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• Immunisation nurses (IMNs) feel that HPV education for 15–17 year olds is important. • IMNs are highly motivated to design and deliver HPV education for adolescents. • IMNs are experts in HPV education and feel their skills are underutilized. • IMN barriers include time, resources, parental attitudes and teacher training. • Further collaboration between the PHA and the EA is key to IMN's role development. Human Papilloma Virus (HPV) is responsible for the development of cervical, vaginal, vulvar, penile, oropharyngeal and anal cancers. Throughout the UK, Immunisation nurses (IMNs) deliver school-based HPV vaccinations to students 12–13 years old. Providing HPV education to 15–17 year old students may promote decision-making regarding their sexual health and award opportunity for unvaccinated students to self-consent to the vaccination. This study aims to explore the perceptions of IMNs regarding the value of providing HPV education to 15–17 year old students and to explore whether IMNs feel that the design/delivery of this education should form part of their professional role. Six focus groups were conducted online with IMNs from all five Health and Social Care Trusts in Northern Ireland, UK, between January-June 2021. Data were analysed using the COM-B model to identify factors that might influence IMNs' behaviour towards designing/delivering this education for 15–17 year old students. IMNs were highly motivated to design and deliver this HPV education. Facilitators promoting this behaviour included their specialist training, their previous sexual health teaching experience and their desire to educate young people. Barriers negatively influencing this behaviour included lack of time/resources, parental influences, lack of school support and lack of teaching/presentation skills training. IMNs feel that they are the most appropriate professionals to design/deliver HPV education for 15–17 year old students. National policy change, based on collaboration between the Public Health Agency and Education Authority, is a key factor in facilitating IMNs to implement this school-based HPV education intervention. [ABSTRACT FROM AUTHOR]

Background: Anticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions. This study aimed to elicit the feedback of participating general practitioners, practice managers, nurses and an adjunct pharmacist on the implementation strengths and limitations of a nurse-led, person-centered anticipatory care planning (ACP) intervention for older people at risk of functional decline in a primary care setting. The findings have implications for a full trial and intervention design. Methods: As part of a feasibility cluster randomized controlled trial (cRCT) testing the ACP intervention, we sought feedback from implementing stakeholders: general practitioners (N = 3), practice staff (N = 3), research nurses (N = 5), and adjunct pharmacist (N = 1) in both the Republic of Ireland (ROI) and Northern Ireland (NI), UK. Following written, informed consent, they were interviewed to investigate their experience of participating in the implementation of the ACP intervention as part of the feasibility trial, and elicit any recommendations for a full trial. Using the Consolidated Framework for Implementation Research, thematic analysis was employed to analyze data. The intervention consisted of home visits by specially trained nurses who assessed participants' health, discussed with them their health goals and plans, and devised an anticipatory care plan following consultation with participants' General Practitioners and the adjunct clinical pharmacist. Results: Participating stakeholders indicated that the strengths of the implementation process included the training provided to the nurses, constructive collaboration of the research team, and structure of implementation process. Perceived limitations included the selection process and screening tool, communication between the research team and the nurses, the assessment questionnaire, and the final document left with the patient, as well as lack of access to medical records for the adjunct pharmacist. Recommendations include better communication and team-wide consensus on alterations to procedure and documents, and standardized protocols for patient selection, data collection, and reporting for research nurses. Conclusions: The findings have identified strengths of the implementation process on which to build, and recognized limitations which can now be addressed to ensure improved efficiency and effectiveness in future trials. Trial registration: Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. [ABSTRACT FROM AUTHOR]

Background: As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland. Methods: As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants' health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants' GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care. Findings: Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability ('4FMA'), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors. Conclusion: Acceptability of this primary care based ACP intervention was high, with nurses' home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital. [ABSTRACT FROM AUTHOR]

Background: Advance Care Planning is recommended for people with end-stage kidney disease but evidence is limited. Robust clinical trials are needed to investigate the impact of advance care planning in this population. There is little available data on cost-effectiveness to guide decision makers in allocating resources for advance care planning. Therefore we sought to determine the feasibility of a randomised controlled trial and to test methods for assessing cost-effectiveness.Methods: A deferred entry, randomised controlled feasibility trial, incorporating economic and process evaluations, with people with end-stage kidney disease, aged 65 years or older, receiving haemodialysis, in two renal haemodialysis units in Northern Ireland, UK. A nurse facilitator helped the patient make an advance care plan identifying: a surrogate decision-maker; what the participant would like to happen in the future; any advance decision to refuse treatment; preferred place of care at end-of-life.Results: Recruitment lasted 189 days; intervention and data collection 443 days. Of the 67 patients invited to participate 30 (45%) declined and 36 were randomised to immediate or deferred advance care plan groups. Twenty-two (61%) made an advance care plan and completed data collection at 12 weeks; 17 (47.2%) were able to identify a surrogate willing to be named in the advance care plan document. The intervention was well-received and encouraged end-of-life conversations, but did not succeed in helping patients to fully clarify their values or consider specific treatment choices. There was no significant difference in health system costs between the immediate and deferred groups.Conclusions: A trial of advance care planning with participants receiving haemodialysis is feasible and acceptable to patients, but challenging. A full trial would require a pool of potential participants five times larger than the number required to complete data collection at 3 months. Widening eligibility criteria to include younger (under 65 years of age) and less frail patients, together with special efforts to engage and retain surrogates may improve recruitment and retention. Traditional advance care planning outcomes may need to be supplemented with those that are defined by patients, helping them to participate with clinicians in making medical decisions.Trial Registration: Registered December 16, 2015. ClinicalTrials.gov Identifier: NCT02631200 . [ABSTRACT FROM AUTHOR]

