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The risk of adverse events from ascending thoracic aorta aneurysm (TAA) is poorly understood but drives clinical decision-making.To evaluate the association of TAA size with outcomes in nonsyndromic patients in a large non-referral-based health care delivery system.The Kaiser Permanente Thoracic Aortic Aneurysm (KP-TAA) cohort study was a retrospective cohort study at Kaiser Permanente Northern California, a fully integrated health care delivery system insuring and providing care for more than 4.5 million persons. Nonsyndromic patients from a regional TAA safety net tracking system were included. Imaging data including maximum TAA size were merged with electronic health record (EHR) and comprehensive death data to obtain demographic characteristics, comorbidities, medications, laboratory values, vital signs, and subsequent outcomes. Unadjusted rates were calculated and the association of TAA size with outcomes was evaluated in multivariable competing risk models that categorized TAA size as a baseline and time-updated variable and accounted for potential confounders. Data were analyzed from January 2018 to August 2021.TAA size.Aortic dissection (AD), all-cause death, and elective aortic surgery.Of 6372 patients with TAA identified between 2000 and 2016 (mean [SD] age, 68.6 [13.0] years; 2050 female individuals [32.2%] and 4322 male individuals [67.8%]), mean (SD) initial TAA size was 4.4 (0.5) cm (828 individuals [13.0% of cohort] had initial TAA size 5.0 cm or larger and 280 [4.4%] 5.5 cm or larger). Rates of AD were low across a mean (SD) 3.7 (2.5) years of follow-up (44 individuals [0.7% of cohort]; incidence 0.22 events per 100 person-years). Larger initial aortic size was associated with higher risk of AD and all-cause death in multivariable models, with an inflection point in risk at 6.0 cm. Estimated adjusted risks of AD within 5 years were 0.3% (95% CI, 0.3-0.7), 0.6% (95% CI, 0.4-1.3), 1.5% (95% CI, 1.2-3.9), 3.6% (95% CI, 1.8-12.8), and 10.5% (95% CI, 2.7-44.3) in patients with TAA size of 4.0 to 4.4 cm, 4.5 to 4.9 cm, 5.0 to 5.4 cm, 5.5 to 5.9 cm, and 6.0 cm or larger, respectively, in time-updated models. Rates of the composite outcome of AD and all-cause death were higher than for AD alone, but a similar inflection point for increased risk was observed at 6.0 cm.In a large sociodemographically diverse cohort of patients with TAA, absolute risk of aortic dissection was low but increased with larger aortic sizes after adjustment for potential confounders and competing risks. Our data support current consensus guidelines recommending prophylactic surgery in nonsyndromic individuals with TAA at a 5.5-cm threshold.

Purpose Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). Methods Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full ‘functional recovery criteria’ (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. Results Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. Conclusion Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

Purpose: The primary purpose of this study was to investigate the current practice and opinions of members of the Irish Society of Chartered Physiotherapists (ISCP) with respect to the care of patients in psychological distress. Method: This was a cross-sectional, survey-based investigation of Irish physiotherapists. An electronic survey was sent by email to the ISCP membership. It consisted of closed- and open-ended questions, as well as opinion questions with Likert scale responses. Results: More than 80% of the respondents reported that they encountered patients with psychological distress at least once a week. A lack of education in the area of mental health emerged as a predominant theme. Reflecting on current practice, many discussed the importance of addressing underlying psychological issues before or in tandem with physical issues. Respondents who had engaged in further education in mental health, psychology, or both rated their confidence in recognizing the signs and symptoms of psychological distress higher (p

OBJECTIVE Identify process indicators to measure public health nursing practice during first postnatal visits in Ireland. DESIGN Using a RAND/UCLA appropriateness- "modified Delphi" method, a two-round rating and ranking process was completed in 2016. Fifty-nine statements were reviewed for consensus and priority ranking. SAMPLE The sample comprised a panel of 21 national and international experts. RESULTS Fifty-nine indicators were identified and subsequently reduced across two rounds of consensus testing. Fifty-six indicators achieved consensus and priority ranking identified 13 indicators to measure care for mothers and 15 indicators to measure care for newborns resulting in 28 process indicators to enable Public Health Nurses (PHNs) to measure care during the first postnatal visit. CONCLUSIONS Measurement of care using quality indicators plays an integral role in quality improvement. Developing quality indicators is important in improving care outcomes. This two round "modified Delphi" study combined with literature and previous qualitative findings identified process indicators to measure public health nursing practice at first postnatal visits and enables benchmarking. Developing quality indicators for public health nursing practice using a "modified Delphi" technique has enabled a platform to provide consensus amongst a panel of experts and identified key processes of care by PHNs and mothers.

