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Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self‐management of stoma‐related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Methods: Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self‐management intervention. Results: Nineteen young people, aged 19–33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty‐nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7‐point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Conclusions: Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self‐management resource for young people with an IBD stoma and have relevance for the clinical management of stoma‐related distress in this population. Patient or Public Contribution: Three patient contributors are co‐authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2‐h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self‐manage distress related to stoma surgery. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative study set within Northern Ireland aims to explore professional perspectives on the application of evidence-informed practice to the adult safeguarding threshold screening process. Design/methodology/approach: Data was gathered from seven social workers in one health and social care trust area, who perform the designated adult protection role, through individual semi-structured interviews in one region of Northern Ireland. The interview schedule comprised of a series of questions examining the role of the designated adult protection officer and included three vignettes (Appendix). A thematic analysis was undertaken using NVIVO software. Findings: This paper reports main findings under the themes of: the role of the designated adult protection officer, threshold decision-making, evidence-informed practice and service improvement. One of the main findings was that professionals viewed the current process as too bureaucratic, and there was a desire to engage in more preventive safeguarding in collaboration with service users. There was a need to promote awareness of evidence-informed practice as it applies to the threshold screening process. Furthermore, the study raised the question of the need to consider the application of models or methods of assessment to the threshold screening process. Originality/value: This in-depth exploration of the role of designated adult protection officers in Northern Ireland provides a valuable insight into the complexity involved in managing adult safeguarding referrals and investigations. This study adds to the existing knowledge base, identifies potential service improvements and highlights the gap in evidence-based practice as it applies to the threshold screening process. Threshold screening of adult safeguarding referrals remains a subjective process and is open to interpretation and differences in professional judgement. The study highlights the need to consider the application of quality improvement methodology to the threshold screening assessment and the need to promote the exchange of safeguarding knowledge. [ABSTRACT FROM AUTHOR]

The use of standardized screening tools to identify trauma exposure and associated symptoms is commonly recommended as a key component in the development of trauma informed services and is seen as integral to facilitating access to evidence‐based therapies. However, there is limited evidence in the UK about the factors influencing the adoption of such tools into routine practice in children's social care. This paper presents the findings from a process evaluation of how practitioners implemented a screening tool for post‐traumatic stress disorder, anxiety and depression into their day‐to‐say practice and what worked or did not work during the process. The findings from this study highlight the potential benefits for both young people and practitioners, alongside some of the challenges involved. In particular, practitioners need to see the direct benefit for young people of being assessed. Additionally, practitioners value regular mentoring as they become more proficient in using standardized screening tools. [ABSTRACT FROM AUTHOR]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings: Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications: Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value: This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the impact of prison experience in ex-political prisoners in Northern Ireland in the context of changing and conflicting master narratives. Design/methodology/approach: A series of nine interviews were conducted with Loyalist and Republican political ex-prisoners in Northern Ireland. Eight were male and one was female. All had been in prison for substantial sentences relating to the Troubles. Findings: This study highlighted the challenges faced by political ex-prisoners regarding the changing conflicting master narratives in Northern Ireland and identified how they deal with these challenges. The participants adapted to post-conflict society by attempting to understand and make sense of their experiences, including justifying their actions as appropriate for the era and identifying positive changes in society resulting from the conflict. Research limitations/implications: A narrative approach can be beneficial for understanding the experiences of political ex-prisoners. It enables a theoretical perspective to look not only at the personal but also at social elements of why people behave as they do. The findings demonstrate that political ex-prisoners do have different experiences to non-political ex-prisoners. The sample size was small and was drawn from a specific group of political ex-prisoners who were actively seeking reconciliation. The findings may be different for other groups. Practical implications: A narrative approach can help the practitioner understand the context in which a person lives; ex-political prisoners may be very different from ordinary ex-prisoners because of the context in which they were imprisoned and the reasons for which they were imprisoned. They are likely to continue with the narrative of the conflict they fought in and may still have the same aims (e.g. Northern Ireland to become part of Ireland), though they may or may not believe in the same means. These are issues that should be discussed and elaborated when working with ex-political prisoners. Social implications: The master narratives active in the society into which the political ex-prisoner is released may impact the success or otherwise of their re-integration into society. Originality/value: Understanding the role of conflicting master narratives in dealing with the implications of being an ex-political prisoner. [ABSTRACT FROM AUTHOR]

This paper reports on the evaluation of a European PEACE III sponsored teaching and learning project that was designed to enable social work students to better understand the needs of victims and survivors of the conflict in Northern Ireland. The paper begins with an introduction to policy, practice and educational contexts before reviewing the literature on social work, conflict and trauma. It also summarises key, innovative pedagogical approaches used in the teaching, including the use of ground rules, teaching teams consisting of lecturer and service user dyads, learning exercises and case studies. The paper then explains the evaluation methodology. This involved two surveys which returned 144 student and 34 practice teacher questionnaires. The findings revealed that students were generally committed to this form of teaching and engagement with victims and survivors of the conflict, although some students reported that their attitudes towards this subject had were not changed. Some students also discussed how the conflict had affected their lives and the lives of families and friends; it is argued that such biographical details are crucial in developing new pedagogical approaches in this area. Practice teachers who supervised some of these students on placement reported general levels of satisfaction with preparedness to work with conflict related situations but were less convinced that organisations were so committed. The paper concludes with a discussion of the study limitations and a recommendation for more robust methods of teaching and evaluation in this area of social work education and practice. [ABSTRACT FROM AUTHOR]

Background: Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings. Method: A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11–15 years). The Theoretical Domains Framework guided a content analysis of the data. Results: We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape. Conclusion: These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping. [ABSTRACT FROM AUTHOR]

