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Purpose: Sociometric studies and adult reports have established that children with Language Disorder (LD) are at risk of peer relationship difficulties. However, we have limited knowledge of how children with LD understand friendship, whom they deem as a good or bad friend, and what role their friendship concepts play in their relationships with peers. This exploratory study aimed to conduct a qualitative investigation into the friendship concepts that children with LD hold and to explore their strategies for making friends. Methods: We conducted multiple, art‐informed interviews on the topic of friendship with 14 children with LD at the age of 6–8 years. Participating children were based in the United Kingdom and Republic of Ireland. They attended enhanced provision, specific speech and language classes and mainstream classrooms. We used framework analysis to map children's responses to Selman's (1979) developmental model of interpersonal understanding, which espouses a theory of children's social development within the context of peer relationships. Results: The understanding of friendship formation in children with LD varied from physical presence to mutual support and sharing. Children's ideas about a good/bad friend represented the lowest developmental stage. Participants from the mainstream classroom demonstrated the highest stages of interpersonal understanding. Children with LD did not mention their language abilities as a barrier to making friends. Conclusion: There are limited studies exploring friendship directly from children with LD, and this study provides insights into this gap, by utilising art‐informed interviews. Children's immature understanding of a good/bad friend points towards a potential susceptibility to false friends, which we suggest needs further empirical validation. We also found that children with LD did not pay attention to their language difficulties when making friends, which raises questions about the ways diagnoses are shared with children. WHAT THIS PAPER ADDS: What is already known on the subject: Children with Language Disorder (LD) are at risk of peer relationship difficulties. Studies to date are based on sociometrics and adult reports. Only a few studies employ participatory approaches to research with children, directly engaging children with LD when exploring their friendships What this paper adds: This paper directly asks children with LD about their understanding of friendship and strategies for making friends.Physical proximity and play are important to children.s understanding of friendship especially in recognising good and bad friends. This indicates potential reasons for children with LD being susceptible to false friendsAdditionally, children with LD do not perceive language and communication as a barrier to making friends. What are the potential or actual clinical implications of this work?: Concepts around friendship and good/bad friends should be routinely assessed and targeted (if appropriate) in interventions. The study highlights the need to continue discussing practices around sharing diagnoses with children with LD. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' observation of patients in seclusion is essential to ensure patient safety.Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy.Direct observation and video monitoring are widely used in observing patients in seclusion.Coercive practices may cause distress to patient‐staff relations. What the paper adds to existing knowledge?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients.Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness.Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized.Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion.Pixellating the video camera would give a sense of privacy and dignity. What are the implications for practice?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs.A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision.Viewing panels (small window on the seclusion door) are important in establishing two‐way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients.Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness.More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations.Patient education is paramount. Providing prior information to patients using a co‐produced information leaflet might reduce their anxiety and make them feel safe in the room.When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. Introduction: A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim: The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method: A retrospective phenomenological approach, using semi‐structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results: Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion: The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice: Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion. [ABSTRACT FROM AUTHOR]

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

Background: People with Parkinson's disease (PD) do not always access specialist outpatient services in a timely manner in Ireland. The perspectives of people living with PD, relating to service access, are largely absent in the existing literature. Aim: To explore experiences of PD service access for people living with PD, using a qualitative approach. Methods: Purposive maximum variation sampling was used. Semi‐structured telephone interviews were conducted with 25 service users, including people with PD (n = 22) and supporting carers (n = 3). Informed consent was obtained from all participants. Interviews ranged in duration from 30 to 90 min. Data were managed in NVivo 12 and interpreted inductively using thematic analysis. The researchers were reflexive throughout the research process. The Consolidated Criteria for Reporting Qualitative Research checklist was employed to maximise transparency. Results: The findings highlight several key barriers to and facilitators of equitable and timely service access. Three key themes were identified comprising experiences of PD service access including 'geographical inequity', 'discriminatory practices', and 'public and private system deficits'. Together, these themes illustrate how a two‐tiered and under‐resourced health system lacks capacity, in terms of infrastructure and workforce, to meet PD needs for both public and private patients in Ireland. Conclusions: These findings point to problems for PD care, relating to (i) how the health system is structured, (ii) the under‐provision and under‐resourcing of specialist outpatient PD services, including medical, nursing, and multidisciplinary posts, and (iii) insufficient PD awareness education and training across health settings. The findings also show that telemedicine can provide opportunities for making access to certain aspects of PD care more flexible and equitable, but the feasibility and acceptability of technology‐enabled care must be assessed on an individual basis. Implications for policy, practice and research are discussed. Patient or Public Contribution: The design and conduct of this study were supported by an expert advisory group (EAG) of 10 co‐researchers living with PD. The EAG reviewed the interview schedule and the protocol for this study and provided detailed feedback from their perspective, to improve the methods, including the interview approach. The group also reviewed the findings of the study and contributed their insights on the meaning of the findings, which fed into this paper. [ABSTRACT FROM AUTHOR]

Dual Sensory Loss and learning disability is a historically neglected area of social work practice. This paper presents one element of a research study conducted with a health and social care provider in Northern Ireland. It explored staff experiences of assessing adults and children with a dual sensory loss and learning disability. Two sensory disability team managers, eight social workers and two rehabilitation officers were interviewed across sensory disability, learning disability and children with disability teams. Current levels of engagement and ways in which more inclusive services and practices could be developed were explored. Staff views indicate that there is minimal engagement between staff and service users with unique, complex needs. Staff use a range of tools, resources and skills in an attempt to promote inclusion and engagement. The paper concludes that to promote engagement staff need to develop their practice, making effective use of tools and resources. Staff skills and knowledge can be enhanced through training which is targeted, relevant and specific. There needs to be commitment to sharing good practice and cascading learning throughout teams. This will enable service users to have input into their own assessments which will form the cornerstone of all ongoing interventions. [ABSTRACT FROM AUTHOR]

Despite the benefits of utilising community‐based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/patterns within participants' subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP's awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user‐centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore keyworkers’ experience and perceptions working with people experiencing homelessness and the use of psychologically informed approaches in an Irish context.Design/methodology/approach In this paper a qualitative descriptive methodology was employed and face-to-face in-depth semi-structured interviews were conducted. Data collected were analysed using a thematic framework and transcribed by the researcher.Findings It was the view of the keyworkers psychological approaches allowed them greater understanding of psychological trauma and its effects promotes safe physical and emotional environments builds rapport between staff and clients and enables keyworkers to work more effectively with people with complex needs. There was also convincing evidence staff are quite receptive to training.Originality/value Given there is no research exploring the use of psychologically informed approaches in homelessness service settings, this study researched an area that has not yet been explored in Ireland. This qualitative descriptive research provides a platform from which further research can be conducted. It is hoped that highlighting the psychological issues of homeless people, the data obtained will help improve Irish homeless services, and the findings extracted beneficial in terms of future service developments, professional training and education. [ABSTRACT FROM AUTHOR]

