Download Joanna and Georgina`s Example of Audit Indicator

Clinical Nurse/Midwife Role
Resource Pack
[2nd Edition – July 2008]
Case Studies
Features –
 Mary, Clinical Nurse Specialist (Asthma) in a General
Hospital
 Patrick, Clinical Nurse Specialist (Challenging Behaviour)
in an Intellectual Disability Service
 Joanna and Georgina, Clinical Midwife Specialists
(Obstetric Ultrasound and Foetal Assessment)
 Anne, Clinical Nurse Specialist (Community Mental
Health) in a Community-Based Mental Health Service
 Sinead, Clinical Nurse Specialist (Paediatric
Dermatology) in a General Hospital with Paediatric
Services
National Council for the Professional
Development of Nursing and Midwifery
Nursing and Midwifery Planning and Development Unit, HSE (South), Kilkenny
Clinical Nurse/Midwife Specialist Role Resource Pack
(2nd Edition)
June 2008
Case Studies
CONTENTS1
PAGE
NOTE ON USING THE CASE STUDIES
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CHAPTER 2: CNS/CMS ROLE CLARIFICATION AND PLANNING
Section 2.2 Role Purpose Statement
CNS (Asthma) - Mary’s Role Purpose Statement
CNS (Challenging Behaviour) - Patrick’s Role Purpose Statement
CMS (Obstetric Ultrasound and Foetal Assessment) - Joanna and
Georgina’s Role Purpose Statement
CNS (Community Mental Health) - Anne’s Role Purpose Statement
Sinead’s Role Purpose Statement
Section 2.3 The Five Core Concepts and Associated Core Competencies
as Key Performance Areas
Mary’s Key Performance Areas
Patrick’s Key Performance Areas
Joanna and Georgina’s Key Performance Areas
Anne’s Key Performance Areas
Sinead’s Key Performance Areas
Section 2.6 Strategic Planning in the CNS/CMS Role: Setting SMART
Objectives
Mary’s Short-Term SMART Objectives
Patrick’s Short-Term SMART Objectives
Joanna and Georgina’s Short-Term SMART Objectives
Anne’s Short-Term SMART Objectives
Sinead’s Short-Term SMART Objectives
Section 2.6 Strategic Planning in the CNS/CMS Role: Setting Outcomes
Measures for each Core Concept
Mary’s SMART Outcome Measure
Patrick’s SMART Outcome Measure
Joanna and Georgina’s SMART Outcome Measure
Anne’s SMART Outcome Measure
Sinead’s SMART Outcome Measure
Section 2.6 Strategic Planning in the CNS/CMS Role: Taking Strategic
Action
Mary’s Outline/Operational Plan for Previous Audit Objective
Patrick’s Outline/Operational Plan for Previous Audit Objective
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Joanna and Georgina’s Outline/Operational Plan for Previous Audit
Objective
Anne’s Outline/Operational Plan for Previous Audit Objective
Sinead’s Outline/Operational Plan for Previous Audit Objective
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CHAPTER 3: COMPETENCY REVIEW AND PERSONAL DEVELOPMENT PLANS
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Section 3.3 – Steps in Formulating a Personal Development Plan
Mary’s Personal Development Plan
Patrick’s Personal Development Plan
Joanna and Georgina’s Personal Development Plan
Anne’s Personal Development Plan
Sinead’s Personal Development Plan
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CHAPTER 4: THE CLINICAL NURSE/MIDWIFE SPECIALIST AND AUDIT AND
RESEARCH
Section 4.4. Setting Standards Using the Donabedian Framework
Mary’s Standard Statement Applied to Role Audit
Patrick’s Standard Statement Applied to Role Audit
Joanna and Georgina’s Standard Statement Applied to Role Audit
Anne’s Standard Statement Applied to Role Audit
Sinead’s Standard Statement Applied to Role Audit
Mary’s Example of Audit Indicator
Patrick’s Example of Audit Indicator
Joanna and Georgina’s Example of Audit Indicator
Anne’s Example of Audit Indicator
Sinead’s Example of Audit Indicator
Mary’s Example of Audit Tool
Patrick’s Example of Audit Tool
Joanna and Georgina’s Example of Audit Tool
Anne’s Example of Audit Tool
Sinead’s Example of Audit Tool
Section 4.6. Outcome Measures for CNS/CMS Audits
Mary’s Ideas for Outcome Measures (1)
Patrick’s Ideas for Outcome Measures
Joanna and Georgina’s Ideas for Outcome Measures
Anne’s Ideas for Outcome Measures
Sinead’s Ideas for Outcome Measures
Mary’s Ideas for Outcome Measures (2-4)
APPENDICES
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Patient/Client Questionnaire
Nursing/Midwifery Staff Questionnaire
Clinicians’ Questionnaire
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NOTE ON USING THE CASE STUDIES
The case studies were developed to assist you in thinking critically about your role and how you
might develop it or introduce innovations into your practice. While each case study refers to the
role and practice of a clinical nurse/midwife specialist working in a specialised area or setting, these
should not necessarily be taken as the only way of working in these specialised areas or settings.
Please feel free to adapt the case studies to the requirements of your practice and/or service and to
update as necessary.
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CHAPTER 2: CNS/CMS ROLE CLARIFICATION AND PLANNING
SEE SECTION 2.2 ROLE PURPOSE STATEMENT
Case Study: Mary – CNS (Asthma)
Mary’s Role Purpose Statement
Mary is based in the respiratory unit of St Blanaid’s Hospital, a Band 1 acute hospital.
“The aim of my job as CNS (Asthma) is to utilise my specialist knowledge and the five core concepts
of the specialist role to lead and maintain a holistic, person-centred, high-quality asthma nursing
service to patients attending St Blanaid’s hospital so that these patients will achieve their maximum
health potential and receive timely, holistic and effective nursing care. “
In this example, Mary, the CNS (Asthma), recognises she cannot see all the patients/clients with
asthma attending the hospital; but she may say she is doing her best to ensure that a quality
service is being provided to all asthma patients in contact with her service through her clinical and
professional leadership and by employing all five core concepts in her role. Leading and
maintaining a quality system will include:
o educating staff on the front-line in best practice for the general management of
asthma care (the core concepts involved are education and training, indirect clinical
focus and research element of audit and research)
o developing referral systems and streamlining referrals to ensure she is reviewing
the patients who really need access to her (core concept – consultant)
o evaluating the quality of patient care (clinical outcomes) and the level of patient
satisfaction (core concept – audit and research).
Case Study: Patrick – CNS (Challenging Behaviour)
Patrick’s Role Purpose Statement
Patrick is a member of the multidisciplinary behaviour management team at Sonas, a service for
adults and children with an intellectual disability and challenging behaviour. The core behaviour
management team comprises two psychologists, two CNSs (Challenging Behaviour), a clinical nurse
manager and a social worker. The team also holds service user review meetings with a consultant
psychiatrist.
“The aim of my role is to incorporate the five core competencies and their associated competencies
within my role as a CNS in challenging behaviour. This is so that I can work as an effective member
of the multidisciplinary behaviour management team and contribute with a clearly defined specialist
nursing role, thus maintaining a holistic, high-quality, person-centred, accountable and equitable
behaviour management service that meets:
 The goals of the national health strategy
 The goals of the Irish disability and inclusion agendas
 The requirements of Sonas’ service plan and its mission statement
 My scope of nursing practice within the area of behaviour management.”
Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Joanna and Georgina’s Role Purpose Statement
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Joanna and Georgina are members of the multidisciplinary obstetric team at Ionad Iompar Clainne
(IIC), a specialised centre within the maternity services at St Ciaran’s Regional Hospital. IIC provides
foetal assessment to all pregnant women in the hospital’s catchment area.
“The aim of our role is to incorporate the five core competencies and their associated competencies
within our shared role as CMSs in obstetric ultrasound and foetal assessment. This is so that we can
work as effective members of the multidisciplinary obstetric team and contribute with a clearly
defined specialist midwifery role, thus maintaining a holistic, high-quality, woman-centred,
accountable and equitable obstetric and midwifery service that meets:
 The goals of the national health strategy
 The goals of advocacy groups and other stakeholders with an interest in improving maternity
services
 The requirements of St Ciaran’s Regional Hospital service plan and its mission statement
 Our scope of midwifery practice within the area of obstetric ultrasound and foetal
assessment.”
Case Study: Anne – CNS (Community Mental Health)
Anne’s Role Purpose Statement
Anne is a member of the multidisciplinary mental health team that serves a mixed urban-rural sector
for adults. The team members include two community mental health nurses, two home therapy
nurses, one consultant psychiatrist, a registrar, one nurse counsellor, one assistant director of
nursing, two psychologists, two CNSs (Challenging Behaviour), a clinical nurse manager and a social
worker. Access to community additions services and family therapy are available on request.
“The aim of my role is to ensure my specialist knowledge and skills and the five core concepts
and associated competencies of the specialist role are best utilised so that I can work as an
effective member of the multidisciplinary community mental health team and maintain a
holistic, high-quality, person-centred, accountable and equitable community mental health
nursing service for patients in my sector.”
Case Study: Sinead – CNS (Paediatric Dermatology)
Sinead’s Role Purpose Statement
Sinead is a member of the multidisciplinary paediatric dermatology team at an urban acute hospital,
Ballyfiachra General Hospital (BGH). The team comprises two consultant dermatologists, two
registrars, one senior house office, two part-time dermatology nurses (non-CNSs) and Sinead herself.
She is keen to facilitate the on-going development and integration of the paediatric dermatology
service at BGH and to promote parental involvement in patient care.



