Abstract
BackgroundIn the Netherlands a need is felt for more flexible Child Health Care services, both efficient and tailored to needs. We set up a study on impact and feasibility of task delegation to child health care nurses performing all regular checkups on children aged 2 months to 4 years. Abnormal findings were discussed with the attending child health care doctor. This article describes impact and feasibility of this task delegation from four viewpoints: competences of nurses; percentage of children assigned to the nurse; change in abnormal findings and referrals; experiences of professionals and parents.MethodsTwo experiment teams and two control teams were compared before and after starting task delegation. Nurses in the experiment teams were trained to carry out regular checkups on healthy children. Assignment to the experiment schedule was a joint decision by doctor and nurse. Nursing competences were measured by means of questionnaires. Percentage of children assigned to the nurse and screening results of eyes, heart, hips, growth and development were extracted from the electronic health record. Difference in change was compared between experiment and control teams. Mann-Whitney tests and logistic generalized estimating equations were used to test for significance. Experiences of professionals and parents were evaluated through focus group interviews, which were subjected to a qualitative analysis.ResultsNurses in the experiment regions showed improvement in medical screening skills. No difference in change was perceived in general nursing competences. In the experiment group, 69% of all children were assigned to the nurse. There were no significant differences in change in the percentages of abnormal findings or referrals in the experiment teams compared to the control teams, except for hips. Interviews showed that both doctors and nurses thought positively of the new working method, yet made some recommendations for improvements. Parents felt well-informed and experienced an equal level of proficiency but less continuity in person.ConclusionThis experiment shows that task delegation from doctor to nurse in preventive child health care is feasible. It is important to pay attention to the acceptation process of professionals during implementation. More investigation is needed in order to assess effectiveness and efficacy of task delegation.
Highlights
Preventive child health care in the Netherlands is provided by medical doctors and nurses specialized in this area
Medical doctors have acquired new knowledge and skills during their training to become a specialist in child health care and public health [4], which they scarcely use in current daily practice
There is little experience with task delegation in preventive child health care, but we found a few examples of task delegation to advanced nurse practitioners [7,8]
Summary
Preventive child health care in the Netherlands is provided by medical doctors and nurses specialized in this area. Partly in response to these changes, the Dutch government [3] obliges organisations in the field of preventive child health care to cooperate more closely with social services, with schools and preschools, forming ‘centres for youth and family’ in order to offer a broad spectrum of facilities to meet the different needs of parents and children. This means that doctors and nurses, and pedagogical and social workers are playing a role in answering questions of young parents about the wellbeing of their children. This article describes impact and feasibility of this task delegation from four viewpoints: competences of nurses; percentage of children assigned to the nurse; change in abnormal findings and referrals; experiences of professionals and parents
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