A district nurse is an expert generalist practitioner who uses advanced clinical skills and knowledge to fulfil an ever-evolving role. The district nurse is accountable for the care planning, coordination and management of people with multi-faceted and intricate health care needs. In addition, an interprofessional approach to health and social care is required to enable the district nurse to co-ordinate care and enable patients to be cared for and remain within their homes. As the demand on primary and community services increases, care is further enriched by working in partnership with families, carers and voluntary service providers. The nurse patient relationship is the founding component for person-centred, holistic care. Through holistic assessment and shared decision making, co-produced care planning permits people to fundamentally take ownership of their health and enhances formal care provision. This case study reflects the role of the district nurse in Northern Ireland, through comprehensive assessment in clinical practice and highlights how a therapeutic relationship, being centred on the patient and shared decision-making impact positively on the care process. [ABSTRACT FROM AUTHOR]

This overview provides insight into changes in clinical practice and the implications for nursing staff and clinicians who are involved in the management of patients undergoing primary total hip arthroplasty. The review highlights commonly used surgical approaches, their advantages, their associated risks and how to manage complications if they occur. [ABSTRACT FROM AUTHOR]

Aim To test the Rapid Response Systems programme theory against actual practice components of the Rapid Response Systems implemented to identify those contexts and mechanisms which have an impact on the successful achievement of desired outcomes in practice. Background Rapid Response Systems allow deteriorating patients to be recognized using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff. Design Realist evaluation. Methods The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation. We used various mixed methods including individual and focus group interviews, observation of nursing practice between June-November 2010 and document analysis of Early Warning Systems audit data between May-October 2010 and hospital acute care training records over 4.5 years from 2003-2008. Data were analysed using NiVivo8 and SPPS. Results A cross-case analysis highlighted similar patterns of factors which enabled or constrained successful recognition, referral and response to deteriorating patients in practice. Key enabling factors were the use of clinical judgement by experienced nurses and the empowerment of nurses as a result of organizational change associated with implementation of Early Warning System protocols. Key constraining factors were low staffing and inappropriate skill mix levels, rigid implementation of protocols and culturally embedded suboptimal communication processes. Conclusion Successful implementation of Rapid Response Systems was dependent on adopting organizational and cultural changes that facilitated staff empowerment, flexible implementation of protocols and ongoing experiential learning. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper was to report the process evaluation of facilitators' delivery of a psychosocial intervention (called CONNECT), in a randomized controlled trial, to men with prostate cancer and their partners. Background There is a lack of information on the process of implementing psychosocial interventions in controlled trials and, in particular, on the role and performance of facilitators who deliver them. Yet, this information is crucial in assessing whether these interventions are effective or not and why. Design Qualitative design. Methods Semi-structured qualitative interviews and diaries were used to collect data (January-October 2012) from four facilitators and a co-facilitator. Data were analysed using the Miles et al. framework. Results Five themes were discernible. These were 'difficulties to keep to the structure of the intervention', 'selective coverage of topics', 'partner participation', 'overall impression of the group and telephone sessions' and 'perceived benefits to participants'. Issues such as not keeping to the aim of the intervention, deviating from the content and/or reluctance in discussing sensitive issues such as sexual health may mean that the psychosocial effects of the intervention may not have been fully realized. Conclusions These findings will be useful for further development and evaluation of the intervention. A tentative conceptual framework of factors, related to facilitators, influencing the fidelity of interventions in the context of controlled trials, is offered. This model, which requires further development and testing, will be useful for researchers worldwide who are involved in developing interventions and training facilitators. [ABSTRACT FROM AUTHOR]

Insulin is one of the top ten high-alert medications worldwide. Approximately 30% of people with diabetes in the UK use injectable therapies, most commonly insulin, to manage their condition. With an increasing number of people with diabetes being managed within the community, district nurses play an important role in the safe and effective use of insulin. This study surveyed a convenience sample of 164 district nurses working within one Health and Social Care Trust in Northern Ireland to ascertain their knowledge and practice regarding insulin. Study response rate was 38% (n=63). It was found that district nurses’ knowledge and practice relating to insulin therapy was lacking as indicated by a total mean score of 53.1%. Total knowledge scores were slightly higher (58%) than total practice scores (46%). Nevertheless, 79.4% of district nurses felt secure and 6.3% felt very secure in managing diabetes. Deficits in district nurses’ knowledge and practice were identified in areas relating to insulin action, dosage, storage, injection site technique and rotation, hypoglycaemic/hyperglycaemic management, pharmacological action and prescription format. These deficits highlight the need for workplace-based learning and development programmes, incorporating real time, point of care interventions, to enhance and maintain district nurses’ insulin knowledge and practice. [ABSTRACT FROM AUTHOR]

