Search

Across the globe, students with disabilities have been increasing in prevalence in higher education settings. In the twenty-first century the struggle to include individuals with disabilities into nursing schools and workplaces continues in different parts of the world. Historically, entry criteria in nursing schools have been based on essential functions, which were primarily designed to be used in the workforce, rather than technical standards for education. In other health professions, such as medicine, this is not necessarily the case. For example, the American Association of Medical Colleges has worked over the past two decades to develop appreciation among medical schools for the need to admit and accommodate students with disabilities. We argue that nursing has not followed suit. This paper presents an integrative literature review, consisting of material from the United States, Ireland, United Kingdom, and Australia, investigating compelling stories, legal mandates, websites, and extant literature looking at essential functions or technical standards as entry criteria for nursing schools. The results show that, when essential functions for employment are used in nursing education, they may be a barrier to entry into that program. The paper concludes with recommendations for well-defined technical standards for nursing schools to be used primarily as entry criteria.

In 2013 Ireland's Association for Higher Education, Access and Disability (AHEAD), in partnership with the School of Nursing University College Dublin (UCD), hosted a summer school for professionals working in the Health Sciences sector who have responsibility for including students with disabilities in the health professions, including clinical placements. The topic of Universal Design for Learning (UDL) was explored and particular emphasis was given to how these principles could translate into practice on clinical placements sites. The summer school used a positive enquiry method to open a detailed dialogue about the inclusion of a diverse range of students in Health Sciences, especially students with disability. The participants comprised 25 academics working across a number of health-related sciences including nursing, medicine, and physiotherapy. While each participant is an expert in their occupational area, they attended the workshop because of an interest in inclusive practice. Using a framework presented by Dr. Joan McGuire from the University of Connecticut, the group explored how Universal Design interacts with the performance standards to be achieved by students in clinical placements. The rich discussion generated a wide variety of examples of the application of UDL. The paper is a summary of the findings of the summer school.

Aim: In the context of widening societal diversity, culturally and linguistically diverse patients continue to experience inequities in healthcare access and deficiencies in standards of nursing care. Re‐framing culturally responsive care as a complex intervention spanning multiple interacting factors at micro, meso and macro levels is an essential prerequisite for addressing knowledge translation gaps into everyday nursing practice. To this end, this paper proposes and explicates the potential of applying synergistic participatory implementation methodologies for developing effective implementation strategies with impact at individual and wider structural levels. Design: Discussion Paper. Data Sources: A co‐design case study is presented as an example of combining normalization process theory and participatory learning and action to investigate and support the implementation of culturally responsive care in general practice nursing. Implications for Nursing: Enacting culturally responsive health care is inherently complex in that it is influenced by multiple interacting factors. Viewing culturally responsive care as a complex intervention and incorporating a synergistic participatory implementation science approach offers possibilities for addressing the documented shortcomings in the implementation of culturally responsive nursing care. Conclusion: There is a need to move away from conventional approaches to conceptualizing and generating evidence on culturally responsive care. Incorporating participatory implementation methodologies can provide a new lens to investigate and support whole system implementation strategies. Impact: The combination of participatory and implementation methodologies is both theoretically and empirically informed. Engaging stakeholders in the co‐design and co‐production of evidence and solutions to long standing problems has the potential to increase the likelihood of influencing iterative and sustainable implementation and changes to clinical practice and systems. Patient or Public Contribution: This work is part of a wider programme of participatory health research on migrant health, partnering with a non‐governmental organization that supports migrants. [ABSTRACT FROM AUTHOR]

Aim: The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice. Background: Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future. Design: A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta‐analyses Scoping Review extension (PRISMA‐ScR) guidelines. Results: One hundred fifty‐five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation. Conclusion: There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work‐ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work‐ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence‐based. [ABSTRACT FROM AUTHOR]

At the turn of the twentieth century, middle-class educated gentlewomen in Ireland had established positions of authority and leadership in the relatively new professions of education and nursing. Acting in the roles of lady principals and lady superintendents, respectively, in education and nursing, many of these women had themselves participated in the social reform movements that led to the establishment of their new professions in the late nineteenth century. This paper critically analyses the roles played by these two distinct but socially related groups of Irish women, who were prominent in the early development of the social practices of education and nursing. The lady principals and lady superintendents entered the public domain as women with supervisory managerial roles, a fact that was in and of itself significant in late Victorian and early Edwardian society. In these roles, they expanded the boundaries of woman's role, provided role models for other women to follow, and forged networks of support for women. While the performance of their respective roles was mediated by public expectations and by extant gender relationships, they negotiated their way through the constraints of their new public space to achieve their aims of advancing their respective professions. (Contains 60 notes.)