Mental health nursing in the forensic services is perceived as stressful as there is often a tension between therapeutic and custodial processes. Clinical supervision has been discussed as a support strategy for nurses. The aim of this paper is to explore forensic mental health nurses understanding of clinical supervision and their perception of its utility within their practice. A qualitative descriptive method was used and 10 mental health nurses were interviewed with the aid of an interview guide. Qualitative data was analysed using a thematic approach culminating in the emergence of three themes. Participants talked about the tension between caring and custodial roles within the forensic services which was stressful and created difficulties in the maintenance of a therapeutic relationship. Clinical supervision was seen as a necessary support to assist nurses working in the forensic services. The findings support the premise that there is a tension between therapeutic and custodial practices. Acknowledgement of the complexities of working within the forensic services and the provision of clinical supervision within a confidential, non-judgemental relationship may assist nurses in the provision of care and the maintenance of therapeutic relationships. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present the unreported phenomenon of migrants with sight loss who experience unsupportive behaviour and attitudes from their own ethnic community due to their disability. In presenting specific case studies from a wider PhD study which investigated the previously undocumented experiences of migrants with sight loss in Ireland, the intention is to raise awareness among service providers of the additional vulnerability of this minority group. Design/methodology/approach – Migrants representing diverse ethnicities (Angolan, Algerian Nigerian, Zambian, Polish, Czech Republic, Malaysia Bangladeshi) described their experiences accessing disability services Ireland and discussed comparative attitudes towards disability in their home and host country. Service providers from the national organization working with people with sight loss were interviewed to gain an understanding of their attitudes and views on access and provision for migrants. By adopting a qualitative method following a constructivist grounded theory approach, migrants' own perceptions, beliefs, views and experiences of the sensitive subject of adjusting to sight loss while away from home were prioritised. Analysis of data was facilitated through qualitative software Atlas.ti and three core interrelated categories emerged most prominently: cultural perceptions of disability; support networks; and cultural barriers. The focus for this paper draws most significantly from the second category, support networks, most specifically the impact of absence or withdrawal of support for the migrant at the most vulnerable time of sight loss away from home. Findings – From grounded theory data analysis, three core interrelated categories emerged most prominently. They are: cultural perceptions of disability; support networks; and cultural barriers. This paper focuses most directly from findings related to support networks specifically highlighting two migrant case studies to report the impact of absence or withdrawal of support for migrant at the most vulnerable time of sight loss away from home. Service providers interviewed report inadequate information about migrants with sight loss. Evidence of stigma related to cultural perception of disability in the home community as trigger for discrimination from migrant's own network is reported by service providers. Findings are examined within an interdisciplinary theoretical framework, combining intercultural studies theories with disability models to facilitate a holistic understanding of the migrants' experience. Practical implications – The challenge of coping with disability for a migrant whose ethnic community network is absent, or withdraws its support owing to an individual's disability, have implications for alerting service providers to increased vulnerability of migrant service users. Consequently, this study has implications for programs and policies and can inform the development of culturally sensitive and appropriate services. Social implications – This study raises awareness of the compounded challenge for migrants with sight loss who are unsupported by their own ethnic group while living in a host country. Originality/value – This study reveals the previously unreported case of migrants who experience unsupportive behaviour from their own ethnic community following acquired disability. Evidence from migrants and their service providers demonstrates the impact of cultural perceptions of disability to influence the level of ethnic community support offered. [ABSTRACT FROM AUTHOR]

The aim of this paper is to inform the development of social work practice and policy by applying a practice-based evidence perspective to the experiential knowledge of social workers responsible for managing cases of elder abuse in Ireland. The study adopted a qualitative descriptive research design. Semi-structured interview data were collected from a purposive sample of eighteen senior case workers and inductive thematic analysis was undertaken. The findings are presented according to three themes: elder abuse case management, practice strategies for overcoming challenges and augmenting protective practice. By examining practice in the context of wider socio-political and legislative contexts, the paper provides learning in key areas for the protection of older people. The challenges to case management practice and the strategies employed to respond to these challenges are discussed in terms of adult protective service policy development and its relationship to practice. While recognising the imperative to respect a client's right to self-determination, increased statutory authority for the duty of the state to protect older people from abuse as well as the role of the case worker to act on behalf of the state to implement protective interventions is important for the future development of the service. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Caring for people with dementia and responsive behaviours is challenging; however, little is known of nurses' experiences of responsive behaviours., What does this paper add to existing knowledge? To demonstrate understanding nurses need to be aware of their own actions, thoughts, attitudes and reactions., Time, education and management support are essential in enabling a person-centred approach., A decision regarding the place of care is difficult to come to, and given the drive to a person-centred approach, there is a need to consider the views of people with dementia., What are the implications for practice? Nursing staff supporting people with dementia should engage more frequently in reflective practice, ongoing education and decision-making., Service providers/managers need to have an understanding of the complexities of caring for a person with dementia and responsive behaviours and provide their staff with relevant supports and education that is accessible to all staff., Abstract Introduction Caring for people with dementia and responsive behaviours can challenge nurses, and little is known of their experiences. Aims To explore nurses' views of supporting people with dementia and responsive behaviours in long-stay facilities. Methods A qualitative descriptive study utilizing in-depth audio-recorded interviews of nine nurses, recruited from private and public care facilities. Qualitative content analyses conducted involving iterative comparisons of transcripts, summaries and memos, where coding, key quotes and tables were developed to determine themes. Results Four themes emerged: recognizing and understanding responsive behaviour, resources and interventions to support people with dementia and responsive behaviour, the impact of education on nursing practice and the care environment. Discussion Availability of staff, adequate time and financial restraints hinder nurses' ability to provide care. Access to ongoing education and being able to provide one-to-one care was valued as dementia-specific education changed nursing practice. Implications for practice Place of care was seen as dependent on the type of responsive behaviour in question, the duration of the behaviour and the impact of the behaviour on the person, other residents and staff. Dementia education needs to be accessible to all staff, and a collaborative approach is necessary in order to develop management guidelines and support strategies. [ABSTRACT FROM AUTHOR]

