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Mental health services are currently undergoing immense cultural, philosophical, and organisational change. One such mechanism involved in this change has been the recognition of lived experience as a knowledge subset in its own right. Within five Community Health Care Organisations [CHOs] in the Irish mental health services, 2017 marked a new era as the traditional statutory mental health service hired a total of 30 Peer Support Workers. Since then, additional Peer Support Workers were recruited along with the added addition of Family Peer Support Work. The purpose of such positions is to use their lived experiences and the knowledge subset within it to normalise experiences, break down hierarchical barriers and facilitate candid conversations that will allow the service user to progress on their own, self-defined recovery journey. Since it's inception into Irish mental health services, peer support has been line managed by a non-peer discipline. It is this where this paper highlights a potential problem. The paper raises concerns that the supervision conducted by these non-peer professionals could tamper, mutate and destroy the essence of peer support—the transfer and use of lived experience between service users. As such, a recommendation is suggested that the literature pauses discussions as to the mechanism by which lived experience is delivered and instead focus energies on identifying the ontological and epistemological position that underpins the experiences.One potential position to examine is that of constructionism as such knowledge is created or constructed through the fusion of life experiences and sub-concious thoughts and emotions experienced at a particular moment in time which are then entangled together with current information to create a narrative or story that can be therapeutic. It is through this philosophical exercise involviong/including existential themes that the essence of lived experience can be identified, protected, and nourished within mental health discourse. [ABSTRACT FROM AUTHOR]

Purpose: The concept of personal recovery is now a key pillar of service delivery. It aims to support individuals to flourish and establish a new identity following an acute episode or diagnosis. This view of recovery is unique to each person on that journey. However, there has been a significant focus on measuring these experiences. This paper aims to explore the influence of social constructionism on the concept of recovery within an Irish context, seeking to understand the influence of language, discourse and power on service users' experiences. Design/methodology/approach: A qualitative, interpretivist methodology was adopted for this case study design. Semi-structured interviews were conducted with 12 service users. Thematic analysis was chosen as the method of analysis. Findings: Personalising recovery did not always lead to the removal of biological symptoms, but with the appropriate supports, individual's recovery journey was greatly enhanced. On the contrary, personal recovery places overwhelmingly responsibility on the individual to succeed, largely driven by neoliberal discourse. This focus on individualism and the pressure to succeed was further experienced when people sought to re-integrate into society and participate in normalised social order. Ultimately, for many service users, they viewed personal recovery as an unfulfilled promise. Research limitations/implications: It is not a representative sample of service users within an Irish context. Originality/value: To the best of the authors' knowledge, this is the first study to explore influence of social constructionism on the concept of personal recovery within a mental health service context. [ABSTRACT FROM AUTHOR]

Background Developing age-friendly communities is a significant global policy issue. The WHO (2007) age-friendly cities and communities initiative has had a significant influence on the development of Ireland's Age-Friendly Programme. With research on such programmes still at an early stage, this paper critically examines the utilisation of the WHO age-friendly planning framework in an Irish context. It explores older adults' experience of living in two towns in an 'age-friendly' county and, in parallel, examines stakeholders' perspectives on the development of the county's age-friendly programme. This multi-perspectival approach facilitates an assessment of how the age-friendly county programme addresses older residents' needs, and illustrates how the WHO conceptual and planning framework has worked in an Irish context. Methods The paper reports on a study which employed a mixed-method, qualitative case-study research design, using a constructivist grounded theory approach to explore the lived experience of older adults, and a case-study framework for the stakeholder perspective. Results The research identifies salient social and cultural dimensions of the day-to-day lived experience of older people which, although they impact on the age-friendliness of the places in which they live, are neglected in the WHO framework. It also identifies a unique combination of economic, political, cultural, and organisational factors which have impacted on age-friendly programme development in Ireland. Conclusion In critically analysing use of the WHO age-friendly model, the paper suggests ways in which the model can be modified to better accommodate the diverse experience of older adults not only in Ireland, but also in other geographic and cultural contexts. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic has impacted health care, economies and societies in ways that are still being measured across the world. To control the spread of the virus, governments continue to appeal to citizens to alter their behaviours and act in the interests of the collective public good so as to protect the vulnerable. Demonstrations of collective solidarity are being consistently sought to control the spread of the virus. Catchphrases, soundbites and hashtags such as 'we're all in this together', 'stronger together' and other messages of unity are employed, invoking the sense of a collective struggle. However, this approach is fundamentally challenged as collectivist attitudes run contrary to the individualism of neoliberal ideology, to which citizens have been subjected. This paper argues that attempting to employ the concept of solidarity is inherently challenged by the deep impact of neoliberalism in health policies and draws on the work of Durkheim to examine the concept in a context in which health care has become established as an individual responsibility. The paper will argue that a dominant private-responsibility model and an underfunded public system have eroded solidarity weakening its effectiveness in generating concerns for the collective. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity has emerged as a major challenge facing health services globally, which will place a substantial burden on health systems going forward. This paper seeks to estimate the association between multimorbidity and direct healthcare costs among older people in Ireland from a healthcare system perspective. Methods: Cross-sectional analysis of data on 8,447 community-dwelling adults aged 50 and over collected between 2009 and 2011 as part of the Irish Longitudinal Study on Ageing. Multivariable generalised linear model regression, employing a log-link and Poisson family distribution, is used to assess the association between self-reported multimorbidity status and direct healthcare costs. Results: For the full sample, 21.20% reported having no chronic conditions, 27.39% had one chronic condition, and 51.40% had multimorbidity. After controlling for a range of socio-demographic and health status variables, we found that relative to those reporting no chronic conditions, one chronic condition was associated with additional average annual costs of €513 (95% CIs: 245, 781), increasing to €1277 (95% CIs: 942, 1612) for those with 6 or more chronic conditions. Relative to those reporting 2 chronic conditions, 4 chronic conditions were associated with additional costs of €411 (95% CIs: 106, 716), 5 chronic conditions with €591 (95% CIs: 214, 969), and 6 or more chronic conditions with additional average costs of €1006 (95% CIs: 641, 1371). Conclusion: This study finds positive and significant associations between the number of chronic conditions and direct healthcare costs and further highlights the potential economic benefits from preventing the onset and progression of multimorbidity [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a novel community development and how the synergies arising from the interaction of diverse perspectives (including arts and health, person centredness, co-production and shared leadership) have led to a transformative initiative for individuals and a local community in the Republic of Ireland. Design/methodology/approach: This is a descriptive case study. It includes the personal narrative of an expert by experience who is one of the co-authors. Links to short digital films are also included along with references to internal evaluation documents and published literature. Reflections from the nurses who contributed to the initiative and a university academic are also incorporated. Findings: A space in the community built around the principles of relational practice has evolved into an alchemical space, enabling creativity, recovery and well-being. The benefits arising out of this network of social relationships have contributed to personal recovery, integration with the local community and generated social capital. This has enhanced mental health and well-being locally. Practical implications: Statutory Irish health policy is reflective of developments in health care internationally, with an emphasis on greater delivery of care in the community. This views citizens as active partners in the maintenance of their health and well-being. This case study illustrates how this has unfolded in practice in a rural mental health community context. Originality/value: This paper adds to the evidence base that demonstrates the potential benefits of participation in the arts to individual recovery journeys. In addition, it shows that when arts and health perspectives coalesce with the wider domain of relational practice, the synergies arising contribute positively to the health and well-being of local communities. [ABSTRACT FROM AUTHOR]