Objectives Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. Design An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. Sample Nineteen public health nurses from four health service regions in Ireland participated. Results Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. Conclusions Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.

Increased mortality rates have been found in those with a diagnosis of psychosis; studies suggest a shortened life expectancy of up to 20 years less than that of the general population. This study aimed to investigate the mortality of a first episode psychosis cohort at 20-year follow-up, compare it to that of the general Irish population, and explore whether the mortality gap has changed over time. 171 individuals diagnosed with a first episode psychosis identified between 1995 and 1999 in a community mental health service were traced. Mortality was established by matching death certificates to deceased cohort members (using name, age at date of death, and address at date of death). Date of first presentation to service was used as date of entry point and date of death or end of follow-up as the end point. Of the 171 cases there were 20 deaths during follow-up. Nine deaths were attributed to natural causes; 7 to unnatural causes; and 4 were unknown. Comparing standardised mortality rates at 20-year follow-up to those at 12 year showed a reduction in rates over time. Findings suggest that the mortality gap in people with schizophrenia and other psychoses remains high, especially in young males.

AimsPhysical illnesses account for the majority of excess deaths following psychosis; access to care and treatment is inequitable and schizophrenia has now been dubbed the life-shortening disease. We compared service-users and clinician’s perspectives of their physical health assuming that one of the fundamental issues in prompting screening and treatment is the view that health is poor.MethodsData comprising sample characteristics, diagnosis, symptoms, insight, antecedents to psychosis and physical health perspectives were obtained prospectively as part of a larger epidemiological study of first-episode psychosis. We compared physical health perspectives between service-users and clinicians and examined clinical correlates. ResultsContrary to our expectations, we found that service-users reported poorer physical health over time than clinicians did. ConclusionReconciling service-users and clinician’s views of physical health may be an important step towards collaborative care and improving access to better quality healthcare for serious mental illness.

Background: Social opportunities can be limited in the lives of people with enduring mental illness (EMI) due to psychiatric stigma, restricted home environments and employment barriers. Supported socialisation programmes have the potential to redress the impact of social isolation. Aim: To explore the experiences of service users with EMI taking part in a supported socialisation programme, using written diary entries. Methods: This article reports on the qualitative component of a randomised controlled trial of supported socialisation for people with EMI (published previously in this journal). Trial participation involved (1) being matched with a volunteer partner and engaging in social/leisure activities while receiving a stipend of €20 or (2) receiving this stipend only and engaging in self-driven socialisation. Participants completed written diaries documenting their perspectives on their experiences of supported socialisation. Data were analysed using Thematic Analysis. Results: Experiences of participation were characterised by involvement ‘normalising’ life, fostering a sense of connectedness, improving physical health, and facilitating engagement with culture. Taking part helped participants integrate socialising into their identity, enhanced their perceived capacity to be social, and cemented/expanded social networks. Participants also experienced significant obstacles to socialisation. Conclusion: Supported socialisation can increase confidence, social competence and self-agency; buffer against psychiatric stigma; build social capital; and afford opportunities to enhance social integration, inclusion and belonging.

BackgroundDiminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention.MethodsDuring the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n = 158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinician’s evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured.ResultsA number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n = 129, Median = 24.5mths, IQR = 7.25–69.25; Mann-Whitney U = 11.78, p = 0.008). Social support at baseline and at one year was predicted by homelessness (t = −2.98, p = 0.001, CI −4.74 to −1.21), duration of untreated psychosis (t = −0.86, p = 0.031, CI −1.65 to −0.08) and premorbid adjustment (t = −2.26, p = 0.017, CI −4.11 to −0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome.ConclusionsImproved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.