Aim: This study aimed to explore perceptions of people with spinal cord injuries regarding the information they received during their rehabilitation programme on post‐injury sexual functioning. Background: Spinal cord injury is a traumatic, life‐altering event that is associated with loss of motor and sensory function and sexual impairment. Existing evidence suggests that sexual issues are poorly handled during the rehabilitation phase of the patient's journey. Design A descriptive qualitative design was utilized in this study. Methods: Twenty‐nine people with spinal cord injury participated in qualitative in‐depth interviews between November 2017 and April 2018, and data were analysed using the Burnard (1991, https://doi.org/10.1016/0260-6917(91)90009-y) thematic analysis framework. Results: Some participants indicated they were sexually inactive prior to their spinal cord injury. They testified that they had not received information on post‐injury sexual functioning. Many participants who received post‐injury information on sexual functioning reported dissatisfaction with the content and timing of this information. Conclusion: Personal conversations between spinal cord injured patients and dedicated members of the interdisciplinary health team can enhance the quality of rehabilitation care and patients' satisfaction with rehabilitation care. Nurses are central clinicians in the rehabilitation programme of spinal cord injured patients and should engage in individually designed conversations about post‐injury sexual functioning. Summary statement: What is already known about this topic? Spinal cord injury causes significant disturbances of sexual functions and sexuality with potential serious implications for sexual relationships.Sexual health issues are considered important aspects of holistic care but are not routinely addressed in health‐care settings.Spinal cord injuries units provide rehabilitation for people with spinal cord injuries. What this paper adds? There are multiple barriers to providing high‐quality information on sexual functioning within the rehabilitation setting, associated with personal, clinician and systems‐related factors.Determinations regarding individualized plans for sexual health conversations must be collaborative with the patients and possibly their family members, considering the individual views of patients regarding the best timing, content and most appropriate method for such interventions.The experiences and views of people with spinal cord injury are diverse and probably culturally dependent, and there are inherent risks associated with stereotypical attitudes to sexual behaviour and age. The implications of this paper: Spinal cord rehabilitation services must respond to the identified unmet needs of people with spinal cord injury regarding education on sexual functioning.Multidisciplinary teams that utilize a holistic approach designed collaboratively with the individual with spinal cord injury will have the best potential for success.To be able to successfully realize rehabilitation standards, clinicians must be immersed in techniques and strategies that motivate and guide them in discussing sexual functioning and other sexual health‐related issues. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse.Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. What this paper adds to existing knowledge?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI.MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings.MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. What are the implications for practice?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. Description: The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020—under review). Introduction: This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery‐orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim: To explore PSI‐trained MHNs' experiences of using PSI within Ireland. Method: A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi‐structured interviews with 40 PSI‐trained MHNs. Findings: Three overarching themes developed from the analysis. These included (a) PSI‐trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI‐trained MHNs; and (c) obstacles limiting the use of PSI by PSI‐trained MHNs. Discussion: MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice: This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement: This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To explore the collaborative nature of an international research project with other advanced practice nurse researchers and critically analyse the process. Background: Research within the nursing community is recognized internationally as important to ensure that nurses participate in cutting‐edge health care and promote evidence‐based practices, yet there is little detail found in literature on how a successful collaborative relationship is initiated and conducted in advanced practice research. Design: Discussion paper: The purpose of this paper is to discuss the process of collaboration on a research study among advanced practice nurses from four countries who are members of an international organization. Implications for Nursing: The collaborative process in international nursing research can be challenging and rewarding. It is important to remember that there is a relationship between the complexity of the study and the time required to complete it. Keys to success include following established guidelines. Conclusion: This project was a valuable experience in developing collaborative relationships as well as creating partnerships for future research to build on the knowledge gained. The authors' linkages to universities facilitated their participation in the research and completion of the ethical review processes. The use of social media and university resources was indispensable. [ABSTRACT FROM AUTHOR]

Public health nurses (PHNs) in Ireland provide preventative child health. An evidence‐based National Healthy Childhood Program (NHCP) has been in development since 2016. The final program implementation, including training all PHNs coincided with the Covid‐19 pandemic. Objective: To describe implementation and evaluation of a blended training program for PHNs Design: The evaluation used quantitative and qualitative methods underpinned by an implementation science framework to assess the training program. The three‐phase blended training was led by a Training and Resources implementation team. Data from a national cohort of PHNs (n = 1671) who completed training were descriptively analysed. Results: The majority of PHNs completed a suite of four online units (phase 1), as well as self‐directed and asynchronous content in phase 2. Results of phase 2 indicated it met participant needs in terms of knowledge but outstanding needs in terms of skills remained. Phase 3 (a modified Face to Face Clinical Skills Review) was completed by 1671 PHNs over a 5‐month period in 2020. Evaluation was very positive in terms of organisation and usefulness for practice. Conclusions: Despite challenges the NHCP training implementation goals were met. A well‐designed blended learning training program met service delivery imperatives and PHN needs. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore a proposed translational research continuum for nurse practitioners. Background: Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence‐based practice and evaluation of outcomes of interventions for their patient groups. Evaluation: This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework. Key Issues: A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals. Implications for Nursing Management: The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role. [ABSTRACT FROM AUTHOR]