Introduction: Increased awareness of testicular diseases can lead to early diagnosis. Evidence suggests that men's awareness of testicular diseases is low, with many expressing their willingness to delay help‐seeking for symptoms of concern. The risk of testicular diseases is higher in gender and sexual minority groups. In this study, we discuss the codesign, refinement and launch of 'On the Ball', an inclusive community‐based 'testicular awareness' campaign. Methods: The World Café participatory research methodology was used. Individuals from Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, policymakers, media/marketing experts and graphic designers were recruited. Participants were handed a brief for 'On the Ball', which was designed based on feedback from a previous World Café workshop. They were assigned to three tables. Participants rotated tables at random for three 20‐min rounds of conversations. Each table had a facilitator who focussed on one element of the campaign brief. Data were collected using audio recorders and in writing and were analysed thematically. Results: Thirteen individuals participated in the workshop. The following themes emerged from the data: (i) campaign identity, (ii) campaign delivery and (iii) campaign impact. Participants recommended enhancements to the campaign logo, slogan, social media posts and poster. They suggested delivering the campaign online via social media and offline using various print and broadcast media. Participants recommended targeting areas with a large number of men such as workplaces. To help measure the impact of the campaign, participants proposed capturing social media analytics and tracking statistics relating to testicular diseases. Recommendations were used to refine the 'On the Ball' campaign and launch it in a university. In total, 411 students engaged with the various elements of the campaign during the soft launch. Conclusions: 'On the Ball' campaign visuals ought to be inclusive. Online and offline campaign delivery is warranted to reach out to a wider cohort. Campaign impact can be captured using social media analytics as well as measuring clinical outcomes relating to testicular diseases. Future research is needed to implement the campaign online and offline, explore its impact and evaluate its feasibility, acceptability, cost and effect on promoting testicular awareness. Patient or Public Contribution: The 'On the Ball' campaign was codesigned and refined with members of Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, health policymakers, media and marketing experts and graphic designers using the World Café participatory research methodology. [ABSTRACT FROM AUTHOR]

Aim To explore nurses' use of the World Health Organization safety checklist in the perioperative setting. Background Promoting quality and safety in health care has received worldwide attention. The World Health Organization surgical safety checklist (2009) is promoted for reducing postoperative morbidity and mortality. The checklist has been introduced in Irish perioperative settings. Method(s) A descriptive, qualitative approach was utilised. A purposeful sample of ten nurses participated in individual, semi-structured interviews. Results Participants were committed to promoting safety in navigating challenges in introducing, complying and accepting the value of the World Health Organization surgical safety checklist in concordance with best practice. Participants moved from task completion to embracing the checklist as an effective surgical safety checking tool. Challenges were identified around roles and responsibilities in overseeing the completion of the checklist. Conclusion(s) The management of processes is critical when implementing any safety initiative. This paper highlights the complexity and challenges in implementing the World Health Organization surgical safety checklist, contributing to global discussions around translating policy into practice. Implications for nursing management The effective implementation of a checklist requires a coordinated management approach in collaboration with team members. These approaches will support learning experiences contributing to a shared understanding of the change being implemented by all team members. [ABSTRACT FROM AUTHOR]

The worldwide growth in formal youth mentoring programmes over the past two decades is partly a response to the perception that young people facing adversity do not have access to supportive relationships with adults and positive role models in their communities to the degree they once had. Formal mentoring programmes facilitate the development of a friendship or ‘match’ between an older volunteer and a young person, with the objective of supporting the young persons’ personal and social development. Drawing on 66 semi‐structured interviews with young people, parents, mentors and caseworkers associated with nine youth mentoring matches in the Big Brothers Big Sisters Programme in Ireland, this paper analyses the forms of social support evident in the mentor–mentee relationships and highlights how the mentoring relationship was perceived to have impacted on the well‐being of the young people participating. The findings reflect the consensus in the mentoring literature that close, well‐established mentoring relationships have the potential to bring about meaningful change in the lives of young people. [ABSTRACT FROM AUTHOR]

Background: Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. Methods: Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. Results: Three themes were generated from the data: "Visibility and relatability"; "Embedding opportunities for engagement into everyday life"; "Societal and cultural barriers to open discussion". Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. Conclusions: Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society. [ABSTRACT FROM AUTHOR]

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

Vocal load related to heavy voice use in particular professions increases the risk of occupational voice disorders. Research on professional voice use has primarily focused on educators, singers, and call-centre advisors. This paper describes the daily experiences of professional soccer managers' occupational voice use through qualitative methods. Four global themes were identified: 1) voice uses, 2) factors affecting voice change, 3) impact of voice use, and 4) the importance of voice in soccer management. All describe the nature of soccer managers' vocal demands. Risk factors for voice disorders include intense and prolonged voice use in environments with adverse acoustic properties for speakers and poor phonation methods. Research on vocal behaviours and early prevention programmes for this population group is warranted. [ABSTRACT FROM AUTHOR]

Background/Aims The extension of termination of pregnancy services in the Republic of Ireland represents a significant change to practice. As a result, education was provided to assist midwives and nurses to fulfil their expanded role. Using Kirkpatrick's framework, this study aimed to conduct an in-depth evaluation to ascertain if knowledge gained at a termination of pregnancy education programme was applied to clinical practice. Methods Semi-structured interviews were conducted with a purposeful sample of seven midwives and nurses, 3 months after attending a termination of pregnancy education programme. Results Attendance at the programme prompted reflection on practice, with participants providing examples of how they applied the knowledge gained to the care they provide. The complexities of providing a termination of pregnancy service were highlighted, along with additional educational requirements. Conclusions Knowledge gained from the education programme was applied to practice improving termination of pregnancy care. Additional education and training needs identified will guide the development of future programmes. [ABSTRACT FROM AUTHOR]

Objective: The study explores the attitudes of people with chronic health conditions towards the use of group-based telerehabilitation. Design: A qualitative research study. Setting: The setting involved semi-structured focus groups via videoconferencing software. Participants: A purposive sample of 18 people with chronic health conditions including cardiorespiratory, neurological and musculoskeletal conditions was recruited via national patient advocacy and support groups in Ireland and clinical contacts. The sample included both those who had, and had not, previously engaged in telerehabilitation programmes. Procedures: An online questionnaire collected demographic information and data regarding previous telerehabilitation participation and telerehabilitation preferences. Focus groups were conducted using videoconferencing software, in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist, and analysed using thematic analysis following Braun and Clarke's methodology. Findings were triangulated with quantitative questionnaire data. Results: Four focus groups were conducted including participants with chronic cardiorespiratory (n = 8), neurological (n = 6) and musculoskeletal (n = 4) conditions. Three themes were identified regarding telerehabilitation: (a) benefits and facilitators (including convenience, increased service accessibility, social connection and technological support), (b) challenges and barriers (including technological access and literacy, limited 'hands-on' therapy, safety concerns and social limitations), and (c) preferences (regarding mode of delivery, content, duration and generic programmes for mixed-condition groups). Conclusions: Telerehabilitation is convenient for people with chronic conditions; however, concerns exist regarding the use of technology and the limitations of this healthcare delivery method. The role of telerehabilitation is valued, and future programmes should acknowledge patient preferences including a hybrid model of care, exercise and educational content, social interaction and synchronous components. [ABSTRACT FROM AUTHOR]