Background Globally, there is evidence that tertiary education students are increasingly combining full time study with paid term-time employment. Despite this dual participation, little is known about the impact of working for pay during term on students' engagement with activities, both academic and social, that are associated with learning and development. Objectives To measure undergraduate nursing students' term-time employment commitments and the impact of those commitments on nursing students' engagement. Design Cross-sectional survey design. Settings Four Higher Education Institutions (HEIs) in the Republic of Ireland - comprising of two Universities and two Institutes of Technology. Participants First and final year undergraduate students (n = 634) enrolled in a four-year Bachelor of Science Nursing (honours degree). Methods The College Student Report – National Survey of Student Engagement (NSSE) self-report questionnaire was utilised. This collects data on core activities associated with student engagement along with how students spend their time in and out of class. The statistical software package SPSS version 21 was used to analyse data. Results Over two-thirds of undergraduate nursing students (n = 423) engaged in term-time employment, working on average 15 h per week, with non-traditional students (i.e. mature-aged, those with children, those who did not enter college based on second level school results) working most hours. Term-time employment had limited impact on student engagement, however, students in employment had increased student faculty interaction compared to students who were not employed but engaged in less time studying (Mean = 7.2, SD 5.9) than those who were employed (Mean = 8.7, SD = 7.6; t(316) = 2.46; p = .014). Conclusions Overall, engaging in term-time employment was not negatively associated with student engagement, but it did reduce the number of hours students studied. Non-traditional students were more likely to be employed and consequently impacted by combining work and educational demands.

Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff-allocation models, staffing levels, nursing shifts, or nurses' work patterns. This is the first update of our review published in 2011.The purpose of this review was to explore the effect of hospital nurse-staffing models on patient and staff-related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff-related outcomes, and, 3) the impact of staffing model(s) on cost outcomes.CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies.We included randomised trials, non-randomised trials, controlled before-after studies and interrupted-time-series or repeated-measures studies of interventions relating to hospital nurse-staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient-, staff-related, or economic outcome. The most important outcomes included in this review were: nursing-staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs.We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence.We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse-staffing models:- introduction of advanced or specialist nurses to the nursing workforce;- introduction of nursing assistive personnel to the hospital workforce;- primary nursing; and- staffing models.The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long-stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment.The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies,464 participants) or staffing models (1 study, 647 participants) reduces nursing-staff turnover, or if primary nursing (2 studies,138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty.The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse-staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.

Background and Information Orientation to PACU encompasses a nurse's ability to confidently and safely cares for patients based on standardization of care as outlined by ASPAN. At the end of orientation for new hires, there was no documentation of progress or opportunities in which both the preceptor and orientees can speak to. Each preceptor did their orientation based on their daily assigned surgical cases. A review of the orientation process was done, and it was evident that, it was disorganized, unstructured and provided inadequate resources for the new hire. Objectives of Project 1. Creation of orientation binder that is user friendly along with detailed competencies 2. ASPAN clinical information was placed in a binder as a resource for new hires 3. Bring together a cohort of consistent preceptors who are acquainted with the flow and expectation of orientation 4. Track and maintain progress reports Process of Implementation An orientation binder was created to set an organized standard of care and resource guideline for incoming nurses to PACU (regardless of skills and experiences). Binders were rearranged and reviewed during the orientation process by preceptors. Preceptors attended a workshop on how to demonstrate a successful and proficient mentorship. Preceptors were given an orientation binder. A record reference resources binder was created which included categories and guidelines related to Recovery care (from pre-anesthesia care to discharge from anesthesia care Statement of Successful Practice Orientees have reported increased confidence and satisfaction after orientation. Orientees can now recover patients independently with confidence with minimal supervision and support. As a result, after orientation preceptees demonstrate consistency and knowledge gained during precepting. Implication of Advancing the Practice of Perianesthesia Nursing Preparing a standardized and comprehensive orientation package and resource binder has proven to contribute to a successful orientation. Preceptees demonstrated confidence and autonomy while using the new orientation process. This has proven to be extremely effective in the PACU at Montefiore Medical Center.

