2013 Endowment Fund Award – The Child and Family Presence at Nursing Shift Handover Project

Krista Keilty and Karen Sappleton were the inaugural recipients of the Hospital for Sick Children Alumnae Association of the School of Nursing Endowment Fund Award in 2013. They received their award for their work on the Child and Family Presence at Nursing Shift Handover Project. Ms Keilty is a Nurse Practitioner with the Centre for Innovation and Excellence in Child and Famil- Centred Care and a Project Investigator through the Research Institute. Ms Sappleton is a Social Worker and Manager of the Centre for Innovation. Ms Keilty has led the research and evaluation of the project and co-chairs the Steering Committee with Dr Mary McAllister Associate Chief-Nursing Practice.
The project’s aim was to explore enabling child and family involvement in nursing shift handover. From initial findings they were able to secure additional funding through the Mary Jo Haddad Innovation Fund to build teams and engage staff across the hospital.
In 2011 and 2012 the hospital had carried out an organizational assessment about child and family-centred care that showed that family presence at handover was one of the most important priorities. The Shift Handover Project set out to study the effects of family involvement during the handover, and implement this novel practice change.
To support the implementation of the initiative on three diverse units, a toolkit was developed to promote the use of a standardized nursing shift handover. The tool kit provides direction for the process through the use of educational aids, a process map, handover template, FAQs and scripting, information pamphlets for families, and an audit tool.
Early Findings – The patients and families that participated in the study were asked to provide feedback before and after implementation, and the effectiveness of the new model was determined based on three areas:
• Did the families and patients feel at ease with the current process
• Did they feel important information was discussed during the handover
• Did they feel that they had input into what was discussed
All scores improved after implementation of the new system. Most notably was the improvement on feelings of partnership, as families felt like they could give more input in the care of their child. Research also indicated that families were not concerned with confidentiality as they felt that their involvement in the handover was more important.
The project is essential to ensuring that SickKids is providing optimal child and family-centred care, and address the concerns that families have expressed in regards to patient care. To ensure that the process is meeting expectations and that the family voice was being heard, the project met with two advisory committees. Implementation is being extended into additional units and adjustments are being made based on patient and family needs.
The Nurses’ Perspective – As expected there was some reservation on the part of the nurses. Challenges that were identified included confidentiality for patients, maintaining timeliness, ability to leave shifts on time and patient interruptions. Nurses were involved in brainstorming and educational sessions to help alleviate concerns and help make the changes more efficient. Feedback from nurses after implementation has been that, while some challenges remain, the practice has become more personal and engaging for both the families and the nurses. Overall, the changes have been beneficial and nurses appreciate the ensuing benefits.
Sharing Results – The findings of the project have been shared at more than 10 different meetings and conferences, internally at SickKids, provincially and internationally. It has won various awards including best child and family centred care poster at the 10th Annual SickKids Patients’ Safety symposium. Presenting at these meetings is beneficial, not only to disseminate the important findings, but it helps the presenter develop their skills and experience and gain recognition for the work being done. The team plans to publish this initiative to share the valuable information. (Website manager: Report here is based on a shortened version of the 2014 Impact Report prepared for the Alumnae Association of the School of Nursing)
The study’s authors:
KRISTA KEILTY – Krista is a Nurse Practitioner with the Centre for Innovation and Excellence in Child and Family-Centred Care and a Project Investigator through the Research Institute. She will complete her PhD Nursing Science at the Bloomberg Faculty of Nursing, University of Toronto in early 2015 and continue her nurse scientist training as the Rotman Post-Doctoral Fellow for Innovation in Paediatric Home Care. Ms Keilty’s clinical practice has informed her research interest in the experience of family caregivers of children with acute and chronic illness.
KAREN SAPPLETON – Karen is a Social Worker and transition healthcare professional in “Good 2 Go”, in the Division of Adolescent Medicine as well as an Interprofessional Education Specialist with the New Immigrant Support Network (NISN). She was a social worker at SickKids for approximately six years. At NISN Karen is an education specialist looking at the dissemination and sustainability of culturally competent healthcare in SickKids as well as in organizations throughout the province, with a focus on health equity and social justice.

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