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Aim: To explain the factors affecting glycemic control (measured by HbA1c) following the Dose Adjustment for Normal Eating (DAFNE) program. Background: DAFNE is a structured education program designed to assist persons with type 1 diabetes mellitus achieve optimal glycemic control. However, not all participants reach this goal. Few studies comprehensively explain why this is the case. Research Design: A concurrent mixed methods design. Data were collected from participants (n = 34) at three time points post DAFNE in five participating sites. Each data set was analyzed separately and then integrated. Results: Motivation and support differed for participants who were out of control and those in control. Conclusion: Setting targets/goals and motivations are key in helping participants attain optimal HbA1c.

There is international interest in, and continued concern about, the potential long-term impact of involuntary admission to psychiatric institutions, and the effect this coercive action has on a person's well-being and human rights. Involuntary detention in hospital remains a controversial process that involves stakeholders with competing concerns and who often describe negative experiences of the process, which can have long-lasting effects on the therapeutic relationship with service users. The aim of the present study was to explore the perspectives of key stakeholders involved in the involuntary admission and detention of people under the Mental Health Act 2001 in Ireland. Focus groups were used to collect data. Stakeholders interviewed were service users, relatives, general practitioners, psychiatrists, mental health nurses, solicitors, tribunal members, and police. Data were analysed using a general inductive approach. Three key categories emerged: (i) getting help; (ii) detention under the Act; and (iii) experiences of the tribunal process. This research highlights gaps in information and uncertainty about the involuntary admission process for stakeholders, but particularly for service users who are most affected by inadequate processes and supports. Mental health law has traditionally focussed on narrower areas of detention and treatment, but human rights law requires a greater refocussing on supporting service users to ensure a truly voluntary approach to care. The recent human rights treaty, the UN Convention on the Rights of Persons with Disabilities, is to guarantee a broad range of fundamental rights, such as liberty and integrity, which can be affected by coercive processes of involuntary admission and treatment. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to explore the experiences of individuals admitted to the hospital involuntarily under the Mental Health Act 2001 in the Republic of Ireland.Methods: In this qualitative descriptive study, 50 individuals who had been involuntarily admitted to a hospital underwent face-to-face semistructured interviews approximately three months after revocation of the involuntary admission order. Data were analyzed by using an inductive thematic process.Results: Participants reported mixed experiences over the course of the admission, with both positive and challenging aspects. Participants reported feeling coerced, disempowered, and unsupported at various stages of the admission and highlighted the long-term deleterious impact on their psychological well-being. However, participants also described encounters with individuals who endeavored to initiate a collaborative, informative, and compassionate approach. Four key themes emerged consistently across the trajectory of participants' involuntary admission experiences: feeling trapped and coerced, feeling disengaged and unsupported, admission-induced distress, and person-centered encounters.Conclusions: This qualitative study of service users' views across the entire trajectory of their involuntary admission identified a number of factors that should be addressed to reduce the negative impact of involuntary admission. A multifaceted strategy could include ongoing education and training of all stakeholders in the principles and practices of person-centered care, repeated provision of accessible information and emotional support to service users during all stages of involuntary admission, and a shift in culture to one that minimizes the traumatic impact of forced detention on individuals' psychological well-being. [ABSTRACT FROM AUTHOR]

The objective of this study was to develop a substantive grounded theory of staff psychosocial intervention use with residents with dementia in long-stay care. “Becoming a person again” emerged as the core category accounting for staffs’ psychosocial intervention use within long-stay care. Interview data were collected from participants in nine Irish long-stay settings: 14 residents with dementia, 19 staff nurses, one clinical facilitator, seven nurse managers, 21 nursing assistants, and five relatives. Constant comparative method guided the data collection and analysis. The researcher’s theoretical memos, based on unstructured observation, and applicable extant literature were also included as data. By identifying the mutuality of the participants’ experiences, this classic grounded theory explains staff motivation toward psychosocial intervention use within long-stay care. It also explains how institutional factors interact with those personal factors that incline individuals toward psychosocial intervention use. [ABSTRACT FROM AUTHOR]