Schools are a key setting for mental health promotion and the provision of emotional support to students. As teachers and school counsellors are adults with whom adolescents have regular contact, it is likely they would be used as a help source by distressed students however there are few studies on this from an Irish context. A mixed methods design was used to identify the extent of adolescent help-seeking in addition to exploring what influences a young person’s decision to seek help in school. Findings generated through surveys (N = 856) and four focus group interviews (N = 35) with adolescents indicate that young people do not regard teachers and school counsellors as a potential help source. Barriers to seeking help include dislike of the dual role of counsellor/teacher and concerns about confidentiality. The provision of independent school counselling and increased mental health education were identified as factors that might increase help-seeking in school.

This small Randomised Controlled Trial (RCT) study aims to investigate whether there is any connection between maternal and infant hypothermia for babies delivered by caesarean section while the baby undergoes skin-to-skin contact (SSC). 20 pregnant women booked for elective caesarean section (singleton pregnancy) and their newborn babies were consented and randomly allocated into two groups, care as usual and intervention group. The care as usual – received room temperature IV fluids (approximately 25 °C), with the intervention group receiving pre-warmed fluids (39 °C) via a fluid warmer device (Hotline Fluid Warmer, Level 1). Maternal temperature in the intervention group who received the pre-warmed IV fluids was maintained within normal levels when compared to the care as usual group. While no statistical significant differences were identified in neonatal temperatures, reduced temperatures were identified in babies resulting in mild neonatal hypothermia especially the neonates of the control group.

Background Student achievement within the Higher Education Sector is predicated upon engagement with college/university life and engagement is identified as having a major impact on the acquisition of knowledge and cognitive growth. Evidence within the higher education sector identifies factors which impact positively and negatively on student engagement. However, the direct application of this evidence to nursing students whose programmes of study are fundamentally different to other non-professional degrees has not, as yet, been examined. Objectives To explore undergraduate nursing students' engagement in college-based education and their perceptions of how their institutions support student engagement. Design Cross-sectional survey design. Settings Four Higher Education Institutions (HEIs) in the Republic of Ireland. Participants Nursing students in first and final year (n = 634) undertaking a four-year Bachelor of Science Nursing (honours degree). Methods The National Survey of Student Engagement (NSSE) self-report questionnaire, which collects data on four core areas related to student engagement, was used. The statistical package SPSS version 21 was used to analyse the data. Independent t-tests were used to compare differences in engagement between students, depending on year of study (first and final year), institution type, and age. Results Students engaged most in activities that are considered core to higher education: higher order learning, collaborative learning and effective learning strategies. Although students perceived that lecturers engaged in effective teaching practices, they reported limited out of class interaction with lecturers. Conclusions The insight gained from this study of the educational realities of contemporary nursing students will provide clarity for nurse educators, regulators, and policymakers in their efforts to support and enhance student engagement.

Objective: Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. Method: iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort ( N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. Results: At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. Conclusion: Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.

Adolescent self-harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help-seeking for self-harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self-harm in an urban region in Ireland, and to investigate help-seeking behaviours for self-harm. This was a cross-sectional study of 856 school-going adolescents, employing an anonymous self-report questionnaire. A lifetime history of self-harm was reported by 12.1% of adolescents. Factors independently associated with self-harm included exposure to self-harm of a friend/family member. Professional help-seeking was uncommon prior to (9%) and after (12%) self-harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self-harm act. These findings indicate that self-harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the 'tip of the iceberg' of adolescent self-harm. Identifying the prevalence of self-harm and associated factors, in addition to help-seeking behaviours, in young people is important to determine the preventative programmes to target 'at-risk' groups. Mental health nurses have an important and increasing role to play in such school-based initiatives.

AIM: Quality of life (QOL) in first-episode psychosis (FEP) is impaired when compared to non-clinical controls and several clinical factors including symptoms and untreated psychosis have been linked with poorer QOL. Measurement methods are varied, however, resulting in inconsistent findings and there is a need to simultaneously combine subjective and objective measures of QOL. METHODS: We examined both subjective (n?=?128) and objective QOL (n?=?178) in a catchment area cohort of individuals with FEP (n?=?222) to determine correspondence between patient satisfaction and clinician-rated functional domains. We also examined the contribution of sociodemographic and clinical characteristics to both subjective and objective QOL. RESULTS: There were complex relationships between subjective and objective QOL domains in that patient's assessments of health status (psychological well-being, symptoms/outlook, physical health) were not correlated with clinicians but there were strong correlations between social functioning domains (occupation, social relations, financial status and activities of daily living) assessed by patients and clinicians. Longer duration of untreated psychosis, being treated as an inpatient, higher positive symptoms and poorer social functioning in client-rated QOL domains predicted poorer objective QOL. CONCLUSION: We found that both subjective and objective assessments of QOL displayed a degree of clinical utility demonstrated by relationships between clinical factors and both QOL perspectives. Moreover, the lack of association between patient characteristics and QOL shows some potential malleability of QOL outcomes through intervention as there were several clinical factors linked with both subjective and objective QOL.