Approaches to the management of patients with cancer have been revolutionised by the ability to examine tumours at a genetic and molecular level and tailor treatments accordingly. Underpinning this work is the need for large numbers of high-quality human biospecimens for use in translational research studies to identify new biomarkers for the prediction, diagnosis and treatment of cancer . Biobanking has subsequently emerged as a dedicated activity to provide the infrastructure required for the standardised collection, storage and distribution of high quality human biospecimens for research purposes. This article provides an overview of the role of biobanks and the vital contribution they make to the delivery of cancer care for patients now and in the future. [ABSTRACT FROM AUTHOR]

This is a case study of an ethical dilemma concerning the appropriateness of encouraging care-staff, working within a dementia care home, to either wear a clinical uniform or not to wear a clinical uniform in practice. It is proposed that people living with dementia may sustain higher levels of wellbeing if care-staff wear clothes that are more akin to their care home environment, for example, wearing similar clothes to the residents or even wearing pyjamas and nightwear during a night shift. The counter argument is that the practice may lead to greater levels of distress due to disorientation, increased potential for infection and inability to identify nurses when needed. [ABSTRACT FROM AUTHOR]

Occupation segregation is a persistent aspect of the labour market, and scholars have often researched what happens when women and men enter into what are seen to be 'non-traditional' work roles for their sex. Research on men within women's roles has concentrated mainly on the challenges to a masculine identity, while research on workplace language has focused on women's linguistic behaviour in masculine occupations. To date, there has been relatively little research into the linguistic behaviour of men working in occupations seen as women's work (e.g., nursing, primary school teaching). To address this gap, this article focuses on men's discursive behaviour and identity construction within the feminized occupation of nursing. Empirical data collected by three male nurses in a hospital in Northern Ireland is explored using discourse analysis and the Community of Practice paradigm. This paper discusses how the participants linguistically present themselves as nurses by performing relational work and creating an in-group with their nurse colleagues by actively using an inherently 'feminine' discourse style. [ABSTRACT FROM AUTHOR]

Aim To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. Background Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. Design A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods. Methods Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). Discussion Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy. [ABSTRACT FROM AUTHOR]

Aim. To explore the use of Facebook by Registered Nurses (RNs) in Italy and the United Kingdom (UK), focusing on the disclosure of personal and professional information. Background. The use of online social network sites among medical students and doctors is posing new ethical challenges to the profession. To date, little research has explored the use of online social networking sites among nurses. Design. A cross-national survey. Methods. Data were assessed on 124 nurses' profile pages, readily available without viewing restrictions. Content analysis and inferential statistics were undertaken to describe usage and identify similarities and differences between the two country-groups of nurses. Data were collected between December 2011-January 2012. Results. Overall, UK and Italian RNs showed a similar use of the online platform, tending to disclose personal pictures, home town and current home location, as well as updates and comments related to personal and work-related activities. A statistically significant higher proportion of nurses in Italy disclosed their sexual orientation. In both groups, a few cases were observed of potentially unprofessional content in relation to the use of alcohol, nudity and material of a salacious nature. Conclusion. Although most of the UK and Italy RNs appear to be aware of the risks posed by their online exposure, their online activity indicates the blurring of their personal and professional lives; this is posing new ethical, legal and professional challenges to members of the nursing profession. Further research and debate is encouraged at national and international level. [ABSTRACT FROM AUTHOR]

More than ever, district nurses require highly developed communication and interpersonal skills to enable and nurture a therapeutic relationship. The 'shift left'—whereby patients are being assessed and cared for in the community at a much earlier stage of their illness or recovery— has significant implications. The complexity of patient care and the need for collaborative working and shared decision making necessitates a focus on fostering person-centred care and improving the patient experience in practice. District nurses are adept communicators with a specialist body of knowledge and skills. In Northern Ireland, the single assessment tool (NISAT) is used by health professionals and follows a person-centred framework. This case study reflects on the assessment process used by a district nursing student in clinical practice and demonstrates how a therapeutic relationship is developed, thereby supporting person centredness. [ABSTRACT FROM AUTHOR]

The article focuses on the Professional Framework for Emergency Care Nursing launched at the Northern Ireland Practice and Education Council (NIPEC) annual conference. Topics covered include the domains under which the career pathways are presented, the range of information linked to each domain and the creation of a project group to develop the framework. Also mentioned is the governance process of NIPEC to ensure modifications are made.

