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Aims: Workplace stress can negatively impact healthcare providers' professionalism and quality of care. One source of workplace stress is the experience of workplace mistreatment. Drawing on the Job Demands‐Resources theory, this study aimed to (a) investigate the impact of mistreatment frequency experienced by healthcare workers from insider sources (i.e. co‐workers, supervisors) and outsider sources (i.e. patients, visitors) on affective ill‐being and (b) the potential moderating role of trait resilience and trait self‐efficacy, as personal resources, in the mistreatment–ill‐being relationship. Design: Lagged design. Methods: We collected data from 153 Irish healthcare workers between January 2018 and June 2019 via three surveys, separated by 1‐week intervals. Personal resources were measured at Time 1, frequency of mistreatment from the two sources was assessed at Time 2 and affective ill‐being was assessed at Time 3. We used moderated regression analyses to evaluate the association of mistreatment frequency from the two sources and affective ill‐being and the moderating effect of personal resources. Results: Only insider mistreatment frequency was positively related to affective ill‐being. Furthermore, the positive impact of insider mistreatment on affective ill‐being was moderated by self‐efficacy (but not by trait resilience). In contrast to our expectations, the relationship was stronger at high levels compared to low levels of self‐efficacy. Conclusion: Mistreatment from co‐workers and supervisors is linked to higher levels of affective ill‐being. Additionally, healthcare workers with high self‐efficacy were more vulnerable to the negative consequences of co‐worker and supervisor mistreatment as it impacted their affective ill‐being. Impact: These findings extend the literature on workplace mistreatment by integrating insider and outsider perpetrators of mistreatment and examining their differential impact on the employees' affective ill‐being. It also highlights mistreatment from organizational insiders as a significant factor in the relationship between mistreatment and affective ill‐being. Patient or Public Contribution: No patient or public contribution. What Does this Paper Contribute to the Wider Global Community?: The findings underscore the detrimental impact of workplace mistreatment on the well‐being of healthcare professionals.The study findings of higher frequency of insider mistreatment being associated with increased affective ill‐being call for action, with line managers and supervisors being critical to achieving respective changes in healthcare workers' environment.The findings have implications for policymakers interested in developing a framework to support healthcare professionals in addressing workplace mistreatment, enabling them to effectively fulfil their role as care providers. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim This paper presents a substantive theory that explains the transition to motherhood for women with a disability. Background Over the last thirty years, interest in exploring women's experiences of motherhood has increased. Extant theories on transition to motherhood originate, primarily, from the perspective and experiences of non-disabled women with few exploring the phenomenon from the perspective and experiences of women with a disability. Those that do tend to focus on issues of accessibility, profiling the challenges that women with a disability encounter while accessing maternity services, attaining a maternal role and fulfilling the requirements of that role. Little is known about the experiences of women with a disability and their transition to motherhood and even less about the relationship of this process on the self. Design The study was conducted using a Strauss and Corbin approach to grounded theory. Method Individual interviews ( n = 22) were conducted over 4 years (2008-2012). Women were interviewed during pregnancy and in the postnatal period. All interviews were recorded, transcribed verbatim, imported into Nvivo 8 and analysed using the constant comparative method. Findings The substantive theory that emerged from the study provides a conceptual framework clinicians can reference when counselling, assisting and facilitating women with a disability during their preparation for and transition to motherhood. Conclusion The substantive theory presented in this paper will increase clinicians' understanding of the process involved in the transition to motherhood for women with a disability. [ABSTRACT FROM AUTHOR]

Aim This paper reports on the qualitative findings from a national review of a nursing and midwifery scope of practice framework. Background Scope of professional practice frameworks offers a system of rules and principles to regulate its members and demonstrate its responsibility to society. Key issues in reviewing the scope of practice include notions of specialist and advanced practice, accountability, autonomy, competence, supervision, continuing professional development and delegation. Evaluation of scope of practice frameworks has particular application value to nurses, midwives, regulatory bodies and healthcare employers across the globe. Design A mixed methods approach was used. This included a national survey of nurses and midwives and focus groups and interviews with key stakeholders. The qualitative data are reported in this paper. Methods Focus groups and interviews were conducted among a convenience purposive sample of key stakeholders, including nurses and midwives working in the widest range of services and settings in 2014. The participants contributed to thirteen focus groups and thirteen interviews. Findings Six global themes, as follows: Evolution of the nursing and midwifery professions and practice; Scope of practice: understanding and use; Expanding scope of practice; Professional competence; Practice setting and context; Reflections on the current framework. Conclusion Practitioners understand the scope of professional practice and while some see it as empowering others see it as potentially restrictive. Nurses and midwives are generally willing to expand their scope of practice and see it as resulting in improved patient care, improvement in overall quality of standards and increased job satisfaction. [ABSTRACT FROM AUTHOR]