Background: The 2008 financial crisis exacerbated an already mounting workforce challenge faced by most health services in the western world, namely the recruitment and retention of qualified nurses. Aim: This paper examines two additional challenges of relevance to workforce planning in health care, an ageing nursing workforce and reliance upon migrant nurses to solve short‐term workforce issues. Methods: Using Ireland as a case exemplar of these issues, this paper argues that policy makers and service providers should seek not only to address the challenge of retaining trained newly qualified and younger nurses but also focus on supporting older nurses and migrant nurses to remain within the workforce. Findings: The findings of this paper highlight the need for workforce planners, policy makers and service providers to take account of an ageing nursing workforce and reliance on foreign‐trained nurses as a solution to short‐term planning difficulties. Conclusion: Failure to address this need is likely to lead to significant workforce difficulties for health services into the future and undermine current efforts to increase the number and long‐term retention of qualified nursing staff. Implications for Nursing Policy: Policy makers and service providers should focus on the retention of trained older nurses as an important element of workforce planning. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The conceptual components of mental health recovery have been proposed, however, the barriers to their sustainability within the context of internal and external stressors require further exploration.Within their emerging adult role, young people will experience the personal challenges that will directly impact their understanding of their recovery, which will be different from other age groups. What the paper adds to existing knowledge?: Findings revealed recovery is understood as an uncharted, timely and personal process of engaging and transcending pain. Perceived barriers to mental health recovery and the internal dynamics experienced within the process have been explored.Recovery in young adulthood involved the reclaiming of their active and purposeful life force. It acquires real‐life relevance when applied to the social and cultural factors that provide meaning in life for young adults. What are the Implications for practice?: This research will impact how mental health nurses understand the catalytic effects of personal, social and cultural meaning of suffering in young adults' actualization of mental health recovery.Findings have significance for practice as the process of mental health recovery must not be presented as a clinical pathway, but understood as a personalized strategy of individual wellness in young adulthood. Introduction: Within their emerging adult role, young people will embark on employment, form intimate relationships and live independently. This indicates that how recovery is experienced and actualized in young adulthood may be different from other age groups. Aim/Question: To explore young adult service user's perspectives of mental health recovery in Northern Ireland. Method: Semi‐structured individual qualitative interviews were analysed using a Gadamerian‐based hermeneutic method and interpreted using a novel theoretical framework. The sample comprised 25 participants with an average age of 28 years. Findings: Five key themes evolved: Services: A Losing Battle Straight Away; From your Foundations to a Step in the Dark; Let Go of the Pain not the Experience; Surviving Out of the Ashes Recovery; and Needs to be More than a Word. Discussion: The main findings were that recovery involved the reclaiming of their active and purposeful life force. It is suggested that young adults have developed an explanatory model of "use that stuff you wanna bury" to transform an illness narrative to a wellness strategy. Implications for Practice: This research has implications for mental health nursing so the process of mental health recovery is not presented as a clinical pathway, but a personalized strategy of individual wellness. [ABSTRACT FROM AUTHOR]

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

Aims and objectives To challenge statements made about 'Careful Nursing' as a 'distinctive system' of nursing established by the Irish Sisters of Mercy, prior to Florence Nightingale, and which is said to have influenced her. Background Numerous publications have appeared claiming the emergence of a 'distinctive system' of nursing as 'Ireland's legacy to nursing', which, it is claimed, influenced Nightingale's system. One paper argues that the Irish system has its philosophical roots in Thomist philosophy. Several papers argue the ongoing relevance of the Irish system, not Nightingale's, for contemporary nursing theory and practice. Nightingale's influence on and legacy to Irish nursing are not acknowledged. Design A Discursive paper. Methods Archival and published sources were used to compare the nursing systems of Florence Nightingale and the Irish Sisters of Mercy, with particular attention to nursing during the Crimean War. Results Claims were challenged of a 'distinctive system' of nursing established by the Irish Sisters of Mercy in the early nineteenth century, and of its stated influence on the nursing system of Florence Nightingale. The contention of great medical satisfaction with the 'distinctive' system is refuted with data showing that the death rate at the Koulali Hospital, where the Irish sisters nursed, was the highest of all the British war hospitals during the Crimean War. Profound differences between the two systems are outlined. Conclusions Claims for a 'distinctive' Irish system of nursing fail for lack of evidence. Nightingale's principles and methods, as they evolved over the first decade of her school's work, remain central to nursing theory and practice. Relevance to clinical practice Nightingale's insistence on respect for patients and high ethical standards remains relevant to practice no less so as specific practices change with advances in medical knowledge and practice. [ABSTRACT FROM AUTHOR]

Irish Travellers are a small indigenous minority group with a distinctive lifestyle and culture which sets them apart from the general population. Travellers are vulnerable to significant mental distress which is exacerbated by the social disadvantage that they experience. A Traveller Mental Health Liaison Nurse (TMHLN) was introduced in one health care region in Ireland to provide support for Travellers and increase their access to mental health services. The aim of this paper is to present the findings from an evaluation which explored Travellers access to and reasons for accessing the TMHLN, the interventions provided and their experiences of and perceptions of the role of the TMHLN. A descriptive qualitative approach was used. Ten Travellers who used the service were interviewed. Following data analysis, three themes emerged: factors affecting Traveller mental health; accessing the TMHLN and the Travellers experiences and perceptions of the TMHLN. The participants were extremely positive about the TMHLN and valued the support provided. The findings highlight how the interpersonal skills associated with mental health nursing set against recovery orientated and culturally congruent practices are suitable approaches when working with Travellers. [ABSTRACT FROM AUTHOR]

