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Aims and objectives To investigate patients’ bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer and the relationship between bowel symptom experiences and the self-care strategies used. Background Earlier diagnosis of rectal cancer allows for less invasive surgical treatments such as sphincter-saving procedures to be performed. Although a permanent stoma is generally not required, patients experience changes in bowel function following this surgery. However, limited research exists on patients’ bowel symptom experiences and the self-care strategies used to manage symptoms following sphincter-saving surgery of rectal cancer. Design Quantitative descriptive correlational. Methods A convenience sample of 143 patients aged 30 to over 70 years was used. Data were collected (April 2010–December 2010) using the Illness Perception Questionnaires, the Difficulties of Life Scale and a researcher developed Self-care Strategy Measure. The research was underpinned by the Symptom Management Theory. Findings Relating to the four most effective self-care strategies used respondents reporting more bowel symptom were more likely to use the self-care strategy proximity/knowing the location of a toilet at all times. Females, respondents with high timeline cyclical scores and respondents with high physiological responses scores were more likely to use protective clothing. Respondents reporting more bowel symptom and with high social responses scores were more likely to use bowel medication. Females were more likely to wear incontinence pads. Conclusion This research provides insights into the daily bowel symptom experiences of patients following sphincter-saving surgery for rectal cancer. It demonstrates the range of self-care strategies that individuals use to manage their bowel symptoms and the self-care-strategies that were most effective for them. Relevance to clinical practice Patients should be encouraged to report on-going bowel problems following sphincter-saving surgery for rectal cancer. Supportive care for patients should be comprehensive and tailored to meet individual needs.

Aims and objectives. To explore the role dimensions, competence and professional development needs of practice nurses in Ireland from both the general practitioner’s and practice nurse’s perspective and highlight any agreement/disagreement between the professions. Background. Economic pressure on healthcare delivery is promoting a re-evaluation of professional roles and boundaries. This coupled with a primary care sector that is evolving prompted an investigation into the role dimensions and competence of the practice nurse. There is a lack of empirical data comparing the general practitioner’s and practice nurse’s perspective on the current role of the nurse, clinical competence (existing and required), strategic direction for the role and continuing professional development. Design. A descriptive cross-sectional survey design was used. Methods. A random sample of general practitioners (n = 414) and a purposeful sample of practice nurses (n = 451) participated. Data from each profession were analysed and comparisons drawn. Results. General practitioners and practice nurses agree (±5%) that the nursing role is centred on immunisation, direct clinical care and elements of chronic disease management. However, in some areas such as preconceptual advice, family planning, advice on menopause, continence promotion and research, there was a 30% difference between the general practitioners perceptions of the nurse’s involvement and the practice nurse’s actual involvement in the role. Perceived competency differed in a number of areas with nurses more likely to indicate competency in health promotion activities. Both disciplines acknowledged that only a minority of practice nurses were competent in audit, research and dealing with ‘problems with living’ (relationship breakdown, addiction and parenting). Conclusion. There is some congruence of opinion among practice nurses and general practitioners in Ireland regarding the current role of the practice nurse. Divergent opinions on the nurses’ involvement in a particular aspect of the role may be due to the general practitioners underestimating the nurse’s involvement in the role. Training is required in the areas of audit, research and ‘problems with living’. Relevance to clinical practice. This research provides data for role clarity and evidence-based role development for practice nurses within the context of evolving primary care services. It also indicates how general practitioners perceive the nursing role.

Aims and objectives. To examine the relationships between social support, maternal parental self-efficacy and postnatal depression in first-time mothers at 6 weeks post delivery. Background. Social support conceptualised and measured in different ways has been found to positively influence the mothering experience as has maternal parental self-efficacy. No research exists which has measured the relationships between social support, underpinned by social exchange theory and maternal parental self-efficacy using a domain-specific instrument, underpinned by self-efficacy theory and postnatal depression, with first-time mothers at 6 weeks post delivery. Design. A quantitative correlational descriptive design was used. Method. Data were collected using a five-part questionnaire package containing a researcher developed social support questionnaire, the Perceived Maternal Parental Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Four hundred and ten mothers completed questionnaires at 6 weeks post delivery. Results. Significant relationships were found between functional social support and postnatal depression; informal social support and postnatal depression; maternal parental self-efficacy and postnatal depression and informal social support and maternal parental self-efficacy at 6 weeks post delivery. Conclusion. Nurses and midwives need to be aware of and acknowledge the significant contribution of social support, particularly from family and friends in positively influencing first-time mothers’ mental health and well-being in the postpartum period. The development of health care policy and clinical guidelines needs to define and operationalise social support to enhance maternal parental self-efficacy. Relevance to clinical practice. These findings suggest that nurses and midwives need to be cognisant of the importance of social support for first-time mothers in both enhancing maternal parental self-efficacy and reducing postnatal depressive symptomatology in the early postpartum period.