Little is known about how recovery oriented policy and legislative changes influence service users’ perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for ‘full functional recovery’ and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the ‘humanising’ of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation.

Purpose/background For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms. Methods/procedures Data were collected from the medical records of people who originally presented with a first-episode psychosis between 1995 and 1999 (N = 171). Data were obtained from first presentation up to December 31, 2013 or until the patient was discharged or transferred. Information on service use and physical health was gathered using a data collection template designed specifically for this audit. Findings/results Twenty-eight (16.3%) of the cohort were prescribed clozapine. Data were available for 24 individuals. Of this clozapine subsample, the mean age at baseline was 23.11 (SD = 4.58); 82.14% (n = 23) were male; and 82.14% (n = 23) had a baseline diagnosis of schizophrenia. The mean time to first trial of clozapine was 6.7 years. The mean number of antipsychotics prescribed before clozapine trial was 4.85. After the initiation of clozapine, the mean number of hospital admissions reduced from 6.04 per year to 0.88 per year. Implications/conclusions Nearly 1 in 5 of the original cohort was considered to have a suboptimal response to trials of antipsychotic medication. The use of clozapine for treatment-resistant schizophrenia is underutilized, and better understanding of the barriers to prescribing clozapine is necessary given the implications for patient's quality of life and hospital admission rates. Physical health data further emphasizes the importance of physical health monitoring in this vulnerable population.

Purpose The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer. Method This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis. Results The key themes to emerge from the date were ‘living in the here and now’ and ‘awareness of the Cancer Society’. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society. Conclusions Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies’ services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement.

According to the World Health Organization ( WHO, 1997 ) a newborn is normothermic when its body temperature is between 36.5°C and 37.5°C with hypothermia considered to be any temperature below this identified spectrum. Neonatal hypothermia is a potentially common and dangerous occurrence related to a number of risk factors categorised as environmental, physiological, behavioural and socioeconomic. Babies delivered by caesarean section are at particular risk of developing hypothermia. The purpose of this review is to provide an overview of the factors contributing to neonatal hypothermia including the physiology of thermoregulation, mechanisms of thermogenesis and heat loss, and the effects that neonatal hypothermia has on the newborn infant. The paper will also review the interventions, which may be adopted to prevent hypothermia occurring and to identify and intervene to reduce the impact of hypothermia including the effect of skin-to-skin contact as both a preventative and management strategy in neonatal hypothermia.

Background: This randomised controlled trial examined if for people with enduring mental illness, being supported to socialise leads to improved social functioning, increased self-esteem and extended social networks; a reduction in social isolation, social, emotional and family loneliness and a reduction in illness symptoms, namely depression. Methods: A prospective randomised controlled trial was undertaken from November 2007 to September 2011. Service users with a diagnosis of enduring mental illness (>18 years) were invited to participate. Participants were randomly allocated to intervention or control group conditions in a 1:1 ratio. Intervention group participants were matched with a volunteer partner, asked to engage in social/leisure activities for 2 hours weekly over a 9-month period, and received a €20 stipend monthly. Control group participants received a €20 monthly stipend and were asked to engage in a weekly social/leisure activity. Social functioning, the primary outcome, was measured using the Social Functioning Scale (SFS) at three time points (baseline, midpoint and endpoint). Findings: In all, 107 people completed this study. There were no significant differences between control and intervention groups at the commencement of the intervention on demographic characteristics or the main outcome measures of interest. Overall social functioning positively changed throughout the three time points from a mean of 99·7 (standard deviation ( SD) = 15.1) at baseline, to a mean of 106.0 ( SD = 27.0) at the endpoint for the control group, and from a mean of 100·4 ( SD = 15.0) at Time 1 for the intervention group, to a mean of 104.1 ( SD = 23.4) at the endpoint for the intervention group. Conclusions: The intervention showed no statistical differences between the control and intervention groups on primary or secondary outcome measures. The stipend and the stipend plus volunteer partner led to an increase in recreational social functioning; a decrease in levels of social loneliness, in depression and in the proportion living within a vulnerable social network.