In recent years, social exclusion has gained the attention of governments around the world. This paper reports on a qualitative study involving 27 young men aged 14-19 years experiencing particular forms of exclusion in the context of Northern Irish society. The study used a focus group methodology to elicit their views with the aim of exploring both emotional and psychological needs and the structural factors that may contribute to their experiences of social exclusion. The findings reveal a range of unmet social and psychological needs, the impact of sectarianism and segregation, and a paucity of support systems in place. The paper concludes by making recommendations about how policy-makers and practitioners could find more imaginative ways of engaging such vulnerable young men to reduce social exclusion. [ABSTRACT FROM AUTHOR]

There is currently a limited understanding of what nurses in nursing homes view as the key education priorities to support their ability to provide the appropriate care for residents with heart failure (HF). A modified Delphi technique was utilized to gain a consensus on the key education priorities for nurses working in nursing homes in Northern Ireland. An initial list of items (n = 58), across 19 domains, was generated using the findings of a scoping review and stakeholder interviews, and a review of available clinical guidelines. Two rounds of surveys were undertaken. Items were presented using a 5-point Likert scale, with an additional exercise in the second round to rank the domains in order of importance. Fifty-four participants completed the first-round survey and 34 (63%) returned to complete the second. The findings highlight the importance of providing nurses in nursing home settings with general HF education and the delivery of person-centered care. Participants perceived education around technology for the management of HF and quality improvement or research methodologies associated with HF in nursing homes as lower priorities. This study illuminates key priorities from nursing home nurses regarding HF education that are applicable to this care setting. [ABSTRACT FROM AUTHOR]

Background Aimed to compare the prevalence, characteristics, and associated mortality risk of frailty in Northern Ireland (NI) and the Republic of Ireland (ROI). Methods Secondary analysis of the first wave of two nationally representative cohorts, the Northern Ireland Cohort for the Longitudinal Study of Ageing or NICOLA study (N  = 8504) and the Irish Longitudinal Study on Ageing or TILDA study (N  = 8504). Frailty was assessed using a harmonized accumulation deficits frailty index (FI) containing 30 items. FI scores classified individuals as non-frail (<0.10), pre-frail (0.10–0.24) and frail (≥0.25). Linkage to respective administrative data sources provided mortality information with a follow-up time of 8 years. Results The prevalence of frailty was considerably higher in NI compared with the ROI (29.0% compared with 15.0%), though pre-frailty was slightly lower (35.8% and 37.3%, respectively). Age, female sex, and lower socio-economic status were consistently associated with a higher likelihood of both pre-frailty and frailty. In the pooled analysis, both frailty and pre-frailty were higher in NI (RR = 2.68, 95% CIs 2.45, 2.94 and RR = 1.30, 95% CIs 1.21, 1.40, respectively). Frailty was associated with an increased mortality risk in both cohorts, even after full adjustment for all other characteristics, being marginally higher in TILDA than in NICOLA (HR = 2.43, 95% CIs 2.03, 2.91 vs. HR = 2.31, 95% CIs 1.90, 2.79). Conclusions Frailty is a major public health concern for both jurisdictions. Further research and monitoring are required to elucidate why there is a higher prevalence in NI and to identify factors in early life that may be driving these differences. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the effectiveness of a digital serious game intervention about COVID-19 on pre-registration nursing student knowledge. Method: This study included 282 nursing students from a university in Northern Ireland, with 210 students providing comparable pre-test and post-test results. The 'serious game' aimed to debunk common COVID-19 myths and provide accurate information about the virus. Participants completed a 25-item questionnaire before and after engaging with the game, which included true/false items based on the World Health Organisation's list of top COVID-19 myths. The data were analysed using paired t-tests to assess knowledge changes, and scores were calculated as percentages of correct answers. Results: A statistically significant improvement in COVID-19 knowledge was demonstrated among first-year nursing students who engaged with the serious game. The post-test scores (M = 92.68, SD = 13.59) were notably higher than the pre-test scores (M = 82.64, SD = 13.26), with a p-value less than 0.001. Conclusion: This research suggests that integrating serious games into undergraduate nursing education can effectively enhance COVID-19 knowledge. This approach is aligned with the evolving trend of employing technology and gamification in healthcare education. [ABSTRACT FROM AUTHOR]

The Warwick–Edinburgh Mental Well-being Scale (WEMWBS) is a relatively new measure and to date has been validated in student samples in England and Scotland, and in population samples in Scotland. No data exist on the psychometric properties of the WEMWBS when used within a general population in Northern Ireland, a region that might be expected to differ in health and well-being given its troubled history. This paper represents the first attempt to assess mental well-being in Northern Ireland using this new questionnaire. Data came from the 2009/2010 Continuous Household Survey and analyses are based on the responses of 3355 people aged 16 years and over who completed the full WEMWBS. The results suggest that the data collected using the WEMWBS among a large-scale random sample of adults in Northern Ireland are comparable to those produced for adults in other parts of the UK. The findings from this study are important as any measure of mental well-being purported to have been validated for the UK needs to include Northern Ireland, given that region's recent history in terms of the civil conflict and its potential impact on the health and well-being of its population. [ABSTRACT FROM AUTHOR]