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

Aim To report the factors that influence clinical specialists' and advanced nurse practitioners' ability to enact their clinical and professional leadership roles; findings from the SCAPE study. Background The importance of leadership for specialist and advanced practitioners is highlighted in the international literature and is considered an important factor in the provision of improved patient outcomes. Despite many studies identifying the barriers in developing and integrating new specialist/advanced practice roles into health services, little is known about the factors that influence the leadership dimension of their role. Method A case study design involving 23 clinical specialist/advanced practitioners working in Ireland and multidisciplinary team members working with them, was used. Data were collected using interview, observation and documentary analysis. Results Four mediating factors influence the specialist/advanced practitioner's ability to perform a leadership role, namely the presence of a framework for the professional development of the role; opportunities to act as leaders; mechanisms for sustaining leadership; and personal attributes of practitioners. Conclusion and implications for nursing management Nursing/midwifery leaders and managers at all levels have a key role in supporting leadership potential, through countering the negative impact of professional isolation, expanding opportunities for specialist/advanced practitioners to influence policy and network with wider professional groups. [ABSTRACT FROM AUTHOR]

Aim To ascertain and explore the views held by key healthcare policy-makers on the impact of clinical specialist and advanced practice nursing and midwifery roles. Background Specialist and advanced practice roles are common world-wide and were introduced in Ireland in 2000. After experiencing these roles for a decade, the views of healthcare policy-makers were sought as part of a national evaluation. Methods A qualitative, descriptive design was used. Following ethical approval, 12 policy-makers were interviewed in 2010, using a six-part interview schedule. Results Policy-makers believed that specialist and advanced practice roles resulted in better continuity of care, improved patient/client outcomes and a more holistic approach. These clinicians were also said to be leading guideline development, new initiatives in care, education of staff, audit and policy development. They lacked administrative support and research time. Budget cuts and a government-applied recruitment moratorium were said to hamper the development of specialist/advanced practice roles. Conclusion Healthcare policy-makers believe that specialists and advanced practitioners contribute to higher quality patient/client care, particularly at a strategic level. Implications for nursing management These roles could make an important contribution to future health service developments, particularly in relation to chronic-disease management and community care, where more advanced practitioner posts are required. [ABSTRACT FROM AUTHOR]

Aim To reflect on the added value that a mixed method design gave in a large national evaluation study of specialist and advanced practice (SCAPE), and to propose a reporting guide that could help make explicit the added value of mixed methods in other studies. Background Recently, researchers have focused on how to carry out mixed methods research (MMR) rigorously. The value-added claims for MMR include the capacity to exploit the strengths and compensate for weakness inherent in single designs, generate comprehensive description of phenomena, produce more convincing results for funders or policy-makers and build methodological expertise. Data sources Data illustrating value added claims were drawn from the SCAPE study. Review methods Studies about the purpose of mixed methods were identified from a search of literature. Discussion The authors explain why and how they undertook components of the study, and propose a guideline to facilitate such studies. Conclusion If MMR is to become the third methodological paradigm, then articulation of what extra benefit MMR adds to a study is essential. The authors conclude that MMR has added value and found the guideline useful as a way of making value claims explicit. Implications for practice/research The clear articulation of the procedural aspects of mixed-methods research, and identification of a guideline to facilitate such research, will enable researchers to learn more effectively from each other. [ABSTRACT FROM AUTHOR]

