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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]

Objectives: The aim of this study was to evaluate a Health Service Executive (HSE) Foundation Programme in Sexual Health Promotion (FPSHP) with a specific emphasis on capacity building. Design: A mixed-method design using both quantitative and qualitative methods was used to collect the data. Setting: The FPSHP was delivered to staff working in health, education and community settings and was designed and facilitated by sexual health promotion staff who are part of the Irish HSE. Methods: A survey, designed by the researchers, as well as individual telephone interviews with past participants was used to evaluate the programme. Out of a possible 200 participants, 97 completed the questionnaire (response rate 49%), and a total of 22 telephone interviews were completed. Results: There was generally a high level of satisfaction with the FPSHP. Participants reported high levels of individual and intra-organisational capacity-building activities, but apart from networking, interorganisational capacity-building activities were reported less frequently and tended to be ad hoc in nature. Satisfaction with the programme was high and so was the perception of its sustained impact. Motivation, satisfaction with the programme and attending of further training were strong predictors of reported sustained impact. Conclusion: Capacity building in sexual health promotion was affected positively by participation in the programme. Nonetheless, a greater emphasis on capacity building at an inter-organisational level needs to be considered. It is recommended that participants need to be motivated, guided and supported in the use of strategies to achieve this.

Background: This article reports on an evaluation of four family support programmes in Ireland for families of people with a physical or an intellectual disability or autism. The focus of the evaluation, which took place within a year of the programmes' completion, was on establishing whether the programmes had an impact on families' capacity to effectively support their family member. Method: A mixed-method design was used, which included a survey (n = 38) and interviews (n = 19) with participating family members. Ethical approval for the study was given by the relevant university ethics committee. Results: Findings suggest that participation in the programmes enhanced knowledge, attitudes, and competencies of families and also impacted their ability to advocate for their family member and to connect with the community. Discussion and conclusions: Whilst outcomes were overwhelmingly positive, further follow-up would be required to ascertain if sustained capacity building took place.

This paper reports on the findings of a pre-post and follow-up evaluation of a sexual health promotion programme in Ireland. Substantial progress in skills, knowledge, confidence and comfort were reported by participants which were to a large extent maintained over time. Evidence emerged of the successful translation of learning into practice in a number of areas, including engaging proactively with service users about sexual health and developing educational programmes and materials. The paper highlights contextual factors that support and inhibit sustainable changes to practice that need to be addressed in order to maximise the impact of capacity building education. [ABSTRACT FROM AUTHOR]

Background: Optimizing quality of life (QoL) remains the central tenet of care in patients with incurable cancer; however, determinants of QoL are not clear. The objective of the current study was to examine which factors influence QoL in patients with incurable cancer.Methods: A multicenter study of adult patients with advanced cancer was conducted in Ireland and the United Kingdom between 2011 and 2016. Data were collected from patients at study entry and included patient demographics, Eastern Cooperative Oncology Group performance status (ECOG-PS), nutritional parameters (the percentage weight loss [%WL]), muscle parameters assessed using computed tomography images (skeletal muscle index and skeletal muscle attenuation), inflammatory markers (modified Glasgow Prognostic score [mGPS]), and QoL data (the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30). The relation between clinical, nutritional, and inflammatory parameters with QoL was assessed using the Spearman rank correlation coefficient and multivariate binary logistic regression. Components of the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30 (physical function, fatigue, and appetite loss) and summary QoL scores were mean-dichotomized for the logistic regression analyses.Results: Data were available for 1027 patients (51% men; median age, 66 years). Gastrointestinal cancer was most prevalent (40%), followed by lung cancer (26%) and breast cancer (9%). Distant metastatic disease was present in 87% of patients. The %WL, ECOG-PS, and mGPS were significantly correlated with deteriorating QoL functional and symptom scales (all P < .001). On multivariate regression analysis, >10% WL (odds ratio [OR], 2.69; 95% CI, 1.63-4.42), an ECOG-PS of 3 or 4 (OR, 14.33; 95% CI, 6.76-30.37), and an mGPS of 2 (OR, 1.58; 95% CI, 1.09-2.29) were independently associated with poorer summary QoL scores. These parameters were also independently associated with poorer physical function, fatigue, and appetite loss (all P < .05). Low skeletal muscle attenuation was independently associated with poorer physical functioning (OR, 1.67; 95% CI, 1.09-2.56), but muscle parameters were not independently associated with fatigue, appetite loss, or QoL summary scores.Conclusions: The current findings indicate that QoL is determined (at least in part) by WL, ECOG-PS, and the systemic inflammatory response in patients with advanced cancer. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative and supportive care, which has been shown to improve QoL. [ABSTRACT FROM AUTHOR]