fealy g.m., treacy m., drennan j., naughton c., butler m. & lyons i. (2011) A profile of older emergency department attendees: findings from an Irish study. Journal of Advanced Nursing 68(5), 1003-1013. Abstract Aims. This paper is a report of a study of older emergency department attendees' demographic, health and social profiles. Background. Relative to the general population, older people are higher users of hospital emergency departments. Attendance is most often associated with medical need, including a chronic condition and related morbidities. Method. A series of standardized health and social profiling questionnaires was administered to a non-probability sample of 307 older emergency department attendees. The sample was recruited during the spring-summer and autumn-winter periods in 2008 and 2009 at two hospitals in the city of Dublin. Subjects who met the inclusion criteria were recruited as they presented to the emergency department during the hours 8 am to midnight. The sample was stratified into those admitted and those discharged, with the aim of equally representing each stratum. Data were collected at the time of the index visit or shortly following hospital admission. Findings. Medical conditions accounted for almost half of all reasons for attendance and the health profile of the sample was characteristic of a population of chronically ill older people. Relative to the national picture for older people's social networks in Ireland, a proportion of the sample was at risk of social isolation. Conclusions. In the absence of other avenues to treatment and based on health profile and diagnostic category, older people's attendance at the emergency department was appropriate. The hospital emergency department remains a major arm of the Irish health service in dealing with the morbidity associated with enduring illness. [ABSTRACT FROM AUTHOR]

o'leary d.f. & ni mhaolrúnaigh s. (2012) Information-seeking behaviour of nurses: where is information sought and what processes are followed? Journal of Advanced Nursing 68(2), 379-390. Abstract Aim. This paper is a report of a study on how nurses inform their decision-making in the workplace. Background. Despite the growing availability of research evidence, nurses have been slow to adopt it into their daily decision-making. Method. The study was undertaken in Ireland between 2006 and 2007 using a sequential mixed methods approach. In phase 1, the views of a quota sample of 29 nurses were explored using semi-structured interviews incorporating vignettes. Phase 2 involved the design and dissemination of a survey to a disproportionate stratified random sample of 1356 nurses. The response rate was 29%. Findings. In decision-making, nurses accessed other people, especially nursing colleagues, the most frequently. Sources that provided prepackaged information such as guidelines were favoured over sources that provided access to original research. The process of information-seeking for routine and non-routine decisions was different. Nurses making routine decisions relied mostly on their experience and an assessment of the patient. In non-routine decision-making, participants experienced more uncertainty about their decisions. Accordingly, sources of information used were more varied and the information-seeking process more extensive. The study highlighted the complexities of establishing whether information used in decision-making is research based or not. Conclusion. Routine practices should be reviewed and updated regularly through organizational mandates, as nurses do not generally question them. Research information to inform non-routine decision-making must be easily available to nurses in their workplace, as information searches generally prioritize finding enough, rather than the best, information to make a decision. [ABSTRACT FROM AUTHOR]

Aims: To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs' identities and how they both enable and constrain their roles. Background: Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers. Design: A qualitative discourse analysis using Gee's Tools of Inquiry. Method: Data were collected between April 2019 and January 2020 through seven in-depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals. Findings: Five key discourses emerged. Language-in-use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs' identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other. Conclusion: This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs' identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals' roles. Impact: By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. Design: A longitudinal design with two data collections points (pre‐ and post‐graduate). Methods: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. Results: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. Conclusion: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. Impact: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses. [ABSTRACT FROM AUTHOR]

