CHILD AND FAMILY HEALTH NURSE (RN)

The term “scope of practice” is defined as the actions and procedures that are permitted by law for a specific profession. The scope of nursing practice refers to the broad framework and context of practice that includes: [1]

• the range of roles;
• functions and responsibilities; and
• decision making capacity.

The scope of nursing practice is influenced by government legislation and policy, level of educational preparation, practice context and the health needs of the population. A sound risk management, professional, regulatory, and legal framework is required to enable the nurse’s decision making capacity. It should be seen as an enabling process for nurses to work within their scope of practice and not merely the addition of tasks and activities.[2]

The ANMC Code of Professional Conduct for Nurses in Australia states that:1 

A nurse must be aware that undertaking activities that are not within their scope of practice may compromise the safety of an individual. The scope of practice is based on each nurse’s education, knowledge, competency, extent of experience and lawful authority.

The scope of practice represents only core practice skills within the defined level of nursing practice and is restricted to what the law permits based on specific experience and educational qualifications. It does not however, reflect further knowledge and/or skills acquired through professional development activities and/or experience.  Further knowledge and/or skills can be reflected within individual professional portfolios.

ACTIVITIES APPROPRIATE TO THE NURSES ROLE ARE DETERMINED BY THE: 

• The registering authority’s licence to practice.
• Extent of educational preparation.
• Relevant legislation, standards, codes and ethical practices, and context of care.
• Organisational policies and clinical practices, and legal requirements and policy directives.
• Level of clinical competence and clinical judgment required.

The scope of practice provides a measure to guide a nurse’s professional growth and development. It assists the nurse unit manager/centre manager and the nurse to appropriately judge the nurse’s performance, areas of strength, practice development requirements and/or the need for additional education and support. Used in conjunction with a professional portfolio it guides the nurse in providing evidence of educational and professional nursing activities that support the nurse’s claims of competence to practice nursing.

CHILD AND FAMILY HEALTH NURSE (RN)

CFHNs are registered nurses with further qualifications in the specialty of child and family health nursing.[3]. CFHNs are recognised as practicing at an extended level of nursing working within a primary health care model with families, their infants and young children.[4]  Primary health care aims to promote the health of individuals, families, communities and populations, and promote an environment that supports health. Working in partnership with parents is identified as the crucial practice foundation. [5] CFH nursing practice is based on a unique understanding of how the environmental context influences health, nursing theory and knowledge, social sciences and public health science with primary health care. The CFHN uses a strength-based, wellness focus and view disease prevention, health protection and health promotion as the goals of nursing practice. CFHNs collaborate with individuals, families, groups, communities, other health professionals and populations to design, implement and evaluate community development, health promotion and disease prevention strategies that build on the capacity of the individual or community.

CFHNs have a key role in the provision of specialist primary, secondary and tertiary level child and family health services. These services are delivered using the Tresillian Model of Care, clinical knowledge, skills, and experience with consideration of the context of care. The CFHN also has responsibility for the delegation and supervision of nursing activities to Enrolled Nurses. These nursing activities must be within the enrolled nurses approved scope of practice to ensure that care is delivered safely. 

NURSE UNIT MANAGERS  

Nurse unit managers (NUMS) are registered nurses with further qualifications in the specialty of child and family health nursing however, in their position they also carry the role of leadership and management within their teams. NUMs not only understand and fulfill the legal and ethical responsibilities and boundaries of the CFHN but also hold the responsibility of ensuring all nurses, within their teams, work within their designated scope of practice, legally and ethically to ensure that care is delivered safely. NUMs are leaders and provide clinical direction and supervision to all levels of nursing staff. In addition, they are responsible for the management duties of their staff, service provision and the assessment, planning, implementing and evaluating service delivery within their units.

CLINICAL NURSE SPECIALISTS   

Clinical Nurse Specialists are registered nurses with further qualifications in the specialty of child and family health however; in their role they provide leadership in the provision of safe, effective, quality collaborative care, consistent with the Tresillian Model of care and principles of practice. Whilst an experienced CFHN may also perform the same functions; the clinical nurse specialist is identified as performing at an advanced level of competency with a high level of clinical knowledge, experience and skills in providing complex nursing care directed towards a specific area of practice requiring minimum direct supervision.