Accessible summaryWhat is known on the subject? Self-harm is a relatively common occurrence in adolescents; however, there remains a lack of understanding about the motivations behind adolescent self-harm, and this poor understanding can have a negative impact on how mental health professionals respond to young people who self-harm. What does this paper add to existing knowledge? This paper identifies the reasons for self-harm in a community sample of young people and finds that the functions of self-harm differ for different people and that there may be multiple reasons for self-harm. Findings provide support for the affect-regulation model of self-harm which states that young people self-harm to regulate how they are feeling, but provides little support for the interpersonal influence model which proposes that self-harm is an attempt to influence how other people respond to them. What are the implications for practice? Self-harm for most young people serves at least one specific function and is an indication of distress. There is a requirement for a non-pathologizing response towards young people who self-harm; self-harm should be understood as a meaningful behaviour rather than a symptom of an illness. Mental health nurses need to understand the multiple functions of self-harm. A better understanding of the individualized meaning behind self-harm can positively impact on attitudes towards young people who self-harm and provide for improved mental health service provision. AbstractIntroduction Although self-harm is a relatively common occurrence in adolescents, there is a lack of understanding about the motivations behind it. A poor understanding of self-harm contributes to negative perceptions about those who self-harm and a poor healthcare experience. Aim & Methods This study identifies motivations behind self-harm in school-based adolescents using a cross-sectional survey. Motivations behind self-harm were elicited using a scale and open-ended responses. Results Of the 856 adolescents who completed the survey across 11 postprimary schools, 103 reported a history of self-harm. The most commonly endorsed reason for self-harm was to ‘get relief from a terrible state of mind’ (79%). Open-ended responses were consistent with scale responses with most reporting that they self-harmed to relieve distressing emotions. Discussion Findings provide support for the affect-regulation model of self-harm with support also demonstrated for the self-punishment and antidissociation models. There was little support for the interpersonal influence model suggesting that the commonly held belief that self-harm is attention-seeking is one attributed by others to young people, and not widely reported by young people themselves. Implications for practice Mental health services need to be responsive to the needs of young people who self-harm which requires eliciting and understanding the individual and multiple meanings behind self-harm to best inform treatment options.

Introduction Historically, the treatment and care of the mentally ill has been influenced by societal, cultural, political, religious and scientific factors. Beliefs about the nature of lunacy, insanity and subsequently mental illness, while divergent across the globe, demonstrate a concordance that has served to determine how those with mental illness have been cared for by the societies in which they live. As societies began the interrelated processes of industrialisation and urbanisation, an increasing drive towards classification and segregation of various groups within society including prisoners, vagrants, the poor, the sick and ultimately the mentally ill, emerged.

Adolescent self-harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help-seeking for self-harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self-harm in an urban region in Ireland, and to investigate help-seeking behaviours for self-harm. This was a cross-sectional study of 856 school-going adolescents, employing an anonymous self-report questionnaire. A lifetime history of self-harm was reported by 12.1% of adolescents. Factors independently associated with self-harm included exposure to self-harm of a friend/family member. Professional help-seeking was uncommon prior to (9%) and after (12%) self-harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self-harm act. These findings indicate that self-harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the 'tip of the iceberg' of adolescent self-harm. Identifying the prevalence of self-harm and associated factors, in addition to help-seeking behaviours, in young people is important to determine the preventative programmes to target 'at-risk' groups. Mental health nurses have an important and increasing role to play in such school-based initiatives.