The gender-based nature of suicide-related behaviour is largely accepted. However, studies that report exclusively on female suicides are rare. Here we demonstrate how female suicide has effectively been 'othered' and appears incidental in studies which compare female and male behaviour. We highlight how recent studies of suicide have tended to be dominated by male-only approaches, which increasingly link issues of masculinity with male death by suicide. Drawing on data collected from the general practitioner and coroner's office, we then apply the sociological autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that, as in male-only suicide studies, it is similarly possible to draw out issues associated with the feminine identity, which can be linked to death by suicide. We find that bereavement, sexual violence and motherhood could all be linked to the lives and help-seeking of the females who died. In closing, we suggest that a reorientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide. A Virtual Abstract of this paper can be found at: [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to investigate the relationship between online friend networks and the mental well-being (MWB) of adolescent males. Design/methodology/approach – The study used a mixed methods approach: first, questionnaire involving a validated MWB scale and questions regarding online friendship to 14-15 year old males (n=521); and second, focus group interviews (n=8) of between six and eight members three months later. Findings – Positive and negative associations were recorded between online friends and well-being. A positive relationship (p < 0.05) was found between the number of online friends and well-being scores. However, higher numbers of online friends were also associated with increases in negative online experiences namely, receiving embarrassing posts online or risky activities such as, chatting frequently with strangers. Online friends may influence perceptions of social support, status and belonging, each of which may contribute positively or negatively to well-being. However, by increasing these perceptions, online friends may cause additional distress when their presence does not provide tangible support during a crisis period. Originality/value – Online friends provide the context to which young males explore and negotiate the online world. To date, little mixed methods research has focused exclusively on the MWB of online friends. Policy makers could do well to consider the growing prominence of online social networking and produce targeted programmes to educate young people on the benefits and pitfalls of building large online “friend” networks. [ABSTRACT FROM AUTHOR]

Background: Most adolescent girls fail to meet current physical activity guidelines. Physical activity behaviours track from childhood into adulthood and providing adolescent girls with opportunities to be physically active may have health benefits beyond childhood. The effects of walking interventions on adult cardiometabolic health are known, however less is understood about the potential of walking to promote physical activity in adolescents. Following the Walking In ScHools (WISH) feasibility study, this definitive trial aimed to evaluate the effectiveness of a novel, low-cost, school-based walking intervention at increasing physical activity levels of adolescent girls (aged 12–14 years). Methods: Female pupils were recruited from eighteen schools across the border region of Ireland and in Northern Ireland. In intervention schools (n = 9), girls aged 15–18 years, were trained as walk leaders, and led the younger pupils in 10–15 min walks before school, at break and lunch recess. All walks took place in school grounds and pupils were encouraged to participate in as many walks as possible each week. The primary outcome measure was accelerometer determined total physical activity (counts per minutes, cpm). Results: In total, 589 pupils were recruited to the study. At baseline, pupils engaged in a median (interquartile range (IQR)) 35.7 (21.2) mins moderate-vigorous physical activity (MVPA) per day and only 12% (n = 66) of participants met physical activity guidelines (60 min MVPA per day). The intervention was delivered for a mean (standard deviation (SD)) 19.9 ± 0.97 weeks. The mean post-intervention total physical activity for the intervention group was 676 cpm and 710 cpm in the control group. Post-intervention total physical activity did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline physical activity (mean difference, -33.5, 95% CI = -21.2 to 88.1; p = 0.213). Conclusions: 'Scaling-up' physical activity interventions is challenging and despite a promising feasibility study, the results of this fully powered trial suggest that in this context, the WISH intervention did not increase device measured physical activity. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low, indicating that there is a need to better understand how to implement interventions within schools. Trial registration: ISRCTN; ISRCTN12847782; Registered 2nd July 2019. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is associated with feelings of burnout and fatigue, which in turn are associated with reduced performance among healthcare practitioners. This study explored movement behaviours of general practitioners (GPs) and the association between these behaviours with burnout and fatigue. Methods: GPs in Northern Ireland were asked to wear a thigh-worn accelerometer for seven days and complete validated questionnaires to assess the association between daily number of steps, time spent sitting and standing with feelings of burnout and fatigue. Results: Valid accelerometer data were obtained from 47 (77.0%) participants. Average workday sitting time, standing time and number of steps were 10.6 h (SD 1.5), 3.8 h (SD 1.3), and 7796 steps (SD 3116) respectively. Participants were less sedentary (8.0 h (SD 1.6)) and more active (4.7 h (SD 1.4) standing time and 12,408 steps (SD 4496)) on non-workdays. Fourteen (30.4%) participants reported burnout and sixteen (34.8%) reported severe fatigue. There were no significant associations between sitting, standing and step counts with burnout or fatigue (p > 0.05). Conclusion: GPs were less active on workdays compared to non-workdays and exhibited high levels of sitting. Feelings of burnout and fatigue were highly prevalent, however movement behaviours were not found to be associated with burnout and fatigue. Given the increased sedentariness among GPs on workdays compared to non-workdays, GPs should consider how they can improve their movement behaviours on workdays to help optimise their wellbeing. [ABSTRACT FROM AUTHOR]

Background: Although prescribing and deprescribing practices in older people have been the subject of much research generally, there are limited data in older people at the end of life. This highlights the need for research to determine prescribing and deprescribing patterns, as a first step to facilitate guideline development for medicines optimisation in this vulnerable population. Aims: To examine prescribing and deprescribing patterns in older people at the end of life and to determine the prevalence of potentially inappropriate medication use. Design: A longitudinal, retrospective cohort study where medical records of eligible participants were reviewed, and data extracted. Medication appropriateness was assessed using two sets of consensus-based criteria; the STOPPFrail criteria and criteria developed by Morin et al. Setting/participants: Decedents aged 65 years and older admitted continuously for at least 14 days before death to three inpatient hospice units across Northern Ireland, who died between 1st January and 31st December 2018, and who had a known diagnosis, known cause of death and prescription data. Unexpected/sudden deaths were excluded. Results: Polypharmacy was reported to be continued until death in 96.2% of 106 decedents (mean age of 75.6 years). Most patients received at least one potentially inappropriate medication at the end of life according to the STOPPFrail and the criteria developed by Morin et al. (57.5 and 69.8% respectively). Limited prevalence of proactive deprescribing interventions was observed. Conclusions: In the absence of systematic rationalisation of drug treatments, a substantial proportion of older patients continued to receive potentially inappropriate medication until death. [ABSTRACT FROM AUTHOR]