“The aim of my role is to ensure my specialist knowledge and skills and the five core
concepts and associated competencies of the specialist role are best utilised so that I can
work as an effective member of the multidisciplinary paediatric dermatology team. I also
aim to maintain a holistic, high-quality, child- and family-centred, accountable and equitable
paediatric dermatology nursing service for children attending Ballyfiachra General Hospital
that will meet:
The goals of the national health strategy
The hospital’s requirements regarding best practice in child protection
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
My scope of nursing practice within the area of paediatric dermatology.”
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SEE SECTION 2.3 THE FIVE CORE CONCEPTS AND ASSOCIATED CORE COMPETENCIES AS
KEY PERFORMANCE AREAS
Case Study: Mary – CNS (Asthma)
Mary’s Key Performance Areas
Key Performance Area
Importance To
Role (on a scale
of 1-5; 1 being
of very high
importance and
5 low
importance)
Current % of
time/month
spent on a
core concept
Ideal % of
time needed
to achieve
role purpose
Clinical Focus
1
70%
60%
Patient Advocacy
5
6%
6%
Education & Training
3
2%
12%
Audit & Research
2
5%
14%
Consultancy
4
13%
8%
100%
100%
TOTALS
Mary has been a CNS in asthma care for three years now. She has a large clinical caseload of
children adolescents and adults with varying degrees of asthma. Having reviewed the needs
of her patients/clients at St Blanaid’s, Mary agreed that the clinical focus was the highest
priority key performance area of her role but the large amount of time spent on direct
clinical care was preventing her from spending time on the other core concepts/key
performance areas of her role. Mary recognised that most of her time was spent on
providing direct patient/client care which meant excellent care was being provided to those
who saw her. She did not know, however, about the care of those who were not referred to
her specialist service and she was aware that patients often had to wait for an OPD
appointment after their discharge before she could see them. She recognised that even
though there was a waiting list of patients/clients to see her and some of her review
patients/clients no longer needed follow-up care in her clinics there was no protocol for
prioritising referrals or discharging them from her care. This meant her clinical caseload has
consistently increased. Thus, to attend to other aspects of her role and to make
improvements in the long term she will need to change the amount of time spent solely on
direct clinical care. She saw education of other key staff and clinical audit as the two areas
she could focus on and which would provide benefits to the patients/clients, service and her
own time management and ways of working.
Comparing her importance ratings and the time spent on the ‘education and training’ and
‘audit and research’ components of her role, Mary could see these roles were not being
addressed as comprehensively as they might have been. Time spent on audit and education
had slipped in particular, though from her experience in the role Mary knew that for optimal
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effectiveness and/or to make changes in her service, performing in these core concepts
would be crucial. By implementing education strategies (education sessions, updating staff
and patient/client information leaflets, etc) she will develop her indirect clinical focus and
enhance the quality of care to those patients/clients receiving care from other members of
the team or in other departments of the hospital. This would aid her to reduce her own
direct clinical care time as well as expanding the clinical service. So when other staff,
through education, feel more competent and confident dealing with asthmatic
patients/clients, she will receive fewer calls for regular general asthma care and can spend
more time on those who need specialist interventions.
Currently, audit in her role relates to Mary being involved, as a member of the
multidisciplinary team, in the activity analysis of the respiratory service/department. For
some time now Mary has wanted to audit some of the new services she is directly involved
in (an acute asthma home care package for children and their parents which has resulted in
most asthma care being treated at home or in the emergency room with rapid discharge; an
education programme for non-healthcare staff on asthma care developed in her second
year in the role and the current adult asthma clinic to see if same could be better managed).
Also Mary’s line manager and the CNM2 she works closely with have indicated they would
like to see an audit of ‘basic’ asthma care – inhaler technique, knowledge of
preventive/relief inhalers, etc, from patients’/clients’ and staff’s viewpoint. To make this a
reality, Mary knows she has to find the time to start auditing. Currently this time will have to
come from her direct clinical care and current amount of time spent on consultancy work
but with improvements to care through better time management, education of others and
audit, this will occur without harming her patients. In the future once audit is established as
part of her regular workload, she could see that it will be more balanced with other
concepts and hopefully be incorporated within her annual and daily activities.
Following a review of her key performance areas, Mary recognised the fluidness of the
concepts, how they overlap and all link into indirect clinical care of her patients/clients.
Mary could see the benefits of applying the other core concepts to her work and realised
that her priorities will change as the service change and monitoring time spent on key
performance areas by repeating this exercise annually would help her be effective in her
role and help prevent the amount of time spent on clinical focus building without a
deterioration in service if the other core concepts were attended to in her role.
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Case Study: Patrick – CNS (Challenging Behaviour)
Patrick’s Key Performance Areas
Key Performance Area
Importance to
Role (1-5)
Current % of
time
Ideal % of
time
Clinical Focus
1
55%
55%
Client Advocacy
2
10%
15%
Education & Training
3
20%
15%
Audit & Research
4
5%
10%
Consultancy
5
10%
5%
Patrick has been a CNS in challenging behaviour for two years, and shares a large caseload
with his CNS colleague. Having reviewed the needs of his clients and of the Sonas service,
Patrick could see the value and importance of his clinical focus. This focus comprises direct
and indirect care, and Patrick recognised that just over half of his time was spent on
providing direct client care, which in relation to his job description and client needs was just
about right. Much of his indirect care overlapped with his consultancy role (for example,
meetings with family members and other members of the multidisciplinary behaviour
management team), which meant that his time allocation to consultancy could be reduced
on paper but continued in practice.
Patrick could see from his importance ratings that while he enjoyed the training aspects of
his role, much of this time was allocated to training other staff in areas not related to
behaviour management. He also realised that he was not allowing enough time to audit his
caseload and the effectiveness of his interventions. By reducing the time spent training in
areas other than challenging behaviour, he would be able to set aside more time to audit
and research, thus improving his effectiveness as a clinician and an advocate for his clients.
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Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Joanna and Georgina’s Key Performance Areas
Key Performance Area
Importance to
Role (1-5)
Current % of
time
Ideal % of
time
Clinical Focus
1
60%
60%
Client Advocacy
4
5%
5%
Education & Training
3
20%
15%
Audit & Research
2
10%
15%
Consultancy
5
5%
5%
Joanna has been a CMS in obstetric ultrasound and foetal assessment for four years, while
Georgina has been in post for three years. They both work on a part-time basis, sharing a
full-time CMS post. Having reviewed the needs of their patients and of the Ionad Iompar
Clainne at St Ciaran’s Regional Hospital, Joanna and Georgina could see the value and
importance of their clinical focus. This focus comprises direct and indirect care, and the two
CMSs recognised that just over half of their time was spent on providing direct patient care,
which in relation to their shared job description and patients’ needs was just about right.
Much of their indirect care overlapped with their consultancy role, for example, meetings
with women and their partners, and counselling and support to women attending the foetal
assessment clinics following detection of foetal anomalies. This meant that their time
allocation to consultancy could be reduced on paper but would continue in practice.
Joanna could see from her importance ratings that while she particularly enjoyed the
training aspects of her role, and received a lot of positive feedback from recipients of her
training, Georgina preferred counselling and support aspects. She too had received a great
deal of positive feedback for this from patients and from other midwives working in the
maternity services. Between them they decided to take a lead in their respective areas of
strong performance, while recognising that they could learn from one another. They also
realised that they had not allowed enough time to audit their combined caseload and the
effectiveness of their interventions, the feedback from which was necessary for them to
develop their practice. By prioritising training topics and staff groups for whom they
provided training, Joanna took the lead in delivering training while Georgina set aside more
time for audit and research, thus enhancing their clinical effectiveness as CMSs and
contributing to the overall effectiveness of the multidisciplinary team.
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Case Study: Anne – CNS (Community Mental Health)
Anne’s Key Performance Areas
Key Performance Area
Importance to
Role (1-5)
Current % of
time
Ideal % of
time
Clinical Focus
1
75%
60%
Client Advocacy
2
5%
10%
Education & Training
3
5%
10%
Audit & Research
4
5%
15%
Consultancy
5
10%
5%
Anne has been a CNS (Community Mental Health) (CNS – CMH) for eighteen months. Each
CNS – CMH has a caseload of eighty patients. Anne spends most of her time providing direct
client care, for example, domiciliary visits and out-patient department visits. Having
reviewed the needs of her clients and of the service overall, Anne could see the value and
importance of her clinical focus but she also recognised that she had an opportunity to reorganise her workload and develop more efficient ways of working. Much of Anne’s indirect
care to her clients overlapped with her consultancy role: for example, meetings with family
members, community workers and other members of the multidisciplinary team. This
meant that her time allocation to consultancy could be reduced on paper but would
continue in practice through education, advocacy and clinical focus. Areas requiring more
attention - and that would benefit the service and Anne’s ways of working overall - were
advocacy, education and training and audit and research.
Anne could see from the importance ratings that advocating for her clients at an individual
or group level (e.g., at multidisciplinary team or with other community services) or
supporting the clients to advocate on their own behalf was a key aspect of her role.
Spending more time on this could reduce her own clinical caseload and would make her role
more effective. Anne estimates she will need to spend 10% of her time (i.e., 3.9 hours per
week) on advocacy rather than the current 5% which was often done on an ad hoc basis.
Anne also rates education and training as important and enjoys these aspects of her role.
Much of her time in education, however, was allocated to inducting new team members,
providing training on the Mental Health Act or to her own professional development. By
training other mental health and community workers on the service, clients’ needs and care
she could potentially release some of her clinical time. Also more structured client and
family education regarding treatments, medications and management of their illness would
help Anne to be more effective and organised in her role. Finally, Anne realised that she was
not allowing enough time to audit her caseload and the effectiveness of her nursing
interventions. By reducing the time spent on direct client care, she would be able to set
aside more time to audit and implementing research within her practice, thus improving her
effectiveness as a clinician and an advocate for her clients.
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Case Study: Sinead – CNS (Paediatric Dermatology)
Sinead’s Key Performance Areas
Key Performance Area
Importance to
Role (1-5)
Current % of
time
Ideal % of
time
Clinical Focus
1
80%
65%
Client Advocacy
2
5%
5%
Education & Training
3
5%
10%
Audit & Research
4
5%
15%
Consultancy
5
5%
5%
Sinead has been a CNS (Paediatric Dermatology) for four years. She spends most of her time
providing direct clinical care, for example, at nurse-led out-patient clinics and on an inpatient basis. Having reviewed the needs of her patients and their families and of the
service overall, Sinead could confirm the value and importance of her clinical focus. She had
also participated in a two-year service-wide project concerned with ensuring best practice in
child protection was built into all policies and procedures concerning paediatric care. The
completion of this project has coincided with the commencement of a new project which
will require her to re-organise her work.
Sinead recognised that much of her indirect care of her caseload overlapped with her
advocacy and consultancy roles: for example, providing relevant education to family
members, community-based nurses and other members of the multidisciplinary team
throughout Ballyfiachra General Hospital. This meant that her time allocation to
consultancy could be reduced on paper but would continue in practice through education
and advocacy. Areas requiring more attention - and that would benefit the service and
Sinead’s ways of working overall - were education and training, and audit and research.
Sinead identified from the importance ratings that audit and research were key aspects of
her role, especially as the multidisciplinary team were planning to evaluate the
implementation of its child protection policies. In addition, one of the registrars has asked
Sinead and the other dermatology nurses to assist him in a study using the Children’s
Dermatology Life Quality Index (CDLQI). By training a small cohort of nurses in specific
aspects of dermatological nursing care and with the agreement of her manager, Sinead
would be able to reduce time spent in direct clinical care and dedicate twelve hours a
month to the child protection evaluation and CDLQI projects. She will also be able to cite
this experience in the continuing professional development section of her personal
professional portfolio.
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SEE SECTION 2.6 STRATEGIC PLANNING IN THE CNS/CMS ROLE: SETTING SMART
OBJECTIVES
Case Study: Mary – CNS (Asthma)
Examples of short-term SMART objectives for Mary could be as follows:
1. Clinical Focus
Direct care:
Indirect care:
By the end of the year, set up an OPD nurse-led clinic to follow up children
newly diagnosed with asthma attending St. Blanaid’s.
By the year- end established a 7-day week (8am – 6pm) nurse-led telephone
support/help-line service for parents of children newly diagnosed with
asthma.
2. Patient Advocacy - on an individual or group basis
Group Advocacy:
To represent the needs and values of asthmatic patients at the quarterly
departmental service review meetings.
3. Education and Training -self, patient or staff
Staff:
By the year end, complete a learning needs analysis for nursing staff on St.
Blanaid’s medical, children and A&E units in relation to asthma and to
develop and implement a time-bound action plan to meet those identified
needs.
4. Audit and Research
Audit:
By the end of the year, to carry out a patient/client satisfaction survey about
the care received from me during their OPD contact.
Research:
The nurse-led children’s clinics that I have implemented and evaluated in
OPD will be based on the ‘best in class’ practice. I will develop guidelines for
the clinic based on same.
I will contribute to research by informing relevant persons of any emerging
issues that may be relevant for future research.
5. Consultancy – inter- and intra-disciplinary
Intradisciplinary:
By the end of the year, to disseminate to relevant clinical areas within St
Blanaid’s updated clinical practice guidelines on asthma care.
Interdisciplinary:
I will also update the referral pathways to my CNS services and communicate
same, with my phone number, to healthcare staff in the hospital and the
community indicating my availability for consultation regarding asthma care
in order to improve patient/client management.
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Case Study: Patrick – CNS (Challenging Behaviour)
Examples of short-term SMART objectives for Patrick could be as follows:
1. Clinical Focus
Direct care:
Indirect care:
Within six months, set up a nurse-led service focusing on the
needs of adolescent service users with challenging behaviour.
Within six months, set up a telephone support service for parents
of the above group of service users.
2. Client Advocacy
