CREATING A PROFESSIONAL PRACTICE ENVIRONMENT  NURSING RETENTION THROUGH ORIENTATION AND ONGOING TRAINING Brazil Hello everyone! My name is Juliana, I am the Nurse Supervisor at the Pediatric cardiology Intensive Care Unit at Hospital da Criança e Maternidade in São José do Rio Preto, state of SP, Brazil. I am here today to talk about CREATING A PROFESSIONAL PRACTICE ENVIRONMENT Thank you for this opportunity to show our approach in providing orientation and on going trainning, for our nursing team.

SÃO JOSÉ DO RIO PRETO SÃO PAULO, BRAZIL This is the map of Brazil, and right beside it, the map of SP estate. São Paulo is responsible for 45% of the gross national Product. SJRP is a coutryside city, with about 500 Thousand inhabitants. The red numbers and arrows arond the map of Brazil represent the number of patients we receive in our service from all over Brazil.

FAMERP / FUNFARME Here is a picture of FAMERP/FUNFARME which is our Medical University and the Medical Foundation from SJRP consisting of Hospital de Base (a 700 bed adult hospital where we previously cared for our pediatric patients), HCM (a brand new 205 bed children and maternity hospital) and the outpatient care. Together, it is the second biggest hospital complex in number of beds in Brazil.

HCM AND CONGENITAL HEART DISEASE IN BRAZIL Of 21 Thousand children with heart deffects in Brazil, only 6.800 are operated HCM and our pediatric cardiology service are nacional and state reference Our service is a specialized center obligated to receive children from 102 nearby cities and interior of the state of São Paulo, but can also receive children from all over Brazil. About 80% of the children we receive have late diagnostics 100% that come from other hospitals are use of antibiotics Around 50% of them are malnourished.

PEDIATRIC CARDIOVASCULAR ICU Our Intensive care unit at HCM has a total of 23 beds (13 general ICU beds, 2 isolation rooms, and 8 semi intensive beds) with surgical and clinical pediatric cardiac patients. Today, we share our ICU with the general pediatric ICU, so only 13 beds are for our pediatric cardiac ICU

OUR NURSING TEAM We have a total of 9 RNs, 2 RNs per 6 hour-shift and 1 nursing technitian for every 2 patients. The nursing techs are the ones who are responsible for patient care, and most times need training to be able to care well for these patients. The RNs on shift are responsible for supervising the care of all the children and FOR specific RN tasks.

These are our number of surgeries per year in the history of our service. The reason they have decreased is due to institutional budget issues.

TRAINING IN THE PAST HCM HOSPITAL DE BASE In the past, our continued professional education went through a lot of difficulties due to a few reasons. The main one is that our nursing team would have to leave their patients in the hand of another nurse tech to walk over to the main hospital of the complex (Hospital de Base) to attend to a one hour class session. Classroom trainning and one hour sessions would have low retention rates since they were more worried about the patients and all the work they would have to accomplish once they arrived at the unit. The topics discussed were not unit specific. And, different professionals provided the same trainning witch could present divergent information. HOSPITAL DE BASE

TODAY – Nurse Educator Improvements in training: Training at bedside Short sessions One nurse educator giving the same training Plan, Do, Check and Action for every training given Topics focused on unit necessities IQIC webinars In January 2015, our hospital gained a Nurse Educator who is responsible for put guidelines into practice, audit the results (PDCA – plan, do, check and Action for every trainning) and provide continued education to the nursing team based on necessities of the unit. With this accomplishment we are able to : Have nursing trainning at bedside with short sessions One professional giving the same information to staff Topics focused on our unit necessities IQIC webinars can be passed on to nursing staff even after the live class.

MOVING FOWARD Patient Safety Pain Scale Braden Q Patient identification methods Double checking of high risk medications Chest tube removal and care Checklist and information guides PEDI project Our team have benefited so far from a diversity of continued education instruments aquired from international visits thanks to CHILDRENS HEARTLINK and their hospital partners such as: Patient safety checklists Pediatric pain score evaluation Pediatric pressure ulcer risk evaluation Medication awareness including DOUBLE CHECK and Patient identification methods Information guides and nursing care guidelines elaboration Pedi project – weekly parent orientation along with ICU staff members All these projects and instruments are performed and monitored monthly.

GREAT VERY GOOD GOOD REGULAR NOT GOOD Knowledge is an issue in our nursing team since the majority of our care is provided by nursing technicians. They go through only 1 year training period before start working in a critical care unit. As you can see in this specific example of SEPSIS TRAINING, the knowledge of over 120 nursing staff members is average (regarding such an important and unit specific subject). Sepsis training was provided to these staff members and the new continued education was greatly approved. Audit results about this training to compare the knowledge acquired will be evaluated soon, but we were able to notice more SEPSIS identification in the unit today.

PACIENT SAFETY – ID GUIDELINE % This is another example of a patient safety continued education on the importance of patient identification methods. As you can see, we have had improved results but the education process needs to be continued and permanent.

TEAM RESULTS Team appreciates the new method of training More open to learning and caring for the patient More confident during the training Nurse reference for possible questions after training Nurses feel more confident and safe while performing certain tasks. Medical team view As a result, the Nursing team is more open to learning and appreciative OF the new method of providing continued education. They feel more confident during and after the learning sessions and they also have a nursing reference when in need for guidance and help after training. The medical team also approve the new method and feel that our nursing staff needs the information provided in order to provide better care for our patients.

Thank you juliana.brachine@hospitaldebase.com.br We value team work and the continued search for knowledge bringing into practice in a shared way. Here is my contact information. Thank you once again for this opportunity. Thank you juliana.brachine@hospitaldebase.com.br