The aim of this paper is to assist the novice researcher in the research ethics application process. The novice researcher in this context refers to any researcher negotiating a research ethics application for the first time. This may be a student or a more experienced registered nurse engaged in research activity. The paper applies ethical principles to the varied elements of a research ethics application form to explain the theoretical basis of the application criteria. The impetus for this paper arose following an internal audit of the decisions made by the research ethics committee of the nursing department at the Institute of Technology in Tralee, Ireland. The audit revealed the common reasons why full approval was not granted following initial review. This information prompted the development of a paper which would assist novice researchers in avoiding common errors and omissions in the research ethics application process. Despite the specific requirements of individual research ethics committees in different jurisdictions, the fundamental elements of research ethics approval remain unchanged. While the paper has local origins, its relevance holds a wider appeal. The paper takes a structured approach using the three ethical principles of respect for persons, beneficence, and justice, as outlined by the Belmont Report (1979) to provide a framework for discussion. Despite the advent of other frequently used frameworks for research ethics, the principles of the Belmont report remain constant as guidance for good practice in the research ethics context. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Developed by Blackhall et al. (2011), the Validation, Emotion, Reassure, Activity (VERA) communication framework seeks to provide student nurses with a guide to provide person-centred care to people living with dementia. The framework aims to enable the caregiver to communicate with the person living with dementia in a respectful manner, and accept that there is both value and meaning to the person's speech and behaviour. This paper presents the findings from a small pilot control pre-post study which aimed to explore the impact of the VERA framework to promote person-centred communication between student nurses and older people with dementia in long term care. Methods A control group of six students, received standard communication training and ten students received additional communication training using the VERA framework. Data was collected using the non-participant observational tool Quality of Interactions Schedule (QUIS) and three self-assessment questionnaires to assess student nurses' confidence, dementia knowledge and communication skills. Results The results of this study found that those students who received the additional VERA communication training were observed to have a significantly (Mann-Whitney U test; p = <0.05) reduced number of negative interactions with people with dementia than those students who had received standard communication training alone. In addition, student nurses trained in the VERA framework showed a significant increase (Mann-Whitney U test; p = <0.05) in their confidence to care for people with dementia than those who had received standard communication skills training. Conclusion The study finding need to be interpreted with caution given the small sample size and the pilot nature of the study. Nevertheless, these findings indicate that the VERA framework has the potential to improve (1) person-centred communication between student nurses and older people with dementia and (2) students' confidence to care for people with dementia. [ABSTRACT FROM AUTHOR]

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

In this section, Nikki Welyczko presents a brief synopsis of a range of recently published articles that may be of interest to nurses working in the renal setting. The aim of this roundup is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided. [ABSTRACT FROM AUTHOR]

Aim This paper reports on the qualitative findings from a national review of a nursing and midwifery scope of practice framework. Background Scope of professional practice frameworks offers a system of rules and principles to regulate its members and demonstrate its responsibility to society. Key issues in reviewing the scope of practice include notions of specialist and advanced practice, accountability, autonomy, competence, supervision, continuing professional development and delegation. Evaluation of scope of practice frameworks has particular application value to nurses, midwives, regulatory bodies and healthcare employers across the globe. Design A mixed methods approach was used. This included a national survey of nurses and midwives and focus groups and interviews with key stakeholders. The qualitative data are reported in this paper. Methods Focus groups and interviews were conducted among a convenience purposive sample of key stakeholders, including nurses and midwives working in the widest range of services and settings in 2014. The participants contributed to thirteen focus groups and thirteen interviews. Findings Six global themes, as follows: Evolution of the nursing and midwifery professions and practice; Scope of practice: understanding and use; Expanding scope of practice; Professional competence; Practice setting and context; Reflections on the current framework. Conclusion Practitioners understand the scope of professional practice and while some see it as empowering others see it as potentially restrictive. Nurses and midwives are generally willing to expand their scope of practice and see it as resulting in improved patient care, improvement in overall quality of standards and increased job satisfaction. [ABSTRACT FROM AUTHOR]

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing. [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]

As populations rise and many global health policies point towards community care, it is important that health care delivery meets demand. In Ireland, a study was undertaken on the level and context of missed care in community nursing. The study used a survey to identify the quantity of, and reasons for, missed care; a reference group to develop possible health economic implications for missed care, and a small sample of semi-structured interviews to consider the macro-environment within which missed care occurred. This paper presents the findings of the health economics and qualitative data, and the study's implications for community nursing. [ABSTRACT FROM AUTHOR]

Background: This paper reports on a research study to inform the development of a specialist role to support front line public health nurses (PHNs) working with vulnerable families and at risk children in Ireland. Aims: This study aimed to investigate the position of a leading role and explore the implications of such change. Methods: Focus group and semi-structured individual interviews were conducted with ten purposively selected participants in public health nursing, social work and a nongovernmental children's organisation working in disadvantaged areas in Dublin. Results: Assistant directors of public health nursing are in a key position to inform decisions regarding the children's services. Conclusion: Access to support and appropriate supervision are fundamental resource requirements for PHNs who work with vulnerable families and at risk children. The introduction of a specialist-leading role to support these PHN's is essential to sustaining best practice. [ABSTRACT FROM AUTHOR]

Background: Intellectual disability services have and continue to experience changes in service provision. This has an implication for leadership in practice as the quality of leadership has a direct influence on staff practice and care provided. Aim: To design, deliver, and evaluate a leadership programme for nurse and social care managers in Ireland. Design: An accredited programme was designed based on evidence from literature, practice, and national expertise. A cross-sectional survey was used to collect information on the attitudes and behaviour of participants before commencing and after completing the programme. Data from the questionnaires were analysed using SPSS and open-ended questions were analysed using content analysis. Setting: Intellectual disability services. Participants: 102 participants completed the programme and survey. Methods: Pre-post survey and reported using the CROSS guidelines. Results: Participants' expectations were rated highly, and all items scored higher in the post-survey. Qualitative data was overall positive regarding opportunities for more time to work through each aspect of the programme. The key learning was through the forum day where participants shared their group projects. Conclusions: Overall, the programme was positively evaluated and through engaging with the programme participants' perceptions moved from seeing leadership as mostly task-oriented to realising that qualities such as good communication, person-centredness, advocacy, supporting, role modelling, and empowering are key to leadership. [ABSTRACT FROM AUTHOR]