The positive deviance approach seeks to identify and learn from those that perform exceptionally well. Positive deviance as an approach to quality improvement is gaining traction in general practice. This study aimed to explore and compare stakeholders' perceptions of the factors that support the delivery of exceptional care in general practice and to refine a previously developed theoretical framework of factors associated with positively deviant care in general practice: the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. Semi-structured interviews were conducted with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers in Irish general practice. Subsequently, a directed content analysis approach was employed to deductively analyse interview data using the IDEAL framework, and newly emerging factors were inductively analysed and abstracted into the framework. Several distinct strategies (e.g. patient activation and team collaboration), structures (e.g. facilities and staffing), and contextual factors (e.g. communication and rapport, and culture) were found to support the delivery of exceptional care, and differences in perceptions, values, and expectations emerged between patients and practice staff. Interview data largely supported the pre-determined factors posited by the IDEAL framework, and new factors were abstracted into the framework (e.g. facilities and infrastructure). Stakeholder engagement regarding the factors supporting exceptional care in general practice supported and extended the IDEAL framework, contributing to a more comprehensive understanding of how exceptional care is delivered in general practice. The refined framework will support researchers, policymakers, and teams looking to support, measure, and achieve exceptionally good patient care in general practice. [ABSTRACT FROM AUTHOR]

Purpose: Efficient delivery of integrated healthcare requires solid alliances and collaboration with stakeholders on a regular basis. Due to coronavirus disease 2019 (COVID-19), it has become necessary to explore new ways of delivering integrated healthcare, and virtual clinics have offered one solution and are likely to continue due to the uncertainty with COVID-19. This study aims to explore clinicians' experiences of how efficient virtual elective knee clinics (VEKC) are in an orthopaedic setting in comparison to traditional face-to-face clinics. Design/methodology/approach: The study utilised a mixed-methods study to obtain qualitative and quantitative data. This involved an anonymous online survey in addition to in-depth qualitative interviews conducted with a purposive sample of multidisciplinary colleagues who work with the VEKC in an acute hospital. Findings: Three overarching themes and nine sub-themes emerged in the qualitative analysis. Overall, clinicians in both the quantitative and qualitative aspects of the study highlighted several ways that virtual clinics are efficient from both the patient and health service perspective. However, participants also highlighted barriers in relation to virtual clinics not being suitable for certain cohorts of patients and pathologies. Originality/value: This is the first study in Ireland to provide valuable insights into the experiences of multidisciplinary clinicians using VEKC and their efficiency compared to traditional face-to-face clinics. [ABSTRACT FROM AUTHOR]

Objective. To explore the experiences of bereaved mothers as they suppress lactation following late miscarriage (>20 weeks), stillbirth or neonatal death. Method. A qualitative, focused ethnographic approach was used involving in-depth interviews with 15 bereaved mothers, who attended a maternity hospital in Dublin. Data were collected from January to August 2012. Findings. Three key themes were identified: (1) suppression of lactation following the loss of a baby: silent tears; (2) mothering; (3) supportive care needs and the bereaved mother's experience. This paper focuses on the first global theme. The majority of bereaved mothers found engorgement and leaking milk particularly challenging both physically and emotionally following the loss of their baby; especially as their baby's funeral or wake took place during this period. The study highlights a number of areas where women could be better prepared for this experience. Conclusion. The findings highlight that the majority of bereaved mothers will require improved guidance and support with their breast care needs following the loss of their baby with awareness and sensitivity to their shortened motherhood. [ABSTRACT FROM AUTHOR]

Background: Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients' experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care. Methods: This qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland's Eastern region, using a stratified sampling matrix to include size of general practice and geographical area. Semi-structured interviews were conducted and analysed using thematic analysis, and audited by a third reviewer. Results: We identified three overarching themes relevant to the purpose of this paper: (1) patients' experience of, and (2) attitude towards, screening and treatment for problem alcohol use in primary care, as well as their (3) views on service improvement. While most patients reported being screened for problem alcohol use at initial assessment, few recalled routine screening or treatment. Among the barriers and enablers to screening and treatment, patients highlighted the importance of the practitioner-patient relationship in helping them address the issue. Nevertheless, patients felt that healthcare professionals should be more proactive in the management of problem alcohol use at a primary care level and that primary care can play an important role in their treatment. Conclusions: Problem alcohol use is an important challenge in the care of problem drug users. While primary care is well placed to address this issue, little data has reported on this topic. The development of interventions which promote screening and brief interventions in practice are likely to benefit this at-risk group and further research and education, that help achieve this goal, are a priority. Strategies such as dissemination of clinical guidelines, educational videos, academic detailing and practice visits, should be explored. [ABSTRACT FROM AUTHOR]

Contemporary health policy increasingly positions responsibility for the management of health with the individual which reflects newer neo-liberal discourses of health. Such an approach can be seen as problematic in the context of men's health, with men tending to be seen as largely 'irresponsible' towards their own health. This paper addresses this question by drawing on qualitative data on how men conceptualise responsibility for health. Whilst the desire to be responsible for health was borne by most of the men in the study, this was not always reflected in practice. There was also evidence of strategies that men adopted for either divesting themselves of responsibility for health or for legitimising lack of responsibility. In some instances, acting 'irresponsibly' was what defined participants as 'real men'. The implications of these findings for men's health policy are discussed with specific reference to the recent publication of Ireland's National Men's Health Policy. [ABSTRACT FROM AUTHOR]

The objective of our research is to analyse career dissatisfaction through the psychoanalytical lens of Jacques Lacan. Taking a multiple-case study approach, semi-structured interviews were conducted with seven male, senior managers working in the highly competitive technology industry. We found that respondents are defining satisfaction against a socially constructed career system that obliterates the concept of an agentic self. By grounding our qualitative investigation in the research fields of career and career dissatisfaction in the under-researched realm of Lacanian theory, we extend career theory to include a psychodynamic lens. We also contribute to practice by providing an alternative approach to career counselling that encourages the client to co-construct a sense of liberation and empowerment. [ABSTRACT FROM AUTHOR]

Introduction: Maternity services underwent much change during the COVID‐19 pandemic. Research on the impact on miscarriage care and experiences during this time is sparse. Within a national evaluation of recurrent miscarriage care, we qualitatively explored stakeholder views and experiences of recurrent miscarriage services in Ireland. This study describes the impact of the COVID‐19 pandemic on those experiences and perceptions of care. Methods: People with professional and lived experience of recurrent miscarriage and service engagement were actively involved in this qualitative study from idea generation to analysis and reporting. We recruited women and men with two or more consecutive first‐trimester miscarriages, and people involved in the management/delivery of recurrent miscarriage services and supports. We used purposive sampling to ensure that perspectives across disciplinary or lived experience, geographical, and health service administrative areas, were included. We conducted semi‐structured interviews, virtually all due to COVID‐19 restrictions, between June 2020 and February 2021. These were audio‐recorded, and data were transcribed, and subsequently analyzed using reflexive thematic analysis. Results: We interviewed 42 service providers and 13 women and 7 men with experience of recurrent miscarriage. We actively generated two central themes during data analysis. The first—'Disconnected'—describes how many women navigated miscarriage diagnosis and management and care in subsequent pregnancies alone; many felt that this resulted in increased trauma. At the same time, men struggled with not being present to support their partners and described feeling disconnected. The second theme highlighted 'The perceived dispensability of recurrent miscarriage services and supports'. Some service providers felt that service reduction and redeployment demonstrated a lack of value in the service. Virtual clinics facilitated access to services, but a preference for in‐person care was highlighted. Conclusion: Our analysis provides rich insights into the significant impacts that the COVID‐19 pandemic has had on the way recurrent miscarriage care is provided and experienced, with important implications for early pregnancy, miscarriage and recurrent miscarriage care. Services have undergone significant changes and, while these may be temporary, how services should be delivered in the future requires consideration, particularly given the deficits in care and care experiences highlighted prepandemic. Patient or Public Contribution: Members of the multidisciplinary RE:CURRENT Project Research Advisory Group (including four parent advocates, two of whom are co‐authors on this article) were actively involved throughout the study, including the generation of topic guides and the refining of themes. [ABSTRACT FROM AUTHOR]