Background. Older people are one of the groups particularly vulnerable to loneliness due to factors such as deteriorating health, widowhood and death of friends/family, fewer confiding relationships, and being more likely to live alone. In the United Kingdom, services to alleviate and/or prevent loneliness can be classified as foundation services, direct interventions, gateway services, and structural enablers. Service managers and personnel involved in the delivery of interventions for older people are well-positioned to report on the mechanisms that contribute to the effectiveness of interventions. This study aimed to elicit from the perspective of a range of service providers, the barriers and facilitators of successful service provision, and the reduction of loneliness among older people. Methods. Semistructured interviews were conducted with 23 service managers of services providing an intervention to older people in Northern Ireland. Services were eligible for inclusion if they reported a goal of preventing or reducing loneliness and/or social isolation among older people. Transcripts were analysed using thematic analysis. Results. Eight themes were produced representing barriers or facilitators of successful service delivery, including characteristics of the service (person-centred approach, empowerment of service users and staff/volunteers, personal qualities of staff and volunteers, and funding for service provision) and characteristics of the wider community were services were located (hard to identify and/or reach lonely people; education and awareness of services; family and community structures; and accessible, affordable, and safe public transport). Conclusion. Developments in this area should prioritise integrated, systemic solutions that harness capacity and partnership working within communities, grounded in the principles of empowerment, inclusion, self-determination, and collective action. [ABSTRACT FROM AUTHOR]

Education is viewed as central to improving future palliative care for children and families across all countries. International education initiatives will ensure practitioners are aware of global health issues and can provide culturally sensitive care. Creative and innovative means of meeting such directives are required to achieve meaningful student learning. This paper focuses on one innovation, a children’s palliative care workshop using case studies as a teaching method, with nursing students from the USA and nursing and midwifery students from the UK. Key learning points arising from student evaluation were recorded under three main themes, these were: differences across countries, similarities across countries, and making learning fun and memorable. Findings indicated that this joint learning activity was viewed positively by all students and has enabled them to learn with and from each other, potentially impacting on their future practice. [ABSTRACT FROM AUTHOR]

Background This paper focuses on the relationships between health 'policy' as it is embodied in official documentation, and health 'practice' as reported and reflected on in the talk of policy-makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland - involving as they do a predominantly state funded (National Health Service) system in the north and a mixed health-care economy in the south. The key question is to determine how the detail of health policy as contained in policy documents connects to and gets translated into practice and action. Methods The data sources for the study include relevant health-care policy documents ( N = 5) and progress reports ( N = 6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers ( N = 28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents' contents and how they saw the impact of 'policy' on primary care practice. Results The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do. Conclusion To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements - specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required. [ABSTRACT FROM AUTHOR]

Aim This paper reports a study on how men cope with the side-effects of radiotherapy and neo-adjuvant androgen deprivation for prostate cancer up to 1 year after treatment. Background With early detection and improved treatments, prostate cancer survivors are living longer with the disease and the side-effects of treatment. How they cope affects their long-term physical and mental health. Design A prospective, longitudinal, exploratory design using both qualitative and quantitative methods was used in this study. Method Between September 2006-September 2007 149 men who were about to undergo radical radiotherapy ± androgen deprivation for localized prostate cancer in Northern Ireland were recruited to the study. They completed the Brief Cope scale at four time-points. Results Acceptance, positive reframing, emotional support, planning and, just getting on with it, were the most common ways of coping. Fewer men used coping strategies less at 6 months and 1 year after radiotherapy in comparison to pre-treatment and 4-6 weeks after radiotherapy. Interviews with these men demonstrated that men adapted to a new norm, with the support of their wives/partners and did not readily seek professional help. A minority of men used alcohol, behavioural disengagement and self blame as ways of coping. Conclusion Men used a variety of ways of coping to help them deal with radiotherapy and neo-adjuvant androgen deprivation for up to 12 months after radiotherapy. Interventions need to be developed to take account of the specific needs of partners of men with prostate cancer and single men who have prostate cancer. [ABSTRACT FROM AUTHOR]

ABSTRACT Until recently, little was known about kinship care in the UK. Research has begun to illuminate the circumstances which lead to children being cared for by relatives, and the stresses and strains experienced by carers. However, most UK research has only considered 'looked-after' children placed with formal approved kinship foster carers, although this group forms the smallest proportion of children in kinship arrangements. In this paper, we use microdata from the 2001 UK Population Census to examine the characteristics of kinship carers and children, and demonstrate that most children in kinship care are growing up in informal unregulated arrangements. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

When a parent is diagnosed with cancer it can have a profound impact on the family, especially the children. This paper reports on the experience of parental cancer for parents' and their children and the impact of a psychosocial intervention for young children whose parent has cancer. Using a qualitative design, data were generated from separate focus groups with children ( n = 7) and parents ( n = 6). One-to-one interviews were conducted with professionals delivering the intervention ( n = 2). Findings indicated that parents are often the gatekeeper to how, when and the context in which children learn about parental cancer. Many parents expressed a lack of confidence and skills as they considered communicating with their children about cancer. Parents stated the need for professional input mainly due to changes in their children's behaviour. Children had a number of fantasies and misconceptions surrounding cancer. This psychological intervention normalized their experience of parental cancer. It also improved children's understanding of cancer and equipped them with coping strategies. Professionals perceived the intervention led to improved family communication and promoted discussion of emotions. Open communication is pivotal for children whose parents have cancer but parents need supported and resourced to promote family coping when diagnosed with cancer. [ABSTRACT FROM AUTHOR]

