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Aims and objectives To explore the experiences and perceptions of healthcare staff caring for people with dementia in the acute setting. This article focuses on the methodological process of conducting framework synthesis using nvivo for each stage of the review: screening, data extraction, synthesis and critical appraisal. Background Qualitative evidence synthesis brings together many research findings in a meaningful way that can be used to guide practice and policy development. For this purpose, synthesis must be conducted in a comprehensive and rigorous way. There has been previous discussion on how using nvivo can assist in enhancing and illustrate the rigorous processes involved. Design Qualitative framework synthesis. Methods Twelve documents, or research reports, based on nine studies, were included for synthesis. Conclusion The benefits of using nvivo are outlined in terms of facilitating teams of researchers to systematically and rigorously synthesise findings. nvivo functions were used to conduct a sensitivity analysis. Some valuable lessons were learned, and these are presented to assist and guide researchers who wish to use similar methods in future. Relevance to clinical practice Ultimately, good qualitative evidence synthesis will provide practitioners and policymakers with significant information that will guide decision-making on many aspects of clinical practice. The example provided explored how people with dementia are cared for acute settings. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand people with dementia, staff and relatives perspectives on reminiscence, its impact on their lives and experience of care and care giving. Background The quality of life of people with dementia living in long-term care is an important question for providers and policymakers. Reminiscence is thought to have potential for increasing resident-staff interaction, thereby contributing to enhanced personhood for people with dementia. Relatively little is known about the effects of reminiscence on people with dementia or staff. Design This is a grounded theory study. This design was chosen because of its focus on understanding people's behaviour, interaction and response to events. Methods In-depth interviews were conducted with residents with dementia ( n = 11), relatives ( n = 5), healthcare assistants ( n = 10), nurses ( n = 9) and nurse managers ( n = 3). Results Reminiscence enabled staff to see and know the person beneath the dementia. It acted as ... a key revealing the person to staff, enabling them to engage with the person with dementia in a different way. Knowing the person enabled staff to understand (through the lens of the person's past) and sometimes to accommodate the person's current behaviour. Conclusion The theory of 'seeing me (through my memories)' was generated from the data. This theory explains that through reminiscing and engaging with the person with dementia, staff begin to see the person (their personhood) through the mirror of their memories. Relevance to clinical practice This study found that reminiscence enhanced the experience of living in long-term care for residents with dementia and working in long-term care settings for staff. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper describes the steps used in developing and piloting a structured education programme - the Structured Education Reminiscence-based Programme for Staff ( SERPS). The programme aimed to prepare nurses and care assistants to use reminiscence when caring for people with dementia living in long-term care. Reminiscence involves facilitating people to talk or think about their past. Background Structured education programmes are used widely as interventions in randomised controlled trials. However, the process of developing a structured education programme has received little attention relative to that given to evaluating the effectiveness of such programmes. This paper makes explicit the steps followed to develop the SERPS, thereby making a contribution to the methodology of designing and implementing effective structured education programmes. Design The approach to designing the SERPS was informed by the Van Meijel et al. (2004) model ( Journal of Advanced Nursing 48, 84): (1) problem definition, (2) accumulation of building blocks for intervention design, (3) intervention design and (4) intervention validation. Methods Grounded theory was used (1) to generate data to shape the 'building blocks' for the SERPS and (2) to explore residents, family and staff's experience of using/receiving reminiscence. Results Analysis of the pilot data indicated that the programme met its objective of preparing staff to use reminiscence with residents with dementia. Staff were positive both about the SERPS and the use of reminiscence with residents with dementia. Conclusions This paper outlines a systematic approach to developing and validating a structured education programme. Participation in a structured education programme is more positive for staff if they are expected to actively implement what they have learnt. Ongoing support during the delivery of the programme is important for successful implementation. Relevance to clinical practice The incorporation of client and professional experience in the design phase is a key strength of this approach to programme design. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the factors that impact on students' implementation of clinical skills in the practice setting. This was a part of a larger exploration into the role of the Clinical Skills Laboratory in preparing student nurses for clinical practice. Background It is already known that students can experience reality shock on clinical placement and that staff support is crucial for their adaptation to the environment. This process is similar to socialisation theory whereby the newcomer adapts to the workplace. Design A multiple case study design ( n = 5) was used. Methods Data were collected using semi-structured interviews ( n = 43) and non-participant observation of students implementing skills in clinical practice. Results Findings revealed the factors that could facilitate students' implementation of clinical skills were as follows: provision of learning opportunities, staff support and supervision, and students' confidence. Factors that hindered students were reality shock, 'the gap' in how skills were taught in the higher education institutions and the clinical setting, and missed learning opportunities. Support from peers in the clinical area and having previous experience of working as a health care assistant, or similar, were the factors that could either positively or negatively impact on students. Conclusions Students need to be adequately prepared for the real-life clinical environment. Understanding, through socialisation theory, how students adapt to the workplace can facilitate this process. Facilitating students' learning includes supporting them, developing their confidence and ensuring that they have prior exposure to undertaking clinical skills. Relevance to practice Staff working with students in clinical practice can help facilitate students' learning and implementing of clinical skills through an understanding of how students adapt and 'fit in' to their working environment. [ABSTRACT FROM AUTHOR]