Quality of life (QOL) in first-episode psychosis (FEP) is impaired when compared to non-clinical controls and several clinical factors including symptoms and untreated psychosis have been linked with poorer QOL. Measurement methods are varied, however, resulting in inconsistent findings and there is a need to simultaneously combine subjective and objective measures of QOL.We examined both subjective (n = 128) and objective QOL (n = 178) in a catchment area cohort of individuals with FEP (n = 222) to determine correspondence between patient satisfaction and clinician-rated functional domains. We also examined the contribution of sociodemographic and clinical characteristics to both subjective and objective QOL.There were complex relationships between subjective and objective QOL domains in that patient's assessments of health status (psychological well-being, symptoms/outlook, physical health) were not correlated with clinicians but there were strong correlations between social functioning domains (occupation, social relations, financial status and activities of daily living) assessed by patients and clinicians. Longer duration of untreated psychosis, being treated as an inpatient, higher positive symptoms and poorer social functioning in client-rated QOL domains predicted poorer objective QOL.We found that both subjective and objective assessments of QOL displayed a degree of clinical utility demonstrated by relationships between clinical factors and both QOL perspectives. Moreover, the lack of association between patient characteristics and QOL shows some potential malleability of QOL outcomes through intervention as there were several clinical factors linked with both subjective and objective QOL.

The Hospitaller Order of St John of God is involved in providing health, educational and social services to people with mental health problems and learning difficulties in the Republic of Ireland. As part of its development plan the Order is engaging in the development of a comprehensive Mental Health Information System encompassing both community and hospital-based services. This system is being developed by local practitioners with the assistance of an external facilitator. The Order is also extensively involved in developing legal and ethical protocols to ensure the system meets all requirements of data protection legislation both nationally and at European levels. Within the overall system, the nursing component is the first part to have been operationalized and some initial evaluation of its efficacy has been conducted. The purpose of this paper is to present the work of the nursing department at St John of God Hospital, Dublin, in the development, implementation and initial evaluation of a computerized patient information system.

A RTICLES THROUGHOUT the nursing literature identify the need for and value of using research in practice (Mayhew, 1993; Stetler, Bautista, Vernale-Hannon, & Foster, 1995; Titler & Goode, 1995). A significant step in the utilization process is the critique of research literature, followed by integration of multiple related findings to create a high quality, best evidence synthesis (Slavin, 1986). The phrase integrative review (IR) is used to indicate the systematic analysis and synthesis of research on a targeted topic. Such a synthesis reduces uncertainty about targeted practice recommendations, enables " . . . accurate generalizations about phenomena from the limited information" available (Jackson, 1980, p. 442), and facilitates decision making regarding actions and interventions that could result in the most effective, costefficient care. As a group of nurses in one acute care setting searched for a framework to guide their conduct of IRs, they discovered that not all IRs are created equal. They also found that available frameworks did not provide the level of direction or detail desired. Outlined below is an overview of attributes perceived as enhancing the quality of reviews applicable to everyday nursing practice, limitations perceived as diminishing the usefulness of published integrative reviews, and the framework developed for this setting to strengthen their reviews and resultant recommendations for practice.

Background Quality of life (QOL) is now recognised as an important measure of outcome that could potentially influence clinical decision-making for those with a first-episode psychosis (FEP). A number of QOL instruments are available however; many differ in their conceptual orientation which may have serious implications for the outcome of QOL studies, interpretation of findings and clinical utility. We aimed to compare two commonly used tools representing both generic and disease-specific constructs to examine whether both tools appraise the same underlying QOL traits and also whether disease-specific tools retain their psychometric properties when used in FEP groups. Methods We assessed 159 consecutive individuals presenting with FEP in a defined catchment area with two commonly used QOL tools and examined the findings using the multi-trait multi-method matrix. Results Similarly named domains of QOL between both tools (Psychological Wellbeing, Physical Health, Social Relations) showed good convergent validity using confirmatory factor analysis. However, discriminant validity was not established given that domains loading onto their indicated latent factors were more strongly correlated with their non-corresponding latent factors. Conclusions A major consideration in undertaking the present study was to assess the extent to which the outcome of QOL studies in FEP were valid and that systematic error did not provide another plausible explanation for findings. Establishing convergent validity demonstrates that either tool could be used satisfactorily to measure the QOL construct identified however; we did not establish discriminant validity. Doing so would have demonstrated that QOL domains are substantively different in that they contain some unique piece of information determining clinical utility. These findings are important for our understanding of multi-dimensional models of QOL.