Aim To describe the Policy Delphi technique and show how it was used in a research study in the Republic of Ireland. Background Policy Delphi is a variant of the Delphi technique, but differs in that its purpose is to explore consensus rather than aid it. It is an appropriate methodological tool for researching complex issues that benefit from the insights and consensus of a group of experts. It is useful in examining options and implications of policy and assessing their acceptability. Data sources A three-round policy Delphi study was the second phase of a sequential mixed-method design. The study was intended to examine stakeholders' perceptions of the clinical role of lecturers in nursing to identify supportive and limiting factors that affect the clinical role, with the purpose of determining a model for best practice. Review methods A review of literature about Policy Delphi from its development to current use (1970-2013) was undertaken to explore the technique. Discussion The complexities of using the Policy Delphi methodology to explore policy options are discussed. Conclusion Policy Delphi is an underused tool that would benefit nursing research. The output from a Policy Delphi study produces a substantial number of new ideas and an evaluation of those ideas for use in decision making. Implications for research/practice Policy Delphi can offer researchers a means to explore levels of consensus on policy issues that have major effects on nursing developments. Practitioners may also benefit because it provides a useful way to assess and validate expert knowledge that could be contestable in a range of practice situations. [ABSTRACT FROM AUTHOR]

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

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

The aim of the PRINCE study was to determine the effectiveness of a structured education pulmonary rehabilitation programme for those living with COPD in primary care in Ireland. This qualitative element of the larger PRINCE trial aims to describe the constituents of 'usual care' for patients allocated to the control arm of the study. A descriptive qualitative study was used to explore the constituents of usual care. A convenience sample of participants (n=20) allocated to the usual care group were interviewed. Three main themes arose from the study: experiences of having and managing COPD, lifestyle advice, and factors that helped or hindered self-management. Usual care left many people grappling in the dark trying to manage their COPD. It was found that usual care was not at its optimum for people with COPD in the control arm of the PRINCE study. [ABSTRACT FROM AUTHOR]

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

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

Aim To provide examples of a qualitative multiple case study to illustrate the specific strategies that can be used to ensure the credibility, dependability, confirmability and transferability of a study. Background There is increasing recognition of the valuable contribution qualitative research can make to nursing knowledge. However, it is important that the research is conducted in a rigorous manner and that this is demonstrated in the final research report. Data sources A multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Multiple sources of evidence were collected: semi-structured interviews (n=58), non-participant observations at five sites and documentary sources. Discussion Strategies to ensure the rigour of this research were prolonged engagement and persistent observation, triangulation, peer debriefing, member checking, audit trail, reflexivity, and thick descriptions. Practical examples of how these strategies can be implemented are provided to guide researchers interested in conducting rigorous case study research. Conclusion While the flexible nature of qualitative research should be embraced, strategies to ensure rigour must be in place. [ABSTRACT FROM AUTHOR]

Aim In this paper, the choice of classic grounded theory will be discussed and justified in the context of the first author's PhD research. Background The methodological discussion takes place within the context of PhD research entitled: Development of a stakeholder-led framework for a structured education programme that will prepare nurses and healthcare assistants to deliver a psychosocial intervention for people with dementia. There is a lack of research and limited understanding of the effect of psychosocial interventions on people with dementia. The first author thought classic grounded theory a suitable research methodology to investigate as it is held to be ideal for areas of research where there is little understanding of the social processes at work. Data sources The literature relating to the practical application of classic grounded theory is illustrated using examples relating to four key grounded theory components: Theory development: using constant comparison and memoing. Methodological rigour. Emergence of a core category. Inclusion of self and engagement with participants. Discussion Following discussion of the choice and application of classic grounded theory, this paper explores the need for researchers to visit and understand the various grounded theory options. Conclusion This paper argues that researchers new to grounded theory must be familiar with and understand the various options. The researchers will then be able to apply the methodologies they choose consistently and critically. Doing so will allow them to develop theory rigorously and they will ultimately be able to better defend their final methodological destinations. [ABSTRACT FROM AUTHOR]

