Using group concept mapping to explore the complexities of managing children's care.

BACKGROUND: Children whose assessed health needs cannot be met by statutory and universal services may require bespoke packages of continuing care. A project management group was set up to design a study that would explore the complexities for a children's community nurse (CCN) of managing such packages. METHODOLOGY: Group concept mapping (GCM), a mixed quantitative/qualitative participant-centred methodology, was used to obtain consensus from 20 CCNs about the complexities inherent in managing such packages and to develop a concept map that illustrated the emerging conceptual framework. DISCUSSION: The participants' ideas were written as statements and analysed. Core analysis of a square symmetrical matrix through multidimensional scaling and hierarchical cluster analysis was undertaken to produce a set of maps and reports. The final concept map was interpreted. It contained 99 statements organised into five conceptual clusters: 'education and training' (17 statements), 'risk and safety' (15 statements), 'continuing care process' (17 statements), 'relationships and boundaries' (22 statements) and 'working with families' (28 statements). CONCLUSION: CCNs used GCM to explore their roles and responsibilities when managing children's continuing care. Their resulting ideas were developed into a five-cluster conceptual framework that illustrated their views about the complexities of managing such care. IMPLICATIONS FOR PRACTICE: The emergent conceptual framework enables CCNs to explore their practice in relation to managing packages of care. Additionally, the framework will be used to design a CCN workforce planning instrument that will be useful to measure complexity in CCN caseloads. The GCM methodology could be used by other nursing teams who wish to develop their practice.

Developing and nurturing a community practice clinical network for community children's nurses in Wales.

Working as a children's community nurse (CCN), especially in remote and rural locations, can evoke feelings of professional isolation. Humans are by nature 'social animals' and the consequences of feeling isolated, and coping with distances, adverse weather and risky situations, could mean that nurses choose to work instead in more familiar and comfortable environments. This can affect retention issues and increase the risk of CCNs experiencing stress, burnout and illness-related absenteeism. The children they care for often have complex needs and parents want their CCN to be 'on the ball'; they will feel concerned and frustrated if the CCN team lets them down. Two academics were approached by CCNs in Wales seeking ways of overcoming isolation. It was decided that the best course of action was to develop a community of practice clinical network for band 5 and 6 CCNs working in Wales, with the aim of supporting staff, sharing best practice, and promoting safe and quality-driven care. Alternating the networks among health boards, whereby the nurses decided the agenda, booked the venue, invited guest speakers, led the meeting and wrote up the minutes, was an excellent way to achieve the designated aim: reducing professional isolation. A range of clinically focused topics were discussed and debated, and the first six meetings were so effective in meeting the aim of the network that each health board is starting the cycle of hosting the network again.