Using psychiatric nursing education and practice as a case study, this paper examines how the achievement of independence by a nation impacts significantly on the organisations, structures and service provision within that country. Furthermore, it sheds light on how an emerging nation is required to engage in a series of 'trade-offs' between priorities in an attempt to ensure progress towards the greater visioning goals such as the (re)establishing of a national cultural identity, freedom to practice religious beliefs and enhanced economic and practical benefits for all citizens. In the case of Irish psychiatric nursing, the achievement of independence resulted in a diminishing of earlier initiatives related to training and ultimately in a prolonged period of retrenchment, due primarily to competitive pressures and to imposed cultural influences and belief systems. The lesson from this Irish case study indicates that the initial phase of national autonomy can, of necessity, lead to a number of sacrifices as part of the realisation of self-governance and determination; and that this is a necessary prerequisite to gaining the strength to enable a much more confident progression into the future.

TPS11133 Background: Patients at risk of lung cancer may have subclinical disease present for years before diagnosis. Exhaled breath condensate (EBC) is water vapour which contains aerosolized part...

BACKGROUND: Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff‐allocation models, staffing levels, nursing shifts, or nurses’ work patterns. This is the first update of our review published in 2011. OBJECTIVES: The purpose of this review was to explore the effect of hospital nurse‐staffing models on patient and staff‐related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff‐related outcomes, and, 3) the impact of staffing model(s) on cost outcomes. SEARCH METHODS: CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included randomised trials, non‐randomised trials, controlled before‐after studies and interrupted‐time‐series or repeated‐measures studies of interventions relating to hospital nurse‐staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient‐, staff‐related, or economic outcome. The most important outcomes included in this review were: nursing‐staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs. DATA COLLECTION AND ANALYSIS: We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence. MAIN RESULTS: We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse‐staffing models: ‐ introduction of advanced or specialist nurses to the nursing workforce; ‐ introduction of nursing assistive personnel to the hospital workforce; ‐ primary nursing; and ‐ staffing models. The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long‐stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment. The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing‐staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty. AUTHORS' CONCLUSIONS: The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse‐staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.

LARGE numbers of turkey poults1 and ducklings2 died on British farms in 1960 as a result of consuming groundnut (Arachis hypogaea) meal imported from Brazil. Afterwards, outbreaks of disease associated with the feeding of Brazilian groundnut meal were reported in cattle3, pigs4, and sheep (Buxton, J. C., personal communication). More recently it has been shown that some samples of groundnut products from a number of other producing countries are toxic to animals5.

ALTHOUGH HEMORRHOIDS are usually not a serious problem, they frequently cause a great deal of concern and discomfort to a patient. The most common symptoms are: rectal bleeding, pain on defecation, constipation, pruritus, staining, and prolapse of the internal hemorrhoids. A patient may complain of one or a combination of these symptoms. Following admission to our 12-bed section reserved for proctological problems at the Veterans Administration Hospital, the patient is usually prepared for a proctosigmoidoscopic examination. Of course, if he has severe rectal bleeding, the physician is summoned before any sort of preparation is begun since emergency surgery may be necessary to control the bleeding. Reassurance is important to the patient admitted with bleeding hemorrhoids because he is apt to be frightened and apprehensive. Strong oral laxatives are not necessary prior to the proctosigmoidoscopy since diarrhea frequently ensues, and the rectum that has been cleared by this means soon fills with loose stool. Soapsuds enemas cause anal burning and the passage of mucus, thus giving the bowel a reddened and inflamed look. For these reasons, one to three plain warm water or normal saline enemas are administered until clear about two hours prior to the examination. The enemas should be given gently to prevent trauma and pain to the already uncomfortable patient. Following this preparation an inspection is made of the lower sigmoid colon to rule out the possibility of polyps or a malignant lesion giving rise to rectal bleeding. Prior to surgery the patient has a complete physical evaluation. This includes a thorough history and physical examination, chest x-ray, complete blood count, serology, urinalysis, and an electrocardiogram if he is over 40 years of age. If his hemoglobin is under 9 Gm., he is transfused before surgery. The day before surgery the rectal area is shaved. Also the day before surgery and the following morning the nurse charts the patient's blood pressure two times, one hour apart, for the anesthetist's information. The patient signs the operative consent for spinal anesthesia, at which time the nurse instructs him about his postoperative care and the routine he will be expected to follow.