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

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

This article describes the development of a Structured Education Pulmonary Rehabilitation Programme (SEPRP), for the PRINCE (Pulmonary Rehabilitation In Nurse-led Community Environments) study. This process involved a literature review of existing PR programmes, a content analysis of national and international PR programmes and a concept analysis of empowerment. Secondly, two small descriptive qualitative studies were undertaken to further inform programme content exploring the views of health professionals and clients on programme content, as well as their perceptions of living with COPD. The findings of these two stages led to the development of the eight-week PRINCE SEPRP, based on a philosophy of empowerment and the SEPRP was underpinned by the Transtheoretical model (TTM) of behaviour change. Programme content included managing medications and managing breathlessness, knowing and managing symptoms, recognizing and managing acute exacerbations as well as an individualized exercise programme. Participants' experiences of self management following participation in the SEPRP were also examined. The findings indicate that nurses working in primary care have an important role in informing the development of SEPRP as well as having a key role in their delivery. They have the potential to work in empowering ways with COPD clients and the PRINCE SEPRP is just one example of how this can be put into practice. [ABSTRACT FROM AUTHOR]

Background: Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units. Methods/Design: The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation. Discussion: Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in relation to scale and scope. This trial is powered to deliver more credible and durable results. The trial may also convey process utility to a long-stay system in Ireland that has not been geared for education and training, especially in relation to dementia. The results of this trial are applicable to long-stay residential units in Ireland and internationally. Trial registration: Current Controlled Trials ISRCTN99651465 [ABSTRACT FROM AUTHOR]

Background: Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups' ability to identify body weight status in both adults and children. The health professional groups are: (a) community related public health nurses; (b) school public health nurses; (c) GPs and practice nurses (primary care); and (d) occupational health nurses (workplace) from both Northern Ireland and the Republic of Ireland. Methods/Design: This all-Ireland multi-disciplinary project follows a mixed methods approach using both quantitative and qualitative methodologies, and consists of four components: 1. Literature review - to explore the role of health professionals in managing obesity through spontaneous intervention in a variety of health promotion settings. 2. Telephone interviews and focus groups - to gain an in-depth insight into the views of health professionals in assessing body weight status. 3. Survey (primarily online but also paper-based) - to determine the attitudes, current practices/behaviours and knowledge of health professionals in assessing body weight status. 4. Online evaluation study - an online interactive programme will be developed to assess health professionals' ability to identify the body weight status of adults and children. Discussion: This project will assess and report the attitudes, current practices/behaviours and knowledge of key health professional groups within Northern Ireland and the Republic of Ireland on body weight status, and their ability to identify body weight status in both adults and children. The results of this project will generate recommendations for clinical practice in managing obesity, which may inform policy guidelines. [ABSTRACT FROM AUTHOR]

Of the estimated 10 000 people annually who have a stroke in Ireland, about 7 500 will continue to live with some residual disability. This study explored older people's perceptions of health, level of independence as well as the factors that enhanced or diminished ability to maintain quality of life after stroke. A grounded theory approach was used and 20 stroke survivors were interviewed. Analysis of the data revealed three main themes: concepts of health and independence, sense of loss, and environmental factors. Despite their disability most participants continued to have a positive concept of health. Participants overall adopted a functional approach toward independence and those with severe disabilities felt less independent. Many reported a profound sense of loss in terms of identity and role function. Environmental factors including availability of transport and social connections had a significant impact on quality of life. Most participants appeared to be struggling to adapt to their disability and subsequent experiences in a rather unsupportive environment. [ABSTRACT FROM AUTHOR]

Aim. The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long-term care settings in Ireland. Background. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research. Method. This was a mixed method study, which involved qualitative and quantitative approaches. A self-response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long-term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people. Results. Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine. Conclusions. The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care. Relevance to clinical practice. Long-term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this. [ABSTRACT FROM AUTHOR]

Aim. The aim of this research was to explore nurses’ perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. Background. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. Method. The study was a qualitative exploration of nurses’ perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. Findings. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. Conclusion. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. Relevance to practice. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care. [ABSTRACT FROM AUTHOR]

People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia ( n = 38), relatives/carers ( n = 28), formal carers ( n = 28) and managers ( n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.