Individual advocacy: To represent the individual needs of the above group of service users to
their parents where necessary and to other members of the multidisciplinary
behaviour management team.
Group advocacy: To represent the concerns of parents of the above group of service users to
the other members of the multidisciplinary behaviour management team.
3. Education and Training
Self: By the end of the academic year I shall have completed a certificate-level course in
supporting independent living.
Clients: Within the next six months I shall have reduced my non-essential training input
with staff, so will be able to provide a personal development programme
for the service users in my group of adolescents.
Staff:
By the year end, the multidisciplinary behaviour management team shall
have completed a learning needs analysis in relation to challenging
behaviour for nursing and health and social care staff working in
specialised behaviour units and in community-based settings. We shall
then develop and implemented a time-bound action plan to meet those
identified needs.
4. Audit and Research
Audit:
Before commencing the nurse-led service for adolescent service users, I
shall identify the areas that will need to be audited. I shall also prepare a
system for documenting parents’ concerns.
Research:
The multidisciplinary behaviour management team is currently engaged in
a qualitative study of the effectiveness of our interventions with those
service users who have a sensory impairment. My CNS colleague and I
shall complete the interviews and write up the transcripts for the
psychologist who is leading the investigation.
5. Consultancy
Intradisciplinary: By the end of the month, I shall have circulated my telephone number to all
nurses working in the community-based settings, and let them know that my
CNS colleague and I are the nursing contacts for queries relating to
behaviour management.
Interdisciplinary: Over the next six months I shall be working closely with the social worker to
develop and/or adapt a format for person-centred plans in line with current
trends in person-centred planning.
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Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Examples of short-term SMART objectives for Joanna and Georgina could be as follows:
1. Clinical Focus
Direct care:
Indirect care:
Within six months, enhance the midwife-led service by
developing a plan for breaking news to pregnant women about a
confirmed foetal anomaly.
Within six months, set up a telephone support service for women
who have been told about a confirmed foetal anomaly.
2. Client Advocacy
Individual advocacy: To represent the individual concerns and needs of women who have
been told about a confirmed foetal anomaly where necessary and to other
members of the multidisciplinary obstetric team.
Group advocacy: To represent the concerns of the above patient group to the other members
of the multidisciplinary behaviour management team and to keep abreast of
the issues raised by specialist patient advocacy group.
3. Education and Training
Self: Within six months both us of shall have completed a short course in audit methods.
Georgina will also complete her diploma in counselling at our local
college.
Clients: Within the next six months Georgina shall have reduced her non-essential training
input with non-midwifery staff, so will be able to take the lead in
developing the new midwife-led service.
Staff:
Within the next six months Joanna shall have prioritised the training
topics and staff groups, and conducted a peer review of Georgina’s
training competencies.
4. Audit and Research
Audit:
In the early stages of developing the new midwife-led service both of us
shall identify appropriate areas for audit in consultation with other
members of the multidisciplinary obstetric team and with the specialist
advocacy group that has conducted research on breaking the news of a
confirmed foetal anomaly.
Research:
The multidisciplinary obstetric team is currently reviewing protocols for
obstetric ultrasound and foetal assessment. We shall be assisting in this
over the next three months. Joanna is planning to commence a master’s
degree in midwifery in Dublin, so will identify a specific area of foetal
assessment in which to conduct research for her dissertation.
5. Consultancy
Intradisciplinary: By the end of the month, Georgina shall have consulted staff midwives
working in the maternity services at St Ciaran’s Regional Hospital in order to
obtain their views on areas of practice to be audited. A report on these
views will be prepared for the next multidisciplinary obstetric team meeting.
Interdisciplinary: By the end of the month, Joanna shall have consulted the specialist
advocacy group about their research on breaking the news of a confirmed
foetal anomaly and will bring feedback to the next multidisciplinary obstetric
team meeting.
16
Case Study: Anne – Clinical Nurse Specialist (Community Mental Health)
Examples of short- and medium-term SMART objectives for Anne’s role could be:
1. Clinical Focus
Direct care:
Indirect care:
Within six months set up a nurse-led service focusing on the
needs of clients receiving depot injections.
Within six months, set up a telephone support service for the
above group of service users and their family.
2. Client Advocacy
Individual advocacy: To represent the individual needs of service users to other members of
the multidisciplinary team; to community and voluntary agencies and
individuals who are in contact with the service user as required.
Group advocacy: To promote self-advocacy among clients by providing education for clients,
the multidisciplinary team and community services and workers so that
clients can maximise their independence and quality of life.
3. Education and Training
Self:
By the end of the next academic year I shall have completed a certified
course in the area of health promotion and education.
Clients:
Within the next six months I shall provide a personal development
programme (which promotes empowerment and independent living) for a
defined group of service users ready to be self-advocates.
Staff:
By the year end, I will develop an information leaflet on my role and
provided staff training on the role of the CNS (Community Mental Health).
Also as part of my own course I will develop a staff programme on the
principles of empowerment, promoting independence and self-advocacy
among mental health service users/clients in the community.
4. Audit and Research
Audit:
Research:
Before commencing the nurse-led depot injection service for
community-based service users, audit outcomes will be identified and a
data collection system will be developed. Also I will conduct a baseline
survey of clients who receive depot injections and develop a database of
same.
In line with the above objectives of empowering the service users,
promoting self-advocacy and independent living, my CNS colleagues and
I shall complete a search and appraisal of the best evidence in the areas
of self-advocacy and empowerment of service users and develop and
implement a guideline on these topics within the next year.
5. Consultancy
Internal to community mental health service: By the end of the month, I shall have
developed a system to refer patients to the nurse-led depot injection service
to. This system will include criteria for acceptance and discharge to other
community services as appropriate.
External to service: Over the next six months I shall work closely with community and
17
voluntary services to develop and/or adapt a person-centred self-advocacy
programme for community mental health clients/service users.
18
Case Study: Sinead – Clinical Nurse Specialist (Paediatric Dermatology)
Examples of short- and medium-term SMART objectives for Sinead’s role could be:
1. Clinical Focus
Direct care:
Indirect care:
For next three months provide direct care in a nurse-led
community outreach service for children with eczema and other
dermatological conditions.
During these three months provide training to practice nurses and
public health nurses at the community outreach service for
children with eczema and other dermatological conditions.
2. Client Advocacy
Individual advocacy: To represent the individual needs of children to: their parents, families
and/or carers; other members of the multidisciplinary team within
Ballyfiachra General Hospital; and members of the nursing teams at the
community outreach service.
3. Education and Training
Self:
In two months’ time I shall have completed a literature search and review
relating to the Children’s Dermotology Life Quality Index (CDLQI).
Children:
Within the next six months Dr McDermott (Registrar) and I shall develop
and provide age-appropriate training in the use of the cartoon version of
the CDLQI.
Staff:
Within the next six months Dr McDermott and I will develop an
information leaflet on the CDLQI and its use. I will also provide training to
practice nurses and public health nurses at the community outreach
service on innovative evidence-based practice in the treatment and
management of eczema.
4. Audit and Research
Audit:
Research:
I shall participate in the evaluation of the child protection project,
focusing on nursing compliance with the new policies. I shall also
continue to audit attendance and practice at the community outreach
service.
I shall be assisting Dr McDermott in his study using the CDQLI.
5. Consultancy
Intradisciplinary (internal to Ballyfiachra General Hospital): Within three months, I shall have
consulted all nursing staff concerned with implementing and evaluating the
new child protection policies.
Intradisciplinary (community outreach service): Over the next three months I shall work
closely with practice nurses and public health nurses to obtain their views
and parents’ views of the new practices in the treatment and management
of eczema.
19
SEE SECTION 2.6 STRATEGIC PLANNING IN THE CNS/CMS ROLE: SETTING OUTCOMES
MEASURES FOR EACH CORE CONCEPT
Case Study: Mary – CNS (Asthma)
Example of SMART Outcome Measure
A SMART outcome for the short-term ‘audit objective’ regarding the CNS carrying out a patient
satisfaction survey could be:
“There is an evidence-based patient satisfaction survey tool, appropriate to patients/clients
attending a CNS service, developed and implemented in OPD within the first three months of the
clinic being set up.
A standard statement, based on best in class evidence, outlining the expected level of satisfaction is
developed within the first three months of the clinic being set up.
By the end of the year, documented evidence of ongoing audit of patient satisfaction surveys against
this agreed standard is available.
By the end of the year, action plans are in place to address aspects where poor performance
identified.
By the end of the year, results demonstrate a high level (>80%) of patient/client satisfaction with the
care received from the CNS in the OPD setting.”
Case Study: Patrick – CNS (Challenging Behaviour)
Example of SMART Outcome Measure
Patrick’s indirect care objective of setting up a telephone support service (for the parents of
adolescent service users with challenging behaviour) might have the following SMART outcome
measures:
“Sonas’ partner intellectual disability service in the region has set up a similar service and
developed a survey tool appropriate for recording and analysing parents’ preferences. We
already have a satisfaction assessment scale relating to a range of services that we provide so I
can combine the two for use within the support service to ensure that parents’ views of and
preferences for service provision can be ascertained.”
Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Example of SMART Outcome Measure: Short-term research objective
Joanna’s research objective of identifying a specific area of foetal assessment on which to base her
intended dissertation might have the following SMART outcome measures:
“I have recently read the document Informing Families’ of their Child’s Disability. National Best
Practice Guidelines (National Federation of Voluntary Bodies, 2007) and have examined recent
trends in the numbers of women attending the Ionad Iompar Clainne and for whom English is
not a first language. I shall complete a preliminary search and review of literature in this area in
order to identify the possible specific needs of this group of women where a foetal anomaly has
been confirmed.”
Case Study: Anne – CNS (Community Mental Health)
Example of SMART Outcome Measure
20
Anne’s indirect care objective of setting up a telephone support service (for service users and their
families using the nurse-led depot injection service) might have the following SMART outcome
measures:
“All clients who receive depot injections will be maintained on a database held by the CNS
(Community Mental Health).
The appropriate use of depot injections will be reviewed every six months.
The nurse leading the depot injection service will work with the multidisciplinary team and
wider community service to administer clients’ medications in the most appropriate place and
at the most appropriate time.
The nurse-led service will be underpinned by educating clients, empowering service users and
involving them in decision making.”
Case Study: Sinead – CNS (Paediatric Dermatology)
Example of SMART Outcome Measure
Sinead’s consultancy objective of consulting nursing staff in relation to the implementation of the
child protection policies might have the following SMART outcome measures:
“All nurses working in paediatric units and shared adult and children services at Ballyfiachra
General Hospital will be identified.
Attendance records of in-service training relating to the new child protection policies will be
reviewed and attendance by nurses will be examined.
Nursing staff will be asked for their views on the implementation of the new child protection
policies.”
21
SEE SECTION 2.6 STRATEGIC PLANNING IN THE CNS/CMS ROLE: TAKING STRATEGIC
ACTION
Case Study. Mary – CNS (Asthma)
Outline/Operational Plan for Previous Audit Objective
Business Plan Reference: Corporate Plan
Operational Plan reference: St Blanaid’s Asthma Service
Key Priority:
Mary surveys a random selection of ten patients each month who attend her OPD clinic for
children newly diagnosed with asthma.
Actions to be taken to implement this priority
She uses a validated or ‘best in class’ tool to elicit patients’/clients’ and parents’ satisfaction with
the nurse-led clinics. The data is collated regularly every second month, the results
communicated to relevant persons, and an action plan implemented to correct any deviations
from the norm or best practice as necessary.
When will it be implemented?
Development of satisfaction tool will commence immediately and within three months
satisfaction surveys will become routine part of the asthma service.
Who will be responsible for its implementation?
Satisfaction tool will be agreed by multidisciplinary team and managers.
CNS (Asthma) will manage satisfaction surveys and compile report.
Secretary will input ten completed surveys a month into an Excel spreadsheet.
Identify funding source:
From existing resources – internal surveys at point of service thus there are no postal costs.
Human and financial costs as to cost of printing and collating the questionnaires and/or cost of
four hours per month of Mary’s and the secretary’s time protected for carrying out audits are not
being costed as these will be taken from within current working hours.
Measurement criteria / performance indicators:
Patient/client and parent satisfaction with service measured on a continuous monthly basis
Satisfaction with the environment of care, facilities and services as well as information provided
and level of courtesy, care and dignity received will be measured.
Review Dates:
This priority will be reviewed every three months from now, e.g., 12th December 2008; 12th
March 2009, etc. The first survey is due for completion by December. A report will be written and
disseminated to relevant personnel at this stage; meetings and an action plan to address any
necessary improvements will be agreed by end of March 2009.
Continuous re-auditing of patient/client satisfaction will be ongoing throughout the year unless it
is agreed by the team such a process no longer required.
22
Case Study. Patrick – CNS (Challenging Behaviour)
Outline Plan Following Previous Audit Objective
Because the number of parents likely to use the telephone support service (for the parents of
adolescent service users with challenging behaviour) will probably be small (less than twenty),
Patrick decides to include all of them in his survey. Although the tool he devises by combining the
Sonas service satisfaction assessment scale with the partner service’s survey tool has not been
validated, he will seek guidance on piloting it and developing it appropriately from other members of
the multidisciplinary behaviour management team who have more substantive research experience.
The data is collated regularly every month, the results communicated to relevant persons, and an
action plan implemented to address any concerns arising from the analysis of parents’ views.
Patrick’s outline plan also includes ‘resource requirements’ (financial and human) to survey the
parents, e.g., cost of printing, sending out and collating the questionnaires and/or cost of one hour
per week of his time protected for carrying out audits.
Case Study. Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Outline Plan Following Previous Audit Objective
We shall:
 make a complete list of areas and activities currently being audited in order to identify which
activities are relevant to the proposed new midwife-led service and hence avoid
unnecessary duplication of effort


