Collaboration is essential to improve health outcomes for children: Widespread and sustained professional collaboration is needed if there are to be long-lasting gains in child health.

WINNING A travel fellowship to North America and Great Britian has opened Plunket clinical adviser Belinda Macfie's mind to the possibilities of professional collaboration. Macfie was one of last year's co-winners of the Mary May Blackwell travel study fellowship, administered by the Nursing Education and Research Foundation. Worth up to $13,000 for each recipient, the fellowship enabled Macfie to travel to Canada, New York and Great Britain to explore issues of nursing leadership, service delivery, policy and education related to children from birth to five years.

Visiting "Sure Start" programme sites in Northern Ireland and Liverpool made Mac fie aware of the potential of collaboration. "Sure Start programmes are a huge government initiative in Britain. They are an umbrella for health, education, social services and housing authorities to collaborate to improve health in high-need populations. And they are getting positive results. The programmes have facilitated collaborative practice--there were no professional silos in the sites I visited."

Macfie also learnt that considerable government investment is needed to ensure collaboration on such a scale happens. "The Sure Start programmes consider health in its broadest sense--employment, housing, nutrition and education issues are all addressed. Visiting these sites and talking to those involved opened my mind to the possibilities of collaborative practice and what it could achieve."

Another area of particular interest was child mental health. "This is a broad term to cover a range of issues that affect a child's emotional wellbeing. These include attachment and bonding, child socialisation, parenting practice, brain development, social competence or exclusion, resilience, the mental health of parents, family violence, addiction issues and depression. The seeds of problems later in children's lives are often sown before they reach five but few people are looking at that stage. There is a huge focus in Britain on developing and supporting good parenting practice. If child health is a priority, a lot of focus needs to be on parenting."

Child health was a genuine priority in Great Britain--"everybody was shouting that mantra in unison".

Macfie is now applying a good deal of what she learnt in her work as a clinical adviser with Plunket in Hamilton. "It has given me and my colleagues so much focus. There is so much information we can use."

She also travelled to Scotland to learn about a new nursing role there. (See story at left.)

Another particular interest of Macfie's was the development of and education for the nurse practitioner (NP) role in Canada and in New York. In Toronto she spent time with NPs in primary health care clinics and attended the NP conference. "A major difference is that in New Zealand there is a legislative framework for the NP role and a clear progression to that role. But in Ontario at least, the NP role is self defined and has no legislative framework. Primary health care NP courses have only existed since 1998 but the role has existed since 1970."

Nurse practitioners do not have to have masters degrees. "The focus on the one-year NP courses is on clinical practice skill development, rather than on higher education content. If a nurse does not have an undergraduate degree, the NP course is for two years--the first to upgrade to a bachelor of nursing and the second is devoted to the NP course. Ten universities throughout Ontario run the NP programme."

The provincial government of Ontario has just committed funding to 369 new primary health care NP roles in the province. Macfie sensed nurses in Ontario were more politically minded, more willing to get involved and knew the issues affecting the profession more than their New Zealand colleagues. And because of the Government's commitment to nurses, they felt valued.

Macfie experienced the polar opposite in the NP education stakes, when she visited New York's Columbia University School of Nursing. All NPs practising in the primary health care clinic attached to the school in Manhattan have nursing doctorates. "The school is wanting to develop a post-doctoral qualification as it wants to extend nurses even further. All educators at the school are expected to practise in the clinics as NPs. Their practice appeared to push the boundaries into medicine from my practice perspective."

Macfie says the study fellowship has been of immense professional benefit. She hopes colleagues and the wider profession will also benefit as she shares what she has learnt and through the papers she has written about a range of aspects of the trip. [These are available through the NZNO library.] "Everything I now do is informed by those experiences and what I have learnt."