The Paediatric Aftercare Service

Case study provided by Joe Smith (Advanced Paediatric Nurse Practitioner) at Norfolk and Norwich University Hospitals NHS Trust.

Summary

This is a guide to the introduction and progression of the paediatric aftercare service. A service used to support all staff involved in a paediatric incident that was distressing, traumatic or caused any form of worry or concern.

Organisation

Paediatrics is a highly emotive and difficult specialty to work within. Not only due to the varied age ranges, families and conditions related to this specialty but also due to having to deal with often distressing and rapidly changing events. All these situations cause highly emotive and distressing feelings for all staff involved whether they are the medical, nursing, support staff or out of hospital services (ambulance crews, police etc).

What initially stated as an idea from the emergency matron, advanced paediatric nurse practitioner and mental health specialist nurse has led to a 20-25 strong team supporting hot and cold debriefs and an overall culture of support and physical and emotionally well-being. Staff in the aftercare team give their time voluntarily on a rolling 2-week rota but the senior team members are always on hand to support, aid and step in if needed to allow for an effective aftercare facilitated session.

What was the problem?

Prior to the service being created there was no formal method to support staff or deliver consistent follow up or reflection. Often with limited or no support after paediatric incidents. There was often no safe space or an appropriate facilitator to discuss and reflect on a situation leading to physical and/or emotional effects from the lack of support. This led to staff morale being low, feelings of being unheard or unsupported and in some instances led to staff sickness.

What was done?

The advanced paediatric nurse practitioner utilised his network of multi-professionals to access the knowledge and experience of nurses, consultants and resident doctors to support setting up the Aftercare team, and lead on the collaborative working. Once established the Aftercare team created a process to follow following each paediatric incident. This includes: a hot debrief taking place after any paediatric event, the paediatric aftercare team being informed (through shared mailbox) of incident, an email sent from paediatric aftercare service stating resources and services that can be utilised now and then informing them of when a cold debrief will be done, a cold debriefs, learning shared with wider team with then the case being closed and then finally formal invite to paediatric morbidity and mortality meeting.

The aftercare service created a simple but affective model of post incident support for all staff involved in any paediatric incident. It allowed a team of experienced professionals from both medical and nursing backgrounds to give time, and facilitate reflection and support and also promote the paediatric team’s ability to feel heard, learn from situations and then move forward. In regard to advanced practice leadership, the advanced paediatric nurse practitioner’s extensive experience in different paediatric environments, involvement in a variety of debriefs and emotive situations meant they could utilise these skills and observations to support and create a supportive aftercare process for the team.

Challenges

The biggest challenge to the aftercare team has been trying to improve the team’s education, supervision and support. Through establishing the team and creating an easy-to-follow process the repeatability is successful. Also, through utilising other team members like mental health nurses, psychologist, symptom management teams etc the team has also been able to become more supported and gained appropriate supervision.

Impact

Staff engagement has been great and that is from the staff using the service and the positive reflections and feedback they have given, but also from staff wanting to join the paediatric aftercare service and be aftercare facilitators.

There are usually an average 12-15 incidents a year (resus, child death, SUDIC, Mental health escalation or Suicide). The service gets an average of 6-12 people attend each debrief (all professionals).

This clear positive evidence was able to be quantified through a Microsoft forms questionnaire. The initial questionnaire was sent before the start of the Aftercare Service being implemented in March 2024 and then repeated June 2024 and finally repeated September 2025. Within this time there were 22 cases requiring debrief.

From the questionnaire we were able to collate and see a dramatic improvement in staff understanding of debriefs, feelings of being supported as well as overall demonstrating effective improvement. With all questions being answered showing a 26-35% positive increase. With the overall, rating on the paediatric aftercare service going from 2.21/5 to 4/5 (35% Increase, on Likert scale).

Learning points, next steps and sustainability

The paediatric aftercare service is an established part of the paediatric department with all new medical, nursing and support staff being introduced to its availability as part of the local induction.  The service has a continued amount of staff asking to volunteer therefore having a growing team rather than a decreasing team. This therefore strengthens is ability to be maintained and continued. Also as discussed through discussion with child bereavement UK and also through enthusiasm of the aftercare team themself we are driving education making sure that we support the paediatric aftercare team to continue to develop their facilitation skills.

As shown in the overall audits of the service staff are happier and understand the benefit of aftercare. This means that moral is better, sickness lower and also overall staff support improved.

There is also evidence that other hospitals want to create similar services. Some colleagues from the paediatric aftercare service recently went to a regional debrief training day and the other hospitals were intrigued and questioning how the service works and how good for staff it is. This type of discussion has also been echoed previously in discussions in other conferences. Through this interest and questioning a clear ability to drive the ethos and process of the service can be seen and therefore demonstrates its need and want to be replicated.

Further, through leading the service, the advanced paediatric nurse practitioner has utilised his skills to audit and reassess the service’s goals and development to highlight how it has worked well and how it needs to improve. This has led to creating aftercare facilitators meeting as well as creating training with a training provider to fully support the aftercare team.

Contact

Joe Smith – Advanced Paediatric Nurse Practitioner – joe.smith@nnuh.nhs.uk

Children’s Assessment Unit

Norfolk and Norwich University Hospital.