A high prevalence of smoking has been reported among people receiving care within inpatient and forensic mental health services. An Irish inpatient mental health service introduced a "smoke free campus" policy in 2018. Six semi-structured interviews were completed with patients within this setting in 2019. Using thematic analysis, five themes were identified: Experience of stakeholder support, routine, experience of being an inpatient, the meaning of smoking, and the experience and perception of the smoking policy and governing bodies. The findings have implications for staff who work in mental health inpatient settings or who develop policies regarding smoking on hospital sites. [ABSTRACT FROM AUTHOR]

Background: Modifiable factors such as substance use, lack of attendance at antenatal care, overweight or obesity and sleeping position are associated with a higher risk of stillbirth. This qualitative study aimed to explore women's experiences of modifiable factors during pregnancy and their awareness of stillbirth. Methods: Purposive sampling was implemented by hospital staff in a large tertiary maternity hospital in Ireland between November 2020 and March 2021. Women were approached during their stay in the hospital and were invited to participate in a semistructured interview 3–5 months later. Eligible women were primiparous, >18 years of age and had an uncomplicated pregnancy and delivery. Eighteen women who consented to be followed up were interviewed at 3–5 months postpartum. Thematic analysis was used to analyse the data. Results: Four themes were identified: attitudes towards behaviour change, awareness regarding stillbirth and risk factors, the silence around stillbirth and risks, and attitudes towards receiving information about stillbirth. Women spoke about behaviour change in terms of outcomes, and most changes (e.g., ceasing alcohol consumption) were perceived as easy to manage. Awareness of stillbirth was limited among the women interviewed, and the association between risk behaviours and stillbirth was not known by any woman. Results suggest that there is a silence around stillbirth, including in antenatal care, which hinders information provision. However, most women highlighted the value of receiving information and extra education about modifiable risk factors and stillbirth. Conclusion: There is a general lack of understanding of the link between behavioural risk factors and potential pregnancy outcomes such as stillbirth. Providing further information to women about stillbirth and providing additional support with behaviour change might contribute to enhancing preventive efforts. Patient or Public Contribution: Patients were involved in this study by providing their experiences of antenatal care which were used as primary data. [ABSTRACT FROM AUTHOR]

Aim: Nurse leaders influence workplace culture; however, little is known about ethnic cultural influences on nurse leader development. This research aims to identify personal strategies promoting effective leadership by nurse leaders from European small island countries. Design: Descriptive qualitative study. Methods: In 2017, nineteen semi‐structured interviews with nurse leaders from England, Greece, Republic of Ireland and Malta explored leadership journeys, strategies employed to support their growth and development, and how cultural identity played a role. Transcripts were analysed using reflexive thematic analysis. Results: Four main themes and 12 subthemes captured the strategies and approaches of the nurse leaders: (1) Influences, (2) Communication, (3) Process and (4) Relationships. These findings reflect and validate the five transformational leadership practices of the Exemplary Leadership Model. While cultural island identity was discussed, there was a shared cultural identity within the role of "nurse leader" that spanned all islands. Patient or Public Contributions: Nineteen nurse leaders contributed to this study. [ABSTRACT FROM AUTHOR]

To address the lack of research on the information needs of spinal cord injured (SCI) patients and family members in acute care, in order to inform the provision of appropriate information supports. Semi-structured interviews were conducted with seven traumatic SCI patients and six family members. Reflexive thematic analysis was used to analyse and interpret the data. Five themes were generated: (1) "You were lying in limbo and you knew nothing" describes how being situated in non-specialist acute care limited participants' access to information; (2) "You'll never walk again" is not enough describes the need for information about the effects of SCI and the management of secondary conditions; (3) "The delivery was awful" demonstrates the importance of information being explained clearly and empathically; (4) "It was going in one ear and out the other" highlights the need for ongoing conversations with healthcare professionals, as retaining information provided in the early stages post-injury is often difficult; and (5) "Hope" not "false hope" discusses the importance of giving patients and family members hope while simultaneously being realistic about potential recovery. SCI patients and family members had significant unmet information needs in acute care. SCI patients and family members had significant unmet information needs while in acute care. Being in non-specialist acute care significantly limited most participants' access to information. During the acute phase of care, most patients and family members would like to know the patient's recovery prognosis, the impact of SCI on the patient's functional independence, how to manage secondary complications, and what to expect in rehabilitation. As patients and family members often had difficulty absorbing information in the early stages post-injury, information should be continuously repeated, reinforced and clarified. HCPs should promote realistic hope for SCI patients and family members even in the absence of neurological recovery, by focusing on what the patient is still capable of while being honest about their prognosis. [ABSTRACT FROM AUTHOR]

Adult safeguarding is characterised by competing debates related to core concepts including policy and legislative frameworks. In some countries, to reconcile the dualism of agency and structure, conflict and ambiguity are legislated for through the introduction of adult safeguarding legislation (ASL). This study set out to explore how the absence of ASL in the Irish context impacts safeguarding processes. A qualitative approach involving semi-structured interviews (N  = 14) and focus groups (N  = 2) with social workers, explored variables from adult safeguarding cases that contribute to positive outcomes in the absence of ASL, and where legislation could have helped, using a critical incident technique. Four themes emerged: practices and processes; coercive control and undue influence; information sharing and multiagency cooperation; and inability to access services. Whilst in the majority of cases existing policy and legislation achieved successful outcomes, legislative powers such as a duty to cooperate, to share information and powers of entry were deemed necessary. This study suggests limits to safeguards and protections within current policy. It illustrates the dualism that often exists between the agency of social workers to act to safeguard adults at risk and the structural rules, relationships and resources that can restrict the context of action in absence of legislation. [ABSTRACT FROM AUTHOR]