QUALITIES OF A CHILD AND FAMILY HEALTH NURSE [6]  

• Demonstrates caring as it relates to self and others.
• Determines meaning and significance in client encounters.
• Establishes meaningful connections with clients to facilitate therapeutic interactions.
• Able to provide comprehensive assessments relating to the health and wellbeing of the infant/child and family. 
• Collaborates with clients and colleagues to ensure consistent, safe and effective care.
• Uses personal knowledge and theory from nursing and related disciplines to determine an appropriate course of nursing actions.
• Uses reflective, critical, and analytical thinking to facilitate creative and flexible nursing practice.
• Critically appraises research studies and utilizes the findings as a basis for nursing practice.
• Identifies gaps in nursing knowledge, considers research possibilities, and participates in research activities where appropriate.
• Analyses health and practice issues within the social/economic/political environment.
• Practices nursing in a skilful, therapeutic, and culturally sensitive manner.
• Provides leadership within his/her own practice to facilitate clients' and colleagues' desired outcomes.
• Role models active participation in his/her personal and professional development.
• Uses population health principles to plan, market, implement, and evaluate health promotion and disease prevention programs.
• Works within the context of a multidisciplinary health care team to apply primary health care principles.
• Practices nursing within legal, ethical, and professional guidelines.
• Participates in developing and implementing strategies for the improvement of the health environment using the political process and the principles of social justice and equity.

CORE KNOWLEDGE AND SKILLS APPROPRIATE TO THE CHILD AND FAMILY HEALTH NURSE (RN)

The underpinning principle when implementing these core knowledge and skills is that the CFHN must understand and fulfil the legal and ethical responsibilities and boundaries of the registered nurse. This includes working with the Enrolled Nurse (A and B) taking responsibility to supervise the Enrolled Nurse’s work through appropriate delegation, and regular review of client progress and outcomes. CFHNs have specialist knowledge and Skills in the Care of Children, Parents and Families 5, 6, 9,[7],[8]

