforce, changing lifestyles and factors indirectly affecting health and care; poverty, environmental and world economy developments. Lifestyle choices and other social and economic influences have,

over the last number of years resulted in a rise of ill health related to, for example: obesity, smoking and harmful drinking.

The vision of Transforming Your Care was built on a desire to reduce variations in accessibility and service provision for patients and service users, ensuring that every person in Northern Ireland has access to safe effective person-centred care, positioned as close to their own homes as possible.

The services within which nurses and midwives and staff aligned to the family of nursing will inevitably continue to change, within a setting of increasing need and challenging resources. Fundamental to the delivery of safe effective care, is the underpinning values of the professions, grounded in the desire to remain person-centred in care approaches.

Underpinning Values of Nursing and Midwifery

There is one area which will remain constant in the midst of anticipated change. The underpinning values of nursing and midwifery are the principles and beliefs that guide the choices and daily practices of individuals and are relevant to any system, care setting or career structure which nurses and midwives may find themselves in. These principles are embodied within the Nursing and Midwifery Council: The Code: Professional standards of practice and behaviour for nurses and midwives (2015). For the purpose of this strategy, nursing and midwifery is expressed as an intellectual, physical, emotional and moral process underpinned by the following values;

treating people1 with caring and compassion, with dignity and respect and with equality and impartiality

and the following principles;

acting in partnership and collaboration with people and colleagues in the interests of the highest quality of care

providing leadership to ensure safe and effective care maintaining ongoing competence throughout their working career

1 Throughout the strategy document the word ‘people’ or ‘person’ refers to all individuals receiving care and treatment and their families and carers within any health and social care setting, or organisation engaged in

care provision, such as the independent and voluntary sectors. This includes: women, children, adults, and those people with mental health needs or learning disabilities.


delegating care appropriately within the family of nursing and midwifery being open and honest if something goes wrong with care provided

being accountable for actions

It is these underpinning values and principles that attract and retain nurses and midwives. Situations can arise where these values come into conflict with pressures of work and this is cited as a reason by some for leaving the profession. One of the outcomes of this strategy must ensure that such values and principles continue to be embedded in the future nursing and midwifery family.

What is the Vision?

The vision of the strategy is a clear statement of the future of services, care and practice reflected from the desires of nurses and midwives in the region of Northern Ireland.

The three Strategic Themes, each of which contains Strategic Objectives, define how the professions in Northern Ireland might bring about the vision practically. Each organisation or employer of nurses and midwives will translate these objectives, and demonstrate compliance across all fields of practice, over the next five years to the Chief Nursing Officer.

Strategy Concept

The conceptual model which the strategy is built upon is the Person Centred Practice Framework (McCormack and McCance, 2010). This model comprises four constructs:

• prerequisites which focus on the attributes of the nurse

• the care environment which focuses on the context in which care is delivered

• person centred processes which focus on delivering care through a range of activities

• expected outcomes which are the results of effective person centred nursing or midwifery.

The relationship between the constructs of the framework is indicated by the pictorial representation, figure 1 right, that being to reach the centre of the framework, the

Figure 1: Person Centred Practice Framework

Insert vision statement here

prerequisites must first be considered, then the care environment, which is necessary in providing effective care through achievement of outcomes acknowledged that there are relationships within, and across constructs.

Strategy Framework

Figure 2, below, pictorially represents the centred outcomes are achieved through a combination of objectives, some of which overlap with each other.

Draft version 6 Strategy for Nursing and Midwifery NI Mar 2015

Figure 2: Strategy Framework

prerequisites must first be considered, then the care environment, which is necessary in providing effective care through the care processes. This ordering ultimately leads to the achievement of outcomes – the central component of the framework. It is also acknowledged that there are relationships within, and across constructs.

represents the framework of the strategy, indicating that person centred outcomes are achieved through a combination of objectives, some of which overlap


prerequisites must first be considered, then the care environment, which is necessary in the care processes. This ordering ultimately leads to the the central component of the framework. It is also

of the strategy, indicating that person centred outcomes are achieved through a combination of objectives, some of which overlap


Strategic Aim:

In the next five years Nursing and Midwifery leaders and organisations

employing nurses and midwives in Northern Ireland should:

• Develop a competent and flexible nursing and midwifery workforce

• Prepare nurses and midwives to lead in a changing health care system

• Update the career pathway to reflect the expansion of nursing and

midwifery roles

• Support nurses and midwives to innovate person centred practice

developments

The attributes of a nurse or midwife are the pre-requisites that each individual nurse or midwife needs, to contribute to the provision of safe, effective, person centred care. This includes the need to:

• be professionally competent • have effective interpersonal

skills

• be committed to the job • be a reflective practitioner

who is aware of self

• be aware of individual values and beliefs.