The term value‐based healthcare (VBHC) describes an approach to the organization and delivery of care that emphasizes reducing the cost of care while improving outcomes. This involves increased investment earlier in the care pathway e.g., in the prevention, timely diagnosis, and screening for complications in order to maximize the overall impact of care. Key elements of VBHC include the collection and interpretation of relevant data to drive quality improvement and appropriateness of care, a focus on a continuum of care from prevention through to complications, an awareness of the financial drivers of the cost of care and a recognition that meaningful outcomes of care are those that are important to patients. Although VBHC has its origins in North America and has mostly been applied to private health systems, the principles can also be applied to national health services. In publicly funded health systems, where resources are finite, VBHC initiatives aim to eliminate ineffective care that has no beneficial impact or added value for patients and to optimize patient outcomes by delivering care that meets the changing healthcare needs of a population over time. The National Health Service in Wales has established a VBHC Office and has begun to realize the benefits of adopting VBHC approaches. The Irish Health Service Executive (HSE) can learn from the approaches used in Wales. In this paper we explore some of the principles of VBHC through case studies from Ireland and Wales highlighting how national health services are using VBHC to achieve improvement in outcomes for people living with diabetes. [ABSTRACT FROM AUTHOR]

Background: Supporting psychosocial well‐being in aphasia is necessarily person‐centred, interdisciplinary and coordinated. Shortcomings in such support are described in Ireland and elsewhere. Speech and language therapists (SLTs) are integral; and describing current practice and barriers they experience is important for enhancing service delivery. Aims: To understand how SLTs enact, and are supported to enact, aphasia psychosocial care in Ireland. Methods & Procedures: This is a cross‐sectional, online, self‐administered clinician survey targeting SLTs working minimally 1 year post‐qualification with persons with aphasia of any aetiology in Ireland. The survey questions were charted against key constructs of the implementation science framework, normalization process theory (NPT), and descriptive statistics were applied. Outcomes & Results: A total of 54 eligible datasets were included. SLTs believed psychosocial support to be part of their role, but perceived multiple barriers in enacting it. These included a lack of training, clinical supervision, management support, role recognition, and access to and joint working with mental health professionals and services. Conclusions & Implications: SLTs in Ireland face a range of individual and structural barriers, including care coordination and resourcing. There is a clear need not only for training, upskilling and mentorship, but also for wider changes around access to mental health professionals and clarity around the processes of referral, coordination and integration of aphasia care across settings. These findings comprise preliminary insights into current practices. Further research is needed as well as clarity on best‐practice pathways for different aetiologies of aphasia. Articulating current practices using NPT may have utility for developing empirically informed and principled interventions to improve service delivery. WHAT THIS PAPER ADDS: What is already known on this subject: People with aphasia of all aetiologies are at risk of psychosocial problems. Shortcomings in access and the availability of appropriate support have been documented both internationally and in Ireland. To address this issue, an important first step is to understand how SLTs in Ireland currently enact and are supported to enact aphasia psychosocial care. What this study adds to the existing knowledge: The findings describe the potential levers and barriers to progressing aphasia psychosocial care in Ireland. A range of individual, team and structural factors were identified. These were locally contextualized but similar issues are reported in other countries. Linking attitudes with NPT constructs provides a first step for further principled implementation projects. What are the practical and clinical implications of this study?: Addressing psychosocial problems is perceived as a legitimate part of the speech and language therapy role. SLTs in Ireland enact a range of therapeutic approaches but may need opportunities for formal training and supervision, and for better coordination and integration with other mental health services and disciplines. Understanding differences in care pathways across the range of aphasia aetiologies is additionally important given the emphasis on post‐stroke aphasia in the literature. [ABSTRACT FROM AUTHOR]

Irish health and social care policy has undergone a significant evolution in recent years to address inequalities, improve standards and update models of care to incorporate a rights‐based approach. The following account describes the Irish health and social care system, as delivered in the Republic of Ireland, and details how it operates for those with intellectual and developmental disabilities. The paper is informed by government policy, legislation, reviews, national plans, parliamentary reports, and population data. Clear progress has been made in shifting from a service‐led to a rights‐based, service‐user led model of care; however, resourcing this fundamental transition in approach to service provision poses challenges for the Irish State. [ABSTRACT FROM AUTHOR]

Background: Recent research, which explored the use of Quality Improvement (QI) methods in the Covid-19 pandemic response, found that Quality Improvement principles were utilised during the crisis management period, albeit without direct intention. Following on from this work, the aim of this paper extends that study by investigating the sustainability and resilience of not only the changes implemented by healthcare staff during Covid-19 in Ireland, but the resilience of the wellbeing of healthcare staff themselves through the various waves of Covid-19. Methods: To explore healthcare staffs experience of Quality Improvement and the sustainability and resilience of both Quality Improvement initiatives and healthcare staff, a qualitative design was implemented. Semi-structured interviews took place online over Zoom with 11 healthcare staff members from the Irish healthcare service in the Spring of 2022. An analysis of the narratives was conducted using thematic analysis supported by NVivo12. Results: Four key themes were evident from the data: (i) From fear to exhaustion; (ii) maintaining person-centred approaches to care; (iii) Covid-19 as a medium for change, and; (iv) staff resilience and appetite for Quality Improvement. Discussion: The results of this work identified three key learnings; (i) integrating learning into policies and practice: (ii) the role of collective leadership and devolving/sharing power; and (iii) key drivers/factors that promote sustainability of QI interventions. Despite the challenges in recruitment of research participants experienced during the pandemic, a narrative approach supported the collation of rich and nuanced insights into the experiences of healthcare staff during this time. Conclusion: A growing body of literature currently exists on how healthcare staff felt during the Covid-19 pandemic. However, as the waves of Covid-19 have declined, it is vital to examine how the feelings of burnout and disillusionment will affect engagement with Quality Improvement in the future. It is also worth noting and examining the feeling of purpose and pride participants expressed from working through the Covid-19 pandemic. This study has helped to address this gap. [ABSTRACT FROM AUTHOR]