• Primary Health Care
  • Understanding of Primary Health Care is fundamental to CFH nursing in order to promote the self-efficacy and self-determination of   families.
  • Recognises the social determinants of health.
  • Asserts the importance of access and equity.
  • Values diversity.
  • Advocates working in partnership with families.
  • Emphasises the importance of building community capacity and child and family-friendly   communities.
  • Understanding that there are a range of influences on children’s developmental outcomes, spanning individual and family characteristics and the broader social, economic and physical environments in which children are raised.
  • Being able to recognise the core needs that all children and families have in common, as well as the unique needs of each individual child and family.
  • Being able to provide education, support and anticipatory guidance including but not limited to immunisation, sudden infant death syndrome (SIDS) risk reduction, and infant nutrition including the promotion and support of breastfeeding, infant/child   sleep and settling techniques, behaviour management, family health and child safety.
• Health Promotion
  • Understanding of a population health approach that recognises health as a capacity or resource rather than a state and the notion of being able to pursue one's goals, to acquire skills. It includes the recognition of the range of social, economic and physical environmental factors that contribute to health.
  •  Understanding of the determinants of health, incorporating all societal influences on the health of individuals and populations, embedded into clinical practice.
  • Being able to provide primary health screening and surveillance, and the identification of disorders and investigate appropriate referral pathway.
  • Promote opportunities to support healthy lifestyle choices. This includes the recognition of self care, emotional and physical, of self and colleagues.
• Culturally sensitivity
  • Being respectful of the Aboriginal and Torres Islander people’s cultural beliefs and practices and being aware that they may have specific needs.
  • Being respectful of diverse cultural beliefs and practices by being aware of the specific issues for parents from culturally and linguistically diverse backgrounds.
  • Being able to advocate for services and environments that accommodate the full range of children and families with diverse backgrounds, experiences, abilities and needs.
• Working in Partnership with Families and Others  
  • Having a holistic view of parenting, and a comprehensive understanding of family dynamics.
  • Possessing effective communication skills to work with parents and families.
  • Forming positive attitudes and using positive behaviours when working with parents (i.e. empathetic, respectful, good listener).
  • Being able to use strength-based approaches to form parent partnerships enabling the provision of services that are responsive to family and child needs and circumstances.
  • Being able to assist and support families to identify and take action to improve their parenting capacity and quality of life.
  • Being able to challenge parenting attitudes and behaviours that place the child at risk of harm (including physically and emotionally).
  • Being able to:
    • monitor and evaluate the child’s and/or parent’s progress in partnership with the parent(s); 
    • recognise signs of developmental or relationship problems and develop appropriate interventions and/or referrals;
    • discuss identified issues with parents, to ensure that children and families have access to community resources for further support.    
    • Working as a member of a multi-disciplinary team.
• Ensuring the Safety, Welfare and Well Being of Children and their Carers
  • Understanding the legal rights of children and families to live in a safe environment. 
  • Understanding the cumulative effects of multiple protective and risk factors and the interplay and developmental implications of these factors.
  • Promote and advocate for safe environments and relationships that are safe for young children.
  • Being able to identify, address and respond promptly to safety concerns for young children and families.  This includes recognising unsafe parenting practices, suicide risk assessment and management, child protection and domestic violence screening. 
  • Being aware of legal and professional responsibilities and acting appropriately when children and their families are at significant risk of harm.
  • Demonstrating knowledge on the processes of identifying and responding to risk of or actual child abuse or neglect.
• Child Development
  • Understanding of the core principles of early child development, and the key developmental tasks or challenges faced by children including:
    • achieving physical, social and emotional milestones;
    • forming attachments;
    • acquiring self-regulation;
    • developing communication and learning skills; and
    • learning how to relate to peers, and managing the key transitions in their lives.
  • Being able to work effectively and sensitively with infants, toddlers and young children, and to help them master the key developmental tasks they face.
  • Role modelling with parents: responding to individual child needs and interests, promoting appropriate stimulation and learning opportunities and to provide developmentally appropriate experiences.
  • Performing comprehensive health assessment of an infant to identify health and developmental problems and initiate early intervention strategies.
  • Utilising knowledge and skills of normal variations in behaviour of infants and young children to support parents to choose and implement management strategies that are specific to the family’s needs.
  • Providing advice and/or anticipatory guidance to parents across a range of parentcraft topics.
• Perinatal Mental Health Family Functioning and Infant Mental Health
  • Understanding the relationship between the child and parent is a dynamic one and can have a significant impact on the outcomes for the child and the family.
  • Understanding the social factors that support or undermine the capacity of families to parent young children.
  • Understanding the importance of human relationships (including the attachment relationship) as the building blocks of healthy development; the developmental importance of the early years of life, and developmental transition periods.
  • Understanding environmental conditions and experiences known to have both positive and adverse effects on prenatal and early child development.
  • Understanding the crucial importance of the provision of appropriate, timely and sensitive caregiving by parent.
  • Having the ability to support the development of this relationship (e.g. providing interventions) 
  • Being able to provide a comprehensive primary health care assessment. This includes using the comprehensive psychosocial assessment processes and tools identifying strengths, risks, vulnerabilities and the early identification of emotional distress.
  • Being able to assist parents to enhance their interactions and relationship with their child – as the parent supports their infant’s attempts to acquire self-regulation, develop communication and learning skills, and learn how to relate to peers.
  • Being able to adapt interventions in partnership with parents to meet their cognitive and physical abilities.
  • Being able, when appropriate, to include the father and / or other members of the extended family in the assessment, development and implementation of interventions.
  • Being able to promote positive infant experiences and create environments that meet the developmental, psychosocial and health needs of children of different ages.
  • Being able to recognise and promote positive responsiveness of parents and others towards their infant/child.
• Family Nutrition
  • Assisting parents with nutrition and dietary management in infancy and early childhood.
  • Utilising knowledge and skills to assist women in the initiation and maintenance of breastfeeding.
  • Knowing how to promote family health by having an understanding of appropriate nutrition and physical exercise.
  • Being able to provide information that is sensitive to the parent’s choice of feeding that is up-to-date and evidence-based in relation to appropriate nutrition and healthy lifestyles.
• Continuity of Care
  • Understands the philosophy of continuity-of-care that enables parents to develop a meaningful relationship with the same nurse(s).
  • Being able to develop a clear care pathway / care plan that ensures the care provided is appropriate, safe and effective and based on the parent’s identified goals and individual circumstances.
  • Being able to review and evaluate, in partnership with the parent, the effectiveness of interventions / strategies and modify when necessary.
• Community Development and Partnerships
  • Recognising the importance of coordinated service delivery to families and possessing the skills of interdisciplinary teamwork and interagency collaboration.
  • Possessing the skills to work collaboratively with other health care workers, agencies and the non-government sector.
  • Knowing how to create programs and environments that ensure the meaningful engagement and participation children and their families.  
• Workplace Safety and Risk Management
  • Understanding the delivery of quality health care is intrinsically linked to the ability to provide a safe working environment for staff and families.
  • Being accountable for the safety of their workplace and safe work practices within their area of control, influence and authority (NSW Health, 2005).
• Evidence based practice
  • Understanding the features of effective evidence-based service delivery, and being able to deliver such services.
  • Being able to access, synthesise and incorporate research evidence and practice wisdom to enhance service delivery; includes access to technology.
  • Participating in regular work practice reviews.
• Reflective practice
  • Understanding one’s own personal values, attitudes, qualities and philosophical views, and how these impact on work with families and young children.
  • Having the ability to critically reflect on one’s own skills, knowledge, attitudes and practice on a regular basis therefore, facilitating professional development.