Background: In the UK the Nursing and Midwifery Council (NMC) standards to support learning and assessment in practice state that mentors are responsible and accountable for the assessment of preregistration nursing students in practice. This study was undertaken to explore mentors' experience of assessing nursing students in practice post implementation of the NMC standards. Method: Five focus groups were conducted with mentors (N=35) who had assessed adult pre-registration nursing students in the previous 12 months. The focus groups were recorded, transcribed and analysed to generate categories. Results: Five categories were identified from the data: Changing roles and responsibilities; Exploring the past to understand the present; Just knowing; The odds; Time to mentor. The findings highlighted that mentors were aware of their role and responsibility for the assessment of students in practice. However, many felt this was a new responsibility and role in which they lacked experience. Some existing mentors felt that they may not have had the necessary preparation to effectively assess students in practice and identified their need for support. Conclusion: Given that mentors are expected to be competent assessors of students in practice and protect the public through gate-keeping professional registration, this study suggests that serious consideration should be given to how mentors are prepared and the ongoing support and education they receive in assessment. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the actual and the potential role of the primary care nurse ( PCN) in the prevention of cancer. International studies have indicated that a range of strategies can have an impact on the incidence of cancer. Due to their frequent front-line contact with the public, PCNs can play an important role in the primary prevention of cancer. Nonetheless, there is a lack of information on their actual and potential role in cancer prevention. A sequential confirmatory mixed methods approach was used. Postal questionnaires were administered to PCNs [ n = 500; 225 returns (response rate 45%)] followed by semi-structured interviews ( n = 15). PCNs provided high levels of cancer prevention activities, specifically focusing on smoking cessation, obesity and cervical screening. They considered that their cancer prevention role could be improved through additional practice-based training and more collaborative inter-professional working. They also identified the need for a better understanding of how to change people's attitudes and behaviours regarding cancer prevention. Evidence from this study provide important insights into the potential of the PCN to empower individuals to take responsibility for their own health and make more informed lifestyle choices. [ABSTRACT FROM AUTHOR]

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts. [ABSTRACT FROM AUTHOR]

Aim To explore the unregistered healthcare worker's role and influence on student nurses' clinical learning experience. Background Across the developed world, the role of the unregistered worker is exceeding its traditional boundaries. Evidence suggests that this includes the day-to-day mentoring of pre-registration student nurses. However, no research to date has explored reasons as to why this is occurring, what types of tasks are taught, and the consequence of this. Design A sequential exploratory mixed method research design was adopted. Method Reporting on the final qualitative phase of a mixed method sequential research study, semi-structured interviews were undertaken with 59 unregistered healthcare workers across four hospitals in Northern Ireland. Transcriptions were analysed using a content analysis approach; all data were collected in 2010. Results Findings show the diversity of the unregistered healthcare workers' roles and confirm that they play a major part in the education of student nurses with regards to basic, clinical, and non-clinical tasks, with and without the approval of registered staff. However, their involvement did not reflect their levels of expertise as evidenced by certified training. Their participation was justified based on mentor unavailability, their closeness to the student and the patient. While some did raise concerns, they recommended that these workers be formally involved in nurse education. Conclusion Mechanisms of workforce planning need to pay particular attention to the expanding role of unregistered healthcare workers as 'role drift' has the potential to alter patterns of work and affect current educational approaches impacting on the acquisition of clinical skills. Further research is recommended in this domain. [ABSTRACT FROM AUTHOR]

Refractory cachexia and truth-telling about terminal prognosisa qualitative study The purpose of this paper is to examine the consequences that medical practitioners' decisions about whether or not to be candid about terminal prognosis have for those suffering from refractory cachexia and their families. It presents the findings of a qualitative study that used focus groups and semi-structured interviews of a volunteer sample of doctors, nurses and dieticians in a cancer centre of a large teaching hospital in Northern Ireland. Respondents reported that some physicians tended to avoid discussing terminal prognosis in a direct manner with their patients. Nurses and dieticians tended to be reluctant to engage in conversations about weight loss with patients with cachexia. One of the reasons they reported for their lack of acknowledgement of weight loss concerned the close association between refractory cachexia and terminal prognosis. Because they viewed the telling of bad news as an exclusive prerogative of medical practitioners, they did not feel in a position to discuss cachexia because they were concerned that this had the potential to raise end-of-life issues that lay outside the boundaries of their professional role. This meant patients and their families were provided with little information about how to cope with the distressing consequences of cachexia. [ABSTRACT FROM AUTHOR]

Aim To guide researchers who are contemplating embarking on research by discussing the methodological challenges encountered in a retrospective follow-up study of three-year-old, late preterm infants (LPIs) who received neonatal intensive care (NIC) in Northern Ireland in 2006. Background The importance of effective research examining the longer term outcomes of infants admitted to NIC has received increasing recognition. Follow-up cohort and longitudinal studies have grown in number globally, yet the research methodology relating to follow up of NIC graduates is unclear. Data sources Neonatal Intensive Care Outcomes and Research Evaluation (NICORE) database; maternity unit delivery records. Review methods This is a reflective-practice methodology paper. Discussion This paper highlights the methodological challenges of conducting retrospective follow-up research, from the initial planning stages through to the collection of data from the children, including identification of infants from a retrospective database, ethical issues, child-safety concerns and recruitment challenges. Conclusion The important lessons learned from this study were that: Input from a multidisciplinary team is central to the success of the study. Protocols and guidelines should be in place before the study to ensure that problems are dealt with quickly. A realistic timeframe for each phase and ongoing monitoring of recruitment rates are essential. Implications for research/practice This paper creates an awareness of potential issues that may arise in follow-up research with NIC graduates. The paper also offers practical and effective examples of dealing with these issues, helping to ensure the smooth running of an ethical, professionally conducted, methodologically sound and clinically relevant follow-up study. [ABSTRACT FROM AUTHOR]