It is essential to understand the experience of living with dementia from the perspective of the person with dementia so that services can be appropriately constructed. This review paper, drawing on prior work, identifies key strategies for the meaningful inclusion of persons with dementia within qualitative research studies, it examines the articulation of these strategies and shares how these strategies were operationalised within one national research study in Ireland. Strategies within the literature were categorised and then synthesized into a guide consisting of four main areas; gaining COnsent, maximizing Responses, Telling the story, and Ending on a high (CORTE). The CORTE guideline was used to as a tool for analysing relevant research reports. CORTE is a synthesized account of grouped strategies that could be used to maximize the meaningful involvement of persons with dementia and can also provide a guide for reporting the strategies used so that researchers can learn from each other., (© The Author(s) 2014.)

An estimated 33.9 million people are living with dementia worldwide. The overall estimated median survival time from onset of dementia to death is 4.1 years for men and 4.6 years for women, with longer survival times in those with early-onset dementia. Much has been discussed about the needs of this vulnerable group of people particularly in terms of their health-care and end-of-life care (EoLC) needs. However, the literature suggests that people with end-stage dementia are still not receiving adequate or appropriate EoLC. Difficulty diagnosing dementia, a stigma surrounding the disease, lack of education of the dementia disease process and the ability to identify complications encountered at end-stage dementia by health-care providers, families and carers are some of the factors preventing those with dementia receiving effective EoLC. Great strides have been made to improve dementia palliative care; however, this cohort of patients still receive fewer referrals to appropriate palliative care services than other terminally ill patients.

Background: There is increasing recognition of the potential use of reminiscence in maintaining or improving the quality of life of people with dementia. Despite being used widely in dementia care, evidence on the effectiveness of reminiscence remains uncertain., Aims: This study aims to evaluate the effectiveness of a structured education-based reminiscence programme-the Dementia Education Programme Incorporating Reminiscence for Staff-for people with dementia residing in long-stay care settings in Ireland., Methods: Dementia Education Programme Incorporating Reminiscence for Staff is a two-group, single-blind, cluster randomised trial conducted in long-stay residential care settings in Ireland. The primary outcome was the self-rated quality of life of residents as measured by the Quality of Life-Alzheimer's Disease instrument., Results: Using an intention-to-treat analysis, we found that the estimated effect of the intervention on the quality of life of residents was a non-significant 3.54 (p = 0.1; 95% confidence interval -0.83, 7.90), expressed as the difference in mean improvement between the intervention and control groups. However, the per-protocol analysis yielded a significant effect for the intervention on the quality of life of residents of 5.22 (p = 0.04; 95% confidence interval 0.11, 10.34)., Conclusions: Reminiscence may, in certain circumstances, be an effective care option for people with dementia in long-stay settings with potential to impact positively on the quality of life of residents., (Copyright © 2014 John Wiley & Sons, Ltd.)

Objective: To evaluate the effectiveness of a structured education pulmonary rehabilitation programme on the health status of people with chronic obstructive pulmonary disease (COPD)., Design: Two-arm, cluster randomised controlled trial., Setting: 32 general practices in the Republic of Ireland., Participants: 350 participants with a diagnosis of moderate or severe COPD., Intervention: Experimental group received a structured education pulmonary rehabilitation programme, delivered by the practice nurse and physiotherapist. Control group received usual care., Main Outcome Measure: Health status as measured by the Chronic Respiratory Questionnaire (CRQ) at baseline and at 12-14 weeks postcompletion of the programme., Results: Participants allocated to the intervention group had statistically significant higher mean change total CRQ scores (adjusted mean difference (MD) 1.11, 95% CI 0.35 to 1.87). However, the CI does not exclude a smaller difference than the one that was prespecified as clinically important. Participants allocated to the intervention group also had statistically significant higher mean CRQ Dyspnoea scores after intervention (adjusted MD 0.49, 95% CI 0.20 to 0.78) and CRQ Physical scores (adjusted MD 0.37, 95% CI 0.14 to 0.60). However, CIs for both the CRQ Dyspnoea and CRQ Physical subscales do not exclude smaller differences as prespecified as clinically important. No other statistically significant differences between groups were seen., Conclusions: A primary care based structured education pulmonary rehabilitation programme is feasible and may increase local accessibility to people with moderate and severe COPD., Trial Registration: ISRCTN52403063.