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

Aim: The aim of this study was to: (1) use cognitive task analysis to describe final year nursing students situation awareness in recognising, responding and escalating care of deteriorating patients in ward settings; and (2) make recommendations for training and practice. Design: A mixed methods cognitive task analysis with a convergent triangulation design. Method: Data collection involved observations of 33 final year nursing students in simulated deteriorating patient scenarios and retrospective cognitive interviews. A process tracing technique was applied to identify the cues to deterioration participants perceived; how cue perception altered as situational demands increased; the extent that participants made connections between perceived cues and reached a situational understanding; and the factors that influenced and constrained participants situation awareness. Qualitative and quantitative findings are woven together and presented using descriptive statistics, illustrative quotations and timeline extractions. Results: The median cue perception was 65.4% and 57.6% in the medical and surgical scenarios, respectively. Perception was negatively influenced by incomplete vital sign monitoring as situations escalated; limited physical assessments; passive scanning behaviours; poor task automaticity; and excessive cognitive demands. Incomplete perception, poor cue integration and underdeveloped mental models influenced situational understanding. Escalation calls did not always accurately reflect situations and a reporting mindset was evident. Clinical exposure to deteriorating patients was described as variable and opportunistic. Reporting Method: The study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. Patient or Public Contribution: Patients and public were not involved in this research. [ABSTRACT FROM AUTHOR]

Aim: To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time. Design: A cross‐sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses. Methods: We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis. Results: Eight hundred and seventy‐three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated 'low travel costs' and 'better ability to do paid overtime' with long shifts and 'healthy diet/exercise' with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: 'When I want to work', 'Impacts to my life outside work' and 'Improving my work environment'. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work‐life balance. Relevance to Clinical Practice: General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters. Patient or Public Contribution: This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers. Reporting Method: The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross‐sectional studies was used to guide reporting. [ABSTRACT FROM AUTHOR]

In this paper John Sweeney outlines key principles for conducting a study employing an historical design based on documentary analysis. It derives in part from his PhD study, in which he employs an historical design based on documentary analysis to investigate the delay in introduction of intellectual disability nursing into the Republic of Ireland from 1921 until 1958. This study examines the social, political and professional context to the decision to forgo the recognition of a professional nursing qualification and education process in intellectual disability until 1958. [ABSTRACT FROM AUTHOR]

fealy g.m. (2004) Journal of Advanced Nursing 46(6), 649–656 ‘The good nurse’: visions and values in images of the nurse The various ways in which the nurse has been publicly portrayed do not merely reflect the value of nursing in society, but also define the boundaries of nursing, and reveal the ideologies and systems of power-brokerage at work in shaping nursing. Therefore, it is of profound interest to the profession to continue to examine the ways in which the nurse is and has been portrayed. This paper aims to present a historical analysis of the image of the nurse in public discourses in Ireland. Using a framework of critical discourse analysis within the method of historical research, the paper draws on documentary primary sources to present an analysis of discourse concerning the ‘good nurse’. In exposing the diverse ways in which the nurse has been depicted in Irish public discourses, the origins of the ‘good nurse’ ideal are identified, the reasons for its continued promotion are critically examined, and the effects of the ideal on the development of nursing in Ireland are considered. While the ways in which Irish nurses have been depicted in public discourses have similarities with international nursing imagery, the ‘good nurse’ ideal has a uniquely Irish expression, indicating that the image of the nurse is both culture-specific and changes to reflect the underlying sociocultural context, and prevailing system of political power and influence. [ABSTRACT FROM AUTHOR]

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

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

The purpose of the National Dermatology Improvement Project was to identify the educational requirements of dermatology nurses and understand factors impacting the uptake of education for nurses. An educational needs analysis was performed to evaluate the strengths and weaknesses of current and future educational provision for all levels of nursing staff. Data were collected from department managers using questionnaires and interviews, and focus groups were held with nursing staff in bands 2–7. The majority of participants felt there was an overall lack of dermatology education, and that most of what was available was peer led and experiential. A number of barriers to the uptake of education were also identified, such as a lack of time, opportunity and motivation. These findings support the need for a nationally coordinated programme of dermatology education with formal and informal education provided for all levels of dermatology nursing staff. [ABSTRACT FROM AUTHOR]

Similar to other countries, there have been a number of high-profile reports into past and recent cases of child abuse and neglect in Ireland. The most recent of these have been the Monageer Inquiry, the Ryan Report, the Roscommon Child Care Case and the Report of the Independent Child Death Review Group. An analysis of these reports highlights the critical role played by public health nurses with troubled families. It also makes explicit key issues that consistently emerge as problematic in terms of professional practice. This paper summarises the main findings of the reports as they relate to the public health nursing service and identifies key themes emerging along with recommendations arising. The emerging themes relate to assessment, early intervention, record keeping, communication and interdisciplinary working and the role of public health nursing management. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring., Background: Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times., Evaluation: Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim., Key Issues: Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money., Conclusions: In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices., Implications for Nursing Management: As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Background: Engagement is couched as the opposite to burnout and while there have been numerous studies that have supported the relationship between organizational antecedents and employee engagement, nurse engagement is still inadequately understood. Recent papers in the nursing literature have called for more research on this construct to be conducted with nurses so that nurse leaders can be better informed about the impact of engagement on outcomes for the organization., Aim: To explore nurses' experiences of their work environments and to reveal factors in the workplace that may facilitate or act as barriers to nurse engagement., Methods and Participants: A qualitative methodology was employed with the data from focus groups with a total of 20 nurses working in both general and psychiatric nursing., Results: Facilitators of and barriers to engagement center around six areas of organizational life, namely; workload, control, reward, fairness, community and values., Conclusion: Interventions aimed at fostering engagement are called for and through future research in the area of engagement, it is believed that nurses will gain more positive experiences from their work and subsequently a greater sense of well-being.