Aim: To explore the experience of people with idiopathic pulmonary fibrosis living through the COVID‐19 pandemic. Design A qualitative descriptive design using semi‐structured interviews. Method: Purposive sampling was employed to recruit 13 participants with idiopathic pulmonary fibrosis attending the respiratory department of a large urban teaching hospital in Limerick, Ireland. Data were collected between January 2021 and February 2021 through semi‐structured interviews, using an online platform. Reflective thematic analysis was used for data analysis. Results: Four key themes were identified from participant's experience of living through the COVID‐19 pandemic: (1) fear of contracting COVID‐19 disease, (2) living with reduced social interaction, (3) the adjustment in the relationship with healthcare professionals (HCP) and (4) navigating an altered landscape. Conclusion: Healthcare professionals have a key role in protecting the physical and psychological health of the person with idiopathic pulmonary fibrosis during this time and into the future. Through being cognisant of the additional supportive care needs of people with idiopathic pulmonary fibrosis, HCP can focus on developing targeted interventions aimed to enhance care provision. Impact This study considers people with idiopathic pulmonary fibrosis as a particularly vulnerable group whose experiences of living through the COVID‐19 pandemic warrant specific attention. Participants felt compelled to self‐isolate due to fear and anxiety of contracting COVID‐19 disease. Participants reported increased social isolation with some experiencing anger and resentment at loss of precious time with loved ones. Participants felt an increased responsibility for self‐monitoring their condition and had concerns about differentiating symptoms of COVID‐19 disease from an exacerbation. A variety of strategies that helped them cope through the pandemic were identified and also the important role these played. The results from this study can be used to inform HCP' understanding of challenges experienced by people with idiopathic pulmonary fibrosis during enforced restrictions related to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

This qualitative study explored healthcare professionals' views in relation to the potential expansion of cardiac rehabilitation services to include stroke patients, thereby becoming a cardiovascular rehabilitation model. 23 semi-structured interviews were completed with hospital and community-based stroke and cardiac rehabilitation professionals in Switzerland (n = 7) and Ireland (n = 19). The sample comprised physiotherapists, occupational therapists, speech and language therapists, stroke physicians, cardiologists, psychologists, dieticians and nurses. Interviews were audio-recorded and the transcripts were analysed in NVivo using inductive Thematic Analysis. Barriers and facilitators to cardiovascular rehabilitation were captured under four broad themes; (i) Cardiac rehabilitation as "low-hanging fruit," (ii) Cognitive impairment ("the elephant in the room"), (iii) Adapted cardiac rehabilitation for mild stroke, and (iv) Resistance to change. Hybrid cardiac rehabilitation programmes could be tailored to deliver stroke-specific education, exercises and multidisciplinary expertise. Post-stroke cognitive impairment was identified as a key barrier to participation in cardiac rehabilitation. A cognitive rehabilitation intervention could potentially be delivered as part of cardiac rehabilitation, to address the cognitive needs of stroke and cardiac patients. The cardiac rehabilitation model has the potential to be expanded to include mild stroke patients given the commonality of secondary prevention needs. Up to half of stroke survivors are affected by post-stroke cognitive impairment, consequently mild stroke patients may not be such an "easy fit" for cardiac rehabilitation. A cardiovascular programme which includes common rehabilitation modules, in addition to stroke- and cardiac-specific content is recommended. A cognitive rehabilitation module could potentially be added as part of the cardiac rehabilitation programme to address the cognitive needs of stroke and cardiac patients. [ABSTRACT FROM AUTHOR]

The Coronavirus disease 2019 (COVID‐19) pandemic public health and social protective measures imposed globally resulted in partial or full closure of key services and supports for services and supports for people with a disability, chronic illness or age‐related dependency. This caused huge disruption to care provision and family carers were relied upon to assume this care at home. Many family carers, including those in employment, found themselves navigating additional care responsibilities without 'usual levels' of support from family, friends, work, school, day care services, homecare and community services. The purpose of this study was to examine the impact of the COVID‐19 pandemic on family carers, their employment and care‐giving responsibilities, through the lens of the Conservation of Resources (COR) theory (Hobfoll, 1989). Adopting a qualitative research approach, 16 family carers (14 females, 2 males) who were in employment prior to the onset of or during the pandemic, participated in an in‐depth, semi‐structured telephone or online video interview between June and September 2020. Interviews lasted between 45 and 100 min, were audio‐recorded and transcribed verbatim. A thematic analysis of the interview data identified four main themes: colliding worlds; navigating unchartered waters alone; opportunity despite adversity and the relentless unknowing. Findings indicate that the onset of the pandemic resulted in the sudden loss of valued resources, which disrupted routines and caused care and work life domains to become intrinsically intertwined. Consistent with the main principles of the COR theory, adapting and transitioning to different ways of working and caring with depleted resources and supports, generated considerable stress for family carers and impacted their well‐being. The implications for employers, healthcare providers, policy makers and other key stakeholders are considered, to enable family carers to successfully reconcile work with care and protect their well‐being, as the pandemic continues to unfold and in the event of future societal crises. [ABSTRACT FROM AUTHOR]

Aims: To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs' identities and how they both enable and constrain their roles. Background: Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers. Design: A qualitative discourse analysis using Gee's Tools of Inquiry. Method: Data were collected between April 2019 and January 2020 through seven in-depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals. Findings: Five key discourses emerged. Language-in-use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs' identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other. Conclusion: This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs' identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals' roles. Impact: By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role. [ABSTRACT FROM AUTHOR]

Background: The critical care outreach service (CCOS) was established in a large teaching hospital in the West of Ireland in 2014 to provide an extension of CCOS between the intensive care unit (ICU) and the wards outside ICU. With the ever‐increasing pressure on ICU resources, CCOS seems to offer an additional service to patients who are critically ill and deteriorating in hospital wards. Aim: The aim of this study is to explore ward nurses' experiences and perceptions of the CCOS. Study design: A qualitative descriptive methodology aimed to obtain a descriptive account of ward nurses' experiences of the CCOS. Data were collected using semi‐structured interviews. Twelve nurses from the West of Ireland participated in the study. Braun and Clarke's six‐step thematic analysis was used to analyse the data. Results: Three core themes identified in this study included clinical support and decision‐making; sharing knowledge and skills, and communication. All 12 nurses identified the positive impacts that they felt the current outreach service provided to them on a daily basis. Conclusions: Study findings indicate that nurses value the role of the CCOS in supporting the care of the critically ill and deteriorating patients at ward level. The CCOS has become invaluable to the ward nurses in their daily practice especially at a time when resources are lacking and patient acuity is on the rise. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapy in palliative care is a developing discipline of clinical practice. Research literature has highlighted that undergraduate palliative care education in speech and language therapy is inconsistent and inadequate. However, limited research has been carried out to date in relation to student speech and language therapists and palliative care. Aim: To explore the role of speech and language therapists in palliative care from the perspective of speech and language therapy students in Ireland. Design: A qualitative descriptive research study was conducted, involving focus group interviews. Setting/participants: Purposive sampling was used to recruit 12 student speech and language therapists from one university site for this study. Undergraduate second, third and fourth year students were eligible for inclusion. Results: This study revealed that undergraduate student speech and language therapists collectively agree that there is a role for speech and language therapy in palliative care. Although students acknowledged that speech and language therapists can make a positive difference to patients' lives, and academic lectures were positively received, insufficient exposure to palliative care has resulted in fear, uncertainty and a lack of confidence amongst student speech and language therapists. Conclusions: A greater emphasis on palliative care is needed in undergraduate speech and language therapy education to ensure confidence and competency development. An exploration of student speech and language therapists' experiences in a specialist palliative care unit would be advantageous to determine the appropriateness of this setting for clinical placements. [ABSTRACT FROM AUTHOR]

