Feasibility and impact of doctor-nurse task delegation in preventive child health care in the Netherlands, a controlled before-after study

DOI

Abstract Background: In 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. Methods: Two 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. Results: Nurses 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-inf ormed and experienced an equal level of proficiency but less continuity in person. Conclusion: This 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.

Identifier
DOI https://doi.org/10.34894/KAN2GX
Metadata Access https://dataverse.nl/oai?verb=GetRecord&metadataPrefix=oai_datacite&identifier=doi:10.34894/KAN2GX
Provenance
Creator Benjamins, S Janine; Damen, Maurice LW; van Stel, Henk F
Publisher DataverseNL
Contributor Janine Benjamins; Lisette Schoonhoven; datamanager for division
Publication Year 2015
Rights The standard Data Sharing Agreement (DSA) of the UMC Utrecht must be signed without adjustments. This DSA is in compliance with Dutch law. No costs are involved.; info:eu-repo/semantics/restrictedAccess
OpenAccess false
Contact Janine Benjamins (Icare JGZ); Lisette Schoonhoven (UMC Utrecht); datamanager for division (UMC Utrecht)
Representation
Resource Type 1) data on contacts, percentage of children assigned to the trained nurse, and percentage of abnormal findings and referrals from the electronic patient record system; 2) survey data on nursing competences and roles; 3) focus group interviews (transcipts).; Dataset
Format text/plain; charset=US-ASCII; application/x-spss-sav; application/pdf
Size 423571; 27745; 143857; 352035; 542505
Version 1.3
Discipline Life Sciences; Medicine