CORE ACTIVITIES OF THE CHILD AND FAMILY HEALTH NURSE (RN)

• Provide a population health approach which focuses on outcomes influencing the determinants of health and strategies that have a wide population coverage.
• Provide a family centred consultancy practice by: participating in direct family care; providing clinical support and education to families, relatives and other community professionals.
• Provide comprehensive assessment, planning, intervention and evaluation.
• Develop a comprehensive discharge plan which may include referrals to other agencies. 
• Enable families to develop their protective factors and build resilience promoting parenting confidence, self efficacy and social connectedness.
• Support the development of responsive and sensitive parenting to facilitate the parent/child relationship.
• Promote the health of children and families through the use of a partnership and anticipatory guidance approach.
• Identify and respond to the unique social / emotional physical spiritual and cultural needs of families.
• Build on the strengths of families identifying how they have previously overcome challenges with the aim of adapting these skills to new challenges.
• Identify and respond to actual and potential health issues and / or deviations from normal and / or improvements to the health status of the family.
• Use developmentally-appropriate strategies based on the best available evidence to address the needs of families identified through comprehensive assessment.
• Use an early intervention approach to identify and address the need of vulnerable families facilitating equity and access through universal and targeted services.
• Responsible for the administration and/or supervision of the administration of medications as per Tresillian policy.   
• Maintain and respect confidentiality of each client including appropriate storage of medical records   
• Perform nursing assessment, initiates care and treatment modalities and evaluate effectiveness.
• Incorporate community capacity building within the CFHN scope of practice to sustain and improve health outcomes for families.
• Provide supervision for students and enrolled nurses.
• Record information on care plans, in the medical records as per the Tresillian Documentation Clinical Practice Guidelines.  
• Participate in the clinical handover processes and staff team meetings.
• Participate in the orientation of new staff to the unit.
• If required provide emergency basic life support and cardiopulmonary resuscitation.

ADDITIONAL CORE ACTIVITIES OF NUMS

• Work collaboratively to ensure clinical staff are supported in their role, have opportunities for advancement and are able to influence future organisational direction. 
• Supports staff to work within the Tresillian MOC Principles of Practice recognising and providing support with professional development where required.
• Coordinates and provides direction in  regards to the multidisciplinary management of the care of families.

---

[1] Australian Nursing Federation (2009) Fact sheet 3; A snapshot of nursing careers, qualifications and experience. Australian Nursing Federation; Federal Office.

[2] The Australian Nursing and Midwifery Council (2007) The national decision-making framework. Act.   

[3] NSW  Health (2010) Maternal &Child Primary Health Care Policy. PD2010_017

[4] NSW  Health (2010) Child and Family Health Nursing Professional Practice Framework. (Final Draft )

[5] The term parent in this document is in inclusive of primary caregiver.

[6] Australian Nursing and Midwifery Council, ANMC (2006) National Competency Standards for the Registered Nurse: 4th edn. Dickson, ACT: ANMC.  www.anmc.org.au/userfiles/file/competency_standards/Competency_standards_RN.pdf

[7]  NSW Health / Families NSW (2010)  Supporting Families Early Package:   Supporting families early SAFE START strategic policy, Maternal and Child Health Primary Health Care Policy, SAFE STA RT guidelines: Improving mental health outcomes for parents and infants

[8]  Community Health Nurses Association of Canada (2008) Canadian Community Health Nursing Standards of Practice. Accessed on 

       www.chnc.ca/documents/chn_standards_of_practice_mar08_english.pdf