As a paediatric nurse in a Community Children’s Nursing team (CCN), I deliver training to a diverse group of individuals including education staff, health care workers, parents and other carers. This training is for competency-based nursing interventions for children with complex nursing needs at home and in other community settings.
Our QI idea, funded through Q Exchange, was to look at how we could embrace technological innovation and migrate from our existing training model to a digital model. We wanted to offer engaging, safe, high quality remote training for our region.
Beyond that, we wanted to share our training approach with partners across the health and care service.
By putting the training online, we would be able to support learning and improvement for all those involved in care of children with complex nursing needs and support safe delegation.
Our aims and methodology
At the start of the project, we set out some high-level aims to guide our approach and methodology. We found this useful as a way of bringing clarity and focus to the whole of the project.
The aims of the project were as follows.
- Expedite hospital discharge and transition into school and community groups.
- Mirror our current face-to-face training in a digital setting, reflect agreed procedures, and link to generic and child-specific competencies.
- Provide virtual training 24/7 to suit carers, supporting work-life balance and backed up by face-to-face practical demonstrations.
- Provide inclusive, intuitive, meaningful, just-in-time training making on-the-go learning a flexible and accessible reality.
- Provide a real-time competency database, with inbuilt triggers to ensure training and competencies are always in date.
- Save time/money; reduce travel and improve time management of current training model.
- Utilise existing Learning Management Systems (LMS).
- Break down silos and increase sharing of knowledge and skills.
- Reduce environmental impact by making training available online rather than at fixed sites.
As the work on this has evolved, some aims have been achieved while others have needed to be revisited. For example, we could not use the trust’s existing LMS because it was not designed to deliver remote training to multiple organisations and users.
So, while we found it helpful to have a clear set of aims, it was also important that we could be flexible and open to fresh approaches.
Co-producing from the start
Co-producing the training with our stakeholders has been vital to helping us to create a shared understanding and build their needs into the training framework.
Once we had our Q funding arranged, we got to work liaising with all those who we knew were going to need this training. That included parents, carers, community children’s nursing teams and educators.
Starting with a co-produced, stakeholder-centred approach to developing the new training programme was important to us.
With this in mind, we identified the most frequently required nursing interventions for children with complex nursing needs – such as enteral feeding, tracheostomy care and home ventilation, amongst others.
By using this methodology, we were able to ensure that those we trained had the appropriate knowledge, clinical skills, competence and confidence in delivering child-specific delegated care.
In addition to our training cohort, we benefitted from a network of partners that included the Q community, the NHS, and social care and education providers. This gave us a diverse pool of knowledge, skills and energy from which to draw on throughout the project. It is one of the key reasons the project has gone as well as it has.
Having scoped the content for the programme, we began exploring options for delivering the training online.
Digital platforms: embracing technological innovation
This phase of the project was an excellent introduction to the challenges of implementing system change across multiple organisations to deliver truly integrated care. A remote training programme for carers and health and education professionals requires a platform that operates across the whole health and care system.
Our trust LMS was only accessible to trust staff, and had never been designed for use by multiple partners or users outside our organisation. This meant that carers and parents or those working in education could not access it. So we decided to go out to the market to find an LMS that would work for us.
We engaged with our trust information governance and cyber security teams to take advice on an appropriate digital solution that would process data within and between teams.
This remains an active area of exploration and learning for ourselves and our partner organisations.
A power-sharing approach to collaborative working
Measuring and capturing data on improvements as the project progressed was logistically challenging. All the people we needed to meet with were providing care at some point during the day so a single, fixed meeting time for all of us would simply not work.
Working with our carers, we designed a timetable that worked around their caring commitments.
This gave us insight into their lived experience and helped us to understand how to create the conditions that would empower them.
We also decided to monitor the additional hours nurses spent providing extra training, outside the set training days. Capturing this information allowed us to build a more detailed picture of the time involved in running our training programme.
Breaking down silos through storytelling
With our improvement methodology in place, we turned our focus to developing a set of process maps and driver diagrams. These visual tools were key to all of us understanding the practical reality of moving from our current training delivery model to a technologically-enabled remote model.
Once we had these resources, we were able to attend a trust-wide quality improvement event to give ourselves and our partners protected time to inform and inspire each other about the journey we were going on together. We also took part in Action Learning Set days and Q Exchange evaluation sessions.
Quality improvement is an iterative, team-based activity that involves sharing knowledge and storytelling.
Events like these are important for forging new relationships and breaking down silos, helping people to work more effectively across organisational boundaries.
Creating animated training videos
While work continues on sourcing a suitable digital platform for hosting our training, we have carried on with making the content for the training programme.
It was important to us that the training content be high quality, safe and engaging. We also needed to be able to update the content quickly and efficiently. After considering various options, we decided to try animation software. Animation offers a cost-effective and user-friendly solution for creating high quality visual training.
It also meant that I had the chance to learn how to make an animated video, something that was an exciting and inspiring challenge for me as a nurse!
Plans are now underway to produce a full set of animated training videos to support our training programme. The videos we make will be made available for free on the LMS.
A whole-system approach to QI
Of the many insights I have gained while working on this improvement project, one of the most important was learning to take a whole-system approach to problem solving. This is as much about creating new networks of collaboration as it is about desk research.
Technologically-driven change for the delivery of our training programme required input from a wide range of partners both within and outside our organisation, including information governance (IG) and IT.
Engaging with our stakeholders meant learning to create the right conditions for them to be active partners.
From initial design, to monitoring progress, to feeding back on the animation videos, the involvement of our stakeholders has made the project both more enjoyable and more productive.
It has helped us to ensure that our competency framework is training all our carers to give each child safe, high quality, integrated care.
Find out more
We would love to hear from anyone who has experience of working with information governance and cyber security when using a cloud-based system within the NHS, particularly in Northern Ireland.
If you have any questions or thoughts to share, please get in touch by email or use the comments box below.