Aims: To identify the costs associated with nurse sensitive adverse events and the impact of these events on patients' length of stay. Design: Retrospective cohort study using administrative hospital data. Methods: Data were sourced from patient discharge information (N = 5544) from six acute wards within three hospitals (July 2016-October 2017). A retrospective patient record review was undertaken by extracting data from the hospitals' administrative systems on inpatient discharges, length of stay and diagnoses; eleven adverse events sensitive to nurse staffing were identified within the administrative system. A negative binomial regression is employed to assess the impact of nurse sensitive adverse events on length of stay. Results: Sixteen per cent of the sample (n = 897) had at least one nurse sensitive adverse event during their episode of care. The model revealed when age, gender, admission type and complexity are controlled for, each additional nurse sensitive adverse event experienced by a patient was associated with an increase in the length of stay beyond the national average by 0.48 days (p = .001). Applying this to the daily average cost of inpatient stay per patient (€1456), we estimate the average cost associated with each nurse sensitive adverse event to be €694. Extrapolating this nationally, the economic cost of nurse sensitive adverse events to the health service in Ireland is estimated to be €91.3 million annually. Conclusion: These potentially avoidable events are associated with a significant economic burden to health systems. The estimates provided here can be used to inform and prepare the way for future economic evaluations of nurse staffing initiatives that aim to improve care and safety. Impact: As many of these nurse sensitive adverse events are avoidable, in addition to patient benefits, there is a potential substantial financial return on investment from strategies such as improved nurse staffing that can reduce their occurrence. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Aim: To examine the prevalence of missed care in the community nursing. Background: Previous studies have used a missed care framework to identify challenges routine nursing care in acute care environments. Several issues related to quality of care, safe staffing, job satisfaction and poor teamwork. However, this concept has not been examined in the community nursing context. Design: A cross‐sectional survey design was used to explore the concept of missed care in community nursing using demographical information, community nursing roles and reasons for missed care. Methods: Online questionnaires were completed by 458 community nurses in the Republic of Ireland to determine the prevalence of and reasons for missed care (31 July–25 September 2015). Results/Findings: With a response rate of 29%, findings were above 70% in several routine care responsibilities. Other findings point to a higher level of missed care in nurses who had less than five years’ experience and other variables such as age, those who worked additional unpaid hours and there were some regional variations. Conclusion: The results of the study indicate a high prevalence of missed care in the community nurses surveyed and that preventative care was the type of care most likely to be missed. This has serious implications for a nursing service that is preventative in nature and suggests that the missed care framework could benefit workforce planning for community nursing services both in Ireland and elsewhere. Accordingly, policy, practice and educational reforms are fundamental to meet current and future population needs. [ABSTRACT FROM AUTHOR]

Aim This study aimed to identify levels of depressive symptoms, social and personal college adjustment and peer support among nursing and midwifery students. Background Student mental health is of international concern, particularly among students who are undertaking professional qualifications in health care. Design Cross-sectional design. Methods Data were collected in 2013 using the Centre for Epidemiology Depressive Symptoms Scale, two subscales of the Student Adaptation to College Questionnaire; and a subscale of the Peer Support Evaluation Inventory with 417 students in Ireland. Results Findings indicated that 34% of participants experienced depressive symptoms, 20% were poorly personally adjusted and 9% poorly socially adjusted. Most students had good levels of peer support. Statistically significant relationships were found between all key variables. Students in their second year of study had significantly higher rates of depressive symptoms. Participants who reported having poor relationships with their fathers were at higher risk and had more difficulties personally and socially adjusting to university life and study. The alcohol consumption of participants had a statistically significant relationship with depressive symptoms with higher consumption rates having a positive impact on symptoms. Conclusion The mental health of undergraduates undertaking professional healthcare studies needs to be a key research, educational and clinical priority. High rates of adjustment and mental health difficulties, particularly in the second year of the programme need to be examined and more effective interventions developed. [ABSTRACT FROM AUTHOR]

Aim. To establish, implement and evaluate the impact of a quality care-metric developed to measure public health nursing practice. Background. Measurement of care practices plays an integral role in quality improvement and promotes positive change in healthcare delivery. Quality caremetrics has been identified as a means of effectively measuring public health nursing practice. Public health nurses in Ireland are 'all-purpose' generalist community-based nurses caring for people across the lifespan, in defined geographical areas, employed by the Health Service Executive. In the public health nurse's child and maternal health role, the 'primary visit' (postnatal visit) has been identified as the most important contact a public health nurse has with a mother and her new baby. Design. Mixed methods using a sequential multiphase design. Methods. This study involves three phases. The first phase will include focus group and individual interviews with key healthcare professionals and new mothers, using purposively chosen sampling. Thematic analysis of data will identify key components for the development of a quality care-metric. Phase two will be a RAND appropriateness survey with a panel of experts, to develop and validate the quality care-metric. The third phase will involve implementation and evaluation of the quality care-metric. Descriptive and inferential statistics will be completed using SPSS version 21. Funding for this research study was approved in December 2013. Conclusion. This study will evaluate the impact of introducing a quality caremetric into public health nursing practice. Results will illuminate the quality of public health nursing practice in relation to the primary visit. [ABSTRACT FROM AUTHOR]