Aim: To report a case study that identifies how leadership is enacted by advanced practitioners in nursing and midwifery and differentiates between clinical and professional leadership in advanced practice., Background: A national evaluation of advanced practitioners in nursing and midwifery was commissioned to inform policy makers' decision-making about future developments in Ireland. Leadership is a key aspect of the advanced practitioner role. However, leadership in the advanced practice context is under researched and lacks empirical evidence on how advanced practitioners enact their clinical and professional leadership function in practice., Design: A multiple case study methodology was used to identify the leadership activities of advanced practitioners., Methods: Purposive sampling of advanced practitioners in nursing and midwifery across various specialities and health regions in Ireland was employed. Data sources included non-participant observation of advanced practitioners, interviews with key stakeholders, and documentary evidence including audits, policies, and guidelines. Collectively these data were used to identify the leadership activities of advanced practitioners in practice. The study was conducted between December 2008-December 2010., Results: Seven key activities that indicated clinical leadership and three key activities for professional leadership at advanced practice level were identified., Conclusions: The leadership activities identified provide greater clarity in distinguishing between professional and clinical leadership and in specifying the nature and scope of leadership activities., (© 2012 Blackwell Publishing Ltd.)

Background: The Clinical Skills Laboratory has become an essential structure in nurse education and several benefits of its use have been identified. However, the literature identifies the need to examine the transferability of skills learned there into the reality of practice., Objective: This research explored the role of the Clinical Skills Laboratory in preparing nursing students for the real world of practice. This paper focuses specifically on the perceptions of the teaching and assessment strategies employed there., Design: Qualitative multiple case study design., Setting: Five case study sites., Participants: Interviewees (n=58) included academic staff, clinical staff and nursing students., Methods: Semi-structured interviews., Results: The Clinical Skills Laboratory can provide a pathway to practice and its authenticity is significant. Teaching strategies need to incorporate communication as well as psychomotor skills. Including audio-visual recording into assessment strategies is beneficial. Effective relationships between education institutions and clinical settings are needed to enhance the transferability of the skills learned., Conclusions: The Clinical Skills Laboratory should provide an authentic learning environment, with the appropriate use of teaching strategies. It is crucial that effective links between educators and clinical staff are established and maintained., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aim: To provide an explanation of the research methodologies and strategies available., Background: There are numerous research methodologies and strategies. The literature is ambiguous in relation to research terminology and this often leads to confusion about which methodology or strategy to adopt., Data Sources: A review of the most up-to-date literature., Discussion: The most commonly adopted methodologies and strategies are discussed., Conclusion: Part 1 (Welford et al 2011) of this two-part paper explained the research paradigms and the rationales for choosing particular paradigms. Part 2 provides an explanation of the methodologies and strategies available to the researcher., Implications for Practice/research: This paper will be particularly useful for novice researchers or doctoral students.