Background: Childhood sexual abuse has complex and multifarious consequences for one's physical and mental health, including injuries and psychological illnesses such as depression (Psychological Bulletin, 99, 1986, 66; The SAVI Report. Sexual abuse and violence in Ireland. A national study of Irish experiences, beliefs and attitudes concerning sexual violence, 2002; Journal of Paediatric Health Care, 24, 2010, 358). In contrast to traditional psychotherapeutic approaches that focus on the treatment of disorders, humanistic integrative frameworks address the relational and neurobiological roots, and cumulative impact, of trauma (Rape: How women, the community and the health sector respond, 2007; The body remembers: The psychophysiology of trauma and trauma treatment, 2000). Quantitative research investigating the efficacy of these various therapies is gaining momentum (Campbell Systematic Reviews, 9, 2013, 3; Clinical Psychology Review, 34, 2014, 645; Journal of Nervous and Mental Disease, 203, 2015, 443), yet qualitative evidence on individuals' experiences, and analyses of a humanistic approach, are lacking. Aim: This study sought to address these gaps by examining the role of Rape Crisis Centre (RCC) specialist psychotherapy in addressing the psychophysiological impact of child sexual abuse in Ireland. Method: Semi‐structured, in‐depth interviews were conducted with a purposive sample of 11 adult survivors of childhood sexual abuse accessing RCC therapy and 12 RCC psychotherapists. Interview questions focused on their experiences and perspectives of RCC therapy and recovery. Interview data were analysed using qualitative thematic analysis. Findings: The analysis showed that working with embodied trauma is integral to the recovery process, while providing salient insights into the complexity of the empowerment approach in trauma work. Recovery is survivor‐led, but it is the individual's somatic experience that guides the process, monitored by the psychotherapist. Conclusions: This study makes an important contribution to trauma treatment research by detailing the lived experience of the recovery process. The findings enhance our understanding of the dynamics involved in processing the biological, psychological and social components of sexual abuse trauma. They also underscore the importance of a non‐directive relational approach. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Ireland has had a reliance on voluntary groups to provide peer-to-peer bereavement support. The aim of this study was to explore volunteers', within these voluntary groups, experiences of supporting parents following a fatal fetal anomaly diagnosis. Purposive sampling was used to recruit volunteers (n = 17) and face-to-face interviews undertaken. NVivo12 was utilized to assist in the thematic analysis of the data. Five themes; "motivation for altruistic acts," "being challenged," "value of education and training," "supporting volunteers to support others," and "it is not a sprint, it is a marathon" were identified. Volunteers felt comfortable in their peer-support role but found the lack of knowledge regarding newly implemented termination of pregnancy (TOP) services challenging. The importance of education/training was identified, emphasizing the need for collaboration with health care professionals and other voluntary organizations for support. The findings illustrate the need for collaborative working between health care professionals and volunteers to assist them in supporting bereaved parents. [ABSTRACT FROM AUTHOR]

Short-term study abroad programs are increasingly embraced by Australian schools of social work. These programs improve access to international experiences and have a demonstrable impact on academic outcomes. However, little is known about the factors that influence students who decide to participate in such programs. Using a qualitative semistructured design, eight Australian social work students were interviewed about their perspectives on the pre-application phase of a short-term study abroad program to Ireland that was advertised in early 2018. The findings reveal a number of multilevel structural, institutional, and personal enablers and barriers that impacted their decision to participate. Implications for future research, the tertiary education sector, and social work educators are identified, especially in terms of broader economic and political issues that contradict social justice and render the future of these programs precarious. IMPLICATIONS Short-term study abroad programs offer important learning opportunities for students, but there is a need to understand the dimensions that can impact the decisions of students to participate in these programs. The qualitative findings indicate that various factors impact on the participation of students, especially financial and caring responsibilities. Further research that is underpinned by a social justice lens is needed to address inequities in student participation. [ABSTRACT FROM AUTHOR]

Background There is a gradient relationship between socio-economic status and health. We investigated the views and perceptions of health promotion service providers regarding factors that affect lack of engagement in public health initiatives by residents in socio-economically disadvantaged (SED) communities. Methods We conducted semi-structured interviews with a purposive sample of key providers (n  = 15) of community-based health promotion services to elicit their views about engagement-related factors and their experiences of the provision, delivery and impact of health promotion in SED areas. Interviews were analysed using thematic analysis. Results Failure to (i) recognise within SED communities, socio-cultural norms of health-related behaviour and (ii) communicate to local residents an understanding of complex lifestyle influences appeared to affect adversely service engagement and contribute to the development of negative attitudes towards health promotion. Engagement is more likely when services are delivered within familiar settings, peer support is available, initiatives are organized within existing groups, external incentives are offered and there are options regarding times and locations. Collaborative working between providers and communities facilitates efficient, context-sensitive service delivery. Conclusions Knowledge of a local community and its socio-environmental context alongside a collaborative, facilitative and tailored approach to delivery are required to ensure successful engagement of SED communities in health promotion. [ABSTRACT FROM AUTHOR]