This paper presents qualitative findings from a larger sequential mixed methods study which sought to provide an in-depth understanding of pharmacist prescribing from the perspective of pharmacist prescribers, medical colleagues and key stakeholders in Northern Ireland. Transcriptions were analyzed using thematic analysis as the interviews progressed and emergent themes were identified and coded (along with supporting quotes) independently and by consensus of the research team. Three major themes emerged in relation to pharmacist prescribing: the effect on patient care; challenges facing pharmacist prescribers and the importance of the interprofessional team (where two or more different professions with varied, yet complementary experience work together with a common purpose). Pharmacist prescribing may have the potential to reduce the medication burden for patients (as reported by pharmacists) as pharmacists tend to provide a more comprehensive medication review than doctors; the additional time for consultations made this possible. Further research is required on how interprofessional team working can be maximized in the context of pharmacist prescribing, particularly in relation to the management of multi-morbidity. [ABSTRACT FROM AUTHOR]

Cognitive balance theory posits that a drive for cognitively consistent thoughts modulates interpersonal relations. We extended cognitive balance theory to intergroup relations and tested it in a real‐life setting where intergroup relations are under strain: Northern Ireland in the wake of the UK's withdrawal from the EU. We predicted that when the groups of Irish people and British people in Northern Ireland are perceived as more compatible, intergroup bias would be lower than when groups are perceived as less compatible. We collected data of residents of Northern Ireland before the UK's official withdrawal from the EU (N = 604) and after (N = 350). As hypothesized, attitudes towards British people positively related to attitudes towards Irish people when participants perceived the groups as more compatible. We found the opposite relationship at low levels of perceived compatibility. Exploratory cross‐lagged panel analyses did not show that these effects occurred longitudinally, suggesting that cognitive balance does not drive judgements over time possibly because people are less likely to notice inconsistent responses across different time points. The present research demonstrates that intergroup attitudes assessed at a certain point in time follow cognitive balance principles. [ABSTRACT FROM AUTHOR]

Background: The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Aim: This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. Study Design: A national one‐day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. Results: Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24‐h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24‐h period and variable assessment methods were used. Conclusion: There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient‐relevant practice. Relevance to Clinical Practice: Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources. [ABSTRACT FROM AUTHOR]

Coercive control and related research have progressed significantly in the past number of years, with an ever-growing evidence base adding to its construct. However, currently there is a lack of evidence on young people's knowledge and understanding of coercive control. We included a module of questions in the 2020 Northern Ireland Young Life and Life and Times survey (n = 2,069) with the aim of capturing baseline measurable data on understanding of coercive control within intimate relationships among 16-year olds. Only 16% (n = 325) of respondents had heard of the term coercive control and knew what it meant. Findings also revealed that females, compared to males, were less likely to have heard of coercive control. When the victim being subjected to the behaviours was portrayed as female as opposed to male there was stronger recognition of the associated risks, need for support, and the seriousness of the situation. Our study findings call to question young people's knowledge of unhealthy intimate relationship behaviours beyond blatant and deliberate acts of harm such as those described in the coercive control scenarios. Gender disparities in awareness of coercive control across the study sample also give cause for concern given the increased risk of intimate partner violence among women and girls as well as lower reporting and help seeking among male victims. Results solidify the necessity for dedicated preventative and intervention efforts which focus on intimate relationships and reflect the diverse needs and experiences of young people. Supporting young people to act on their own behalf is an important step change to empowerment within their own intimate relationships. [ABSTRACT FROM AUTHOR]

Aims: To evaluate whether adding financial incentives to usual care is cost‐effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone. Design: Cost‐effectiveness analysis (CEA) and cost–utility analysis (CUA) from a health‐care provider's perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long‐term analyses were conducted from the same perspective, using an existing Markov model over a life‐time horizon. Setting: Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom. Participants: In the short‐term analysis, CPIT III participants were assessed: women 16 years or older, self‐reporting as smokers, fewer than 24 weeks pregnant and English‐speaking (n = 944). The same population was used for the life‐time analysis, plus their infants. Measurements Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was a biochemically verified quit rate for the CEA and quality‐adjusted life‐years (QALYs) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the life‐time analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied. Findings The short‐term incremental cost per quitter was £4400 and cost per QALY was £150 000. Results of sensitivity analyses confirmed these results. The long‐term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 [95% confidence interval (CI]) = £35–106] and increase in QALYs of 0.171 (95% CI = 0.124–0.229). These findings indicate that, over a life‐time, financial incentives are cost‐saving and improve health outcomes. Conclusions: In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost‐effective over a life‐time for mother and infants. [ABSTRACT FROM AUTHOR]

Objectives: Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11–19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors. Designs and Methods: A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed. Results: A total of 16.2% (n = 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46). Conclusions: This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample. [ABSTRACT FROM AUTHOR]

Organisations funded by Sport England or UK Sport must work towards achieving standards for safeguarding and protecting children in sport as set by the National Society for the Prevention of Cruelty to Children's Child Protection in Sport Unit (CPSU) and encourage a culture of listening to children. The present research was commissioned by the NSPCC CPSU to understand the practices of UK sports clubs regarding this objective. An electronic questionnaire was distributed through the national governing bodies of sport working with the CPSU. Some 64 clubs/squads representing 6,000+ juniors (under 18 years) responded. Quantitative data were analysed using simple statistics and qualitative data were themed utilising Foucault's theory of power and following Braun and Clark's six‐phase guide. Discourse, hierarchical judgement and docility were considered with reference to formal management and cultural environments. Semantic and latent themes were explored. The themes identified were: expectation awareness, reframing voice and preserving discourse. Clubs recognise the value of listening to children. However, existing power relations valorise adult knowledge fields over the experiences of juniors. Technology could provide an effective solution as it is remote, potentially anonymous and culturally accessible. As power is a productive force, problematisation of organisational culture could centralise children's voices and limit/prevent abuse. [ABSTRACT FROM AUTHOR]