Aim. To understand the uniqueness of the experience of testing HIV positive from the perspective of pregnant women. Background. As more people learn of their HIV diagnosis through routine screening processes, it is timely to reflect on the impact of receiving an unexpected positive result. Design. A prospective qualitative study. Methods. This paper draws on the case studies of four women who were participating in a larger prospective qualitative study of reproductive decision-making, pregnancy and childbirth following HIV diagnosis. Multiple interviews were conducted following diagnosis during pregnancy, and, after the birth of their babies. Thematic data analysis was undertaken. Results. Drawing on Becker's theory of disruption, we document the 'sudden disjuncture' of their antenatal diagnosis and the embodied emotional struggle the women engaged in to create continuity in their lives. A diagnosis of HIV disrupted the women's biographies in terms of their health, relationships and social identity. As pregnant women, the threat of HIV was experienced most significantly in relation to their unborn child. However, their narratives also revealed how a diagnosis of HIV in the context of pregnancy, whilst traumatic, provided a focus for regaining continuity in their lives, as the baby became a metaphor for hope and orientation toward the future. Conclusions. As HIV testing becomes more 'routine', the findings of this study serve to remind health professionals that a positive diagnosis continues to constitute a major trauma to individuals and families. Relevance to clinical practice. We propose that appropriately educated nursing and midwifery staff could facilitate the 'meaning making' process that is required for newly diagnosed HIV positive persons to find a subjective sense of well-being in their lives. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In this study, we sought to measure treatment culture (beliefs, values, and normative practices associated with medication prescribing and administration) in two samples of nursing homes (in Northern Ireland and New Zealand) and to document the range of scoring achieved by staff in both countries. Responses between nurse managers and registered nurses were also compared. Design: A cross-sectional study using an adapted treatment culture questionnaire was distributed by mail (in June and September 2008) to 159 nursing homes in Northern Ireland and completed by the nurse manager and registered nurses. In New Zealand, staff in 14 facilities participated and questionnaires were distributed by a research assistant who visited the homes (March to November 2008). Measurements: Completed questionnaires were scored using a prespecified scoring system, with a higher score indicating a more resident-centered treatment culture and a lower score indicating a more traditional approach to care. The maximum score possible was 75. Scores were compared between countries and between different categories of staff. Views were also sought and knowledge tested (from structured questions) on the use of psychotropic prescribing in the nursing home environment. Results: The response rates for nurse managers and nurses in Northern Ireland were 35.5% and 10.1%, respectively; in New Zealand, the response rate was 90.9% for managers and 71% for nurses. The mean score for the Northern Ireland and New Zealand homes was 39.5 and 39.1, respectively (P > .05). There were also no differences between scores achieved by nurse managers and registered nurses between and across both countries. There were some cross-country differences on the approach to challenging behavior in residents and nurses (in both countries) were more likely than nurse managers to report (incorrectly) that haloperidol is indicated for short-term insomnia. Conclusion: This quantitative assessment has raised interesting issues in relation to the measurement of treatment culture in the nursing home setting in two countries. Further insights into the importance of treatment culture will be pursued in qualitative studies. [Copyright &y& Elsevier]

Abstract: Background: Recombinant tissue plasminogen activator (rT-PA) is an effective treatment for acute ischaemic stroke when given within 3h of symptom onset but can be delayed as patients wait for a diagnosis. The ROSIER assessment tool () has been found to be effective in diagnosing stroke but to date has only been tested when used by doctors. Objective: To compare registered nurses’ ability to diagnose stroke using the ROSIER assessment tool with doctors’ ability to diagnose stroke using traditional neurological assessment. Design, setting, and participants: A prospective audit of all suspected stroke patients (n =106) admitted to the stroke unit of a district general hospital over an eight month period, assessed by registered nurses trained to use the ROSIER assessment tool to identify stroke. Main outcome measures: Time from admission to the stroke unit until initial assessment by doctors and registered nurses. Comparison of initial diagnosis by doctors and registered nurses with final diagnosis by a consultant for stroke. Results: Of 106 suspected stroke patients, 78 (73.5%) had a final diagnosis of stroke or transient ischaemic attack (TIA) and 28 (26.4%) had an alternative diagnosis. Six patients with TIA were subsequently excluded as they were asymptomatic at the time of assessment, leaving 100 participants in the validation phase of the study. Using the ROSIER tool registered nurses achieved a diagnostic sensitivity for stroke of 98% (95% confidence interval 88–99), positive predictive value (PPV) 83% (95% confidence interval 73–90). Doctors using standard neurological assessment had a similar diagnostic sensitivity of 94% (95% confidence interval 86–98), PPV 80% (95% confidence interval 70–88). The mean time from initial assessment by registered nurses using the ROSIER tool, until assessment by doctor on the stroke unit was 75min (SD=65.8min). Conclusions: Registered nurses working on a stroke unit using the ROSIER assessment tool are able to diagnose stroke with a degree of accuracy comparable to doctors using clinical neurological assessment. Prompt assessment of suspected stroke patients by registered nurses using the ROSIER tool could reduce delays in eligible stroke patients being assessed for rT-PA treatment. [Copyright &y& Elsevier]