Background: The literature reveals that structured education programmes, such as DAFNE, result in many positive outcomes for people with Type 1 diabetes including a decrease in HbA1c levels and reductions in hypoglycaemia. While there is evidence that some of these outcomes are maintained we do not know at present what factors are most important over time. The study aim was to identify the key factors impacting on persons with Type 1 diabetes ability to assimilate the Dose Adjustment For Normal Eating (DAFNE) DAFNE principles into their daily lives and how these factors change over time., Methods: This is a longitudinal descriptive qualitative study. Interviews were undertaken with 40 participants who had attended DAFNE in one of 5 study sites across the Island of Ireland, at 6 weeks, 6 and 12 months after completion of the programme. The interviews lasted from 30 to 60 minutes and were transcribed verbatim. Data were analysed in three ways, a within time analysis, a cross sectional analysis for each participant and a thematic analysis which focused on examining changes over time, Results: Four themes that influenced participants' ability to assimilate DAFNE into their daily lives over time were identified. These were: embedded knowledge, continued responsive support, enduring motivation and being empowered. Support at the 6 month period was found to be crucial to continued motivation., Conclusions: Understanding the factors that influence people's ability to assimilate DAFNE principles over time into their daily lives can help health professionals give focused responsive support that helps people with diabetes become more empowered. Understanding that continued support matters, particularly around 6 months, is important as health professionals can influence good management by providing appropriate support and enhancing motivation., Trial Registration: ISRCTN79759174.

Background: A key strategy in improving care for people with chronic obstructive pulmonary disease (COPD) is the provision of pulmonary rehabilitation programmes. Pulmonary rehabilitation programmes have been successful in improving patients' sense of dyspnoea and Health Related Quality of Life. However, the effectiveness of structured education pulmonary rehabilitation programmes delivered at the level of the general practice on the health status of people with COPD remains uncertain and there is a need for a robust and fair assessment of this. The PRINCE study will evaluate the effectiveness of a Structured Education Pulmonary Rehabilitation Programme (SEPRP), delivered at the level of the general practice, on the health status of people with COPD., Methods/design: The PRINCE Trial is a two-armed, single blind cluster randomised trial conducted in the primary care setting in Ireland. Randomisation to control and intervention is at the level of the General Practice. Participants in the intervention arm will receive a SEPRP and those allocated to the control arm will receive usual care. Delivery of the SEPRP will be by a practice nurse and physiotherapist in the General Practice (GP) site. The primary outcome measure of the study will be health status as measured by the Chronic Respiratory Questionnaire (CRQ). Blinded outcome assessment will be undertaken at baseline and at twelve-fourteen weeks after completion of the programme. A comparison of outcomes between the intervention and control sites will be made to examine if differences exist and, if so, to what extent between control and experimental groups. Sample size calculations estimate that 32 practices with a minimum of 10 participants per practice are required, in total, to be randomised to control and intervention arms for power of at least 80% with alpha levels of 0.05, to determine a clinically significant change of 0.5 units in the CRQ. A cost effectiveness analysis will also be conducted., Discussion: The results of this trial are directly applicable to primary care settings in Ireland. Should a SEPRP delivered by practice nurses and physiotherapists in primary care be found to be effective in improving patients' sense of dyspnoea and HRQoL, then the findings would be applicable to many thousands of individuals in Ireland and beyond.

Aim: This paper is a report of a study conducted to identify the determinants of quality of life for older people living in residential care, including exploration of mediating factors at personal and institutional levels and to construct a model of these., Background: The quality of life of older people living in residential care is an under-researched area. The focus in the gerontology literature has been on quality of care rather than quality of life for these people. There is emerging consensus, however, that quality of life for older people is a complex, multidimensional concept, incorporating both subjective and objective elements, whether people live at home or in residential care., Method: A grounded theory study was conducted in 2005-2006. A total of 101 interviews were undertaken with older people across 12 sites, representing different types of residential care in Northern Ireland. The constant comparative technique was used to analyse data., Findings: Four themes having an impact on the quality of life of residents were identified: ethos of care; sense of self and identity; connectedness; and activities and therapies. Mediating and facilitating and/or constraining factors for quality of life were also identified. The core category was conceptualized as 'maximizing potential'., Conclusion: Achieving optimal quality of life for older people in residential care will remain elusive unless all the factors which affect on it are taken into account by practitioners and policy-makers. Improving the quality of life of older people in residential care will require action in respect of all of the domains identified in this paper.