The present study uses a prospective longitudinal research design to examine whether previously identified risk factors for prison interpersonal violence can predict violent prison misconduct in Northern Ireland (NI). Administrative data drawn from the records of 429 adult males imprisoned on November 22, 2017 were used to predict involvement in violent prison misconduct during a 1-year follow-up period. The results revealed that only a small number of previously identified risk factors were found to be significant in the NI context. Nationality, neighborhood deprivation, history of addiction, submission of prison complaints, past involvement in prison misconduct, and number of incarcerations emerged as significant, while religion, head injury/epilepsy, property offences, and prison visits were significant at the marginal level. Given the variation in risk factors identified as significant in the NI context compared to previous research, it is argued that cultural context matters when attempting to generalize the risk factors for prison interpersonal violence from one jurisdiction to another. These results offer some support for the importation theory, although it should be noted that the inclusion of prison environmental factors was limited due to the nature of the data. It is argued that specialist services and supports should be provided to address the factors contributing to interpersonal prison violence, including interventions to improve feelings of fairness, identify and treat underlying medical issues, as well as support visitation. [ABSTRACT FROM AUTHOR]

Background: Sedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality. Aim: To explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs). Design & setting: Sequential, cross-sectional design (initial online sedentary behaviour questionnaire and subsequent thigh-worn accelerometer substudy) of GPs and GPSTs in Northern Ireland. Method: Self-reported questionnaire data were aggregated and compared with device-measured accelerometry data. Results: Data from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 hours, SD 2.97) than those in secondary care (7.9 hours, SD 3.43 [mean difference {MD} 2.43 hours; P<0.001]). An active workstation (for example, sit-stand desk), was used by 5.6% of participants in general practice, while 86.0% of those without one would consider using one in future. Active workstation users self-reported lower workday sedentary time (7.88 hours, SD 3.2) than non-users (10.47 hours, SD 2.88 [MD -2.58 hours, P = 0.001]). Accelerometer substudy participants underestimated their workday sedentary time by 0.17 hours (95% confidence interval [CI] = -1.86 to 2.20; P = 0.865), and non-workday sedentary time by 2.67 hours (95% CI = 0.99 to 4.35; P = 0.003). Most GPs (80.7%) reported increased workday sitting time compared to prior to the COVID-19 pandemic, while 87.0% would prefer less workday sitting time. Conclusion: GPs have high levels of workday sedentary time, which may be detrimental to their health. It is imperative to develop methods to address sedentary behaviour among GPs on workdays, both for their own health and the health of their patients. [ABSTRACT FROM AUTHOR]

Abstract: It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a ‘global public health problem’ and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate ‘issue webs’. Particular attention is paid to the ways in which lay people conceptualize ‘activity’ and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which ‘activity’ occurs. [Copyright &y& Elsevier]

Background There is a dearth of literature on how different domains of sitting time relate to other health behaviours. Therefore, this study aimed to explore these associations in a sample of office workers. Methods 7170 Northern Irish Civil Servants completed an online survey which included information on workday and non-workday sitting time in five domains (travel, work, TV, computer-use, leisure-time), physical activity, fruit and vegetable intake, alcohol consumption and cigarette smoking. An unhealthy behaviour score was calculated by summing the number of health behaviours which did not meet the current guidelines. Multinomial regressions examined associations between unhealthy behaviour score and each domain of sitting time. Results ≥7 hours sitting at work and ≥2 hours TV viewing on a workday both more than doubled the odds of partaking in ≥3 unhealthy behaviours [Odds ratio, OR = 2.03, 95% CI, (1.59–2.61); OR = 2.19 (1.71–2.80)] and ≥3 hours of TV viewing on a non-workday nearly tripled the odds [OR = 2.96 (2.32–3.77)]. Conclusions High sitting time at work and TV viewing on a workday and non-workday are associated with increased odds of partaking in multiple unhealthy behaviours. Interventions need to focus on these domains and public health policy should consider sitting time as an important health behaviour. [ABSTRACT FROM AUTHOR]

Background: Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients' symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. Aim: To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. Design: Cross-sectional national online survey. Setting/participants: Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. Findings: 61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. Conclusion: This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care. [ABSTRACT FROM AUTHOR]

In a national and international context where there is a concern about the effectiveness of social care services for children and families to address chronic, enduring social problems and where there are finite resources available, the concept of social innovation in social work policy and practice to address need in new ways is receiving increased attention. Whilst an attractive term, social innovation in child and family services is not without its challenges in terms of conceptualisation, operationalisation, implementation and evidencing impact. This article reports on the development and evaluation of the Early Intervention Support Service (EISS), a newly designed family support service in Northern Ireland set up as part of a government-supported innovation and transformation programme that aims to deliver a voluntary, targeted, flexible and time-limited service to families experiencing emergent problems. Using the EISS as a case study, the challenges, benefits in terms of addressing policy imperatives and future direction of social innovation in social work practice are reflected upon. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common disorder affecting several people in primary, secondary, and tertiary settings. The condition is frequently under-diagnosed leading to long-lasting physical and cognitive impairment or premature death. Despite this, there has been limited research on the impact of innovative approaches to delirium education amongst undergraduate nursing students. The aim of this study was to evaluate the effect of a delirium awareness podcast on undergraduate nursing student knowledge and confidence related to the condition in Northern Ireland. Methods: The intervention was a 60-min delirium awareness podcast, available throughout May 2020, to a convenience sample of year one undergraduate nursing students (n = 320) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The podcast focused on how nursing students could effectively recognise, manage, and prevent delirium. Participants had a period of 4 weeks to listen to the podcast and complete the pre and post questionnaires. The questionnaires were comprised of a 35-item true-false Delirium Knowledge Questionnaire (DKQ), a 3-item questionnaire about professional confidence and a 7-item questionnaire evaluating the use of podcasting as an approach to promote knowledge and confidence about delirium. Data were analysed using paired t-tests and descriptive statistics. Results: Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.78% increase), causes and risk factors of delirium (13.34% increase) and management of delirium (12.81% increase). In relation to perceived confidence, students reported a 46.50% increase in confidence related to recognition of delirium, a 48.32% increase in relation to delirium management and a 50.71% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.001). The final questionnaire illustrated that nursing students positively evaluated the use of podcast for promoting their knowledge and confidence about delirium and 96.32% of nursing students believed that the podcast met their learning needs about delirium. Conclusions: A 60-min podcast on delirium improved first year student nurse knowledge about delirium. Nursing students also expressed that this approach to delirium education was effective in their learning about the condition. [ABSTRACT FROM AUTHOR]