The purpose of this research was to consider why absenteeism in Health and Social Care is so high and to suggest proactive changes in organization activity to address this. The research took a multimethod approach with a quantitative emphasis; there were three parts: (i) quantitative survey questionnaire; (ii) analysis of absenteeism and related secondary data; and (iii) qualitative data from other questions in survey and discussion groups. The quantitative emphasis in the research is appropriate, given the gap identified in the literature. Perceived limitations are that the study considers just one part of the overall system. The research indicates that managers underestimate staff absence levels and almost half believe absenteeism cannot reduce. Professional managers were more negative and over half of nurse managers believed that absence could not reduce. Unless there is a systematic systemic change in organizations, which changes managers' attitudes and understanding of absence with a consequent change in activity across the absence continuum, there is no prospect of a sustained reduction in absence levels. Manager impact and role in absence management are poorly covered in research, so this research helps inform those gaps. [ABSTRACT FROM AUTHOR]

To explore the personal experiences of carers of stroke survivors and to elicit their views and opinions of what constitute the major issues and concerns of people in their situation. The unexpected nature of stroke can propel people into the role of carer with little or no warning. Some carers of stroke survivors suffer from considerable stress and a range of psychological and physical disorders. A small-scale qualitative study of experienced carers of stroke survivors. Ten carers with experience of caring for a stroke survivor were recruited to the study through community stroke staff. Data were collected using semi-structured interviews and a focus group. The women's main concerns were focused around the need for information and support, including the need for some preparation and training in the necessary skills of caring. To understand fully the lives that carers lead, it is necessary to explore what carers want to do, and expect to do, for the care-recipient. There is a need to develop an understanding of factors that appear to be protective against stress, to identify how they can be enhanced and to develop ways to minimise the impact of those factors that have a detrimental impact on the well-being of carers and on those for whom they care. Health professionals need to ensure that appropriate information is clearly provided for carers. Communication between health professionals to ensure the 'joined up' provision of therapeutic services is another area for continual development. Carers expressed the wish to be better prepared to take on the caring role in the home and would have welcomed some training in this area. [ABSTRACT FROM AUTHOR]

This paper presents the preliminary descriptive findings from an online survey commissioned by the Royal College of Nursing to ascertain members' perceptions of spirituality and spiritual care. There is a professional requirement for nurses to achieve competence in the delivery of spiritual care and to assess and meet the spiritual needs of their patients. Recently, the area of spirituality has come under criticism bringing into question the role of the nurse with regard to the provision of spiritual care. A descriptive online survey was conducted with all Royal College of Nursing members to obtain their perceptions of spirituality and spiritual care in an attempt to identify what action they feel is required with regard to this aspect of nursing practice. An online survey consisting of a five-part questionnaire was developed incorporating the Spirituality and Spiritual Care Rating Scale. Members were asked to complete the survey during a three-week period in March 2010. Overall, 4054 Royal College of Nursing members responded, making this probably the largest UK survey ascertaining nurses' perceptions of spirituality and spiritual care. Descriptive statistics, frequencies and percentages were used to identify key findings. A Cronbach's alpha of 0·80 was obtained for the Spirituality and Spiritual Care Rating Scale. The preliminary analysis confirms that nurses across the full health economy in the United Kingdom consider spirituality to be a fundamental aspect of nursing. The findings indicate that nurses recognise that attending to the spiritual needs of patients enhances the overall quality of nursing care. However, despite all the attention given to the spiritual dimension, the majority of nurses still feel that they require more guidance and support from governing bodies to enable them to support and effectively meet their patients' spiritual needs. [ABSTRACT FROM AUTHOR]

boomer c.a.& mccormack b. (2010) Journal of Nursing Management  18, 633-644 Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods Programme evaluation methodology to determine the 'worth' of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators. [ABSTRACT FROM AUTHOR]

Aim. To identify self-reported perceptions of the barriers to research utilisation by Turkish staff nurses working in a university hospital and to ascertain whether involvement in research-related activities influenced their perception of the barriers. Background. Research utilisation in nursing has been a prominent concern for the last 30 years. While investigators in several countries have identified nurses’ perception of barriers to research utilisation, this is the first study to investigate such barriers in Turkey. Design. This is a descriptive, cross sectional study with a sample of 329 staff nurses working in a university hospital. Two instruments were used; a demographics questionnaire that investigated research activities and the Barriers Scale to measure perceptions. An additional item, ‘studies are published in English’ was added to the scale. Results. The lack of time to implement new ideas was the most frequently, 84·5%, perceived barrier. The second most frequently perceived barrier was difficulty in reading English. The top six barriers were all related to the setting. Additionally, research-active nurses found insufficient time less of a barrier but unawareness of research findings and being isolated from knowledgeable colleagues as greater barriers to research utilisation. Conclusions. Turkish nurses’ perception of barriers is similar to the findings in other countries, i.e., that the top six barriers were related to setting. Language barrier compares similarly with studies in other countries that investigated this variable. Relevance to clinical practice. The gap between theory and practice in nursing can be minimised by identifying strategies to increase research utilisation in clinical settings. Such strategies can also improve patient care outcomes. [ABSTRACT FROM AUTHOR]