McCormack and McCance (2010)

Attributes of the Nurse or Midwife

Moving towards 2020, the acquisition of enhanced

knowledge and skills through the development of new

roles to meet the needs of people will support the

delivery of person-centred care across a diverse range

of settings and changing services. Nurses and

midwives, working within the multidisciplinary team,

must be able to articulate their professional

accountabilities within the changing environments of

care that they find themselves in.

The expansion of roles and responsibilities for nurses

and midwives, particularly in the area of enhanced

management of Long Term Conditions, dementia and

palliative care needs will require registrants to be at

the forefront of leading change. Nurses and midwives

should have the knowledge and skills, therefore, to

lead innovation in practice, thus requiring employing

organisations to develop and foster supportive learning

cultures.


Attributes of the Nurse or Midwife

Theme Objective Measures of Success Professional accountability for professional practice

Nurses and midwives will be enabled to articulate the value of nursing and midwifery from ward to board.

Nurses and midwives will be encouraged to engage in constructive critical reflection on practice, enhancing self-awareness.

Nurses and midwives will be enabled to revalidate in accordance with the requirements of the Nursing and Midwifery Council.

Nurses and midwives will be supported to challenge unacceptable standards, and raise concerns through appropriate mechanisms.

Evidence of the value of the nursing and midwifery contribution Evidence of an efficient system of revalidation Evidence of appropriate support to raise and escalate concerns.

Leadership for quality improvement in practice.

Nurses and midwives will be developed, facilitated and encouraged to lead quality improvement within health and social care.

Nurses and midwives will identify and lead on opportunities to innovate and develop person centred cultures.

Nurses and midwives will demonstrate the impact of quality improvements on resources.

Nurses and midwives will share quality improvement work with other colleagues, regionally, nationally and internationally.

Nurses and midwives will receive recognition for engaging in innovation, service/quality improvement or practice development approaches.

Evidence of innovation leading to quality improvement Evidence of a culture of continuous quality improvement

Education and learning for personal and professional development

Education and learning programmes for nurses and midwives will be commissioned within a robust framework based on the needs of the people they care for.

Nurses and midwives will work in environments that support a culture of learning and development.

Nurses and midwives will be supported to enhance their confidence, competence and resilience to practice.

Evidence of confident and competent practitioners

Research and development to build a knowledge base for practice

Nurses and midwives will be supported to engage in research and development activity within care settings.

Education and training opportunities are provided to continue to build capacity for research and development within the nursing and midwifery workforce.

Nurses and midwives will share research and development outputs regionally, nationally and internationally.

Evidence of research capacity within the workforce Research outputs that demonstrate contribution to the nursing and midwifery evidence base


The care environment focuses on the context in which care is delivered and includes the need for:

• skill mix with the appropriate knowledge and skills

• shared decision-making systems

• productive staff relationships

• supportive organisations systems

• potential for innovation and risk taking

• appropriate physical care environments that balance aesthetics and function

• effective staff relationships linked to the sharing of power.


Strategic Aim:



• Enable service development through nurses and midwives that supports

independence, maximising health and wellbeing for the people of

Northern Ireland

• Measure, produce and use evidence that leads to positive outcomes for

people

• Ensure the right staff, are in the right place, in the right numbers

• Partner with agencies, organisations, professions and the public to

innovate services, to improve safety, quality and experience outcomes

for people.

Care Environment

Nurses and midwives should enable services to

promote health and wellbeing so that, for example:

children get the best start in life; the risk of

dementia is reduced through tackling lifestyle risks,

and individual independence is maintained,

amongst other regional health goals. Thus care

provision will continue to be under review and

innovative ways of working applied to nursing

practice to enable an effective transition to a

health and wellbeing approach to service provision.

This will also require that nurses and midwives are

appropriately skilled, for the right care

environment, in the right numbers to provide safe,

effective, person-centred care.

As information and technology systems advance

and increasingly enhance the opportunity to

provide timely, safer, more effective care, nurses

and midwives should be prepared to interact with,

lead on and influence growth in this area. This will

require the skills of the professions to be developed

specifically related to technology.

