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Background: Advanced practice nursing (APN) roles offer improved access to care and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles. Aim: To explore the implementation of APN roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles. Methods: A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well developed (Ireland, Spain, Norway and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, nursing associations and universities. The consolidated criteria for reporting qualitative research (CPREQ) has been used throughout. Limitations: The small number of countries when considering the size of the region and key informants representing the view of only three to four people in each country. Results: Four themes were identified, including the rationale for the development of the roles, influence, the evolutionary nature of role development and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation. Conclusion: Successful role implementation is dependent upon a tripartite approach between managers, practitioners and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation. Implications for nursing policy: APN policy should be based on patient needs rather than on the workforce or professional imperatives. The process of implementation can take 15–20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has had both a psychological and physiological effect on the human race. For those working in health care, particularly in critical care, the pandemic has put unprecedented strain on staff. Witnessing suffering during crisis in an organizational setting can be a traumatic experience and critical care nurses often risked, not only their own lives, but their psychological well‐being, so that those infected with the virus might have a better chance at survival. Aim: The aim of this study was to explore the challenges to mental health and psychological well‐being experienced by Critical Care Nurses during the COVID‐19 pandemic. Study Design: A longitudinal, qualitative study involving semi‐structured interviews with 54 critical care nurses across 38 hospitals in the United Kingdom and Ireland. Interviews were transcribed verbatim and analysed using thematic analysis. Results: Four key themes were identified which represent the challenges faces by critical care nurses during the COVID‐19 pandemic: Lack of control, Psychological trauma, Unexpected leadership, Public‐political betrayal. Conclusions: While public‐political praise may lead to a short‐term lift in morale for front line workers; where it is not accompanied by practical support in terms of appropriate equipment, leadership, emotional support and renumeration it is likely to be damaging in the longer term. Relevance to Clinical Practice: This study has provided a greater understanding of the factors which affected the well‐being and mental health of critical care nurses during a global pandemic. [ABSTRACT FROM AUTHOR]

Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation. [ABSTRACT FROM AUTHOR]

Background: Cancer survivorship is associated with co‐morbidities including anxiety, depression and cardiovascular disease (CVD). Rehabilitative care post‐treatment is vital for survivors' psychological and physical well‐being. The present study aimed to investigate breast cancer survivors' attitudes towards their health post‐treatment; their awareness of co‐morbidities associated with treatment; and their awareness of support systems available. Methods: A qualitative research approach was employed, using semi‐structured interviews with breast cancer survivors from the UK and Ireland. Data were analysed using thematic analysis. Eight breast cancer survivors were recruited through purposive sampling. Results: Two themes emerged from the data: (1) health and rehabilitation post‐treatment, which included mental and physical health and a desire to control one's own health in survivorship as well as a discussion around co‐morbidities, and (2) access to support services in survivorship, which highlighted both positive and negative experiences of accessing support, as well as reasons for not accessing support in survivorship. Conclusions: Access to rehabilitation support, including diet, exercise and stress management, is key to survivorship. Rehabilitation and support services need to be more readily available for survivors to aid them in this journey and to educate them on the increased risk of conditions such as CVD with cancer treatment. Utilising current cardiac rehabilitation models could be a solution to provide a holistic cancer rehabilitation, thus providing the lifelong support that cancer survivors both want and need. Key points: Access to rehabilitation support, including diet, exercise and stress management, is key to survivorship; however, access to support differed and was lacking for many survivors. Longer‐term comorbidities of cancer treatment were not fully understood. Therefore, there is a need for rehabilitation and support services to educate survivors on the increased risk of conditions such as cardiovascular disease with cancer treatment. These services must also address long‐term risk through lifestyle factors, including diet and physical activity. Utilising current cardiac rehabilitation models could be a solution to provide a holistic cancer rehabilitation, thus providing the lifelong support that cancer survivors both want and need. [ABSTRACT FROM AUTHOR]

The research goals were to obtain an understanding of who the users of e‐books in the NHS are, what they are using e‐books for, and when and how they use them. This article presents the methodology used and the findings from the research. It also explores the outputs and next steps from the research, both for the individual countries and collectively. The Five Nations group, (library leads in England, Northern Ireland, Ireland, Scotland and Wales) commissioned research into healthcare staff use and non‐use of e‐books to understand the behaviours, needs and expectations of healthcare staff and to identify shared challenges around e‐books to inform policy and practice. [ABSTRACT FROM AUTHOR]