Aim: This paper is a report of a study conducted to identify the determinants of quality of life for older people with a disability living in the community and to construct a model to explain these., Background: There is no consensus in the literature as to the meaning of quality of life. Few studies have focused on the determinants of quality of life for people with a disability., Methods: A grounded theory study was conducted between 2005 and 2006, using semi-structured interviews to collect data. The constant comparative technique was used to analyse data. The sample comprised 122 older people with one of six disabilities: stroke (n = 20), arthritis (20), depression (20), vision and hearing deficits (20), learning disability (24) or dementia (18) who were living in the community., Findings: A model of the factors that determine quality of life of older people with a disability was developed. 'Living well' was conceptualized as the core category. The potential to 'live well' was influenced by foundation, mediating and facilitating/constraining factors. Quality of life of older people with a disability was revealed as a complex mix of these factors., Conclusion: Quality of life cannot be fully understood unless the totality of factors that have an impact on and shape perceptions are taken into account. The model implies that good support from nurses, a focus on a person's abilities and access to information and connectedness to others can make a difference and may help people cope in a better way.

Service learning is a teaching tool that facilitates students' ability to link theory to practice while simultaneously providing a needed service to the community. This paper describes Irish nursing students' experiences of a service learning placement undertaken in a developing country. The students complete 30 h of theoretical content, which includes lectures and workshops on such topics as personal safety, health, and human rights, as well as the preparation of students for the emotional impact of the experience. All the content is underpinned by a commitment to developing reciprocal relationships with the service learning communities. To explore these students' experiences, a descriptive qualitative study was conducted. The data were collected using interviews and were analyzed by thematic analysis. Four main themes were identified: developing cultural sensitivity, caring for people in different cultures, learning/knowing more, and the potential impact on nursing practice. The findings suggest that the students are more culturally aware and are becoming more responsible citizens.

The aim of this study was to explore nurse managers' perceptions of quality of life of older adults living in residential care in Ireland and key policy issues. Residential care facilities ultimately determine residents' quality of life. A qualitative descriptive design was used in all seven focus groups with 67 participants. Two themes were identified: Factors Influencing Quality of Life and Factors Influencing Policy. Managers highlighted that the physical environment, making it like home, involving the family, the social environment, meaningful recreational activities, and community connections were central to residents' quality of life. It is argued that a Bill of Rights for older adults should be developed.

Aim: The aim of this study was to explore the quality of life of older people living in long-stay care in Ireland from the perspectives of residents and staff., Background: While the literature on quality of life is complex, several areas of agreement are evident. Quality of life is a multi-dimensional concept, which cannot be explained solely in medical terms and only makes sense if presented in an holistic context. Quality of life contains both subjective and objective elements; therefore, there is a need to take account of both when measuring the concept., Method: A mixed method research design was selected for this study. Three methods were employed; focus groups (n = 7) a quantitative survey of 526 long-stay facilities and qualitative interviews with 101 residents and 48 staff., Results: The findings revealed four thematic domains of quality of life: care environment and ethos of care, personal identity, connectedness to family and community and activities and therapies., Conclusion: The study found that there were differences in resident experiences across care study sites and important differences in staffing provision, skill mix and physical environment between private and public facilities. Several factors were also found that either enhanced or diminished residents' potential to retain their connections and relationships with other people. Finally, residents were most likely to participate in activities which were designed to take into account their own particular interests., Relevance to Clinical Practice: This study articulates domains of quality of life from the perspective of residents and staff and gives support to the claims that management and organizational structures within long-stay care facilities matter for quality of life. Clear identification of what is important to older people is important as services need to be shaped around quality of life as much as quality of care, notwithstanding the close relationship between the two.