Aim. To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. Background. Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. Method. A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. Results. Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. Conclusion. The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. Relevance to clinical practice. Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

Aims. The primary aim of this study was to describe the unintentional and intentional aspects of non-adherence in patients diagnosed with hypertension. A secondary aim was to examine the relationships between medication adherence and purposeful actions (intentional non-adherence), patterned behaviours (unintentional non-adherence) and demographic questionnaire variables. Background. Non-adherence to medications continues to be a significant health-care issue, the extent and consequences of which have been well documented. Despite considerable research over the past five decades, little progress has been made in solving this healthcare problem. Recent literature indicates that this lack of progress can be attributed to the fact that past research has concentrated solely upon either the unintentional or the intentional aspects of non-adherence, instead of addressing both facets simultaneously. Methods. A quantitative, descriptive, correlation research design was employed using Johnson's (2002) Medication Adherence Model as a theoretical framework. A convenience sample of 73 participants with hypertension, attending the outpatients’ clinics of two university hospitals was recruited. Data were collected by means of a researcher administered questionnaire and analysed using the Statistical Package for Social Sciences. Results. High levels of medication adherence with a mean adherence score of 4·75 (maximum 5) were reported. Low and medium levels of purposeful actions and medium and high levels of patterned behaviours towards medication taking were found. Correlational analyses did not demonstrate statistically significant associations. Conclusions. Both the intentional and unintentional dimensions of medication-taking are simultaneously considered by patients to varying levels when adhering to therapeutic regimens. This is an important research area for nurses as it facilitates an increased understanding of non-adherence and, in so doing, aids the uncovering of more effective interventions aimed at sustaining lifelong pharmacotherapy. Relevance to clinical practice. By acknowledging a broader approach to patient medication-taking, nurses will be able more effectively to assess and intervene in non-adherent behaviours and actions.

To explore the role dimensions, competence and professional development needs of practice nurses in Ireland from both the general practitioner's and practice nurse's perspective and highlight any agreement/disagreement between the professions.Economic pressure on healthcare delivery is promoting a re-evaluation of professional roles and boundaries. This coupled with a primary care sector that is evolving prompted an investigation into the role dimensions and competence of the practice nurse. There is a lack of empirical data comparing the general practitioner's and practice nurse's perspective on the current role of the nurse, clinical competence (existing and required), strategic direction for the role and continuing professional development.A descriptive cross-sectional survey design was used.A random sample of general practitioners (n = 414) and a purposeful sample of practice nurses (n = 451) participated. Data from each profession were analysed and comparisons drawn.General practitioners and practice nurses agree (±5%) that the nursing role is centred on immunisation, direct clinical care and elements of chronic disease management. However, in some areas such as preconceptual advice, family planning, advice on menopause, continence promotion and research, there was a 30% difference between the general practitioners perceptions of the nurse's involvement and the practice nurse's actual involvement in the role. Perceived competency differed in a number of areas with nurses more likely to indicate competency in health promotion activities. Both disciplines acknowledged that only a minority of practice nurses were competent in audit, research and dealing with 'problems with living' (relationship breakdown, addiction and parenting).There is some congruence of opinion among practice nurses and general practitioners in Ireland regarding the current role of the practice nurse. Divergent opinions on the nurses' involvement in a particular aspect of the role may be due to the general practitioners underestimating the nurse's involvement in the role. Training is required in the areas of audit, research and 'problems with living'.This research provides data for role clarity and evidence-based role development for practice nurses within the context of evolving primary care services. It also indicates how general practitioners perceive the nursing role.

The aim of this research was to identify needs, perceptions and experiences of first-time mothers in the postnatal period. Data were collected through focus groups and in-depth interviews from a sample of 13 women, 61% were aged 20 years or less, from an urban city area in Southern Ireland. Through content analysis, key themes were identified relating to birth and hospitalization, support, motherhood and psychological issues. Attendance at antenatal classes was variable and perceptions of being unprepared for birth and motherhood prevailed. Participants appeared shocked at the amount of pain experienced during birth and had little rest during hospitalization. They received physical and emotional support and preparation for childcare from midwives. Breastfeeding, while promoted, by midwives was not acceptable. The 'maternal mother' was key in providing direct childcare, advice and emotional help, support for attendance at school and 'time out' to socialize. Support was reciprocal if the maternal mother had young children. Professional support by public health nurses was well-established. However, emphasis was perceived to be on 'baby's development'. Maternal depression, loneliness, living in homes with limited space and difficulty in 'letting go' of baby care to return to school or work were reported. Implications for antenatal preparation, national policies, motherhood, and the need for further research are discussed.