Purpose Academic researchers are increasingly required, and rightly so, to demonstrate the impact of their work beyond the gates of the university. This has led to an increasing focus, especially in response to funded calls, on developing research partnerships that cross disciplines, sectors and borders to help address our grand societal challenges. The purpose of this paper is to set out learning from the work of the organisation the Centre for Ageing Research and Development in Ireland (CARDI) and reflections on how to bring forward effective research partnerships involving users.Design/methodology/approach This paper is based on reflections and learning from the organisation CARDI which delivered a highly successful programme of interdisciplinary, cross-sectoral and cross-country research partnerships in both rural and urban areas between 2007 and 2015, across the island of Ireland.Findings Research partnerships that wish to involve users require time, commitment, support, understanding and a willingness to change and be challenged. This paper highlights that there are methodological, philosophical, moral, economic and of course, practical aspects to be considered.Research limitations/implications This reflective paper is based on a case study from the island of Ireland during the period 2007–2015 working in the area of ageing and older people.Practical implications The author emphasises that for research partnerships involving users to be successful, they need to not only consider the most effective research methods but also focus on the overarching purpose of the work and adopt an ethos and practice that maximises each partner's knowledge and expertise to their full potential.Social implications This reflective paper focused on the characteristics associated with partnership success, i.e. communication style, values, philosophy and practice and argues that establishing effective and inclusive partnerships requires time, the appropriate framework and reviewing the process on an ongoing basis.Originality/value The issue of user involvement in research partnerships requires much more consideration. Researchers, government, funders, businesses and service providers are increasingly recognising the benefits of "user" involvement to help design programmes and services that are most effective. Nowhere is this more important than in planning and delivering services, policy and programmes for our ageing population. [ABSTRACT FROM AUTHOR]

This paper reports on the findings of a pre-post and follow-up evaluation of a sexual health promotion programme in Ireland. Substantial progress in skills, knowledge, confidence and comfort were reported by participants which were to a large extent maintained over time. Evidence emerged of the successful translation of learning into practice in a number of areas, including engaging proactively with service users about sexual health and developing educational programmes and materials. The paper highlights contextual factors that support and inhibit sustainable changes to practice that need to be addressed in order to maximise the impact of capacity building education. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline the historical background and policy context of mental health services for people with intellectual disability (ID) in Ireland. It then considers recent implementation and lessons from the Irish experience.Design/methodology/approach The policy background and research literature relevant to the development of mental health services for people with ID in Ireland was reviewed and discussed.Findings Mental health services in Ireland remain in a state of change, moving towards the implementation of specialist multi-disciplinary teams in the community, alongside previous models of care and service.Research limitations/implications This paper summarises recent advances and research regarding mental health services for people with ID in Ireland.Practical implications The paper illustrates the process of delivering changes to mental health services with practical implications for mental health services internationally.Originality/value This is the first paper in many years to summarise the development of mental health services for people with ID in Ireland. There has been considerable recent change and it is therefore important to provide a useful reference for the current status of services. [ABSTRACT FROM AUTHOR]

Background & Objective: Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health‐care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. Setting and Participants: Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. Results: Participants' needs were grouped into five themes: support managing physical health‐care issues; access to community/home‐based services; EB‐specific information and psychosocial support; effective interaction with health‐care professionals; and advice regarding benefits and entitlements. Discussion and Conclusions: This article represents the health‐care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition. [ABSTRACT FROM AUTHOR]

The aim of this study was to provide evidence of the acceptability of the primary care psychology services that have been enhanced by the employment of assistant psychologists in Ireland to the parents of children with psychological difficulties. Data were collected from a sample of 74 parents who responded to quantitative and qualitative questions on the experience of service questionnaire. Reflexive thematic analysis was used to analyse the questionnaire responses. On average 88% of participants selected 'certainly true' in response to the statements in the experience of service questionnaire statement they were 'Totally satisfied'. Three major themes were developed; 'communication is more than talking', 'structure can facilitate or impede', and 'emotional reactions'. 'Communication is more than talking' is organised around communication The 'structure can facilitate or impede' acknowledges that systems influence psychological supports. 'Emotional reactions' captured parents' experiences, such as joy, frustration, and solidarity. The results demonstrate that the newly enhanced mental health service is acceptable to parents. Their voices provide ideas about what helps and hinders their experience of care. [ABSTRACT FROM AUTHOR]

Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population. [ABSTRACT FROM AUTHOR]

Background: Patients and family members make complaints about their hospital care in order to express their dissatisfaction with the care received and prompt quality improvement. Increasingly, it is being understood that these complaints could serve as important data on how to improve care if analysed using a standardized tool. The use of the Healthcare Complaints Analysis Tool (HCAT) for this purpose has emerged internationally for quality and safety improvement. Previous work has identified hot spots (areas in care where harm occurs frequently) and blind spots (areas in care that are difficult for staff members to observe) from complaints analysis. This study aimed to (i) apply the HCAT to a sample of complaints about hospital care in the Republic of Ireland (RoI) to identify hot spots and blind spots in care and (ii) compare the findings of this analysis to a previously published study on hospital complaints in the UK.Methods: A sample of complaints was taken from 16 hospitals in the RoI in Quarter 4 of 2019 (n = 641). These complaints were coded using the HCAT to classify complaints by domain, category, severity, stage of care and harm. Chi-squared tests were used to identify hot spots, and logistic regression was used to identify blind spots. The findings of this study were compared to a previously published UK study that used HCAT to identify hot spots and blind spots.Results: Hot spots were identified in Irish hospital complaints while patients were receiving care on the ward, during initial examination and diagnosis, and while they were undergoing operations or procedures. This aligned with hot spots identified in the UK study. Blind spots were found for systemic problems, where patients experience multiple issues across their care.Conclusions: Hot spots and blind spots for patient harm can be identified in hospital care using the HCAT analysis. These in turn could be used to inform improvement interventions, and direct stakeholders to areas that require urgent attention. This study also highlights the promise of the HCAT for use across different healthcare systems, with similar results emerging from the RoI and the UK. [ABSTRACT FROM AUTHOR]