Background Due to the increasing number of persons with dementia being hospitalised (Timmons et al. 2015), nurses working in acute hospitals need to be competent in caring for this patient population. Amongst other dementia-care specific competencies, nurses require competence in caring for those with dementia who experience responsive behaviours, a common phenomenon in acute hospitals. The aims of this study were to explore challenges encountered by nurses in caring for persons with dementia experiencing responsive behaviours in an acute hospital and to explore strategies used by nurses to address the encountered challenges. Methods A qualitative descriptive study, involving semi-structured interviews with nine nurses was conducted. Ethical approval was received from the School of Nursing & Midwifery Research Ethics Committee in the participating University. Data was collected in 2018 and was analysed using a thematic analysis approach. Results An analysis identified three challenging components for nurses, namely: emotional, environmental and organisational challenges. These challenges in turn contributed to barriers to the provision of nursing care and management of responsive behaviours in the setting. To address these challenges, nurses implemented therapeutic interventions, for example reminiscence, and engaged with other healthcare professionals and caregivers. Conclusion This study explored how various emotional, environmental and organisational challenges are experienced and addressed by nurses when managing responsive behaviours in the acute hospital. The increasing number of persons with dementia attending acute hospitals necessitates an urgency for service development to enhance the specific dementia-care competency levels of nurses. Changes at an organisational level, to support competency development in dementia-care in acute hospitals, must also be adopted. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of intimate partners of people with an eating disorder. Design: Qualitative grounded theory study. Methods: In‐depth interviews were conducted with 18 partners of people with an eating disorder from 2013–2016. Data were analysed using the principles of classic grounded theory including, concurrent data collection and analysis, theoretical sampling, constant comparative analysis and memo writing. Results: Partners encounter disruptions to their lives when their significant other experiences an eating disorder. As a result, partners engage in a four‐stage cyclical process involving: encountering a disruption; becoming an informed self; countering the disruption and reclaimed livability. By engaging in this process partners learn to support their significant other, remain committed to the relationship and recover their own lives. The process is drawn together and defined as the theory of 'Reconstructing Livability'. Conclusion: The theory of 'Reconstructing Livability' provides a unique conceptualization of the experiences of partners who are living with a person with an eating disorder. It highlights the challenges faced by partners when supporting the recovery of their significant other and the intimate relationship, while reclaiming their own lives. Impact: This study addresses the dearth of knowledge and understanding of partners' experiences. Partners engage in a process to enable them support recovery of their significant other and their own lives, but this is hindered by the challenges and unmet needs they experience. The theory provides a basis on which nurses can provide effective and timely supports to partners. [ABSTRACT FROM AUTHOR]

Background: Little is known about staff's attitudes in Irish acute hospital settings towards people living with dementia and their perceived dementia knowledge. The aim of this study was to understand the general level of dementia knowledge and attitudes towards dementia in different types of hospital staff, as well as to explore the potential influence of previous dementia training and experience (having a family member with dementia) and the potential moderating effects of personal characteristics. This data was required to plan and deliver general and targeted educational interventions to raise awareness of dementia throughout the acute services.Methods: A cross-sectional survey was carried out among a diverse range of hospital staff (n = 1795) in three urban acute general hospitals in Ireland, including doctors, nurses, healthcare attendants, allied professionals, and general support staff. Participants' perceived dementia knowledge and attitudes were assessed as well as their previous dementia training and experience. To measure participant's attitude towards dementia, the validated Approaches to Dementia Questionnaire (ADQ) was used.Results: Hospital staff demonstrated positive attitudes towards people living with dementia, and believed they had a fair to moderate understanding of dementia. Both 'having previous dementia training' and 'having a relative living with dementia' predicted attitude towards dementia and perceived dementia knowledge. Interestingly, certain personal staff characteristics did impact dementia training in predicting attitude towards dementia and perceived dementia knowledge.Conclusion: This study provides a baseline of data regarding the attitudes towards dementia and perceived dementia knowledge for hospital staff in Irish acute hospitals. The results can inform educational initiatives that target different hospital staff, in order to increase awareness and knowledge to improve quality of dementia care in Irish hospitals. [ABSTRACT FROM AUTHOR]

