abstract: 'Background: There is a growing need for quality, community care models

  centered on the care of the child with medical complexity. This quality

  improvement project was conducted in a community-based medical daycare

  program within a large, metropolitan, pediatric hospital network of care

  location. A multi-disciplinary team, led by a clinical nurse specialist,

  occupational therapist, and early childhood special education teacher,

  addressed staff frustrations and low morale related to barriers to

  working at top of scope and feelings of a chaotic care and learning

  environment for children. Aims: To improve staff satisfaction through a

  decrease in perceived barriers to practicing at top of scope and to

  refocus each discipline''s role. A secondary aim was to improve child

  engagement through restructuring the ther-apeutic and learning

  environment and reducing distractions to better meet the unique needs of

  the children the program serves. Methods: This quality improvement (QI)

  project used multiple methods, including staff surveys, child

  observa-tions and timecard review, to measure the project''s impact on

  ability to work at top scope, child engagement and staff satisfaction.

  Results: The QI project resulted in positively impacting work culture

  and structure by increased time professional staff practiced at the top

  of scope, decreased perceived barriers to do so, improved overall job

  satisfaction and im -proved child engagement. Conclusion: Increased

  multidisciplinary collaboration and increased structure promoted an

  enhanced learning environment, healthier staff environment, and a more

  fiscally responsible program. There is little knowledge about medical

  daycares and further investigations in this setting is warranted. (c)

  2021 Elsevier Inc. All rights reserved.'
affiliation: 'Colby, A (Corresponding Author), 860 N Potomac Circle,Box 295, Aurora,
  CO 80011 USA.

  Colby, Amy; Yanco, Abigail; Inson, Ann, Childrens Hosp Colorado, KidSt 3615 Martin
  Luther King Jr Blvd, Denver, CO 80205 USA.

  Gance-Cleveland, Bonnie, Univ Colorado, Coll Nursing, 13120 E 19th Ave, Aurora,
  CO 80045 USA.'
author: Colby, Amy and Yanco, Abigail and Inson, Ann and Gance-Cleveland, Bonnie
author-email: 'amy.colby@childrenscolorado.org

  ann.inson@childrenscolorado.org'
author_list:
- family: Colby
  given: Amy
- family: Yanco
  given: Abigail
- family: Inson
  given: Ann
- family: Gance-Cleveland
  given: Bonnie
da: '2023-09-28'
doi: 10.1016/j.pedn.2021.02.023
earlyaccessdate: MAR 2021
files: []
issn: 0882-5963
journal: JOURNAL OF PEDIATRIC NURSING-NURSING CARE OF CHILDREN \& FAMILIES
keywords: 'Multidisciplinary; Staff satisfaction; Quality improvement; Medical

  daycare; Top of scope'
keywords-plus: JOB; INTERVENTION; CHILDREN; NURSE
language: English
month: SEP-OCT
number-of-cited-references: '17'
pages: 92-99
papis_id: 3a2267782df0f1bbd8fda60f523febdb
ref: Colby2021reimaginemultidiscip
times-cited: '0'
title: 'ReImagine: A multi-disciplinary quality improvement plan to work at top of
  scope'
type: Article
unique-id: WOS:000703599100011
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '60'
web-of-science-categories: Nursing; Pediatrics
year: '2021'