The diagnosis of borderline personality disorder (BPD) has been found to carry stigma and poor hope of recovery. More recently, it has been regarded as a treatable condition through psychotherapy. Despite this, patients often experience lengthy hospitalizations, limited access to treatment, and poor outcomes. This paper describes the experiences of psychiatric nurses working with people diagnosed with BPD in acute mental health in‐patient settings in Ireland. Seven nurses were interviewed, and the transcripts were analysed using a reflective and inductive approach. Overall, the nurses did not feel confident that their interventions were effective or valued by the wider service or patients. The nurses articulated their invidious professional circumstances, whereby they were required to act in ways, which ran counter to their vision of therapeutic or recovery‐focused work. These views and perceptions that in‐patient care is often ineffectual are widely echoed in the literature. We contend that the effect of this circumstance for these nurses approaches moral distress. The nurses were aware of more effective methods of care and treatment for BPD but perceived that they were unable to influence the culture of in‐patient care. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to and use of health and social care services by adults with learning disabilities during the COVID-19 pandemic in England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected in three waves between December 2020 and September 2021 and concerned the use of health and social care services during the COVID-19 pandemic. Data were collected at one or more time-points directly from 694 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 447 adults with learning disabilities. Findings: Many people with learning disabilities who reported regularly accessing services/supports pre-pandemic were not receiving them during the timeframe of this study. There were indications of increasing access to some services and supports between Wave 2 and 3, but this was not universal. Practical implications: People in Cohort 2, who were likely to have severe/profound learning disabilities, were less frequently reported to access online community activities than people in Cohort 1, which is likely to exacerbate existing social isolation for this cohort and their family carers. Service providers should seek to ensure equitable access to services and activities for all people with learning disabilities in the event of future lockdowns or pandemics. Originality/value: This is the largest longitudinal study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. We primarily collected data directly from adults with learning disabilities and worked with partner organisations of people with learning disabilities and family members throughout the study. [ABSTRACT FROM AUTHOR]

Introduction: Early assessment and management of depression and/or anxiety for patients post stroke is critical. However, suboptimal provision of psychological care is widely reported. Nurses are the largest professional group to care for patients post stroke and have an important role in addressing their emotional wellbeing. Aim: The aim of this paper is to examine nurses’ knowledge, experiences, and perceptions of the provision of psychological care to patients post stroke in Ireland. Methods: A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of seventy-four (n=74) nurses working in six Irish community hospital rehabilitation units. Results: Fifty one (n=51) questionnaires were completed and returned which represented a 69% response rate. Findings demonstrate suboptimal psychological care provision for patients post stroke with no formal pre-defined care pathways. Despite nurses’ knowledge of psychological problems and symptomology, participants revealed receiving limited training in psychological monitoring and no systematic allocation of psychological care duties. This research suggests that pre-defined/formal care pathways; access to psychology expertise; further training and support for members of the Multi-Disciplinary-Team has the potential to improve the provision of psychological care for patients post stroke. Conclusions: This study has implications for the reform and development of rehabilitation services in relation to practice, education, and research. It identifies opportunities to support nurses to improve the delivery of psychological care for patients post stroke. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with multimorbidity in deprived areas experience worse health outcomes and fragmented care. Research suggests that primary care-based link workers providing social prescribing have potential to improve health and well-being. This paper reports the results of a pilot study conducted in preparation for a randomised controlled trial (RCT) that aims to test the effectiveness of primary care-based link workers providing social prescribing in improving health outcomes for people with multimorbidity who attend general practices in deprived areas in Ireland. Methods: An uncontrolled pilot study of an intervention based on the Glasgow Deep End links worker programme, in a single general practice, tested the feasibility and acceptability of planned processes for a RCT. Outcomes were recruitment and retention rates and acceptability of the trial processes and intervention to patients, general practitioners (GPs) and the link worker. Structured interviews were conducted with six patients, the link worker and two GPs within the practice and analysed using descriptive qualitative analysis. Feedback from a Public Patient Involvement group and an Implementation Advisory Group of key stakeholders was incorporated into the evaluation process. Results: Twelve out of 14 patients completed the intervention. Selection and recruitment processes were lengthier than expected. GPs recommended including psychosocial need in the selection process. Interviewed patients, the GPs and the link worker were positive about the intervention. Conclusion: A range of adaptations were identified for the main trial, mainly considering psychosocial need in the selection process to reflect normal referral pathways. This has resulted in a pragmatic RCT design. [ABSTRACT FROM AUTHOR]

This research explores service providers' views on the barriers that prevent women in the sex work industry in Ireland from accessing co-ordinated health services. A purposive sample of eight service providers in the field of women's health and social care in the West of Ireland were selected and interviewed for this study. The service providers were asked about their perception of the barriers of sex workers accessing health and social care services. Using thematic analysis, three key themes were identified: (1) lack of knowledge of women's involvement in sex work; (2) identified barriers to health services; and (3) legislative and policy barriers to providing supportive services. While the service providers acknowledged that they do not knowingly provide services for sex workers, they all recognise that some of their service users are at risk of, and potentially are, involved in sex work. Yet, they were able to identify some of the barriers sex workers face when accessing their services. All these barriers were the result to the services' limited capacity to support women engaging in sex work. At the time of data collection, the legislative context meant that selling sex under certain conditions was outside the law. This study highlights the consequences that criminalisation can have on the health of sex workers and the need for a paradigm shift in existing health and social care services. In this paper, we propose that a social justice rather than a criminal justice approach has the potential to address sex workers' right to access appropriate health care. This paper gives due recognition to marginalised women, and advocates for better provision of services for women in the sex industry, while considering the new legislation of 2017. [ABSTRACT FROM AUTHOR]

The article offers information on a study related to the challenges faced by business process management (BPM) in Irish healthcare sector. It reports that the study aimed at developing a framework outline for analyzing the system implementation of management projects of healthcare process in Ireland. It informs that the study also developed the standardization of healthcare human resource and payroll for the Irish healthcare sector. It reports that the paper provides information on business process management (BPM) project in order to determine the BPM success factors which are required raising awareness for both managerial factor and content factors.

