Redefining practice: A model for early childhood community health nurses

Early Childhood Services is a unit within a health department that provides home-based services to pregnant and parenting women, their partners and their children. Over time, nursing practice in this unit shifted in response to various factors. In addition, the system of documentation became increasingly cumbersome. Several concerns were voiced by the nurses: the practice has eroded; providers no longer have a current curriculum; there are no clear practice guidelines; documentation tools are inadequate.

In response to this feedback, supervisors began a process of redefining the practice. The first step was identifying the components of a practice model. One component is a set of guiding principles, which were agreed upon after considerable deliberation and reflection. Some of these principles are: social determinants of health; honoring the diversity of clients; interventions are evidence-based; emphasis on health promotion; and population based approach.

Another major component is the standards of practice. This consists of instruments of practice as well as other standards. Instruments include reference tools and standardized client education materials. A principal instrument, the assessments and interventions for visit types, was developed by the nurses who would actually implement the standards. Work groups were convened to develop the standards through research and collaboration and to develop a documentation system.

The work of sustaining this model is on-going. An additional instrument of the practice is continuous quality assurance and improvement, which aligns with another of the guiding principles: assuring that the model is dynamic and innovative, accommodating the flow of new information