identify areas that will require audit and make enquiries from the other members of
the multidisciplinary about appropriate audit tools
hold discussions with representatives from the specialist advocacy group about
other areas that might be audited.
Case Study: Anne – CNS (Community Mental Health)
Outline Plan Following Previous Audit Objective






Develop a database of clients currently using the nurse-led depot injection service.
Undertake a baseline evaluation of current service users’ reasons for depot injections,
frequency of administration, drug types, timeliness and adherence to medication regime in
the last twelve months and clients’ satisfaction with service.
Review clients and appropriateness of service; explore alternative methods as appropriate.
Continue to collate data monthly on the nurse-led depot injection service.
Identify areas of improvement in the service and address same in consultation with key
stakeholders.
Communicate results and an action plan implemented to address any concerns to relevant
persons.
Anne’s outline plan also includes identification of ‘resource requirements’ (financial and human) to
audit the nurse-led depot injection service, e.g., cost of printing, sending out and collating the
questionnaires and/or cost of one hour per week of his time protected for carrying out audits.
23
Case Study: Sinead – CNS (Paediatric Dermatology)
Outline Plan Following Previous Audit Objective
Business Plan Reference: Corporate Plan
Operational Plan Reference: Ballyfiachra General Hospital’s Dermatology Service
Key Priority:
Sinead surveys a random selection comprising 10% of children aged between five and twelve and
who attend the outpatient eczema clinic.
Actions to be taken to implement this priority
A validated tool will be used to elicit children’s and parents’/carers’ satisfaction with the nurse-led
clinics following agreement with the management and multidisciplinary teams.
Starting immediately, the data will be collated every second month, the results communicated to
relevant persons, and an action plan implemented to correct any deviations from the norm or best
practice as necessary.
The CNS (Paediatric Dermatology) and the dermatology nurses will collect data; the CNS will collate
the data and compile reports.
Measurement criteria/performance indicators
Children’s and parents’/carers’ satisfaction with the dermatology service will be measured on an ongoing basis.
Satisfaction with the environment of care, facilities and services, information provided, and
interaction between staff and service users will be measured.
Review dates:
This priority will be reviewed six months from now. Future action plans will be developed on the
basis of findings.
24
CHAPTER 3: COMPETENCY REVIEW AND PERSONAL DEVELOPMENT PLANS
SEE SECTION 3.3 – STEPS IN FORMULATING A PERSONAL DEVELOPMENT PLAN
Case Study – Mary, CNS (Asthma).
Example of Personal Development Plan
(CMT Ltd 2002) (ONE PLAN PER COMPETENCY / DEVELOPMENT NEED)
Competency: Evidence-based decision-making.
Related Core Concept: Clinical Focus (Direct and Indirect care) and Research Utilisation.
Target Outcome:
A clear description of what I will be able to do, once I have
addressed the competency.
I shall make decisions in a judicious and timely manner, considering all relevant
information when addressing a problem or issue in a clinical or professional area.
I will use logical analysis to break down complex problems into their component parts and
question my approach to care/the solution.
I will find and appraise relevant literature to my area of speciality.
I will apply research findings/evidence-based knowledge to improve nursing practice.
I will assess if nursing care has improved because of the actions applied.
Specific Steps that I will take to address this particular development need, including the date
steps to be completed by.
Steps I will take
Expected Completion
Update my knowledge of problem solving, critical
analysis/appraisal and factors influencing decision-making
in clinical practice.
Practise using analysis and logic in my problem-solving
approaches - differentiating critical elements from minor
ones and consulting widely with others to ensure solutions
are based on the’ full picture’ - all available information,
the best in class evidence, my clinical expertise and
patient/client values.
Based on evidence, generate a number of options, have a
plan B and intervene appropriately.
In 1 month’s time
Allocate 1 hour a week as ‘Library Time’ to update myself
on best available evidence relevant to my practice.
Practise for 3 months, then
ongoing
Practise for 3 months, then
ongoing
Practise for 3 months, then
ongoing
How will I measure my success?
1. I have updated my knowledge of problem solving, critical thinking and decision-making and
also have sound knowledge of my organisations policies and procedures.
25
2. I can demonstrate the promotion of evidence-based decision-making in my practice (seen in
my activity analysis diary, any reflective, critical analysis I document and any audit of outcome
performance measurements I do).
3. I demonstrate awareness of complex problems in my specialist area.
Ways I will be able to utilise this competency

Clinical decision making in relation to patient/client care - to reflect the level of decisionmaking required of a CNS/CMS.
 Decisions regarding service needs and developments.
 Decisions regarding professional career matters.
 Part of the CNS role is to promote the use of researched, evidence-based practice. I can
promote this by being a role model in research utilisation and contributing to nursing
research where appropriate. This sub-role also requires decisions to be made regarding
changing practice at ward level and thus require me to have knowledge and skills in this
competency.
Support I will need to develop this competency -whose support do I need and how will I obtain
it?