Aims. To explore the perspective of midwives offering serum screening for Down’s syndrome. Background. Previous literature has indicated that the offer and discussion of prenatal serum screening tests with women is complex, and health professionals may influence women’s decisions to accept or decline screening. Midwives are usually the key professional to offer serum screening for Down’s syndrome in the UK but their perspective is relatively neglected in the literature. Design. An explorative qualitative interview study with 15 midwives employed in a maternity unit in Northern Ireland involved in offering prenatal screening to pregnant women. Data were collected from 1 July 2005–31 October 2005. Methods. A focused ethnographic approach was used to explore the perspective of midwives. Results. Midwives reported difficulty in explaining the test to women and felt unable to provide the necessary information to adequately inform women within their appointment time. The test offered (the triple test) and potential pathway of subsequent care, were identified as sources of professional and personal conflict by midwives. The expectation that midwives would provide a universal offer of Down’s syndrome serum screening but be unable to support women regarding termination of pregnancy also created dissonance. Conclusions. The feasibility of proceeding with a universal serum screening programme for Down’s syndrome is questionable in countries which legally or culturally oppose termination of pregnancy. Professionals practising within environments such as this experience conflict in their role, which affects communication with women when discussing screening tests. Relevance to clinical practice. As midwives are often, the primary health professional providing information to women, it is important that midwives are key participants in ongoing planning and discussions about screening policy to ensure programmes are implemented successfully. [ABSTRACT FROM AUTHOR]

In this article the authors discuss the usefulness of focus groups for researching sensitive issues using evidence from a study examining the experiences of nurses providing care in the context of the Northern Ireland Troubles. They conducted three group interviews with nurses during which they asked about the issues the nurses face(d) in providing nursing care amid enduring social division. Through a discursive analysis of within-group interaction, they demonstrate how participants employ a range of interpretive resources, the effect of which is to prioritize particular knowledge concerning the nature of nursing care. The identification of such patterned activity highlights the ethnographic value of focus groups to reveal social conventions guiding the production of accounts but also suggests that accounts cannot be divorced from the circumstances of their production. Consequently, the authors argue that focus groups should be considered most useful for illuminating locally sanctioned ways of talking about sensitive issues. [ABSTRACT FROM AUTHOR]

The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations. [ABSTRACT FROM AUTHOR]

Objective: To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design: Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. Setting: Acute district hospital, Northern Ireland. Participants: Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. Results: Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in ‘real life’ and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. Conclusions: The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. [ABSTRACT FROM AUTHOR]

This qualitative study was designed to explore the perception of stress of nephrology nurses within a major nephrology center in Northern Ireland. The information was collated from a sample of 10 nurses through semi-structured taped interviews. The findings indicate that stress was derived from the following categories: job content, resource issues, professional concerns, professional working relationships, and extrinsic factors. The coping mechanisms adopted by these nurses are also discussed. The actual dialogue of the nurses is included to provide depth and substance to the categories and themes, and a discussion is presented of the relationship of these findings to theory. These findings have relevant implications for nursing practice, nursing education, and nursing administration. [ABSTRACT FROM AUTHOR]

• This study aimed to investigate the information provided to patients undergoing gastroscopy procedures in Northern Ireland. • Questionnaires were developed by the authors and were completed by 402 patients (RR = 43.8%) and 62 nurses (RR = 75.6%). • Patients received most of the procedural information from nurses, and they recognized the importance of providing sensory information. Patients were generally satisfied with the information provided. • There is clear evidence of fragmented care, and major changes are required to ensure that patients receive holistic information that includes procedural and sensory aspects. • Nurses and doctors must realize that their role in information giving is to ensure that comprehensive information is provided by the appropriate professional at the appropriate time. [ABSTRACT FROM AUTHOR]

Assesses nurses' knowledge of constipation in a teaching hospital in Northern Ireland. Knowledge variation between specialties and nursing grades; Incidence and cost of constipation; Implications of the study on nursing practice.

Qualified nurses’ smoking prevalence: their reasons for smoking and desire to quit Aim and rationale. The preventable nature of smoking related diseases places a major responsibility for health promotion on all health professionals. This study used a questionnaire to survey qualified nurses in Northern Ireland as to smoking prevalence and their desire to quit the habit. It also explores their knowledge base relating to smoking related diseases and their motivation to act as health promoters with patients who smoke. Methods. A random sample (n=1074) of qualified nurses employed by the Health and Social Services Trusts, private, and voluntary organizations in the province were surveyed. Results. Results show that 25·8% were smokers, 19% were ex-smokers and 55·2% were nonsmokers. Three quarters expressed a wish to stop within 6-months. Almost all smokers and half of ex-smokers had taken up the habit prior to commencing nursing. ‘Addiction’ and ‘enjoyment’ were given as the principle reasons for continued smoking. Health reasons were paramount in smokers’ desire to stop smoking. Conclusions. These findings suggest that smoking prevalence among qualified nurses in no greater than that reported by females in the general Northern Ireland population. Results also indicate that those nurses who smoke were less willing to take on the role of a health promoter with patients who smoke. Implications and recommendations for practice, education and research are explored. [ABSTRACT FROM AUTHOR]