The culture of health and care organisations is pivotal to providing services which are safe,

high quality and promote a positive personal experience. Nurses and midwives occupy roles

which can lead in the integration of best evidence and improvement science within the

multi-professional teams they work in. It is necessary that nurses and midwives are

supported to work collaboratively with their colleagues to build organisational cultures that

are safety and quality conscious, remaining focused on the person receiving care.


Care Environment

Theme Objective Measures of Success Supportive technology for health and wellbeing

Nurses and midwives will develop skills to engage with current and emerging technologies to support healthcare.

Nurses and midwives will be at the forefront of technological innovation, influencing and guiding future advances for people.

Evidence of integration of technology within nursing and midwifery practice

Workforce planning to support person centred practice

Nurses and midwives will be supported to plan their careers taking account of the need for succession planning.

Nursing and midwifery staffing levels are calculated using a recognised or validated tool to support evidence based approaches.

New roles for nurses and midwives are developed using a robust evidence base linked to improving safety, quality and experience outcomes for people.

Evidence of career progression Evidence of maintenance appropriate staffing levels

Positive relationships for a positive care experience

Nurses and midwives will develop opportunities to work across professional and disciplinary boundaries to reach improved safety, quality and experience outcomes for people.

Nurses and midwives will partner with other members of the multi-professional team to build positive working environments.

Evidence of collaborative working across professional boundaries

Leadership for changing service delivery models

Nurses and midwives will be supported to recognise and evidence service need.

Nurses and midwives will respond proactively to develop innovative approaches to changing service delivery.

Nurses and midwives will be lead on the coordination of care across professional boundaries for people.

Evidence of the nursing and midwifery contribution in the development in new models of care


Person centred processes focus

on delivering care through a

range of activities that

operationalise person-centred

nursing and include:

• working with the beliefs and

values of the service user

• connecting with service users

through engagement

• shared decision making

• providing treatment and care

that is holistic

• recognising the uniqueness

and value of the individual.


Strategic Aim:



• Work with staff, and people to provide a positive care experience

• Support nurses and midwives to integrate the voice of people into

practice innovation

• Support nurses and midwives to lead the development of a culture of

quality and safety

• Support nurses and midwives to partner with a range of professions to

provide person-centred care.

Person Centred Processes

A high quality health service exhibits safety, quality

and patient experience which ultimately happen

when a caring culture, professional commitment

and strong leadership are combined to serve

people. The underpinning professional values of

nursing and midwifery should continue to be

integrated into any service they provide. In the

next five years as services change and develop,

nurses and midwives must partner, therefore,

with people, to transition through this time of

redesign.

It is important that people are listened to by the

professions to guide innovation in service models

and ensure that person-centred practice is

developed to enhance individual health and

wellbeing enablement. This will include the

availability of services closer to the person’s

home, where safety and quality remain central to

care provision.


Person Centred Processes

Theme Objective Measures of Success Securing the voice of person

Nurses and midwives will be supported to develop skills in meaningful engagement with people.

Nurses and midwives will use feedback provided by people in the development of nursing and midwifery services/practice.

Nurses and midwives will influence the development of innovative approaches to effectively include the voice of the person.

Evidence of engagement with people

Partnering with people

Nurses and midwives will actively seek to understand the needs of people to ensure a positive care experience.

Nurses and midwives will support people to actively participate in decisions which will be reflected in person centred plans of care.

Nurses and midwives will encourage people to actively seek healthy lifestyle choices.

Nurses and midwives actively seek to reduce inequality and improve access to the services they provide.

Nurses and midwives will develop skills to enable them to engage in courageous conversations with people.

Evidence of a positive care experience

Delivering safe and effective care

Nurses and midwives will develop positive relationships with people that will ensure a sense of safety.

Nurses and midwives have tools and resources which are appropriate to the care setting to identify and manage risks for people.

Nurses and midwives will monitor aspects of practice and use the information to develop appropriate actions to improve the care experience.

Nurses and midwives will work in partnership with other professionals to develop an embedded culture of quality and safety.

Evidence of safe and effective care


Person Centred Outcomes: Implementing and Monitoring the Strategy

[Title] Nursing and Midwifery Strategy 2015 - 2020, defines how the nurses and midwives

in Northern Ireland might bring about the vision for the professions in a practical way

through the strategic aims, themes and objectives. Each organisation or employer of nurses

and midwives will demonstrate translation of these objectives, and compliance across all

fields of practice, over the next five years to the Chief Nursing Officer.