Background: A new legal capacity act was introduced in Ireland in 2015. This study aimed to identify and critically examine key issues in the area of decision‐making capacity from the perspective of psychologists working with adults with an intellectual disability. Methods: A qualitative exploratory approach was employed, and the study was positioned in a social constructionist framework. Purposive and snowballing sampling methods were used to recruit 15 clinical psychologists working with adults with an intellectual disability. Data were collected with the use of individual semistructured interviews. Interview transcripts were analysed using a model of thematic analysis. Results: Six themes were identified: (1) a presumption of capacity but a culture of incapacity, (2) supporting decision making as a process, (3) authenticity of decision making, (4) need for support and training, (5) contributions of psychology and (6) the way forward. Conclusions: Participants described that people with intellectual disabilities were often excluded from decision‐making processes. They welcomed the functional approach to decision making, considered substituted decision making to be necessary within a support framework and described supporting decision making as a process. Systemic, resource and attitudinal challenges were identified. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE) to implement those parts of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) referring to assistive technology and products. A particular vulnerable group deeply affected by health inequity affecting access to assistive products are people with intellectual disabilities. Objective: The objective of this study is to understand the barriers and facilitators to effectively access and continuously use essential assistive products for people with intellectual disabilities. Materials and methods: Face-to-face interviews with 15 adults with a mild to profound intellectual disability and 15 providers of assistive products were conducted to gain insights about current use, needs, knowledge, awareness, access, customization, funding, follow-up, social inclusion, stigma and policies around assistive products and intellectual disability. The technique of constant comparative analysis was used to analyze the data. Results and conclusion: An overview of factors is presented that fit within seven domains for access and eight domains for continuous use of assistive products for people with intellectual disabilities. It illustrates that access and continuous use are influenced by different barriers and facilitators. These different influences should be taken into account in country policies and frameworks that seek to implement the UNCRPD through assistive technology. Proactive assessment for assistive products by health professionals is rare and the vast majority of people with intellectual disabilities depend on carers to signal the need. A lack of education for carers around available assistive products and the benefits of assistive products for people with intellectual disabilities may lead to an underutilization for this group. The paternalistic attitude of care providers towards people with intellectual disabilities limits access and use to certain (high-tech) assistive products. The segmented and disjointed aspect of public funding to support assistive products found in this study is a key issue for policymakers who aspire to adhere to implementing the UNCRPD equally in all areas of their country. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma is a B-cell haematological malignancy characterised by uncontrolled plasma cell proliferation. Patients with the disease often undergo periods of remission followed by multiple relapses. Understanding patients' experience of living with this chronic condition is key to providing effective patient-centred care. Aims: This qualitative descriptive study explored the experiences of patients living with multiple myeloma. Methods: A purposive sample of 6 patients was used. Data were collected using in-depth unstructured interviews and analysed using Colaizzi's (1978) thematic framework. Findings: The emergent themes included: information and communication; treatment and symptom burden; the importance of support from family/friends and professional help; psychosocial elements of survivorship. Conclusion: The complex symptoms of multiple myeloma need to be treated holistically to manage the unpredictable nature of this disease. [ABSTRACT FROM AUTHOR]

Women make choices throughout pregnancy and childbirth and interactions with healthcare providers are integral to the journey. Healthcare providers have the potential to advise, influence and support women in their choices as to where to give birth. The aim of this study was to examine Northern Ireland healthcare providers' attitudes and experiences of women choosing place of birth, independent of risk profile. A qualitative study design was used to undertake key informant interviews with healthcare providers who were involved in caring for women antenatally, intrapartum and postnatally. Seven midwives and five obstetricians were interviewed. These interviews were transcribed, coded and presented in themes. Emerging themes included: informed decision-making among pregnant women; understanding and judgement of risk; autonomy and choice; culture of control and fear; and human rights. Interviewees highlighted barriers to women being able to access their chosen place of birth because of legal concerns, cultural perception of birth, and lack of senior managerial support for those providing clinical care to women who are considered at risk of complications during pregnancy or birth. Proposed solutions include developing a human rights-based approach which is about health and not isolated pathologies and focuses on empowering women, and not merely avoiding maternal morbidity or mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pregnancy is the main risk factor for the development of Stress Urinary Incontinence (SUI) which is known to have detrimental effects on quality of life in approximately 54.3% of women. The recommended treatment for SUI is to increase pelvic floor muscle strength, however, it is not clear why long-term adherence to pelvic floor muscle exercise (PFME) is poor. OBJECTIVES: To understand multiparous women's experience of incontinence and the prescription of pelvic floor muscle exercise (PFME) in the ante and post-natal period on their first pregnancy, and the differences, if any, that they experienced on subsequent pregnancies. METHODS: Purposive sampling was used to recruit women who had two or more children. The 1 : 1 semi-structured interviews were recorded, transcribed verbatim and anonymised. Thematic analysis was undertaken by both researchers, independently, and the codes and themes were agreed by consensus. RESULTS: Women were not aware that PFME could prevent incontinence, and the education provided was not sufficient to enable adherence to a PFME program. PFME were prescribed by health professionals, but there was a lack of detail, and the importance of PFME was not emphasised on first or subsequent pregnancies. On subsequent pregnancies, women were more aware of PFME and incontinence, however, this education came from informal sources, not the health care professionals providing the ante or post-natal care. CONCLUSIONS: Health care professionals should include more information, and better guidance regarding PFMEs. Most of the information about PFMEs came from informal sources, especially on the second and subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Using an experiential qualitative design, this study explored 11 female prisoners' perspectives of problems living in prison. The findings reflected the immediate impact of the physical, social, and institutional environment. Problems with drug detoxification and bullying were prevalent. Prisoners were outward-looking and future-focused. Some feared substance-abuse relapse on release while mothers persistently worried about family outside prison. Many used maladaptive strategies to cope with their problems and most used activities to remain occupied. The study recommended creating supportive prison environments and interventions that enable women to manage the everyday problems they experience living in prison. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to understand the contemporary public health nurse's (PHN) role and the issues that they face working in rural Ireland. Design and Sample: This study was based on an ethnographic approach with 13 PHNs working in rural areas in the South West of Ireland. Measurements: A combination of solicited diaries and semi‐structured interviews referred to as the diary/interview method were employed. Diaries were used by the PHNs to record their working day on a staggered basis from February to April 2017 with the subsequent interviews carried out in June and July 2017. Results: Working as a PHN in a rural area presented a number of issues such as time spent on traveling as a result of geographical disparity & poor road networks; client transport issues; a sense of working in isolation; communication issues with respect to computer/tablet hardware availability, mobile phone and broadband connectivity and the availability of, and the physical access to services. Conclusion: PHNs operating in rural communities face a distinct set of challenges that they have a limited ability to address. Legislators, health care providers and policymakers need to create a supportive environment that helps address these challenges in Ireland. [ABSTRACT FROM AUTHOR]

This article reports on findings from a study with recently qualified social workers on the use of social media in their practice. The findings reported here are drawn from a broader study on the use of electronic communications conducted with both newly qualified teachers and social workers. The focus group data reported here provide an insight into the practice realities associated with the use of social media by clients and social workers. The qualitative methodology employed helps to reveal the richness and complexity of technology use in practice. This rich picture reveals multi-directional surveillance, by clients and social workers, facilitated by social media. This includes surveillance by clients taking videos of meetings without consent. The article also highlights situations when social workers themselves consider it acceptable to gather information on clients through social media. The research identifies a range of ethical issues for social workers to navigate and highlights their need for support and guidance in the form of standards, codes, and education and training. The surveillance lens illuminates the ethical dilemmas being faced with reference to concepts such as power, privacy and consent as well as the broader debate of care and control in social work. [ABSTRACT FROM AUTHOR]

Aim: To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland. Background: Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles. Method: A descriptive qualitative approach using semi‐structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education. Results: Participant's perspectives on the enablers and challenges to enacting specialist and advanced practice roles resulted in the generation of three themes: organisational factors; collegial, interprofessional and interpersonal support; and role clarity, economic and regulatory contexts. Conclusion: Addressing organisational factors, encouraging collegial and interprofessional support and establishing role clarity contribute to the effective development and implementation of the role of advanced practitioners. Implications for nursing and midwifery management: Managers of nursing services need to provide leadership in developing strategies to enhance the enablers and overcome the challenges to advanced practice role development in their own organisation. [ABSTRACT FROM AUTHOR]