• Recent proposals recommend that cancer patients are cared for, as much as possible, in specialist cancer units and centres. • However, a large number of these patients will still be admitted to medical and surgical wards of general hospitals at one time or other. Yet little is known about the knowledge and skills of nurses dealing with this group of patients. • A survey design was used to assess the self-reported level of competence, in a number of activities relating to their work with cancer patients, among medical and surgical nurses (n=106) in a district general hospital in Northern Ireland. It also aimed to identify their self-reported educational needs in caring for this group of patients. • Results showed that these nurses cared for people with a range of cancers. • While they reported an above-moderate level of competence, they also rated their level of competence higher in physical than in psychosocial care. • Among their self-perceived educational needs were more knowledge, and skills in psychosocial care, communication, dealing with side-effects of treatment and pain management. [ABSTRACT FROM AUTHOR]

The current emphasis on evidence-based practice has focused attention once again on the research activities of health professionals in general and their research utilization in particular. While there has been a limited number of studies on research utilization in the United Kingdom, these have tended to concentrate on general nurses and midwives. Little is known about the research activities, research utilization and the attitudes to research of learning disability nurses. This paper reports on data from a survey of a convenience sample of 87 nurses from three learning disability hospitals in Northern Ireland. The results show that while these nurses generally held positive attitudes to research, a substantial minority (18.3%) believed that 'research is not relevant to the day to day work in nursing'. Only a quarter of the sample reported using research 'frequently/all the time' in their practice. The extent of research utilization among these disability nurses must be considerably improved if evidence-based practice is to become a reality in their field of nursing. [ABSTRACT FROM AUTHOR]

In a study involving 276 nurses in a large hospital in Northern Ireland, a comprehensive set of questionnaires was administered to assess multiple job-related variables. Nurses in general appeared to display high scores on the stresses related to confidence and competency in role, home-work conflict, and organisational involvement (subscales which are themselves closely associated with demands in social interaction at work). These are stresses which were related to psychological well-being. There were no gender differences on occupational stress or the health outcome variables. Age did emerge as significantly related to total stress and mental health (older nurses reporting more stress, and the younger nurses experiencing better psychological health). Grade of nursing was unrelated to job stress and outcome health variables, including work satisfaction. Although no differences were observed between wards/specialism and stress, differences were revealed along satisfaction, with maternity nurses (and intensive care nurses) displaying the highest level of satisfaction at work, and surgical (and medical) nurses showing the lowest. Finally, Type A emerged as a significant determinant of physical health, in contrast to internal locus of control, which was more related to mental health, (lower) occupational stress, and job satisfaction. No significant Type A × locus of control interactions were observed. The implications of these findings for nursing care are discussed. [ABSTRACT FROM AUTHOR]

It is clear from the nursing literature that there are a number of factors which can impede or facilitate the use of research in practice. It is important that these are identified and addressed, both at local and national levels, if evidence-based practice is to become a reality. This study surveyed nurses' perceptions of barriers to, and facilitators of, research utilization. The Barriers Scale was administered to a convenience sample of 2600 nurses in 23 hospitals in Northern Ireland. The number of completed questionnaires was 1368 (52.6%). The results show that the top barrier was 'The nurse does not feel she/he has enough authority to change patient procedures' followed by 'statistical analyses are not understandable'. Seven out of the top 10 barriers were related to 'setting'. The implications of these and other findings are discussed. [ABSTRACT FROM AUTHOR]

A manpower database for nurses employed by the Department of Health and Social Services (DHSS) in Northern Ireland is used to identify the qualified nurses not currently employed by the DHSS, i.e. the limbo stock, and describe this stock in terms of age, sex, length of previous service, grade and location. This information is invaluable for manpower planners who must decide on how many vacancies can be filled by recruitment from the limbo stock, as opposed to training new nurses. Such a methodology provides a valuable tool for the nurse manpower planner. [ABSTRACT FROM AUTHOR]

The Ulster Cancer Foundation's teaching package Nurses and Smoking was evaluated by testing nurses' knowledge and skills in the area of smoking-related health education. As smoking is still a major cause of mortality and morbidity, does the nurses' training equip them with an adequate knowledge of its consequences? Questionnaire data, together with material from in-depth interviews, were analysed and pre- and post-package results produced significant differences (P < 0.001) between the experimental and control groups, suggesting that a teaching package significantly improves a nurse's knowledge and expertise with regard to smoking and its effect on both patients and their environment. [ABSTRACT FROM AUTHOR]

A manpower database for nurses employed by the Department of Health and Social Services in Northern Ireland has been developed. This database contains information on all nurses employed between March 1977 and July 1988 and consists of data on all posts held in this period, including breaks in service. The authors show how these data may be used to analyse the durations of spells in post and spells out of service prior to departure to a number of destinations for the sister and staff nurse grades. The results are presented in a graphical format which enables us to evaluate the relative proportion of departures to each destination and at what stage in service these departures are likely to occur. Such a methodology provides a valuable tool for the nurse manpower planner, and utilizes personnel data which are routinely collected by most health authorities. [ABSTRACT FROM AUTHOR]