Aim To report a case study that identifies how leadership is enacted by advanced practitioners in nursing and midwifery and differentiates between clinical and professional leadership in advanced practice. Background A national evaluation of advanced practitioners in nursing and midwifery was commissioned to inform policy makers' decision-making about future developments in Ireland. Leadership is a key aspect of the advanced practitioner role. However, leadership in the advanced practice context is under researched and lacks empirical evidence on how advanced practitioners enact their clinical and professional leadership function in practice. Design A multiple case study methodology was used to identify the leadership activities of advanced practitioners. Methods Purposive sampling of advanced practitioners in nursing and midwifery across various specialities and health regions in Ireland was employed. Data sources included non-participant observation of advanced practitioners, interviews with key stakeholders, and documentary evidence including audits, policies, and guidelines. Collectively these data were used to identify the leadership activities of advanced practitioners in practice. The study was conducted between December 2008-December 2010. Results Seven key activities that indicated clinical leadership and three key activities for professional leadership at advanced practice level were identified. Conclusions The leadership activities identified provide greater clarity in distinguishing between professional and clinical leadership and in specifying the nature and scope of leadership activities. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the meaning of chronic obstructive pulmonary disease (COPD) for people and their response to this disease. Background COPD is a major cause of disability and death. The symptoms of COPD have the potential to impact on every aspect of a person's day-to-day life. To date most published qualitative studies have focused on the 'experience' of breathlessness and its impact on the person. Few studies have sought to 'understand' the meaning of COPD to people and their response to this disease. This study aimed to address this gap. Design Straussian grounded theory guided study design. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems they encounter. Methods Data were collected through semi-structured interviews with 26 people with COPD. Study participants were recruited from general practices on the western seaboard of Ireland. Results Two interrelated categories were identified as contributing to 'co-existing with COPD': 'hiding' and 'battling'. 'Co-existing with COPD' was conceptualised as the core category. The potential to 'co-exist' with COPD was influenced by mediating factors. Conclusion The Theory of Co-existing with COPD was generated from the data. This theory explains the delicate balance people with COPD maintain to 'co-exist with COPD'. 'Controlled co-existence' enables the person to feel in control and live life to the optimum. This is a fragile balance however and the unpredictability of COPD can tip the person into 'strained co-existence' or 'uncontrolled co-existence'. Relevance to clinical practice Understanding the experience of living with COPD and the balances involved in 'co-existing with COPD' can help health professionals provide more focused and empowered client care. Enabling people to achieve 'controlled co-existence' with COPD challenges health professionals to educate people with COPD on how to effectively manage their disease. [ABSTRACT FROM AUTHOR]

A variety of terms are used to describe advanced practice nursing roles internationally. This has resulted in confusion in terminology around these roles. The aim of this concept analysis was to clarify what is meant by advanced practice nursing internationally, what attributes signify advanced practice nursing and what are its antecedents, consequences, references and related terms. Rodgers's evolutionary method of concept analysis was used. Data sources included Medline, CINAHL, Applied Social Sciences Index and Abstracts ( ASSIA), Cochrane Library, Science Direct, SCOPUS, Web of Science, Dissertation Abstracts and DARE as well as relevant nursing texts and professional organization websites. The analysis reveals that there are many different articulations of the advanced practice nursing role outlined in the literature. This variety in terminology hinders developments in advanced practice nursing roles. Consensus on advanced practice nursing definitions, terminology, educational requirements and regulatory approaches is integral to the implementation of the advanced practice nursing role internationally. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore key stakeholders and direct care managers' perspectives on the current provision of end-of-life care for older people in acute and long-stay care settings in Ireland and to construct a model of these. Although the literature reveals a number of factors that impact on end-of-life care, no study has examined staff perceptions concerning the provision of good end-of-life care for older people in an Irish context. Grounded theory was used. Semi-structured interviews were employed to collect data between 2007-2008. A purposive sample of 33 staff involved in the delivery of end-of-life care to older people working in six sites were selected. Factors that influence provision of end-of-life care in Ireland were identified. The core category was 'dying well'. The potential to 'die well' was influenced by three factors, namely philosophy, culture and organisation of care, knowing the person and physical environment and resources. People are living longer consequently acute and long-stay care setting will increasingly become places where older people die. This study identified the factors that influence the provision of good end-of-life care for older people. Mobilising resources to ensure that these factors are considered is crucial to ensuring that regardless of where older people die in Ireland, they will receive the highest standard of care that nurses can provide. Understanding the factors that influence the provision of end-of-life care in acute and long-stay facilities in Ireland can help health professionals give more focused support and ensure that influencing factors are addressed so that older people at end-of-life receive quality end-of-life care. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines. The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity. A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique. Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim. Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'. Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management. Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources. [ABSTRACT FROM AUTHOR]

Aims and objectives. To undertake a concept analysis (CA) of residential autonomy to identify its attributes. To reveal the antecedents and consequences of autonomy for older people in residential care and thus enable this concept to be operationalised. Background. Globally, there is an ageing population. This population and their families demand that services offer choice and recognise the older individual in care relationships. Design. Concept analysis. Methods. Using the same search terms, findings from a literature search in 2007 and from a follow-up search in 2009 were used to conduct the CA. Rodgers (1989) framework was used to develop a model case of autonomy for older people in residential care. The attributes, antecedents, consequences and references were delineated. Results. Six attributes of autonomy for older people in residential care were delineated. (1) Residents are involved in decision making while their capacity is encouraged and maintained. (2) Residents delegate their care needs based on the right to self-determination and this can be achieved through (3) negotiated care planning, which is encouraged through open and respectful communication and (4) including families or significant others when the resident is cognitively impaired. (5) The residential unit operates a culture and atmosphere of flexibility within an ethos of maintaining resident dignity. (6) Meaningful relationships are enabled by the presence of regular and motivated staff, and these relationships enhance the residents’ opportunities to be autonomous. Conclusions. A CA framework is useful in trying to understand a term in its context and thus make it operational. Relevance to clinical practice. This CA is the first step required for further research on this aspect of care. This is essential in informing this nursing specialty. The attributes, antecedents and consequences can now be used to operationalise the concept in practice. [ABSTRACT FROM AUTHOR]