Access at work to library and internet.
Schedule times in diary, book in advance internet / reading room when required.
Access to organisation’s up to date policies, protocols and guidelines.
Ask nurse manager or nurse practice development co-ordinator/facilitator if there in an
updated list.
Support from my manager and clinical team to allocate one hour a week to ‘library time’
and also to support my decision making processes and at times decisions.
Discuss with relevant staff.
How will I measure my progress?
Evidence of:
 Increased body of knowledge of problem solving, critical analysis and decision-making.
 Ability to articulate the theory behind my decision-making processes.
 Evidence-based decision-making’ in my clinical and professional practice.
 Critical incident analysis maintained.
 Adherence to library time.
 Adherence to review of this PDP.
Review Dates: May, September and November 2008
Signed: CNS/CMS
Signed: Nurse Manager
Mary O’Brien, CNS (Asthma), St Blanaid’s
Date _________
Maire Malone, Asst Director of Nursing, St
Blanaid’s; 01/01/2008
Date________
Date _________
Date________
26
Case Study – Patrick, CNS (Challenging Behaviour)
Example of Personal Development Plan
(ONE PLAN PER COMPETENCY/DEVELOPMENT NEED)
Competency to be addressed: Enabling service users to participate in decisions about their health
and personal development needs.
Related Core Concept(s): Clinical Focus (Direct and Indirect Care) and Advocacy.
Target Outcome: A clear description of what I will be able to do, once I have addressed
the competency.
 I shall make decisions in a judicious and timely manner, considering all relevant information
when addressing a problem or issue in a practice or professional area.
 I will use logical analysis to break down complex problems into their component parts.
 I will locate and critique relevant literature to my area of speciality.
 I will apply evidence in order to improve nursing practice.
Specific Steps that I will take to address this particular development need, including the date steps
to be completed by.
Steps I will take:
Update my knowledge of advocacy in relation to people with
intellectual disability and their families, self-advocacy,
supporting advocacy and ethical issues relating to advocacy.
Expected Completion
In 1 month’s time
Practise using advocacy skills at multidisciplinary behaviour
management team meetings, in discussions with service
users and with families, and in person-centred planning
processes.
Practise for 3 months, then
ongoing
Allocate 1 hour a week as ‘Library Time’ to update myself on
best available evidence relevant to my practice.
Practise for 3 months, then
ongoing
How will I measure my success?
1. I have updated my knowledge of advocacy in relation to people with intellectual disability
and their families, self-advocacy, supporting advocacy and ethical issues relating to
advocacy. I have also reviewed Sonas’ policies and procedures relating to advocacy.
2. I can demonstrate the promotion of service users’ views and parents’ concerns by reference
to notes in service users’ person-centred plans (where it has been appropriate to document
these), notes from multidisciplinary behaviour management team meetings and in the
progress made in the development of the telephone support service.
3. I demonstrate awareness of complex problems, such as conflict of service users’ interests
with those of the service provider and/or those of parents.
Ways I will be able to utilise this competency


Decision making in relation to direct care of service users and indirect care (e.g., approaches
to working with parents) - to reflect the level of decision making required of a CNS.
Decisions regarding service needs and developments relating to advocacy by or on behalf of
service users.
27


Decisions regarding professional career matters.
Part of the CNS role is to promote the use of evidence in practice. I can promote this by
being a role model in research utilisation and contributing to nursing research where
appropriate. This sub-role also requires decisions to be made regarding changing practice in
promoting self-advocacy among service users. These decisions require me to have
knowledge and skills in this competency.
Support I will need to develop this competency -whose support do I need and how will I obtain it?




Access at work to library and internet.
Schedule times in diary; book library time and use of computer.
Access to Sonas’s current policies, protocols and guidelines; check with other members of
multidisciplinary team and with my front-line manager.
Obtain support from multidisciplinary team and front-line manager to spend one hour a
week in the library and to discuss issues relating to development of advocacy policies and
services for service users.
How will I measure my progress?





Increased body of knowledge on advocacy in relation to people with intellectual disability
and their families, self-advocacy, supporting advocacy and ethical issues relating to
advocacy.
I am able to articulate the theory behind developing advocacy services in Sonas.
Evidence of ‘evidence-based decision-making’ in my professional practice.
Development of advocacy services sustained.
Adherence to library time.
Review Dates: May; August and November 2008
Signed: CNS /CMS
Patrick O’Hehir, CNS (Challenging Behaviour)
Signed: Nurse Manager
Valerie Duff, Clinical Nurse Manager
(3) ; 01/01/2008
Date _________
Date________
Date _________
Date________
28
Case Study – Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Example of Personal Development Plan
(ONE PLAN PER COMPETENCY/DEVELOPMENT NEED)
Competency to be addressed: Providing training to midwives on obstetric ultrasound and foetal
assessment.
Related Core Concept(s): Education and Training.
Target Outcome: A clear description of what I will be able to do, once I have addressed
the competency.
I shall make decisions in a judicious and timely manner, considering all relevant information when
addressing a problem or issue in a practice or professional area.
I will use logical analysis to break down complex problems into their component parts.
I will locate and critique relevant literature to my area of speciality.
I will apply evidence in order to improve midwifery practice.
Specific Steps that I will take to address this particular development need, including the date steps
to be completed by.
Steps we will take:
Georgina: I shall review feedback from staff midwives and
other grades relating to training I have provided in the last
six months.
Joanna: I shall review the above with Georgina in order to
help her identify particular difficulties.
Expected Completion
In 2 weeks’ time
Georgina: Although I am cutting back on some of my non1 month
essential training, I shall arrange to sit in on some of Joanna’s
sessions and see what I can learn from her.
Joanna: I shall arrange to sit in on some of Georgina’s
training sessions and identify her strengths and weaknesses
as a trainer.
Commence in 1 month’s time
and complete in 2 months’
time
How will I measure my success?
1. Georgina: Joanna and I have completed the review of feedback on training I have provided in the
last six months.
2. Georgina: I have addressed some of the difficulties identified and feedback is improving.
Ways I will be able to utilise this competency


Provide enhanced one-to-one and group training of midwives and other grades
Provide enhanced preceptorship of newly qualified midwives
Support I will need to develop this competency - whose support do I need and how will I obtain it?


Peer review from CMS colleague at work.
Schedule times in diary for supervised training sessions and review.
29
How will I measure my progress?

More positive feedback from staff for whom I provide training.
Review Dates: June and September 2008
Signed: CMS
Signed: Midwife Manager
Georgina Orwell, CMS (Obstetric Ultrasound and
Foetal Assessment)
Rosemary Rogan, Clinical Midwife
Manager (3) ; 02/03/2008
Date _________
Date________
Date _________
Date________
30
Case Study: Anne – CNS (Community Mental Health)
Example of Personal Development Plan
(ONE PLAN PER COMPETENCY/DEVELOPMENT NEED)
Competency to be addressed: Enabling service users to participate in decisions about their health
and personal development needs.
Related Core Concept(s): Clinical Focus (Direct and Indirect care) and Advocacy.
Target Outcome: i.e. a clear description of what I will be able to do, once I have addressed
the competency.
I shall make decisions in a judicious and timely manner, considering all relevant information when
addressing a problem or issue in a practice or professional area.
I will use logical analysis to break down complex problems into their component parts.
I will locate and critique relevant literature to my area of speciality.
I will apply evidence in order to improve nursing practice.
Specific Steps that I will take to address this particular development need, including the date steps
to be completed by.
Steps I will take:
Update my knowledge of advocacy in relation to clients
accessing mental health services and their families, selfadvocacy, supporting advocacy and ethical issues relating to
advocacy.
Practise using advocacy skills at multidisciplinary team
meetings, in discussions with community service provider
(voluntary and non-voluntary), service users and with their
families.
Allocate 1 hour a week as ‘Library Time’ to update myself on
best available evidence relevant to my practice.
Expected Completion
In 1 month’s time
Practise for 3 months, then ongoing
Practise for 3 months, then ongoing
How will I measure my success?
1. I have updated my knowledge of advocacy in relation to community mental health service users
and their families, supporting self-advocacy and ethical issues relating to advocacy. I have
developed and reviewed policies and guidelines relating to advocacy in community mental
health.
2. I can demonstrate the promotion of service users’ views and parents’ concerns by reference to
notes in service users’ person-centred care plans (where it has been appropriate to document
these), notes from multidisciplinary team meetings and in the progress made in the development
of the telephone support service.
3. I demonstrate awareness of complex problems, such as conflict of service users’ interests with
those of the service provider.
Ways I will be able to utilise this competency

Decision-making in relation to direct care of service users and indirect care (e.g., approaches
31



to working with parents) - to reflect the level of decision making required of a CNS.
Decisions regarding service needs and developments relating to advocacy by or on behalf of
service users.
Decisions regarding professional career matters.
Part of the CNS role is to promote the use of evidence in practice. I can promote this by
being a role model in research utilisation and contributing to nursing research where
appropriate. This sub-role also requires decisions to be made regarding changing practice in
promoting self-advocacy among service users. These decisions require me to have
knowledge and skills in this competency.
Support I will need to develop this competency -whose support do I need and how will I obtain it?




Access at work to library and internet.
Schedule times in diary; book library time and use of computer as access at work difficult.
Access to current policies, protocols and guidelines; check with other members of
multidisciplinary team and with my front-line manager.
Obtain support from multidisciplinary team and front-line manager to spend one hour a
week in the library and to discuss issues relating to development of advocacy policies and
services for service users.
How will I measure my progress?