Background: The various ways in which the nurse has been publicly portrayed do not merely reflect the value of nursing in society, but also define the boundaries of nursing, and reveal the ideologies and systems of power-brokerage at work in shaping nursing. Therefore, it is of profound interest to the profession to continue to examine the ways in which the nurse is and has been portrayed., Aim: This paper aims to present a historical analysis of the image of the nurse in public discourses in Ireland., Methods: Using a framework of critical discourse analysis within the method of historical research, the paper draws on documentary primary sources to present an analysis of discourse concerning the 'good nurse'., Findings: In exposing the diverse ways in which the nurse has been depicted in Irish public discourses, the origins of the 'good nurse' ideal are identified, the reasons for its continued promotion are critically examined, and the effects of the ideal on the development of nursing in Ireland are considered., Conclusions: While the ways in which Irish nurses have been depicted in public discourses have similarities with international nursing imagery, the 'good nurse' ideal has a uniquely Irish expression, indicating that the image of the nurse is both culture-specific and changes to reflect the underlying sociocultural context, and prevailing system of political power and influence.

Background: The role of the clinical nurse/midwife specialist and advanced nurse/midwife practitioner is complex not least because of the diversity in how the roles are operationalised across health settings and within multidisciplinary teams. This aim of this paper is to use The SCAPE Study: Specialist Clinical and Advanced Practitioner Evaluation in Ireland to illustrate how case study was used to strengthen a Sequential Explanatory Design. Methods: In Phase 1, clinicians identified indicators of specialist and advanced practice which were then used to guide the instrumental case study design which formed the second phase of the larger study. Phase 2 used matched case studies to evaluate the effectiveness of specialist and advanced practitioners on clinical outcomes for service users. Data were collected through observation, documentary analysis, and interviews. Observations were made of 23 Clinical Specialists or Advanced Practitioners, and 23 matched clinicians in similar matched nonpostholding sites, while they delivered care. Forty-one service users, 41 clinicians, and 23 Directors of Nursing or Midwifery were interviewed, and 279 service users completed a survey based on the components of CS and AP practice identified in Phase 1. A coding framework, and the generation of cross tabulation matrices in NVivo, was used to make explicit how the outcome measures were confirmed and validated from multiple sources. This strengthened the potential to examine single cases that seemed 'different', and allowed for cases to be redefined. Phase 3 involved interviews with policy-makers to set the findings in context. Results: Case study is a powerful research strategy to use within sequential explanatory mixed method designs, and adds completeness to the exploration of complex issues in clinical practice. The design is flexible, allowing the use of multiple data collection methods from both qualitative and quantitative paradigms. Conclusions: Multiple approaches to data collection are needed to evaluate the impact of complex roles and interventions in health care outcomes and service delivery. Case study design is an appropriate methodology to use when study outcomes relate to clinical practice. [ABSTRACT FROM AUTHOR]

Ireland has become a multicultural society in just over a decade, with non-Irish nationals comprising 12% of the population. The challenge for nurses working in the Irish healthcare system is to provide culturally appropriate care to this diverse population. This paper reports on a qualitative descriptive study exploring nurses' experiences of communicating with people from diverse cultures, and focuses on language barriers and the use of interpreters. The findings indicate that communicating with people who do not share the same first language is challenging, in particular the participants (nurses) were concerned about their ability to make a comprehensive assessment that ultimately forms the basis for quality care provision. The use of interpreters can inform the assessment process, but there are challenges in accessing and utilising these services. Further continuing education is required to promote culturally appropriate care. There is a need for increased discussion between nurses and interpreters to maximise communication with patients. [ABSTRACT FROM AUTHOR]

Torture and human rights abuses are a global epidemic, occuring in the majority of world nations. Global population movement has seen an increase in applications for asylum and refugee status in Western nations; Ireland is no exception. Many of these applicants have been subjected to torture and abuse in their homeland resulting in a significant burden of mental health problems to include depression, psychological disturbances and/or posttraumatic stress syndrome (Health Service Executive, 2008). Specialists teams work with survivors of torture on these issues however many of the other illnesses they experience are similar to those of the general population and they will seek care and attention from acute healthcare facilities where they will be met by the general medical/surgical nurse. While those working in the mental health sector will play a primary role in the provision of care, a multidisciplinary approach is essential. Nurses working in the acute general setting have a role to play in providing culturally competent care, advocating for this group and directing them to specialist services to support them in rebuilding their lives. These nurses have a moral and ethical responsibility to provide the best possible care and attention to all their patients (International Council of Nurses, 2006). The aim of this paper is to explore the impact of torture on the survivor's life and the contribution of the general medical/surgical nurse in caring for these survivors in the acute hospital setting. [ABSTRACT FROM AUTHOR]