Background: Limb strength is a central component of neurological assessment and monitoring in nursing practice, yet there is a lack of research examining the tools used by nurses or challenges nurses encounter when using these tools. The evidence base is lacking to inform effective practice and the underpinning educational approaches. Aim: To determine which tools are used by UK and Irish neuroscience nurses in the assessment of limb strength and the associated challenges and variations in practice. Methods: This study used an online self-reported survey design to ascertain which tools neuroscience nurses used and their experience of using these (n=160). Findings: Practices varied, with a dominance of two tools being used in practice: the Medical Research Council scale and the 'normal power' to 'no movement' scale found on the neurological observation chart. Most respondents used the same tool across all conditions. Conclusion: This study highlights variations in assessment practice and the absence of a sound evidence base behind choice of motor limb strength assessment tools used. [ABSTRACT FROM AUTHOR]

Despite efforts to reduce adolescent smoking via minimum age-of-sale legislation, many young people continue to access tobacco through a mix of social and commercial sources. Little is known about the roles of habitus, capital, and social topographies in shaping under-age access to tobacco. This article draws on Bourdieu's theory of practice and data generated from 56 focus groups with 14- to 19-year-olds across seven European cities to answer the question "via what sources and by what means do adolescents obtain tobacco?" We find that adolescents use a range of personal capitals (social, cultural, and economic) to access tobacco, with the specific constitution and deployment of these capitals varying according to the regularities of different fields. Since adolescents access tobacco via culturally embedded practices, attempts to curtail this access are more likely to be effective if they are multi-pronged, culturally informed, and attuned to the lived experiences of adolescent smokers. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well‐being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia‐related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims: To establish the current practices of SLTs managing dementia‐related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & Procedures: An anonymous, cross‐sectional web‐based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open‐ended questions were analysed using conventional content analysis. Outcomes & Results: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self‐rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & Implications: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well‐being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper addsWhat is already known on the subjectResearch indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice.What this paper adds to existing knowledgeThis paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints.What are the potential or actual clinical implications of this work?These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia‐related dysphagia and mealtime difficulties effectively. [ABSTRACT FROM AUTHOR]

Background: Palliative care is acknowledged as an appropriate approach to support older people in nursing homes. Ethical issues arise from many aspects of palliative care provision in nursing homes; however, they have not been investigated in this context. Aim: To explore the ethical issues associated with palliative care in nursing homes in the United Kingdom. Design: Exploratory, sequential, mixed-methods design. Methods: Semi-structured interviews with 13 registered nurses and 10 healthcare assistants (HCAs) working in 13 nursing homes in the United Kingdom were used to explore ethical issues in palliative care. The 'Ethical Issues in Palliative Care for Nursing Homes' instrument was used to measure the frequency and level of distress arising from ethical issues through a cross-sectional survey with 69 registered nurses and 129 healthcare assistants. Data collection occurred between December 2014 and November 2015. Ethical considerations: Ethical approval was granted by Queen's University's School of Nursing and Midwifery Research Ethics Committee and governance sought from each nursing home's manager. Findings: The interviews revealed three themes: ethical issues in practice; relational issues; and organisational issues. No significant differences between registered nurses and healthcare assistants were evident, confirming the patterns emerging from the interviews. Relational issues, primarily issues with residents and families, occurred most frequently and caused greater distress. Conclusion: The shared environment is key in the experience of ethical issues; therefore, multidisciplinary education is needed for ethical decision making in palliative care. Addressing staff knowledge and service organisation may reduce ethical issues locally and provide a benchmark for global change. [ABSTRACT FROM AUTHOR]