It is of importance, therefore, in order to determine whether or not the objectives are being

achieved, the nursing and midwifery professions should develop skills and be supported via

appropriate systems and infrastructure to describe, measure and publish relevant

comparable measurements for activity. From these measurements, practice and ultimately

nursing and midwifery care and treatment can be improved, taking into account the views

of, and involving people.

Each strategic theme has aligned associated measures of success, through which achievement of the theme might be demonstrated. The next section of this document sets out an evaluation strategy, which outlines the range of methods through which that evidence might be collected.

It is expected that a baseline level of achievement against the strategy objectives will be measured at the point of implementation in each organisation through the evaluative methods and again at a number of milestone stages within the five year period that the strategy spans.

Implementation will be monitored by the Safety, Quality and Experience Sub Group of the statutory committee: Central Nursing and Midwifery Advisory Committee (CNMAC). A subsequent report will be offered by the Chair of this Sub group to CNMAC for review and action at each milestone stage.

[insert para related to time frame for milestones once agreed by CNMAC]

[Insert diagram of accountability processes up to CNMAC]


Evaluating the Strategy

This section of the document sets out an evaluation strategy, which outlines the range of methods through which that evidence might be collected.

It is expected that a baseline level of achievement against the strategy objectives will be measured at the point of implementation in each organisation through the evaluative methods and again at a number of milestone stages within the five year period that the strategy spans.

[insert para related to time frame for milestones once agreed by CNMAC]

[Insert table of themes and related evaluative methods]


References

Belfast Health and Social Care Trust (2009). Nursing and Midwifery Strategy

Department for Health, Social Services and Public Safety. (2004). A Healthier Future: A

Twenty Year Vision for Health and Wellbeing in Northern Ireland. Belfast, DHSSPSNI.

Department for Health, Social Services and Public Safety, Scottish Executive, Welsh

Assembly Government, Department of Health. (2006). Modernising Nursing Careers: Setting

the Direction. London, DoH.

Department for Health, Social Services and Public Safety. (2008). Improving the Patient and

Client Experience. Belfast, DHSSPSNI.

Department for Health, Social Services and Public Safety. (2009). Delivering the Bamford

Vision. Reponses of the NI Executive to the Bamford Review of Mental Health and Learning

Disability Action Plan 2009-2011. Belfast, DHSSPSNI.


Assembly Government, Department of Health. (2010). Midwifery 2020. Delivering

Expectations. London, DoH.

Department for Health, Social Services and Public Safety. (2011). Transforming Your Care: A

Review of Health and Social Care in Northern Ireland. Belfast, DHSSPSNI.

Department for Health, Social Services and Public Safety. (2011). Quality 20:20. A 10 year

Strategy to Protect and Improve Health and Social Care in Northern Ireland. Belfast,

DHSSPSNI.

Department for Health, Social Services and Public Safety. (2011). Promoting Good Nutrition.

A Strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-

2016. Belfast, DHSSPSNI.

Department for Health, Social Services and Public Safety. (2012). A Strategy for Maternity

Care in Northern Ireland 2012-2018. Belfast, DHSSPSNI.


Assembly Government, Department of Health. (2012). Strengthening the Commitment, the

report of the UK Modernising Learning Disabilities Nursing Review. Edinburgh, Scottish

Executive.

Department for Health, Social Services and Public Safety. (2012). Fit and Well – Changing

Lives 2012-2022. Belfast, DHSSPSNI.

Department for Health, Social Services and Public Safety. (2014). Delivering Care: Nurse

Staffing in Northern Ireland. Belfast, DHSSPSNI.

Health and Social Care Board (2014). E-health and Care Strategy for Northern Ireland:

Improving health and wealth through the use of information and communication technology

(Consultation document). Belfast, HSCB.

McCormack B. and McCance, T. (2010). Person-centred Nursing: Theory and Practice. Oxford, Wiley-Blackwell.


Northern Health and Social Care Trust (2013). Quest for Excellence – Our Promises, Nursing

and Midwifery Strategy 2013-2016. Available for download at:

http://www.northerntrust.hscni.net/about/2111.htm

Nursing and Midwifery Council (NMC, 2014). Revalidation for nurses, midwives and specialist

community public health nurses. Information available at: http://www.nmc-uk.org/Nurses-

and-midwives/Revalidation/

Nursing and Midwifery Council (2015). The Code: Professional standards of practice and

behaviour for nurses and midwives. London, NMC.

South Eastern Health and Social Care Trust. (2013). Nursing and Midwifery Strategy

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Available for download at:

http://www.southerntrust.hscni.net/pdf/A_Strategy_for_Nursing_and_Midwifery_2009-

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