o'leary d.f. & ni mhaolrúnaigh s. (2012) Information-seeking behaviour of nurses: where is information sought and what processes are followed? Journal of Advanced Nursing 68(2), 379-390. Abstract Aim. This paper is a report of a study on how nurses inform their decision-making in the workplace. Background. Despite the growing availability of research evidence, nurses have been slow to adopt it into their daily decision-making. Method. The study was undertaken in Ireland between 2006 and 2007 using a sequential mixed methods approach. In phase 1, the views of a quota sample of 29 nurses were explored using semi-structured interviews incorporating vignettes. Phase 2 involved the design and dissemination of a survey to a disproportionate stratified random sample of 1356 nurses. The response rate was 29%. Findings. In decision-making, nurses accessed other people, especially nursing colleagues, the most frequently. Sources that provided prepackaged information such as guidelines were favoured over sources that provided access to original research. The process of information-seeking for routine and non-routine decisions was different. Nurses making routine decisions relied mostly on their experience and an assessment of the patient. In non-routine decision-making, participants experienced more uncertainty about their decisions. Accordingly, sources of information used were more varied and the information-seeking process more extensive. The study highlighted the complexities of establishing whether information used in decision-making is research based or not. Conclusion. Routine practices should be reviewed and updated regularly through organizational mandates, as nurses do not generally question them. Research information to inform non-routine decision-making must be easily available to nurses in their workplace, as information searches generally prioritize finding enough, rather than the best, information to make a decision. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to establish pressure ulcer prevalence and prevention in the long-term care setting. Background. There is no information on pressure ulcers prevalence in care of the older person in Ireland; therefore, a prevalence study was undertaken to investigate key aspects related to current practices in pressure ulcer prevention. Design. A cross-sectional survey design was employed. Method. Ethical approval was received. Participants included 1100 older individuals residing in 12 long-term care settings. Data were collected using the Braden scale, the European Pressure Ulcer Advisory Panel minimum data set and pressure ulcer grading system. Results. All participants were Irish and white, 70% were women, and 75% were aged 80 years or older. Prevalence was 9%, with 28% of pressure ulcers grade 1, 33% grade 2, 15% grade 3 and 24% grade 4, mainly located on the sacrum (58%) and the heel (25%). Seventy-seven per cent scored Braden low risk or not at risk; however, 53% were completely immobile/very limited mobility and 58% were chair/bedfast. There was a significant association between activity and mobility and pressure ulcer development ( χ2 = 45·50, p < 0·001 and χ2 = 46·91, p = 0·0001, respectively). Fifty per cent had a pressure redistribution device in bed, and 48% had one in use on the chair; however, 9% had a repositioning regime planned for when in bed and 5% planned for when seated in the chair. Conclusions. This paper reports on the first ever pressure ulcer prevalence survey conducted in long-term care in Ireland, and results provide significant insights into decision-making and use of resources in the prevention of pressure ulcers. Relevance to clinical practice. Pressure ulcers are common, costly and impact negatively on individuals. Current practices in prevention show several areas for improvement, namely, risk assessment, care planning and documentation. [ABSTRACT FROM AUTHOR]