Nursing and midwifery practice has evolved, with many nurses and midwives now holding prescriptive authority. This paper reports on findings in relation to care which formed part of a broader qualitative study which aimed to explore the experiences of nurse and midwife prescribers in the maternity setting in Ireland. Following research ethics approval, 16 nurse/midwife prescribers participated in one-to-one audio recorded semi-structured interviews. Prescriptive authority both enhances the caring role of the nurse/midwife and supports safer care. The ways in which this happened have been illuminated though barriers have also been identified. In order for the full potential of nurses/midwives with prescriptive authority to be realised, measures such as increasing the number of prescribers and the provision on non-interruption zones need to be considered. [ABSTRACT FROM AUTHOR]

Recent policy developments in Ireland have led to a focus on research capacity building as a means of consolidating nurse and midwifery education in the Irish academic setting. This follows similar initiatives in the United Kingdom and Australia. However, sparse literature and a lack of clarity of the term ‘research capacity building’ leads to some confusion. A concept analysis using Rodgers' framework was conducted. The literature examined included ‘grey’ literature, policy documents and indexed papers across a range of disciplines, derived from CINAHL/PubMed searches. The concept of research capacity building was deemed to imply a funded, dynamic intervention operationalized through a range of foci and levels to augment ability to achieve objectives in the research field over the long-term, with aspects of social change as an ultimate outcome. This is presented as an interim statement because of the evolutionary nature of the concept and the limitations of the exercise. [ABSTRACT FROM AUTHOR]

Background: A new class of antibody-based drug therapy with the potential for disease modification is now available for Alzheimer's disease (AD). However, the complexity of drug eligibility, administration, cost, and safety of such disease modifying therapies (DMTs) necessitates adopting new treatment and care pathways. A working group was convened in Ireland to consider the implications of, and health system readiness for, DMTs for AD, and to describe a service model for the detection, diagnosis, and management of early AD in the Irish context, providing a template for similar small-medium sized healthcare systems. Methods: A series of facilitated workshops with a multidisciplinary working group, including Patient and Public Involvement (PPI) members, were undertaken. This informed a series of recommendations for the implementation of new DMTs using an evidence-based conceptual framework for health system readiness based on [1] material resources and structures and [2] human and institutional relationships, values, and norms. Results: We describe a hub-and-spoke model, which utilises the existing dementia care ecosystem as outlined in Ireland's Model of Care for Dementia, with Regional Specialist Memory Services (RSMS) acting as central hubs and Memory Assessment and Support Services (MASS) functioning as spokes for less central areas. We provide criteria for DMT referral, eligibility, administration, and ongoing monitoring. Conclusions: Healthcare systems worldwide are acknowledging the need for advanced clinical pathways for AD, driven by better diagnostics and the emergence of DMTs. Despite facing significant challenges in integrating DMTs into existing care models, the potential for overcoming challenges exists through increased funding, resources, and the development of a structured national treatment network, as proposed in Ireland's Model of Care for Dementia. This approach offers a replicable blueprint for other healthcare systems with similar scale and complexity. [ABSTRACT FROM AUTHOR]

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care. [ABSTRACT FROM AUTHOR]

This paper details preliminary explorations of how the Power Threat Meaning Framework (PTMF) may be applied in an early intervention youth mental health service. The PTMF is discussed under the organisation's strategic priority of influencing change regarding youth mental health in Ireland. [ABSTRACT FROM AUTHOR]

This paper describes a research study carried out in Ireland looking at transport provision in rural areas in Ireland. The objective of the study was to look at experiences of older people in rural Ireland and to assess how well current levels of transport provision were meeting their transport needs. A series of focus groups with older people living in rural areas was conducted in different parts of rural Ireland, both in the Republic of Ireland and in Northern Ireland. A number of interesting findings were revealed. This paper focuses on the findings relating to health trips and accessibility of health services. It was apparent that trips to health facilities (such as doctors, clinics, and hospitals) were the most important trips for older people and were also the most difficult trips to make in rural areas. It was clear that this was due to a lack of synergy between transport operators and health service providers and also a lack of synergy and coordination between government bodies devising and implementing health policy and government bodies implementing transport policy. It was also discovered that driving cessation is a major issue for older people in rural Ireland, who are often forced to give up their car at some point due to ill health or visual impairment and that this leads to significant decreases in relative mobility. [ABSTRACT FROM AUTHOR]

Introduction: The Patient Narrative Project was initiated in 2016 to position the voice of patients and service users centrally in the design and implementation of Integrated Care. This paper presents the findings from Phase Two; the piloting of a qualitative survey tool called 'Your Voice Matters' (YVM) to capture a high volume of patient experiences and analysing these to find out the extent to which the person centred coordinated care indicators were made real during 2017. Methods: YVM utilises the SenseMaker® software tool and is underpinned by a partnership approach between service users and providers. The framework is dynamic and can be used to provide real time feedback to inform changes at local levels. The YVM framework consists of: - An online survey that utilizes the SenseMaker® software programme - Engagement plan to maximize service user participation, knowledge and empowerment - Analysis of data by staff and service users together - Identification of key themes and actions to influence the design and delivery of services The survey was available online, in a paper copy or through an app for smartphone or tablet. Results: There were 584 responses. 52% patients/service users and 45% carers, family/friends. 63.8% of respondents were female. A national workshop of service users and providers was held to review, analyse and interpret the data from the pilot together and identify key themes using a Quantitative Evaluation Matrix. The key issues that impact on successful implementation of integrated care were identified as: Limited joined up communication between patients and healthcare staff and between healthcare settings Limited evidence of partnership approach in healthcare Challenges in accessing services is a concern for service users Patient Experience is a driver for sustainable quality health and social care services Person-centred co-ordinated care is not yet a lived reality for patients and service users despite the rhetoric in health and social care strategy Discussions: The results from Phase 2 give a clear direction of travel for person centred integrated care and show that the approach being taken currently is attempting to address the issues raised. The results also challenge us to move more rapidly towards co-production Conclusions (comprising key findings): The journey towards person centred coordinated care has only begun and although much progress has been made, there is much more to be done and more rapidly. There is a real appetite among patients, carers and healthcare professionals to co-produce solutions. Lessons learned: Clear governance and the need for senior buy is very important. Although often stated, it is not always apparent in actions. Regular communication with key stakeholders and local buy in is key to success. Limitations: There were only 584 responses. More responses will be required to inform the design and operation of health and social care at local levels. Future research: A more detailed analysis of the outputs from Phase 2 is planned which will inform Phase 3. A collaboration involving several countries in the use of this technology would be a positive development. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate the usefulness of the first Trialogue Meetings throughout Ireland for individuals from mental health communities by using a participatory action research (PAR) framework.Design/methodology/approach Seven communities participated in monthly Trialogue Meetings as a community-based PAR project. A mixed-methods PAR evaluation was performed on data from 48 participants (service users, service providers, family members/friends and interested community members) who participated in the final Trialogue Meetings.Findings Participants identified that Trialogue increased knowledge/awareness of mental health, irrespective of gender, mental health role, age or employment status. Trialogue Meetings provided a supportive environment for many, where men may be comfortable talking and where service providers may benefit from exposure to broader perspectives on mental health. Participants also perceived that Trialogue Meetings deconstructed pre-existing mental health power structures, allowed them to understand mental health from different perspectives and express themselves better.Research limitations/implications The study identifies barriers to Trialogue efficacy such as low service provider engagement and political dynamics extraneous to the meetings themselves.Practical implications Where desirable conditions are present, Trialogue Meetings appear to be sustainable community development initiatives where pre-existing mental health power dynamics may be levelled and knowledge/communication surrounding mental health may be enhanced.Originality/value This is the first large-scale evaluation of the innovative Trialogue method among mental health stakeholders using a PAR approach. [ABSTRACT FROM AUTHOR]

Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches. [ABSTRACT FROM AUTHOR]

Aim. To identify the barriers and enablers to the implementation of a national policy to increase and develop the advanced nurse practitioner (ANP) workforce in Ireland. Background. The Department of Health (Ireland) introduced a policy to increase the number of ANPs to 2% of the nursing workforce. Evaluation provides information to inform successful policy implementation and development of ANP roles in healthcare services. Methods. Qualitative descriptive design. Twenty candidate ANPs participated in four focus groups. Nine key stakeholders were also interviewed. Results. Analysis identified four barriers: lack of infrastructural resources; delay in releasing and arranging replacements for candidate ANPs; role resistance from administration, allied healthcare professionals and other nurses; and lack of organisational readiness. The five enablers were: supportive physicians; Nursing and Midwifery Practice Development Units; supportive directors of nursing; role awareness and clarity; and educational preparation. Conclusions. This evaluation identifies barriers and enablers to the implementation of a national policy to increase the critical mass of advanced practitioners within the healthcare services. Evaluation at the implementation phase informed the roll-out of future advanced practice initiatives. Implications for Nursing Management. To support advanced practice development, leadership, infrastructure, and resource planning are needed to harness known enablers and address identified barriers to the implementation and sustainability of these posts. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is the world's leading cause of viral acute lower respiratory infections (ALRI) in infants. WHO has identified maternal RSV vaccination a priority and candidate vaccines are in development; however, vaccine hesitancy remains an impediment to successful implementation of maternal immunization. This study, the largest antenatal survey conducted to‐date, aimed to examine maternal RSV awareness, likely acceptance of RSV vaccination in pregnancy, and attitudes to maternal vaccination. Methods: Pregnant women of all gestations attending antenatal clinic of a university maternity hospital in Ireland were invited to participate. An information leaflet provided, consent obtained, and survey administered examining RSV awareness, willingness to avail of antenatal RSV vaccination, factors influencing acceptability and preferred sources of assistance. Research Ethics Committee (REC) approval obtained, and general data protection regulation (GDPR) guidelines followed. Results: 528 women completed the survey. A large proportion (75.6%) had never heard of RSV, yet 48.5% would still avail of a vaccine, 45.8% were undecided and only 5.3% would not. The main factor making vaccination acceptable to women (76.4%) was that it protects their infant from illness (p <.001, CV 0.336 for association with acceptance) and general practitioner (GP) was the preferred guidance source in decision‐making (57.7%). Conclusions: Despite low levels of maternal awareness of RSV, pregnant women in Ireland are open to availing of antenatal vaccination. Maternal immunization strategies need to focus on infant's protection from RSV‐associated ALRI along with vaccine safety, and build on an interdisciplinary collaboration of maternal, neonatal, primary care and public health services. [ABSTRACT FROM AUTHOR]

Background: In prosperous nations like Ireland, home support workers (HSWs) play an increasingly vital role in providing person-centred care to ageing populations. However, challenges such as workforce shortages, role ambiguity, low pay, and limited career advancement, hinder workforce development and career building. Method: A scoping review using key terms for "HSWs" and "career pathways" was conducted following the Joanna Briggs Institute Methodology, examining electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PscyINFO, Social Care Online, Social Sciences Citation Index). Inclusion criteria were applied, and a thematic analysis followed and inductive-deductive approach. Results: The review encompassed 261 relevant articles from different countries. Four key themes were identified: (1) Data-driven decision-making on the future workforce, (2) Attracting and developing a competent and motivated home support workforce, (3) Enhancing working lives and retention at every stage of career pathways, and (4) Crafting career pathways to improve quality and impact. Discussion: Leadership, collaboration, and data-driven decision-making across policy, research and practice are pivotal for expanding and enhancing home support. Emphasising a shift towards preventative self-management models, supported by digitally skilled and regulated HSWs, could enhance independence and quality of care. Clear career structures, professional development, and inclusive organisational environments are essential to attract, retain, and empower a competent and motivated workforce, fostering quality and impact. Conclusion: This scoping review provides foundational evidence to establish career pathways for HSWs, identifying key areas for development such as data collection, care model transformation, career progression structures, and systems for safety and quality improvement. [ABSTRACT FROM AUTHOR]

This document is a collection of abstracts from the Proceedings of the 6th UK and Ireland implementation science research conference. The abstracts cover a range of topics, including interventions to promote interprofessional collaboration in healthcare for older people, the impact of After Action Review on safety culture in an Irish hospital, and the process evaluation of a community-based, digital approach to improving health during pregnancy. Other abstracts discuss the feasibility of implementing rapid-learning methodology in radiotherapy treatment and the need for a standard methodology for patient and public involvement in addressing health inequalities. These abstracts provide valuable information for improving healthcare practices and offer insights into various aspects of implementation science. [Extracted from the article]