Objective: Despite a growing body of evidence suggesting inequalities in breast cancer screening uptake in the United States for women with disabilities, few attempts have been made to examine whether this association applies to the United Kingdom. We conducted the first population-wide study investigating the impact of disability on uptake of breast cancer screening in Northern Ireland. Methods: Breast screening records extracted from the National Breast Screening System were linked to the Northern Ireland Longitudinal Study. This identified a cohort of 57,328 women who were followed through one complete three-year screening cycle of the National Health Service Breast Screening Programme in Northern Ireland. The presence of disability was identified from responses to the 2011 Census. Results: Within this cohort, 35.8% of women reported having at least one chronic disability, and these individuals were 7% less likely to attend compared with those with no disability (odds ratio 0.93; 95% confidence interval 0.89–0.98). Variation in the degree of disparity observed was evident according to the type and number of comorbid disabilities examined. Conclusion: This is the first population-wide study in Northern Ireland to identify disparities in breast screening uptake for women with chronic disabilities, in particular, those with multimorbidity. This is of particular concern, given the projected rise in the prevalence of disability associated with the ageing population. [ABSTRACT FROM AUTHOR]

This article addresses the challenge of promoting physical activity through a focus on equity and engaging physically inactive citizens through the development of inclusive strategies within parkrun UK—a free, volunteer-led, weekly mass community participation running event. We discuss how a UK-based action research design enabled collaboration with volunteer event organizers to understand participant experiences, constraints and develop localized inclusive practices. In contrast with 'expert'-driven health behaviour interventions, our research pursued a 'ground up' approach by asking what can be learnt from the successes and challenges of organizing community events, such as parkrun UK, to promote inclusion? A modified participatory action research approach was used with four parkrun sites across England, Scotland and Northern Ireland, that involved quantitative and qualitative analysis of survey data (n  = 655) that informed the process. Our analysis explored parkrunners' and volunteer organizers' perceptions relating to (i) the demographics of parkrun participation and (ii) actions for change in relation to the challenges of engaging marginalized groups (women, ethnic minorities, low income, older people, those with disabilities or illness). We discuss the challenges and opportunities for addressing (in)equity and inclusion through volunteer-based organizations and the implications for translating knowledge into organizational strategies. [ABSTRACT FROM AUTHOR]

Purpose: The Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap. Design/methodology/approach: An exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions. Findings: Overall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described "holistic" and "person-centred care" as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for "meaningful living", comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships. Originality/value: This study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries. [ABSTRACT FROM AUTHOR]

This study uses eye-tracking technology to assess the differences in gaze behaviours between ophthalmologists of different experience levels while interpreting retinal images of diabetic retinopathy. The differences in gaze behaviours before and after a teaching intervention which introduced a suggested search strategy is also investigated. A total of 9 trainees and 10 consultant ophthalmologists interpreted six retinal images. They were then shown a 5-min tutorial that demonstrated a search strategy. This was followed by six further retinal image interpretations. Participants completed questionnaires indicating clinical signs seen, appropriate retinopathy grade, and confidence. Eye movements were tracked during each interpretation.Overall, trainees compared to consultants demonstrated more uncertain and unstructured gaze behaviours. Trainee eye gaze metrics included: longer interpretation time, 36.5 s (SD = 6.2 vs. 31.4 s) (SD = 4.2) (p = 0.024), higher visit count, 17.38 visits (SD = 5.13) versus 12.18 visits(SD = 2.64) (p = 0.01), higher proportion of fixation, 57.0 per cent (SD = 5) versus 50.5 per cent (SD = 5) (p = 0.05) and shorter time to first fixation, 0.232 s (SD = 0.10) versus 0.821 s (SD = 0.77) (p = 0.001), respectively. The teaching intervention resulted in more focused gaze patterns in both groups. Pre-intervention and post-intervention mean proportion fixation on areas of interest were 38.6 per cent (SD = 6.8) and 51.8 per cent (SD = 13.9) for the trainee group, respectively, and 39.9 per cent (SD = 4.1) and 50.9 per cent (SD = 9.3) for the consultant group (p = 0.01).Consultants used more systematic and efficient approaches than trainees during interpretation. After the introduction of a suggested search strategy, trainees showed trends towards consultant eye gaze behaviours. Eye tracking gives an interesting insight into the thought processes of physicians carrying out complex tasks. The implication is that eye tracking may have future use in teaching and assessment. Its use in objectively assessing different teaching strategies could be a valuable tool for medical education. [ABSTRACT FROM AUTHOR]

