Registed Nurses' Association of Ontario

Advancing Clinical Support Leaders: Developing a best practice framework

Sarah Kamal
The Hospital for Sick Children (Sickkids)

I was unsure how to start working on my Advanced Clinical Practice Fellowship, as this was a unique opportunity for me and 12 weeks seemed like a short amount of time to encourage practice change for pediatric nurses. My goal was to raise awareness about the importance of oral health and oral care for children throughout the Hospital for Sick Children as oral care is often set aside to deal with more acute medical issues. Reminding nurses to ‘Lift the Lip’ in order to assess the health of the oral cavity and incorporating oral health assessments into the head-to-toe assessments were my main objectives. Oral care is an essential component of quality nursing care, yet unfortunately nurses often give low priority to it. As a bedside nurse who works with pediatric hematology/oncology patients, I have experienced oral breakdown and mucositis due to chemotherapy and radiotherapy throughout my career. I will admit however, that oral care related to dental caries was never something I considered in my daily practice even though dental caries still remains the most common chronic childhood disease.

The RNAO has a fantastic guideline outlining oral care for the geriatric population however there are few resources for nurses working with the pediatric population. I myself did not receive much training while in nursing school about the oral care of children, and I found through speaking with other nurses that the responsibility of oral care for hospitalized children is often placed on the caregiver of children in hospital or on the dentistry team-which not every child has the resources to access.I felt oral assessments were an important topic to take on and the ACPF was a great opportunity to expand my knowledge. While I was excited to be able to learn about a topic that is out of my comfort zone, I was also unsure of how to approach the daunting task of educating with the intention of changing practice.

While 12 weeks is a short amount of time to create practice change throughout an organization, I have used the knowledge and leadership skills I have gained to spread my knowledge to nurses though nursing practice councils, nursing committees and educational blitzes throughout the hospital.I have put together an education campaign that shows how quick and easy oral assessments can be through the tagline ‘Lift the Lip’. I have learned through this process that gaining knowledge in order to provide accurate evidence based practice is time consuming, and requires a lot of hard work and dedication from nursing educators as well as significant buy-in from the institution and the nurses who provide direct care. I was fully supported by the dentistry team at The Hospital for Sick Children, and they were very welcoming to my eagerness to gain knowledge in order to improve the oral health care of our pediatric patients. My mentors were always willing to read over my many edits of my literature reviews and educational materials. I have gained a new respect for nursing educators as well as mentors that are willing to take on the challenge of supporting nurses who chose to take part in the RNAO ACPF. The independent work can be overwhelming and a significant change for a nurse who works at the bedside day to day.

Looking back I realize how much my oral health knowledge has increased and the leadership experiences I have gained have been such an asset to my portfolio and nursing skills. Future plans are to continue to work with the dentistry team at The Hospital for Sick Children as I am a member of the Oral Health Working Group that meets periodically to discuss oral health awareness around the hospital. Every April is Oral Health Month and there is always a targeted campaign blitz to spotlight oral health at The Hospital for Sick Children.As well I will continue to share the knowledge I have gained through poster presentations and conferences such as PedNIG and encourage practice change throughout the hospital. This is such a fantastic program offered by the RNAO and any nurse that puts in the time and effort into the ACPF challenge will be greatly rewarded, and feel incredibly accomplished at the end.