Increased body of knowledge on advocacy in relation to community mental health service
users and their families, self-advocacy, supporting advocacy and ethical issues relating to
advocacy.
I am able to articulate the theory behind developing advocacy services and self-advocacy in
mental health.
Evidence of ‘evidence-based decision-making’ in my professional practice.
Development of advocacy services sustained.
Adherence to library time.
Review Dates: May; August and November 2008
Signed: CNS /CMS
Anne McGann, CNS (Community Mental Health)
Signed: Nurse Manager
Sean Duffy, Clinical Nurse Manager
(3) ; 01/01/2008
Date _________
Date________
Date _________
Date________
32
Case Study: Sinead – CNS (Paediatric Dermatology)
Example of Personal Development Plan
(ONE PLAN PER COMPETENCY/DEVELOPMENT NEED)
Competency to be addressed: Evaluating the implementation of child protection policy; conducting
satisfaction surveys.
Related Core Concept(s): Audit and research; clinical focus (indirect care); and advocacy.
Target Outcome: i.e., a clear description of what I will be able to do, once I have addressed
the competency.
I shall make decisions in a judicious and timely manner, considering all relevant information when
addressing a problem or issue in a practice or professional area.
I will use logical analysis to break down complex problems into their component parts.
I will locate and critique relevant literature to paediatric nursing.
I will apply evidence in order to improve nursing practice.
Specific Steps that I will take to address this particular development need, including the date steps
to be completed by.
Steps I will take:
Expected Completion
Update my knowledge of audit techniques.
In 1 month’s time
Update my knowledge of child protection within healthcare
settings.
In 1 month’s time
Seek advice on collating data from surveys and preparing
reports.
In 1 month’s time
How will I measure my success?
1. I have updated my knowledge of audit techniques. I can complete forms, collate data and review
for consistency and discrepancies.
2. I can demonstrate knowledge of child protection policies in this hospital and other healthcare
settings and can discuss their application in practice.
3. I demonstrate awareness of complex problems, such as conflict of children’s interests with those
of their families/carers or of the service.
Ways I will be able to utilise this competency



Decision-making in relation to relevance and validity of findings from audit data collection to
reflect the level of decision making required of a CNS.
Decisions regarding implementation of child protection policy by nursing staff.
Part of the CNS role is to advocate on behalf of children. I can promote this by being a role
model in the implementation of the child protection policy and by raising concerns arising
from consultations with front-line nursing staff.
Support I will need to develop this competency -whose support do I need and how will I obtain it?
33


Access at work to library and internet.
Obtain support from nursing management and multidisciplinary teams to consult front-line
nursing staff – refer to hospital policy and implementation plan.
How will I measure my progress?


I am able to adhere to study plan.
I can commence consultations with front-line nursing staff.
Review Dates: May; August and November 2008
Signed: CNS /CMS
Signed: Nurse Manager
Sinead Kincaid, CNS (Paediatric Dermatology)
Violet Palmer, Divisional Nurse
Manager; 01/01/2008
Date _________
Date________
Date _________
Date________
34
CHAPTER 4: THE CLINICAL NURSE/MIDWIFE SPECIALIST AND AUDIT AND RESEARCH
SEE SECTION 4.4: SETTING STANDARDS USING THE DONABEDIAN FRAMEWORK
CASE STUDY: MARY – CNS (ASTHMA)
A STANDARD STATEMENT APPLIED TO ROLE AUDIT
Topic: Role of the CNS in Asthma
Sub-topic: Clinical focus (indirect care) Education and Training (of staff)
Care Group: In-patient requiring treatment for asthma
Achieve by (date): _______________
Review by (date): ________________
Standard Statement: The CNS will provide in-service education sessions for ward staff on topics
relating to the management of asthma and new developments in asthma. This will occur on a
monthly basis to improve the staff’s level of knowledge and the management of patients at ward
level.
Background/rationale: Mary (CNS - Asthma) has noted increasing number of bleeps from ward
regarding relatively ‘simple’ queries. She believes this is due to a relatively high staff turnover and
suspension of the in-service education programme on asthma. A baseline evaluation of the
educational needs of staff showed moderate knowledge levels in key areas of asthma management
and high level of interest in re-commencing the in-service education programme for staff.
(Evidence: Up-skilling staff will improve quality of patient care (Benner 1984; Hamric and Spross
1989; Castledine and McGee 1998; Marshall and Luffingham 1998).
The above standard statement is then broken down into individual criteria.
Structure
CNS, ward management
structure and adequate
staffing
Process
Education room located close
to wards
Staff and ward managers are
aware of education sessions
and topics two weeks prior to
sessions
Sessions are held on a
monthly basis
Protected time allocated for
staff education
Staff are released to attend
sessions
Publicity and educational
materials on specific topics
made available
CNS preparation, facilitation
and evaluation of education
sessions to include booking
education room, preparing
35
Outcome
Education sessions are
attended
Management of patients at
ward level improves from
baseline audit
Patient survey results show
high levels of satisfaction
Number of charts reviewed
increases
Number of bleeps/calls to CNS
about simple queries
decreases
Staff level of knowledge
improved
Improved test results among
staff
Survey shows increased staff
satisfaction with education
sessions
Audit forms to include level of
patient satisfaction with their
overall management during
hospital stay
CNS and staff given protected
time to audit chart and
patient satisfaction survey
CNS allocated time and tools
to evaluate staff knowledge
level and satisfaction with
education sessions
hand-outs, developing
distribution and analysing
evaluation sheets, adapting
sessions in response to
feedback
Audit of patient charts
designed to assess quality of
asthma care by ward staff
Audits carried out by CNS with
member of ward staff prior to
session and every 6 months
thereafter
Patient satisfaction survey
carried out prior to session
and every 6 months
thereafter
36
CASE STUDY: PATRICK – CNS (CHALLENGING BEHAVIOUR)
A STANDARD STATEMENT APPLIED TO ROLE AUDIT
Topic: Role of the CNS in Challenging Behaviour
Sub-topic: Clinical Focus (Direct and Indirect care) and Advocacy.
Care Group: Adults, adolescents and children using the Sonas behaviour service.
Achieve by (date): _______________
Review by (date): ________________
Standard Statement: The CNS will provide in-service education sessions for staff working in
community- and campus-based residential settings on advocacy in relation to people with
intellectual disability and their families, self-advocacy, supporting advocacy and ethical issues
relating to advocacy on a monthly basis to improve knowledge and enhance the person-centred
planning programme currently being implemented throughout Sonas services.
Background: Patrick and other members of the multidisciplinary behaviour management team have
noted some difficulties in incorporating service users’ responses to and family members’ views on
behaviour management plans within the person-centred planning system currently being
implemented in Sonas. They have concluded that this is due to a period of staff turnover and limited
opportunities for staff development activities. A baseline evaluation of staff learning needs and a
preliminary review of the person-centred plans showed a moderate awareness of advocacy issues
and a high level of interest in further education and training in the area.
(Evidence: Up-skilling staff will improve quality of patient care (Benner (1984); Hamric and Spross
(1989); Castledine and McGee (1998) Marshall and Luffingham (1998)).
The above standard statement is then broken down into individual criteria.
CASE STUDY: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
A STANDARD STATEMENT APPLIED TO ROLE AUDIT
Topic: Role of the CMS in Obstetric Ultrasound and Foetal Assessment
Sub-topic: Clinical Focus (Direct and Indirect Care)
Care Group: All women referred to the Ionad Iompar Clainne at St Ciaran’s Regional Hospital
Achieve by (date): _______________
Review by (date): ________________
Standard Statement: The CMS will perform obstetric ultrasound and foetal assessment for women
from St Ciaran’s catchment area at daily clinics. Clinic times may vary in order to meet St Ciaran’s
service plan requirement that the hospital provides services and clinics at times based on alignment
of patients’ and staff needs.
Background: Joanna, Georgina and other members of the multidisciplinary obstetric team have
noted low attendance rates at clinics on certain days and at certain times, most notably Friday
afternoons. From data provided by the hospital’s appointments office they have concluded that this
is due to women being unable to attend appointments scheduled close to primary school opening
and closing times.
(Evidence: Data provided by the appointments office at St Ciaran’s Regional Hospital).
The above standard statement is then broken down into individual criteria.
37
Case Study: Anne – CNS (Community Mental Health)
A STANDARD STATEMENT APPLIED TO ROLE AUDIT
Topic: Role of the CNS in Community Mental Health
Sub-topic: Clinical Focus (Direct and Indirect care) and Advocacy
Care Group: Clients with mental health difficulties in the community who require depot Injections
Achieve by (date): _______________
Review by (date): ________________
Standard Statement: The CNS will provide in-service education sessions for staff working in
community- and campus-based residential settings on advocacy in relation to people with
community mental health clients and their families, self-advocacy, supporting advocacy and ethical
issues relating to advocacy on a monthly basis.
Background: Anne and other members of the multidisciplinary team have noted some difficulties in
incorporating service users’ responses to and family members’ views on depot injections within the
care planning system currently being implemented in her sector. They have concluded that this is
due to a period of staff turnover and limited opportunities for staff development activities. A
baseline evaluation of staff learning needs and a preliminary review of the person-centred plans
showed a moderate awareness of advocacy issues and a high level of interest in further education
and training in the area.
(Evidence: Up-skilling staff will improve quality of patient care (Benner (1984); Hamric and Spross
(1989); Castledine and McGee (1998) Marshall and Luffingham (1998)).
The above standard statement is then broken down into individual criteria.
Case Study: Sinead – CNS (Paediatric Dermatology)
A STANDARD STATEMENT APPLIED TO ROLE AUDIT
Topic: Role of the CNS in Paediatric Dermatology
Sub-topic: Clinical Focus (Direct and Indirect care) and Advocacy.
Care Group: Children aged from 5 to 12 with eczema attending the out-patient clinic
Achieve by (date): _______________
Review by (date): ________________
Standard Statement: The CNS will assess the condition of children with eczema who attend the
out-patient clinic in order to determine compliance with the prescribed treatment regime.
Background: Sinead and other members of the multidisciplinary team have noted that some
children have not been adhering to the prescribed treatment regime, leading to exacerbation of
their condition. The team has concluded that in some cases parents may be unwilling or unable to
gain their child’s co-operation, so will investigate this possibility.
The above standard statement is then broken down into individual criteria.
38
Case Study: Mary – CNS (Asthma)
Example of Audit Indicator
Statement
The CNS will provide inservice education sessions
for ward staff on topics
relating to the
management of asthma
and new developments in
asthma will occur on a
monthly basis to improve
the level of staff
knowledge and the
management of patients
at ward level
Standard
100%
Exceptions
Definition
Staff who have
not been on
the ward for
longer than
one month.
Patients who
spent less than
24 hours as an
in-patient.
In-service = sessions inside organisation
Ward Staff = nursing staff on wards
where asthmatic patients cared for
On a monthly basis = same day each
month, one 40-minute session every
month
New development in asthma = new
literature on medications, other
treatments or nursing
Patients at ward level = in-patients
with asthma Improve management of
= care pathway reflects best practice
and high patient satisfaction
39
Case Study: Patrick – CNS (Challenging Behaviour)
Example of Audit Indicator
Statement
The CNS will provide inservice education sessions
for staff working in
community- and campusbased residential settings
on advocacy in relation to
people with intellectual
disability and their
families, self-advocacy,
supporting advocacy and
ethical issues relating to
advocacy on a monthly
basis to improve
knowledge and enhance
the person-centred
planning programme
currently being
implemented throughout
Sonas services.
Standard
Exceptions
Definition
Staff who have
been
employed in
the residential
settings for
less than 3
months.
In-service = sessions within
Sonas during working hours.
Staff working in communityand campus-based residential
settings = nursing staff, health
and social assistants working in
houses on the main Sonas
campus and in houses owned by
Sonas in Nosuchtown.
On a monthly basis = same
day each month, one 35-minute
session every month.
Advocacy in relation to people
with intellectual disability and
their families, self-advocacy,
supporting advocacy and
ethical issues relating to
advocacy = current literature on
influencing the needs and rights
of the wider community in
favour of the needs and rights
of people with intellectual
disability
Improve knowledge and
enhance the person-centred
planning programme currently
being implemented throughout
Sonas services = Raising levels
of skills in putting into practice
the person-centred planning
system adopted by Sonas so
that service users’ views may be
articulated within personcentred plans and actions
developed appropriately.
100%
40
Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Example of Audit Indicator
Statement
The CMSs (Obstetric
Ultrasound and Foetal
Assessment) will perform
obstetric ultrasound and
foetal assessment for
women from St Ciaran’s
catchment area at daily
clinics. Clinic times may
vary in order to meet St
Ciaran’s service plan
requirement that the
hospital provides services
and clinics at times based
on alignment of patients’
and staff needs.
Standard
Exceptions
Definition
Bank holidays
and occasions
when staff
cannot be
replaced due
to annual
leave overlaps.
CMS = clinical midwife specialist.
Obstetric ultrasound (imaging) = a type
of diagnostic radiological examination
carried out to provide intra-uterine
images and performed when clinically
indicated.
Foetal assessment = a range of specific
tests carried out to assess the wellbeing (or otherwise) of a foetus
women = pregnant women.
St Ciaran’s catchment area = people
living in the three counties around St
Ciaran’s Regional Hospital,
Ciaranstown.
Clinics = locations either within St
Ciaran’s Ionad Iompar Clainne or at
specified out-reach centres.
Daily clinics = Generally, these are
clinics provided on weekdays (Monday
to Friday).
100%
41
Case Study: Anne – CNS (Community Mental Health)
Example of Audit Indicator
Statement
The CNS will provide inservice education sessions
for staff working in
community- and campusbased residential settings
on advocacy in relation to
community mental health
clients and their families,
self-advocacy, supporting
advocacy and ethical
issues relating to advocacy
on a monthly basis.
Standard
Exceptions
Staff who have
been
employed in
the residential
settings for
less than 3
months.
Definition
In-service = sessions within sector
area during working hours.
Staff working in community- and
campus-based residential settings =
nursing staff, allied health and social
care staff working in the community.
On a monthly basis = same day each
month, one 35-minute session every
month.
Advocacy in relation to community
mental health client and their
families, self-advocacy, supporting
advocacy and ethical issues relating
to advocacy = current literature on
influencing the needs and rights of
the wider community
100%
42
Case Study: Sinead – CNS (Paediatric Dermatology)
Example of Audit Indicator
Statement
Standard
The CNS will assess the
condition of children with
eczema who attend the
out-patient clinic in order
to determine compliance
with the prescribed
treatment regime and to
identify factors affecting
compliance.
Exceptions
Definition
Children under
the age of five;
children who
have been
attending the
clinic for less
than three
months.
Children = Children between the ages
of five and twelve who have been
attending the out-patient clinic for
over three months.
Out-patient clinic = the paediatric
out-patient clinic located in
Ballyfiachra General Hospital and run
two mornings and two afternoons a
week.
Determine compliance with the
prescribed treatment regime =
identify the extent to which the child
and his/her parents adhere to the
treatment plan and/or use of
applications
prescribed/recommended by the
multidisciplinary team and with
reference to evidence-based practice
and outcomes.
Identify factors affecting compliance
= explore why the prescribed
treatment regime is not being
implemented through nonjudgemental interviewing of children
and parents/carers.
100%
43
Case Study: Mary – CNS (Asthma)
Example of Audit Tool