Background: Delirium is recognised internationally as a common disorder that causes acute deterioration in a person's cognitive abilities. Healthcare professionals play a key role in the early identification and management of delirium and effective education can support timely recognition and treatment. There is currently a lack of research exploring the delirium education provided to undergraduate nursing students. The aim of this study was to evaluate the effectiveness of a co-produced delirium awareness programme on undergraduate nursing students in Northern Ireland. Methods: The intervention was a 2-h delirium workshop, delivered in April 2019, to a convenience sample of year one undergraduate nursing students (n = 206) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The workshop focused on four core elements: defining delirium, reflecting on practice, recognition of delirium and management of delirium. Participants completed a 35-item true-false Delirium Knowledge Questionnaire (DKQ) at baseline and post intervention using Socrative, a cloud-based student response system. In addition, students also completed a short questionnaire at baseline and post-workshop, designed by the authors, to ascertain perceived confidence about caring for people with delirium. Data were analysed using paired t-tests and descriptive statistics. Results: In the DKQ, Scores were normally distributed around the mean at baseline (71.89%) and post intervention (81.89%). Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.32% increase), causes and risk factors of delirium (17.91% increase) and management of delirium (5.72% increase). In relation to perceived confidence, students reported a 60.20% increase in confidence related to recognition of delirium, a 49.51% increase in relation to delirium management and a 45.04% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.01). Conclusions: A 2-h workshop on delirium improved first year student nurse knowledge about delirium. Nursing students expressed that this approach to delirium education enabled collective thinking about how knowledge could be transferred into individual practises. Students also stated that learning incorporating the voice of the person who has experienced delirium, was an effective and powerful way to deliver education. [ABSTRACT FROM AUTHOR]

This article reports on findings from a qualitative study that explored the experiences of eight deaf participants in interacting with the justice system in Northern Ireland. The study was spurred by anecdotal evidence of challenges facing members of the Deaf community in obtaining access to solicitors. The UN Convention on the Rights of Persons with Disabilities, to which the United Kingdom is a State Party, requires providers of goods, facilities, and services, which include solicitors, to provide effective communication access to deaf people seeking their services on an equal basis with non-disabled people. The Disability Discrimination Act comes into play, requiring service providers like solicitors to make a "reasonable adjustment" in order to provide access to deaf clients. Eight participants provided narratives from which three thematic categories emerged: (a) Barriers to Access, (b) The Contested Meaning of "Reasonable Adjustment," and (c) Deaf Cultural Awareness. [ABSTRACT FROM AUTHOR]

Background Alcohol is often involved in hospital-treated self-harm. Therefore it is important to establish the role of alcohol in self-harm as well as to identify associated factors, in order to best inform service provision. Methods Data on self-harm presentations to hospital emergency departments in Ireland and Northern Ireland from April 2012 to December 2013 were analysed. We calculated the prevalence of alcohol consumption in self-harm. Using Poisson regression models, we identified the factors associated with having consumed alcohol at the time of a self-harm act. Results Alcohol was present in 43% of all self-harm acts, and more common in Northern Ireland (50 versus 37%). The factors associated with alcohol being involved were being male, aged between 25 and 64 years, and having engaged in a drug overdose or attempted drowning. Presentations made out-of-hours were more likely to have alcohol present and this was more pronounced for females. Patients with alcohol on board were also more likely to leave without having been seen by a clinician. Conclusions This study has highlighted the prevalence of alcohol in self-harm presentations, and has identified factors associated with presentations involving alcohol. Appropriate out-of-hours services in emergency departments for self-harm presentations could reduce the proportion of presentations leaving without being seen by a clinician and facilitate improved outcomes for patients. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of traumatic brain injury (TBI) among offender populations is significantly higher than among the general population. Despite this, no study has yet assessed the knowledge of members of the probation service surrounding TBI. Method: Knowledge was assessed among members of the Probation Board for Northern Ireland (PBNI) using a cross-sectional online version of the Common Misconceptions about TBI (CM-TBI) questionnaire. Mean total misconception scores, along with scores on four subdomains (recovery, sequelae, insight, and hidden injury) were calculated. Analysis of variance was used to explore differences in misconceptions based on the collected demographic information. Results: The overall mean percentage of misconceptions for the group was 22.37%. The subdomain with the highest rate of misconceptions (38.21%) was insight into injury which covered misconceptions around offenders' self-awareness of injuries. Those who knew someone with a brain injury scored significantly higher in the CM-TBI total score, F(1,63)=6.639, p=0.012, the recovery subdomain, F(1,63)=10.080, p=0.002, and the insight subdomain, F(1,63)=5.834, p=0.019. Additionally, significant training deficits around TBI were observed among the probation service. Conclusions: This study is the first of its kind to examine the level of understanding around TBI within probation services. The findings reflect potential barriers to identification and rehabilitation of TBI for offenders coming into contact with the criminal justice system. A lack of identification coupled with misconceptions about TBI could lead to inaccurate court reporting with a subsequent impact on sentencing. [ABSTRACT FROM AUTHOR]

Largely as a result of early adverse experiences, children and young people in care are more likely to suffer from mental health difficulties than their peers. Despite these difficulties, they tend to find it hard to seek help and engage with professional services to address their needs. In Northern Ireland, the Mind Your Health study collected data for 233 children and young people in care through phone interviews with their carers, and twenty-five of these young people were interviewed. Focus groups with professionals were also carried out. According to their carers, 35 per cent had diagnosed emotional difficulties, and 36 per cent scored in the abnormal range for the Strengths and Difficulties Questionnaire's emotional symptoms scale. Carers described difficulties in accessing mental health services for young people, due to lengthy waiting lists, a lack of information offered and a lack of effort to engage them. Young people found it difficult to engage with these services because of their feelings of stigma, embarrassment, insecurity, guilt and fear. Some felt unable to seek help even from their families and friends. We recommend that mental health services are made more locally accessible and waiting times are reduced, with a greater emphasis on pro-active outreach work. [ABSTRACT FROM AUTHOR]

Practice learning is integral to the curriculum for qualifying social work students. Accreditation standards require regular student supervision and exposure to specific learning activities. Most agencies offer high-quality placements, but organizational cutbacks may affect supervision and restrict the development of competence and professional identity. Undergraduate social work students in Northern Ireland universities (n=396) were surveyed about the usefulness of the learning activities they received on placement for developing practice competence and professional social work identity. Results suggest that students most valued regular supervision, constructive feedback, observing social workers, and thinking critically about the social work role. Differences were reported across placements with students feeling disadvantaged in agencies where there was no clear social work role. [ABSTRACT FROM AUTHOR]