Introduction: There is an increasing emphasis on the use of Integrated Care Pathways for dementia in the hospital environment. Despite this, the Irish National Audit of Dementia Care in Acute Hospitals De Siún et al. 2014 found that 94% of acute hospitals did not have a dementia care pathway in operation. The Health Service Executive HSE and Genio provided funding to three hospitals in Ireland to develop an ICP for dementia care. An independent evaluation was conducted to uncover the strengths and challenges of the ICPs developed, as well as to collate learning from the sites to further develop ICPs for those living with dementia. Methods: Mixed methods were used to evaluate two of the ICPs developed to date. This included analysis of service provider and service user data, as well as audit and Hospital Inpatient Enquiry HIPE data. Ethical approval was secured from the Faculty of Health Sciences Research Ethics Committees in Trinity College Dublin and relevant hospital Ethics Committees. Results: The complexity involved in developing and rolling out an ICP for dementia was highlighted. Findings demonstrated a number of facilitators and challenges in the development of ICPs. Facilitators included: project leadership; organisational support; dedicated project personnel; project responsiveness; and dovetailing with other clinical, educational or organisational developments. Challenges identified included: competing initiatives and acuity of care demands; absence of standardisation; deficits in communication; and pressure on resources. Discussion and conclusions: The person with dementia and their individualised needs should be central to any innovations in integrated dementia care. A dementia-friendly orientation needs to be embedded in the strategic objectives and operational planning of an organisation in order for meaningful impact to be achieved. Innovation in the development of ICPs needs welldefined governance and visionary leadership. Dedicated resources are required by such leaders to support dementia care development. Findings demonstrated that a consortium approach is beneficial for projects to design, test and implement innovations to develop integrated dementia care. ICP development and dementia-friendly environmental design are protracted and require extensive planning to include process mapping of the care journey, evidence review and multi stakeholder consultation. Therefore, such projects should make consideration of sufficient lead-in time to devise related interventions. Such planning activities should be viewed as sub-components of the overall intervention. In cases where dementia-specific roles are shown to have positively influence project impact, commitment and resources are required to maintain these roles in order to maximise and further develop gains. [ABSTRACT FROM AUTHOR]

Objectives: Acute hospitals, in particular the emergency department, can be disorienting for people living with dementia. As part of a larger project to improve care for people living with dementia, dementia-inclusive modifications were made to two emergency department bays in a large acute care hospital in Ireland. Modifications to spatial configuration included noise reduction, altered lighting and the addition of an orientation aid and fixed seating for relatives., Method: A mixed methods approach was employed with both service user and service provider perspectives explored (survey of service providers ( n  = 16) and interviews with family carers ( n  = 10) at one time point and interviews with service providers ( n  = 8 and n  = 5) and key stakeholders ( n  = 3) as well as audit data (at two time points) to evaluate the impact of the modifications made to the emergency department., Results: Orientation and navigation within the modified bays were improved though technical issues with the orientation aid were highlighted. Further user information on the functionality of the adjustable lighting would be required to maximise its benefits. This lighting and use of calming colours, together with the addition of noise-reduction bay screens, served to reduce sensory stimulation. The provision of adequate space and seating for family carers was extremely beneficial. The removal of unnecessary equipment and use of new structures to store relevant clinical equipment were other positive changes implemented. A number of challenges in the design development of the modified bays were highlighted, as well as ongoing broader environmental challenges within the emergency department environment., Conclusion: The findings suggest that the modified bays contributed positively to the experience of people living with dementia and their families in the emergency department.

Background and Aims: The systemic inflammatory response is associated with the loss of lean tissue, anorexia, weakness, fatigue and reduced survival in patients with advanced cancer and therefore is important in the definition of cancer cachexia. The aim of the present study was to carry out a direct comparison of the prognostic value of Eastern Cooperative Oncology Group Performance Status (ECOG-PS), modified Glasgow Prognostic Score (mGPS) and Body Mass Index/Weight Loss Grade (BMI/WL grade) in patients with advanced cancer., Method: All data were collected prospectively across 18 sites in the UK and Ireland. Patient's age, sex, ECOG-PS, mGPS and BMI/WL grade were recorded, as were details of underlying disease including metastases. Survival data were analysed using univariate and multivariate Cox regression., Results: A total of 730 patients were assessed. The majority of patients were male (53%), over 65 years of age (56%), had an ECOG-PS>0/1 (56%), mGPS≥1 (56%), BMI≥25 (51%), <2.5% weight loss (57%) and had metastatic disease (86%). On multivariate cox regression analysis ECOG-PS (HR 1.61 95%CI 1.42-1.83, p < 0.001), mGPS (HR 1.53, 95%CI 1.39-1.69, p < 0.001) and BMI/WL grade (HR 1.41, 95%CI 1.25-1.60, p < 0.001) remained independently associated with overall survival. In patients with a BMI/WL grade 0/1 both ECOG and mGPS remained independently associated with overall survival., Conclusion: The ECOG/mGPS framework may form the basis of risk stratification of survival in patients with advanced cancer., Competing Interests: Conflicts of interest The authors declare no potential conflicts of interest., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)