Quantify number of in-service sessions held.
Record and collate number and profile of attendees.
Analyse evaluations, looking at timing, venue location and topics covered in
education sessions, level of attendee satisfaction and any ideas for improvement.
Make changes to education sessions as per identified needs.
Over a six-month period, randomly select ‘30’ sets of asthmatic patient notes from
relevant wards (number of charts review should reflect minimum of 20+% of
patients admitted).
Check nursing notes for evidence of care plan for asthmatic patient.
Check notes for deviation from the ‘norm’ in relation to best practice.
Identify percentage admitted, percentage who deviated from expected course of
recovery, identify those who had documented evidence of nursing care on problems
related to asthma, identify those where inappropriate decisions regarding care were
made.
Case Study: Patrick – CNS (Challenging Behaviour)
Example of Audit Tool







State the number of in-service sessions held on advocacy.
Record and collate numbers and profiles of participants.
Analyse evaluations, looking at timing, venue location and topics covered in
education sessions, level of participants’ satisfaction and any ideas for improvement.
Make changes to education sessions as per identified needs.
Over a six-month period, randomly select 20 sets of person-centred plans,
prioritising those of service users who are using Sonas’ residential AND behaviour
management services.
Check notes for evidence of integration of behaviour management plan and services
users’ responses and/or views within the person-centred plan.
Check notes for difficulties in relation to best practice.
Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Example of Audit Tool




State the number and times of midwife-provided ultrasound and assessment clinics
currently provided at Ionad Iompar Clainne and at outreach locations.
Record and collate numbers and profiles of women attending each location.
Analyse evaluations, looking at timing, venue and interaction between between
midwives and women, level of womens’ satisfaction and any ideas for improvement.
Review preferred timing of clinics as per identified needs and compare with aims of
St Ciaran’s service plan.
44
Case Study: Anne – CNS (Community Mental Health)
Example of Audit Tool







State the number of in-service sessions held on advocacy.
Record and collate numbers and profiles of participants.
Analyse evaluations, looking at timing, venue location and topics covered in
education sessions, level of participants’ satisfaction and any ideas for improvement.
Make changes to education sessions as per identified needs.
Over a six-month period, randomly select 20 sets of care plans, prioritising those
service users who are using the nurse-led depot injection service.
Check notes for evidence of integration of services users’ responses and/or views,
promotion of self-advocacy within the care plan and mode of delivery of depot
injections.
Check notes for difficulties in relation to best practice.
Case Study: Sinead – CNS (Paediatric Dermatology)
Example of Audit Tool