Aims. This paper reports the findings of a national study of the variations in the provision and correlates of respite breaks to families. Background. Internationally, respite breaks are a major support service to family carers, demand for which often exceeds supply for persons with an intellectual disability. Hence, the length of breaks available to families has to be rationed. Nurses are often involved in such decisions. Method. National data on the use of respite breaks by over 4000 families in a full calendar year (2008) were analysed to examine the variation within the Republic of Ireland on two indicators: namely the proportion of carers who had any access to breaks and the median number of days they had received. Findings. Striking differences across health service areas were found on both indicators of usage. These were not solely attributable to the availability of provision but also reflected variations in the criteria local services used to allocate places. However, those persons with more severe disabilities were given priority, whereas carer characteristics were not a major influence. Contact with social workers and community nurses also increased the likelihood of carers receiving respite breaks. Conclusion. Intra-country comparisons of service delivery should assist planners in creating more equitable access to respite breaks and the development of more explicit eligibility criteria for their use. Nurses are well placed to lead on this. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an exploration of the experiences of patients with end-stage kidney disease who were having haemodialysis. Background. The losses and lifestyle disruptions caused by end-stage kidney disease are a fundamental source of suffering for people. The hope of a transplant is an important factor in people's ability to cope with end-stage kidney disease and dialysis. Method. A Heideggerian phenomenological methodology was used. A purposive sample was selected of 16 patients with end-stage kidney disease having hospital-based haemodialysis therapy in the Republic of Ireland. Qualitative interviews were conducted in 2006-2007. Data were analysed using qualitative interpretive analysis. Findings. The overarching pattern identified was 'Waiting for a kidney transplant'. This pattern consisted of three themes: living in hope, uncertainty and being on hold. Participants described their experiences of living in hope while they waited for a kidney transplant. However, as the waiting time continued indefinitely, participants became uncertain, and this meant that they were unable to contemplate opportunities in the future. Moreover, the restrictions of haemodialysis therapy prevented them from performing many of the activities they had taken for granted in the past. Consequently, they described their experiences of being on hold while they waited for a kidney transplant. Conclusion. Nurses should engage in open and honest discussions with patients in relation to kidney transplantation so that they are able to recognize and address their concerns about kidney transplantation. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study measuring attitudes of primary care nurses towards caring for people with hepatitis C. Background. Hepatitis C is a major public health problem. Attitudes to caring for people with hepatitis C vary and can have an impact on nursing care practices. International literature has identified discriminating practices amongst healthcare professionals including nurses. There is limited research examining primary care nurses' attitudes to caring for people with hepatitis C. Methods. A cross-sectional postal census survey of 981 nurses working in one health board region in the Republic of Ireland was conducted during the period March 2006 to June 2006. Results. A response rate of 57.1% (n = 560) was achieved. Exploratory factor analysis of an attitude scale identified three latent variables: 'infection control behaviour', 'caring' and 'fear'. Attitudes were generally positive towards caring for persons with hepatitis C; however, 51.7% of respondents would use additional infection control precautions if caring for someone with known hepatitis C. Younger nurses and those educated to degree level and above held significantly more positive attitudes to caring. Nurses agreed that they have a central role in managing and treating people with hepatitis C; however, many agreed that they lack the knowledge and skills to care for persons with hepatitis C. Conclusions. Negative attitudes can result in discriminatory experiences for persons with hepatitis C or at risk. Nurses require ongoing education on hepatitis C to improve knowledge, to limit concerns and ensure adherence to infection control guidelines. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study conducted to compare knowledge of hepatitis C virus infection amongst three groups of registered nurses working in primary care, to identify their current sources of information and access to educational resources. Background. Hepatitis C virus infection is a public health problem;no vaccine exists to prevent the disease. Previous studies identified limitations in nurses' knowledge of hepatitis C virus infection and the impact on care. Limited research has been conducted in primary care. Methods. A cross-sectional postal census survey of 981 nurses working in one Irish health board region was conducted March--June 2006. Questionnaires measured knowledge of hepatitis C virus infection. Data were collected on demographics, current working practices, information resources and previous education. Results. The response rate was 57.1% (n = 560). A minority (27.3% 145/531) of respondents agreed they were well informed about the virus. Almost 40% reported having contact with clients with the virus; however, information and service provision differed. Factors influencing higher knowledge included: contact with clients with hepatitis C virus infection (P < 0.0001), working in the addiction services (P < 0.0001), educated to degree level and above (P < 0.010) and previously attending education programmes (P < 0.0001). Only 21.5% (119/553) of respondents had attended any form of education on hepatitis C virus infection. Conclusion. Gaps in nurses. knowledge exist and can limit information and advice. Educational and information resources need to be developed for registered nurses working in primary care; care for clients with hepatitis C virus infection is not the sole remit of the addiction services. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study conducted to explore how nurses working at advanced practice level in chronic and acute care outpatient contexts responded to decision-making concerns in clinical practice. Background. Current theoretical explanations of clinical judgement offer insight into how healthcare professionals process information; however, they are incomplete as they do not consider psychosocial issues. Research evidence informing clinical judgement practice is based largely on acute care hospital settings. Consequently, little is known about how practitioners make clinical judgements in outpatient contexts where patients can participate in their own care. Method. A grounded theory approach was used to analyse interview data about clinical judgements made in actual clinical practice. Twenty-one nurses working at advanced practice level in mental healthcare clinics and accident and emergency in the Republic of Ireland were recruited. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2002- 2005. Findings. The core category to emerge from the data was 'mutual intacting'. This refers to the main strategies that practitioners used to resolve concerns about eliciting patient information and selecting treatments that were acceptable to patients. It highlights the clinical judgement practices that practitioners find useful to engage patients to facilitate effective decision-making. Conclusion. Practitioners could draw from the various strategies identified in this research to develop their clinical judgement practice further in ways that include the development of an effective relationship with their patients. Negotiation and compromise are particularly useful strategies that should be used to facilitate effective treatment delivery that takes account of patients' circumstances. [ABSTRACT FROM AUTHOR]

Aim: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion.Background: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation.Method: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study.Results and conclusions: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing.Implications for nursing management: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers new understandings on the views of senior clinicians concerning nurse prescribing at a time of ongoing professional policy iteration and practice change in the area. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to report findings from a study investigating nurses’ experiences of strike in one public general hospital in the Republic of Ireland. Background. October 1999 heralded the first nationwide nurses strike in the Republic of Ireland. The strike reflected an international shift towards industrial action in a profession which had previously viewed such action as the antithesis of professional behaviour. Methods. A focused ethnographic approach studied a group of striking Registered Nurses, not as a culture per se, but as a collection of individuals sharing a common human experience. A purposive sampling approach identified eight information-rich cases from a modified quota structure. Semi-structured interviews were carried out immediately prior to, during and at the end of the 1999 strike. The participants also maintained journals which were explored during the interviews. Data were analysed using a constant comparative approach, seeking to achieve category saturation. Findings. Four strike versions were identified. The anticipatory version is constructed as an inevitable protest, the orientation version as history-making solidarity and the performing version as a job of work. The withdrawal version is constructed as a conspiracy from which nurses are excluded. These versions portray ongoing tension that is experienced between conflicting self-identities of Registered Nurses as nurses and as strikers. The analysis revealed strategies adopted to resolve tensions between these identities within the dimensions of carer, patient advocate, multidisciplinary team member and professional. Conclusions. Debate on such potentially contentious issues by individual nurses, hospital managers and union leaders may facilitate awareness and preparation in advance of any future industrial action. Strategies that may be helpful in the event of a strike include a prestrike orientation programme for the entire organization, a support system for staff during the strike and informal de-briefing among all staff in the context of a social gathering when the strike is over. [ABSTRACT FROM AUTHOR]