Endometriosis is an incurable chronic condition associated with debilitating pain and subfertility, affecting 1 in 10 women. The current study aims to explore the perceptions and experiences of women with endometriosis regarding the diagnosis, support and treatment options available in Ireland. It will further determine whether additional supports or improvements are needed to care well and effectively for women with this disease in the Irish healthcare system. A qualitative study design was deemed most suitable. Twenty participants, women aged 18 and over with a diagnosis of endometriosis and experience of the Irish healthcare system, were recruited through purposeful sampling to complete semi-structured, one-to-one online interviews. Data was analysed using reflexive thematic analysis, and five themes were identified: 'dismissive attitudes normalising severe pain', 'inadequate health system', 'the impact of delayed diagnoses', 'lack of education and awareness' and 'navigating ignorance, taboo and societal views'. Insights into the experiences and needs of women diagnosed with endometriosis in Ireland were gained, and we discuss the implications of our findings for Irish healthcare services with reference to feminist health equity and recent national action plans. We propose a series of recommendations for patient-centred care models including increased access to training and education, as well as support for longer-term chronic pain management. [ABSTRACT FROM AUTHOR]

Introduction: The paper provides the perspective of emergency managers within a healthcare service, using a multi-agency framework to coordinate a regional response to COVID 19. While health services play a role in the planning, response and recovery to major emergencies they are rarely the lead in coordinating the response. The exploration of existing research through Pauchant and Mitroff Onion Theory is combined with the challenges and experiences faced by emergency managers during the COVID 19 response in Ireland. The research mirrors the experience of emergency managers that preparedness and relationship building are key to quickly establishing a response. However the experience of emergency managers was that although shared situational awareness is critical a flexible system framework is required, particularly in a prolonged pandemic situation. A hierarchical command and control system can negatively impact on strong local relationships and problem solving capability. The experience of emergency mangers concurs with research that the development of a learning organization is pivotal in information preparedness before and during the response and recovery phase. The challenges of implementing lessons learned across a national health service can be challenging especially during an extended response phase. Method: A deductive manifest analysis approach was adopted to carry out a qualitative thematic content analysis of exercise reports and emergency debrief reports. Results: Research Questions Lessons learned in the five years prior to COVID 19 enhanced the response to the pandemic emergency–yes there are several examples of how lessons learned can improve response to seemingly unrelated emergencies. The principals of the MEM Framework in Ireland are applicable to a pandemic emergency–yes but this is dependent on local arrangements and relationships to allow flexibility in the implementation of the framework. Conclusion: Regular training and exercising as well as a debriefing of exercises and real emergencies enhances preparedness for emergencies. [ABSTRACT FROM AUTHOR]

In the nineteenth century the medicinal leech Hirudo medicinalis evolved into a lucrative commodity in great demand throughout the western world. In less than a century its trade became big business by any measure, involving tens of millions of animals shipped to every inhabited continent. In this context Ireland is particularly instructive in that it was the first country in Europe to exhaust its supply of native leeches. Concomitantly, it was also the first country to import leeches from abroad, as early as 1750. Being an island with manageable border controls, and a clearly definable medical market, Ireland serves superbly as a microcosm of the leech as a worldwide commodity. Being a relative small country it is possible for the first time to gain a balanced perspective of various economic factors underlying this trade, including supply and demand, exploitation of natural resources, and an evolving network of competitive traders. This paper addresses these and other aspects of the leech trade in Ireland. The principal, and unexpected, finding of this paper is that leeches were unequivocally very expensive in Ireland and became a significant drain on hospital budgets. As such, they found little use amongst the Irish poor. An estimate of several million leeches were imported into Ireland in the nineteenth century, a practice which continued into the twentieth. They were imported initially from Wales and then from France following the defeat of Napoleon, but the bulk came ultimately from Hamburg, via importers in England. [ABSTRACT FROM AUTHOR]

Migrant care workers make a substantial contribution to older adult care in Ireland and the United Kingdom (UK). However, little is known about the relational aspects of care involving migrant care workers and older people. Given that the care relationship is closely linked to quality of care, and that the Irish and UK sectors are increasingly restricted by economic austerity measures, this lack of information is a concern for care practice and policy. Our paper explores the relationship between migrant care workers and older people in Ireland and the UK and draws on data collected in both countries, including focus groups with older people (N = 41), interviews with migrant care workers (N = 90) and data from a survey of and interviews with employers. The findings illustrate the complexity of the migrant care worker–older person relationship; the prevalence of need orientated, friendship and familial-like, reciprocal, and discriminatory interlinking themes; and the role of individual, structural and temporal factors in shaping these relationships. [ABSTRACT FROM PUBLISHER]

This paper explores men's behaviour and attitudes in relation to health matters. While there has been some practical and research progress in engaging with users of health services, there is less development in the area of engaging non-users. In effect, all members of the society can be the consumers/users of health promotion, though not all are. This paper reports on the first stage of a wider project aimed at increasing the effectiveness of skin cancer awareness messages aimed at men. The project focuses on men over 50 from an area of socio-economic disadvantage, since these men tend to have the lowest life expectancies in general, and the highest incidences of mortality for skin cancer both at a national and international level. The research was conducted through community-based focus groups and while the sample was relatively, small it produced some interesting outcomes in terms of how this cohort audited and responded to public health promotion campaigns; how they perceive cancer and health issues in general; how they respond to health issues; and how they view both the public health service in Ireland and the ways health professionals relate to them. It confirms many theories about how men view their health and how they respond to health promotion campaigns. Among other points, it raises questions about the possible mixed benefits of testimonial-based advertising. It also indicates that there may be further layers of complexity connected to identity, fatalism, problem solving and respectful treatment that have not been sufficiently articulated in the literature. It points to the need for greater engagement by service planners and providers with the needs of their target audience, which may require a more encompassing definition of service user. [ABSTRACT FROM AUTHOR]