State the number of eczema out-patient clinics.
Record and collate numbers and profiles of children attending (must be aged
between five and twelve and have been attending for more than three months).
Analyse attendance patterns of individual children.
Analyse progress with prescribed treatment regime as noted in patient record and
select those children who have not made expected progress.
Record and collate numbers of children and parents/carers interviewed using
interview schedule devised in collaboration with multidisciplinary team for
exploration of compliance with prescribed treatment regime.
45
SEE SECTION 4.6. OUTCOME MEASURES FOR CNS/CMS AUDITS
Case Study: Mary – CNS (ASTHMA)
IDEAS FOR OUTCOME MEASURES (1)
(Adapted from Hartley and Cowe 1997)
Core Concepts: Clinical Focus (Direct Care) and Education and Training (of the Patient)
Imagine Mary and her work as an asthma specialist nurse. She could consider evaluating
her impact on patients’ understanding of their drug therapies.
1. Firstly, she could formulate a short questionnaire to assess the patient’s baseline
knowledge levels.
2. Then after an agreed programme of education, based on best practice in patient
education and complemented by a learning pack she had put together, she could
repeat the questionnaire. It may be possible to detect an improvement in
patients’ knowledge and understanding of their therapies. The next step is to
identify whether this improved understanding has translated into better
management of their condition.
3. She could examine the number of acute admissions to hospital amongst those
patients who have received her learning pack.
4. She could then compare this to the average re-admission rate amongst her patients prior to
this exercise. Alternatively she could track the re-admission rate of individual patients
before and after the pack, and see whether any reduction in frequency could be detected. If
re-admission rates were not showing any differences, perhaps length of hospital stay has
changed in those who received the learning pack.
Case Study: Patrick – CNS (CHALLENGING BEHAVIOUR)
IDEAS FOR OUTCOME MEASURES
Clinical Focus (Direct Care) and Education and Training (of Service Users)
Imagine Patrick in his role as a CNS in challenging behaviour. He could consider evaluating his
impact on service users’ understanding of their behaviour management programme.
1. Firstly, Patrick could develop a short questionnaire for use with those service users who can
articulate their views with spoken or sign language. These questionnaires would be used to
assess service users’ views on behaviour management programmes developed in
collaboration with the multidisciplinary behaviour management team.
2. Then Patrick could institute an education programme for service users in relation to
particular aspects of behaviour management. He may be able to detect an improvement in
the level of co-operation with the behaviour programme and more successful outcomes.
3. He could then review the levels of use of psychotropic medication in service users who have
participated in the education programme, identifying in particular those whose medication
levels have been reduced in consultation with the psychiatrist during the course or on
completion of the programme.
4. Using the data from this project, he could develop a questionnaire for use with the family
members of service users who cannot articulate their views using conventional means; or he
could examine the behaviour management programmes of those service users whose co-
46
operation with the behaviour management programme did not alter.
Case Study: Joanna and Georgina – CMSs (Obstetric Ultrasound and Foetal Assessment)
Ideas for Outcome Measures
Clinical Focus (Direct Care) and Advocacy (on behalf of women for whom English is not a
first language)
Imagine Joanna and Georgina in their role as CMSs in obstetric ultrasound and foetal assessment.
Joanna has become interested in the needs of women whose first language is not English and who
attending the midwife-provided obstetric ultrasound and foetal assessment clinics. She could
consider these womens’ understanding views of the clinics.
1. Firstly, Joanna could check patients’ records to confirm the nationalities of women referred
to and/or attending the maternity services at St Ciaran’s Regional Hospital.
2. Then Joanna could talk to the hospital’s diversity officer to find out what difficulties such
women might be experiencing in relation to communication and cultural matters. The
diversity officer might be able to advise on resources and services already available in St
Ciaran’s and what is available elsewhere.
3. She could then review any differences in the numbers referred and the numbers attending,
and determine if there is a link between non-attendance and lack of translation services.
4. Using the data from this project, she could follow up with the diversity officer on ways of
improving attendance rates if these are found to be poor.
Case Study: Anne – CNS (Community Mental Health)
IDEAS FOR OUTCOME MEASURES
Clinical Focus (Direct Care) and Education and Training (of Service Users)
Anne could consider evaluating the impact on service users’ understanding of the self-advocacy
programme and/or nurse-led depot injection service.
1. Firstly, Anne could develop short questionnaires for use with those service users who can
articulate their views. These questionnaires would be used to assess service users’ views on
the self-advocacy programme and/or nurse-led depot injection service developed in
collaboration with the multidisciplinary team.
2. Then Anne could institute an education programme for service users in relation to particular
aspects of the self-advocacy programme and/or nurse-led depot injection service. She may
be able to detect an improvement in the self–advocacy or with the appropriateness of depot
injections or reduction in travel as depot injections provided in general practice/community
or at nurse-led clinic.
3. She could then review agreed outcome measures such as the levels of use of psychotropic
medication in service users who have participated in the self–advocacy education
programme, identifying in particular those whose medication levels have been reduced in
consultation with the psychiatrist during the course or on completion of the programme.
47
Case Study: Sinead – CNS (Paediatric Dermatology)
IDEAS FOR OUTCOME MEASURES
Clinical Focus (Direct Care and Indirect Care) and Advocacy
Sinead could consider evaluating children’s and their families’/carers’ understanding of the
treatment regime prescribed at the out-patient eczema clinic.
1. Firstly, Sinead could develop two short questionnaires for use with children and their
families/carers. The first questionnaire would be used to assess children’s understanding of
their condition, the rationale behind the treatment regime being used, and any worries or
concerns relating to the condition and the treatment regime. This questionnaire would be
adaptable for different ages. The second questionnaire would be used with parents/carers
and cover the same areas as in the children’s version.
2. Then Sinead could then review the programme used for teaching children and their
parents/carers about eczema and the various treatment regimes in consultation with the
multidisciplinary team, including thinking about ways to help children talk about their
concerns. This might lead to reviewing and updating the eczema information packs and staff
training programmes provided at Ballyfiachra General Hospital.
3. She could then review agreed outcome measures such as the efficacy of the treatment
regime in children and their parents/carers who have participated in the revised programme
self–advocacy education programme.
48
Mary’s Ideas for Outcome Measures (2-4)
Ideas for outcome measures (2): Core Concepts: Clinical Focus (Direct & Indirect care) and
Education & Training (of Patient)
Perhaps interventions by the CNS (Asthma) could help clients stop smoking.
1. First identify smokers within client caseload (the sample).
2. Provide advice about benefits of smoking cessation and publicise availability
of smoking cessation service to all smokers. Assess smokers to identify those
interested in stopping, using an evidence based approach, e.g., using the
wheel of change.
3. Provide a course of counselling/brief interventions for the sample focused on
stopping smoking, giving advice and support on the availability and use of
nicotine replacement therapies.
4. Offer the sample a telephone number where they can phone to get support if
they are experiencing a problem with cessation.
5. Six months later measure the numbers still smoking aiming to identify any
reduction.
Ideas for outcome measures (3): Core Concepts: Clinical Focus (Indirect Care), Patient Advocacy and
Consultancy
Perhaps better liaison between the hospital and community services by a skilled specialist
nurse could reduce the length of in-patient stays experienced by these patients during an
acute exacerbation of their asthma.
1. Examine records to identify average length of hospital (ALOS) admission
amongst patients in the year before CNS (Asthma) was in post and/or liaison
activity occurred.
2. Now identify ALOS for the year after CNS (Asthma) came into post (don’t
count the first 6-8 months as this may be too early for impact to be made).
3. Is there any improvement? It may even be possible to find out the ALOS of
asthma patients nationally or in a similar organisation with similar profile to
compare results.
Ideas for outcome measures (4): Core Concepts: Clinical Focus (Indirect Care) and Education and
Training (of Staff)
Could in-service training by CNS (Asthma) help nurses to feel more confident when
teaching patients inhaler technique?
1. Assess baseline confidence and competence by working with nurses teaching
inhaler technique, using a short self-assessment questionnaire.
2. Provide update sessions on inhaler technique for nurses with theory, practical
demonstration and participation.
3. Reassess competence and confidence after session through asking them to
again complete the quiz, and demonstrate how they would perform the
technique against identified criteria.
49
APPENDICES
50
PATIENT/CLIENT QUESTIONNAIRE
Case Study: CNS (Asthma)
Patient Questionnaire
My name is —- and I was your asthma specialist nurse during your recent stay in hospital. I am always keen to
ensure that the service I provide meets the needs of my clients. Please help me to improve by completing the
following questionnaire. Your replies are anonymous, but if you wish to put your name on the sheet please
feel free to do so.
1. Some information about you
Please tick the relevant box:
Your age: 0 - 16 ❒ 17 - 30 ❒ 31 - 45 ❒ 45 - 60 ❒ 60 plus ❒
Your gender: Male ❒ Female ❒
When was your asthma diagnosed?
2. Your views on the services provided by the asthma nurse
How helpful was the information about asthma you were given by the asthma specialist nurse?
Good, complete and easily understood
❒
Average, all right but could have been better ❒
Unsatisfactory, incomplete and confusing
❒
What impact has this information had on your confidence in managing your asthma?
I feel more confident and independent
❒
It has made no difference
I feel less confident
❒
❒
3. Please circle any words from the selection below which describe the care you received from the asthma
specialist nurse?
Supportive
Bossy
Not enough contact
Crucial to my recovery
Poor
Wonderful
Sensitive
Irrelevant
Adequate
Easy to contact
Unhelpful
Rushed
Considerate
Friendly
Invaluable
Difficult to contact
Condescending
Informative
Promoted independence
Professional
4. Are there any other comments you would like to make?
51
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
5. Do you have any suggestions for improvements in the service?
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
6. Was there any topic not covered that you would have liked to discuss with the Nurse Specialist?
........................................................................................................................................................
Please return by (allow 7 - 10 days) in SAE to (name appropriate Dept/collection point) by (day & date).
Thank-you for your help in completing this questionnaire
52
NURSING/MIDWIFERY STAFF QUESTIONNAIRE
Confidential
Please help me evaluate the asthma specialist nurse service. All replies will be treated in confidence, with only
summary data being reported with anonymised quotes. Please tick the appropriate boxes.
1.0
Have you recently cared for a patient with asthma?
YES
❒ NO ❒
1.1
a) less than 3 months ago
b) between 3 and 6 months ago
c) between 6 and 12 months ago
d) between 12 and 18 months ago
❒
e) more than 18 months ago
❒
❒
❒
2.0
What position/role were you in when you had this most recent contact?
3.0
Do you know who the asthma specialist nurse is?
Yes
I think I know
I’m not sure
No
4.0
Have you met the asthma specialist nurse?
YES ❒
NO
5.0
❒
Have you ever attended any formal training given by the asthma specialist
nurse?
YES ❒
NO
6.1
❒
Do you know how to contact the asthma specialist nurse?
YES ❒
NO
6.0
❒
❒
❒
❒
❒
If yes, did you find this training relevant to your work?
Yes
Yes, most of it was relevant
❒
❒
53
Not much of it was relevant
No, it definitely wasn’t relevant
❒
❒
6.2 If you didn’t think it was relevant, why not?
7. 0 HAS THE ASTHMA SPECIALIST NURSE EVER GIVEN YOU ANY ADVICE
CONCERNING THE CARE OF AN ASTHMATIC PATIENT?
YES
❒
NO
❒
7.1
IF YES, DID YOU FIND THIS ADVICE RELEVANT TO YOUR WORK?
Yes
Yes, most of it was relevant
Not much of it was relevant
No, it definitely wasn’t relevant
7.2
❒
❒
❒
❒
If you didn’t think it was relevant why not?
8.0
If you have had either formal training, or advice from the asthma specialist nurse
do you feel you have a greater understanding of the needs of asthmatic patients?
Yes
Not particularly
No
8.1
❒
❒
❒
If no, please explain why not.
9.0
Are there any topics you would like the asthma nurse specialist to train/advise on?
If yes, please list topics.
10.
If you have ever had cause to contact the asthma specialist nurse, was she:
Easy to contact
Fairly easy to
Fairly hard to contact
Very hard to contact
11.
❒
❒
❒
❒
What is the best aspect of the service the asthma specialist nurse
54
provides?
12. What is the worst aspect of the service the asthma specialist nurse provides?
PLEASE COMMENT ON ANY OTHER ASPECTS OF THE SERVICE THE ASTHMA NURSE
PROVIDES:
Thank you for taking the time to complete this questionnaire.
Please return to the Clinical Audit Department/appropriate collection point by -day & date
55
Clinicians’ Questionnaire
Strictly Private and Confidential
Clinical Nurse/Midwife Specialist
1.
2.
3.
Has the CNS/CMS been involved in the care of your patients/clients?
Yes
❒
No
❒
Do you think the services currently provided improve the quality of patient/client care ?
Yes
To some degree
❒
❒
No
❒
Which services currently offered by the CNS/CMS do you feel make the greatest impact on the quality
of patient/client care?
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
4.
What other services would you like to see offered by the CNS/CMS?
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
5.
6.
Do you think the CNS/CMS facilitates discharge?
Yes
❒
To some degree
No
❒
❒
Please make additional comments about the service the CNS/CMS provides:
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
56
Thank you for taking the time to complete this questionnaire.
Please return to: ........................................
By :.............
Day & date........................................
57