Despite the extensive literature on the tobacco industry, there has been little attempt to study how transnational tobacco companies (TTCs) coordinate their political activities globally, or to theorise TTC strategies within the context of global governance structures and policy processes. This article draws on three concepts from political science - policy transfer, multi-level governance and venue shifting - to analyse TTCs' integrated, global strategies to oppose augmented packaging requirements across multiple jurisdictions. Following Uruguay's introduction of extended labelling requirements, Australia became the first country in the world to require tobacco products to be sold in standardised ('plain') packaging in 2012. Governments in the European Union, including in the United Kingdom and Ireland, adopted similar laws, with other member states due to follow. TTCs vehemently opposed these measures and developed coordinated, global strategies to oppose their implementation, exploiting the complexity of contemporary global governance arrangements. These included a series of legal challenges in various jurisdictions, alongside political lobbying and public relations campaigns. This article draws on analysis of public documents and 32 semi-structured interviews with key policy actors. It finds that TTCs developed coordinated and highly integrated strategies to oppose packaging restrictions across multiple jurisdictions and levels of governance. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition that dysphagia has significant implications for a person's psychological well‐being, social participation and quality of life (QOL). However, a paucity of research exists regarding the clinical management of this area. To inform future research and the development of appropriate and beneficial resources and guidelines, a better understanding of the current practice of speech and language therapists (SLTs) in this area would be useful. This information will highlight current challenges to clinical practice and the ongoing development needs of the profession, which are, as of yet, undocumented. Aims: To determine the practices of SLTs when addressing QOL issues in individuals with dysphagia, the beliefs of SLTs regarding the impact of dysphagia on QOL, the current trends in assessing and managing QOL in dysphagia, and if variations in beliefs and practices in this area exist. Methods & Procedures: An anonymous cross‐sectional, non‐experimental survey study was used. The survey consisted of 18 questions exploring participants' beliefs and opinions regarding dysphagia and QOL, current clinical practice in the area, perceived facilitators and barriers, and education, training and development needs. The survey was created on Survey Monkey and disseminated by e‐mail link to SLT professional bodies. Purposive and snowball sampling were used and participants self‐selected based on the information provided alongside the e‐mail link. Inclusion criteria for the study were a qualification in speech and language therapy, proficiency in the English language, and access to a computer with the internet. Outcomes & Results: A total of 148 SLTs working across the UK, Ireland and South Africa completed the survey. Over 90% of respondents believe that dysphagia has a negative impact on QOL, but only 25% are currently satisfied with the amount of clinical time they can dedicate to this area. Staffing, resources, a lack of best‐practice guidelines and disease‐specific QOL assessment tools were cited as contributing factors. A number of facilitators and barriers to best practice were also highlighted. Based on these findings, professional development actions for the future are suggested. Conclusions & Implications: SLTs believe they have an important role to play in supporting QOL issues in dysphagia. However, it is reported that the area is currently under‐developed, under‐resourced and under‐supported. Increased awareness raising of the role of SLT, alongside the development of best‐practice guidelines and disease‐specific QOL assessment tools, will enhance the quality of care that can be offered in this area. [ABSTRACT FROM AUTHOR]

Survivors of clerical institutional childhood abuse (ICA) experience poor mental health outcomes in adulthood. Resilience research with this group has focused on psychological adjustment and we know less about the factors across the social ecology that support positive adaptation, including the impact of migration. This study explores the influence of resilience‐enhancing factors across the social ecology on the mental wellbeing (MWB) of Irish emigrant survivors of ICA and how this compares with non‐migrant survivors. Fifty‐six survivors based in the UK and 46 based in Ireland completed a quantitative survey that assessed resilience‐potentiating resources and associations with MWB. A further nine participants, resident in the UK, engaged in a structured interview which aimed to further explain these quantitative data. Results indicate more resilience‐enhancing resources across the ecology of emigrant survivors of ICA. Personal skills and competencies, such as problem‐focused coping, altruism and defiance, and social inclusion were associated with MWB regardless of country of residence. For the migrant group, social identity not defined by institutional care facilitated social inclusion. Migration to the UK and informal instrumental support in the aftermath of institutional care were identified as key turning points towards resilience. Key Practitioner Messages: Multiple factors across the ecology influence the resilience of survivors of institutional childhood abuse (ICA).Resilience strategies for survivors of ICA are contextual and may appear maladaptive to practitioners unfamiliar with the cultural context of this abuse.For Irish emigrant survivors of ICA, problem‐focused coping, defiance, altruism, social inclusion, instrumental support and a social identity not defined by childhood abuse enhanced resilience.Resilience is dynamic and emerges over time for adult survivors of chronic childhood abuse. 'Explores the influence of resilience‐enhancing factors across the social ecology on the mental wellbeing... of Irish emigrant survivors of institutional childhood abuse' [ABSTRACT FROM AUTHOR]

Understanding how survivors of complex trauma navigate towards resources can inform the design of interventions and health promotion strategies. However, there are little data on the resilience and help-seeking experiences of this group or others who have experienced institutional abuse in childhood. This empirical study sets out to illustrate the help-seeking experiences of Irish emigrant survivors of institutional childhood abuse (ICA). Twenty-two survivors of ICA were purposefully recruited from community organisations in the UK and data were collected via semi-structured interviews. As a result of negative initial help-seeking experiences in Ireland, most participants engaged in long periods of self-management and disclosed information about their childhood as part of a redress scheme in later life. Outside of this scheme, turning points, such as illness or family problems, and the needs of children were influential in seeking help. Peer support networks played an important role as a trusted signposting pathway towards formal interventions. Participants identified interpersonal barriers to formal help-seeking as helping professionals' failure to share control, insensitivity to identity loss and literacy issues, and the lack of explicit boundaries. The paper concludes with a discussion about the implications for research and future practice. Key Practitioner Messages: Turning points, such as illness and bereavement, and the desire to provide for children, influence the help-seeking of survivors of ICA., Irish emigrant survivors of ICA cite failure to share control, insensitivity to identity loss, literacy issues and the lack of explicit boundaries as barriers to help-seeking., General awareness of ICA can help practitioners in low-threshold services prevent against culturally insensitive practice., Peer support networks can provide uniquely trusted signposting towards formal interventions. [ABSTRACT FROM AUTHOR]

Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]