Healthcare is the keystone of a number of complex progressive social justice issues that evoke complex emotions. As the demography of Ireland rapidly changes, the practices and expectations of some asylum-seekers and others seeking refugee status present new opportunities and challenges for health-service providers. This paper looks at some of the emotions evoked in healthcare issues. It draws on observations and interviews from empirical fieldwork carried out for the Health Research Board. The research was conducted both in the Adelaide and Meath Hospital, incorporating the National Children's Hospital, Tallaght and in a number of refugee reception centres in Ireland. At one level, honouring faith choices within a healthcare setting is a societal acknowledgement—often made to people at their most vulnerable—that the potent and cathartic transformative rituals they value are significant in mediating and managing their emotions. This paper argues that, at another level, it is a practical and symbolic communication of a statutory commitment to interculturalism and community cohesion. [ABSTRACT FROM AUTHOR]

mckenna hp, keeney s&hasson f (2005) Journal of Clinical Nursing14, 426–434Views on the ground: teaching and clinical assessors’ views on vocational training for healthcare assistants in IrelandThis paper reports the views of teaching staff and clinical assessors on their experience of programme delivery and assessment.In 2001, the Irish Department of Health and Children developed a vocational training programme for healthcare assistants. This programme was piloted nationally across 14 hospital and community sites. Teaching staff and clinical assessors at each site delivered the programme.One-to-one semi-structured interviews were undertaken with 16 clinical staff and 26 teaching staff. With consent, all interviews were tape-recorded, from which the transcripts were subject to content analysis.A lack of experience and preparation among teaching staff and clinical assessors was evident. The staff's commitment to their role on the programme while maintaining their normal duties caused frustration and uncertainty. Not withstanding, the value of the programme in terms of increased motivation, satisfaction and knowledge of healthcare assistants and the impact on care delivery, was recognized by respondents.This programme represents the provision of a national standard training programme for healthcare assistants. It provides an insight into the delivery of such a programme and the educational and training needs of healthcare assistants through the views of staff that taught and assessed on it.Findings suggest that the development and implementation of a national training programme for healthcare assistants is achievable. [ABSTRACT FROM AUTHOR]

The World Health Organization have stressed the importance of nurses and midwives as a “force for health” in society's efforts to tackle the public health challenges of our time. The public health challenges are both diverse and complex. Principally, they emanate from a social model of health that takes cognizance of our behavior, our environment, and the historical, political, and cultural structures that facilitate health or militate against it. This paper provides a critical overview of public health nursing in Ireland, toward situating both our contribution to public health and some of the challenges that lie ahead of us. Specifically, it looks at nonquantifiable practice, where, through the presentation of stories, the wealth of public health nursing work is demonstrated in the ordinary voices of public health nurses. The potential risk of ignoring and minimizing the contribution of public health nursing in future developments in primary care in Ireland is discussed. Finally, it is proposed that public health nurses need to get political. [ABSTRACT FROM AUTHOR]

In a previous paper we described the transitional process that the concept and practice of clinicians in management is going through in Ireland.1 Following an exploration of the divergence of power and responsibility within current paradigms of clinical and administrative management, this paper addresses some of the root factors influencing such divergence. Training and education, when examined against a backdrop of current management structures, provide considerable insight into existing relationships and the future progression necessary to integrate clinicians into effective healthcare management structures. [ABSTRACT FROM AUTHOR]

This paper sought to determine the understanding of an expert panel of senior personnel in the Irish public healthcare system on ways of achieving evidence based resource allocation for all components of publicly funded healthcare in the Republic of Ireland. We used a policy Delphi survey to get the opinions of the expert panel and to facilitate consensus building among them. We analysed the data with deLoe method to determine the level and direction of consensus. The panel had high consensus on many of the propositions e.g. the inadequacy of data and data sharing modalities. Furthermore, the panel agreed on the amendment of the Data Protection Act (1988, 2003) to allow obligatory inclusion in healthcare databases of persons in receipt of publicly funded healthcare services. The results demonstrate the disposition of expert panel on the need for a change to an evidence based resource allocation formula, and the feasibility of its implementation. [ABSTRACT FROM AUTHOR]

The apparent speed and impact of creating a global digital landscape for health and social care tells us that the health workforce is playing catch-up with eHealth national programmes. Locating how and where the profession of nursing fits with future models of health service delivery is critical to provide focused engagement for the populations they serve. In 2016, Dublin City University (DCU) School of Nursing and Human Sciences (SNHS) created a research and development centre for International Classification for Nursing Practice (ICNP®) in Ireland. This paper provides a summary of the first year of the centre's research, describing how the initial activities link to the development of global eHealth policy. A key aspect of service delivery relates to defining care requirements, specifically to support sustainable intersectoral healthcare. Considering how nursing-sensitive language (clinical terminology) is best mapped is necessary to articulate the care requirements and processes to achieve optimal patient outcome. The World Health Organisational Framework for Integrated Care provides a pathway for crystallising the steep learning curve that the profession has currently found itself situated in, to deliver on contemporary digital healthcare. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery., At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members., What this paper adds to existing knowledge? This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland., In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy., What are the implications for practice? Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment., Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally., Abstract Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N = 1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care. [ABSTRACT FROM AUTHOR]

Background: Medical diaspora options, including the engagement of expatriate physicians in development efforts within their home country, are being called for to reverse the effects of brain drain from developing countries. This paper presents the results of a study exploring the potential contributions for the Sudanese Medial Diaspora Options to the healthcare delivery system (HCDS) in Sudan, focusing on the options of temporal and permanent returns and the likely obstacles faced in their implementation.Methods: This was a cross-sectional study using a mixed methods design including quantitative and qualitative approaches. For the quantitative approach, the study, which focused on the possible contribution of the diaspora to healthcare delivery in Sudan, was based on an online survey using random purposive and snowballing sampling techniques involving 153 Sudanese physicians working in Saudi Arabia and other Gulf States, the United Kingdom, the Republic of Ireland, and the United States of America. The qualitative approach involved in-depth interviews with returnee physicians and key informants in Sudan, focusing on the return experiences, the barriers for return, and the options to improve future contributions.Results: Despite contributions of the Sudanese medical diaspora being of a small scale considering the size of the phenomenon, as well as infrequent and not appropriately organized, their inputs to academia and the links built with overseas institutions and specialist clinical services were nevertheless remarkable. The main barrier to temporal return was inappropriate organization by the local counterparts, while those for permanent return of physicians were poor work environment, insufficient financial payment, unsecured accommodation, and offspring education. The study identified short-term return as a feasible option considering the country's current conditions. Proper coordination mechanisms for short-term returns and facilitation of permanent return through stakeholders' collaboration were proposed to improve diaspora contributions.Conclusions: The potentials of Sudanese medial diaspora contributions to the HCDS in Sudan are promising. Short-term contributions were observed as the best option for the current country situation. Creation of a coordinating body from within the healthcare sector in Sudan to effectively coordinate diaspora contributions is recommended. [ABSTRACT FROM AUTHOR]