Aims To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners. Background In many countries, advanced practitioners in nursing and midwifery have responsibility as leaders for health care development, but without having leadership outcome measures available they are unable to demonstrate the results of their activities. In Ireland, a sequential mixed method research study was used to develop a validated tool for the evaluation of clinical specialists and advanced practitioners. Despite strong evidence of leadership activities, few leadership-specific outcomes were generated from the primary analysis. Design Secondary analysis of a multiple case study data set. Methods Data set comprised 23 case studies of advanced practitioner/clinical specialists from 13 sites across each region in Ireland from all divisions of the Nursing Board Register. Data were collected 2008-2010. Data sources included non-participant observation ( n = 92 hours) of advanced practitioners in practice, interviews with clinicians ( n = 21), patients ( n = 20) and directors of nursing/midwifery ( n = 13) and documents. Analysis focused on leadership outcome-indicator development in line with the National Health Service's Good Indicators Guide. Results The four categories of leadership outcomes for advanced practitioner developed were as follows: (i) capacity and capability building of multidisciplinary team; (ii) measure of esteem; (iii) new initiatives for clinical practice and healthcare delivery; and (iv) clinical practice based on evidence. Conclusions The proposed set of leadership outcome-indicators derived from a secondary analysis captures the complexity of leadership in practice. They add to existing clinical outcomes measuring advanced practice. [ABSTRACT FROM AUTHOR]

Aim The aim was to identify key patient outcomes and to compare these outcomes across services that employed clinical specialists (either nurse or midwife) or advanced nurse practitioners with matched, non post-holding services. Background In nursing and evaluation research, it is recognized that, further patient outcome studies, which measure and evaluate the impact of the new advanced roles, are urgently needed. Design A cross-sectional study design with a comparison group was implemented across Ireland. Method A total of 279 surveys were completed by service users in 41 services in 2009/10. Key outcomes were identified, then chosen as primary outcomes and assessed for differences across post-holding and the matched comparison sites. To identify the priority of importance of the key outcomes, a logistic regression model was computed with difference in overall care observed (yes or no) as the dependent variable, and gender, age grouping and the key outcomes as the independent predictors. Results Analysis revealed that the key outcomes were, on anxieties, dignity and respect, time waited, confidence in the clinician and the clinician making a positive difference. Results of the logistic modelling of the key outcome on noticing any difference in the care given by the clinical specialists or advanced nurse practitioners compared with the care from others revealed that the single most important predictor was being treated with respect. Conclusion Further studies evaluating advanced health professions roles measuring these six key outcomes, at a minimum, will ensure that service users' main concerns are being accounted for. [ABSTRACT FROM AUTHOR]

Aim To investigate the use of psychosocial interventions by mental health nurses following training and perceived benefits to service users. Background Psychosocial interventions are recommended to support the recovery of persons with enduring mental illness. Despite two decades of postgraduate training in psychosocial interventions internationally, implementation challenges still remain. Design A cross-sectional exploratory, descriptive survey was employed. Methods A survey was mailed to the total population of nurses ( n = 58) working in some health regions in Ireland who completed training in psychosocial interventions between 2005-2010. Data were collected between November 2011-January 2012, yielding a response rate of 64%. Descriptive and correlational statistics were used to analyse the data. Results There were statistically significant increases in the use of psychosocial interventions post training. Cognitive behavioural therapy and family interventions were the least used interventions. Assessment and outcome measures, concordance therapy and relapse prevention were preferential interventions. Perceived outcomes for service users were awareness of relapse indicators, enhanced coping skills and fewer admissions. Case load demands, lack of access to supervision and time constraints prevented implementation. Free text comments indicated a dissonance between generic nursing roles and implementation of structured psychosocial interventions in practice. Conclusions The findings indicate a requirement for nursing leadership to legitimize psychosocial interventions as core nursing work. For service users to experience this type of nursing, we propose the nomination of dedicated psychosocial intervention nurses to multidisciplinary teams. Support through guidelines, clinical supervision and audit by senior nurse managers is critical to implementation. [ABSTRACT FROM AUTHOR]

Aim To introduce how nursing students discursively construct their dyslexic identities. Background Identity mediates many important facets of a student's scholarly journey and the availability and use of discourses play a critical part in their ongoing construction. Design A discourse-based design was used to examine the language employed by students in constructing their dyslexic identities. Methods Using narrative methods, 12 student nurses with dyslexia from two higher education institutions in the Republic of Ireland were interviewed during the period February-July 2012. Discourse analysis of interviews entailed a two-stage approach: leading identity analysis followed by thematic analysis. Results Discourses used by students to construct their dyslexic identity correspond with positions on an 'Embracer, Passive Engager and Resister' continuum heuristic. The majority of students rejected any reference to using medical or disabled discourses and instead drew on contemporary language in constructing their dyslexic identity. Nine of the 12 students did not disclose their dyslexic identity in practice settings and drew on not being understood to support this position. In addition, a discourse linking 'being stupid' with dyslexia was pervasive in most student narratives and evolved from historical as well as more recent interactions in nurse education. Conclusion This study indicates variation in how students discursively construct their dyslexic identities, which, in turn, has an impact on disclosure behaviours. Policy leaders must continue to be mindful of wider sociocultural and individualized understandings of dyslexic identities to enhance inclusion prerogatives. [ABSTRACT FROM AUTHOR]

Aim To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. Background The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. Design A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients' records and 208 medications prescribed by 25 Registered Nurse Prescribers. Methods Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen's kappa statistic (inter-rater reliability). Results Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)−80% (reviewer 1) of prescribing decisions met all eight criteria. Conclusion The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing. [ABSTRACT FROM AUTHOR]

Aim To report a study designed comparing the roles, responsibilities, and perceived outcomes of Clinical Nurse Specialists, Clinical Midwife Specialists, and Advanced Nurse Practitioners in Ireland. Background A clinical career pathway that encompasses progression from staff nurse or midwife through clinical specialist to advanced practitioner level was introduced in Ireland in 2000. Such roles are common internationally, but little evaluation has been conducted and few comparisons have been made between roles. Design A mixed-method case-study design was used. Methods Following Research Ethics Committee Approval, data were collected in 2009-2010, using non-participant observation (92 hours) of 23 Clinical Specialists and Advanced Practitioners, interviews with 21 clinicians and 13 Directors of Nursing or Midwifery. A survey was completed by 154 service-users. Results A clear difference was seen between Clinical Specialist and Advanced Practitioners, with advanced practice roles providing improved service delivery, greater clinical and professional leadership, increased research, and a clear governance and accreditation structure. Clinical Midwife Specialists were rated at a similar level to Advanced Nurse Practitioners for certain aspects and rated more highly for 'continuity of care and carer'. Conclusion Advanced Practitioners do give a higher level of care, particularly at a strategic level. Existing Clinical Specialists should therefore be encouraged to develop their skills and education to achieve advanced practice level and more specialist and advanced practice posts should be instituted. [ABSTRACT FROM AUTHOR]

higgins a., callaghan p., devries j., keogh b., morrissey j., nash m., ryan d., gijbels h. & carter t. (2012) Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: a mixed methods pre-postevaluation. Journal of Advanced Nursing 68(11), 2418-2428. Abstract Aim. To report a study evaluating the effectiveness of a Wellness Recovery Action Planning education programme. Background. Internationally, mental health policy is advocating using recovery approaches to care. Underpinning these approaches is investment in education in recovery principles and methods and a need to provide evidence of the impact of this education. Design. The study design employed a mixed methods approach. Methods. Using questionnaires and focus groups, we evaluated 2- and 5-day Wellness Recovery Action Planning Education Programmes and assessed participants' attitudes towards recovery, knowledge of recovery and Wellness Recovery Action Planning beliefs. Data were collected between 2009 and 2010. Participants were people with personal experience of mental health problems, practitioners in mental health services and family members/carers of those with mental health problems. Results. Comparing the pre and postmeasures showed that the programme increased participants' knowledge of and attitudes towards recovery and Wellness Recovery Action Planning. Although this increase was statistically significant for the 2-day programme, it was not so for the 5-day programme. Participants reported being very positive and enthusiastic about the programme and the benefits they had achieved personally and professionally as a result of participating. Conclusions. This exploratory study shows that providing mental health practitioners and people with personal experience of mental health problems with a systematic education and training in recovery principles using the Wellness Recovery Action Planning approach leads to positive changes in people's knowledge, skills and attitudes towards recovery. This education appeared to inspire, invigorate and empower people, and for many, it was a life changing experience. [ABSTRACT FROM AUTHOR]