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9. Clinical judgement of critical care nurses in the context of the ventilated patient in pain in the immediate phase post cardiac surgery : a case study

Author

O'Connor, Laserina

Subjects
617.412
Abstract

The critical care environment is a complex arena in which clinical judgements of the ventilated patients pain state are made over the course of their surgical trajectory. The presence of the critical care nurse at the bedside is the key to informed judgement in this unpredictable and fragile situation. This study sought to capture the judgement process of thirty critical care nurses in the context of the ventilated patient in pain in the immediate phase after cardiac surgery i.e. six-hours. Evidence of the judgement process was sought using the Lens Model as a framework, utilising the cognitive side of the model. Moreover, in order to capture this phenomenon of interest, the researcher observed the pain behaviours of thirty ventilated patients in the immediate phase post cardiac surgery. Within-methods triangulation was employed as an approach for justifying and underpinning knowledge by acquiring additional knowledge, which was seen as pertinent to this naturalistic case study. The data collection approach included think-aloud by thirty critical care nurses and simultaneous researcher observation over a six-hour period in the natural habitat of the ventilated patient post cardiac surgery. The findings give tentative support for the hypothesis that critical care nurses use a pattern of cues to make a judgement of ventilated patients' pain state in the immediate phase post cardiac surgery. Conversely, there was tentative support for the hypothesis that ventilated patients convey a pattern of cues to the critical care nurse in the immediate phase post cardiac surgery. Moreover, tentative conclusions are afforded which are as follows: a judgement structure is employed by critical care nurses which is comprised of two stages. The initial stage involves a pattern of physiological, behavioural general, covert behaviour, physical, overt motor pain behaviour, mechanical, technical, paraclinical, knowledge and pain descriptor cues. These aforesaid cues are utilised and integrated into a small number of intermediate judgements which operate as second order cues. Consequently the second order cues are combined in order to make a final judgement of the ventilated patient's pain state in the immediate phase post cardiac surgery: '(s)he is in acute pain' or '(s)he is not in acute pain'. In addition, critically ill ventilated patients convey a pattern of pain cues to the critical care nurses which comprises of physiological, behavioural general, overt motor pain behaviour cues, patient ventilator dysynchrony cues and verbal subjective pain behaviour cues. The pattern of cues conveyed by the ventilated patient may be influenced by many factors in an unpredictable and delicate surgical trajectory and chief among these factors is haemodynamic instability. The critical care nurse must make sense of all of this to gain access to the pattern of cues.

Published
2006

19. Ireland

Author

Finn, David P., primary, Fullen, Brona M., additional, McGuire, Brian E., additional, O’Brien, Joanne, additional, O’Connor, Laserina, additional, Victory, Raymond, additional, and Wright, Shelagh, additional

Published
2018
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20. Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care

Author

O’Connor, Laserina, primary, McAuliffe, Eilish, additional, Casey, Mary, additional, Rogers, Lisa, additional, Gallen, Anne, additional, Finnegan, Leonie, additional, Glasgow, Mary Ellen, additional, White, Mark, additional, White, Ciara, additional, Kavanagh, Paula, additional, Bell, Miriam, additional, Killeen, Angela, additional, and Barnard, Marlize, additional

Published
2022
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25. sj-pdf-1-jrn-10.1177_17449871211021138 - Supplemental material for Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care

Author

O’Connor, Laserina, McAuliffe, Eilish, Casey, Mary, Rogers, Lisa, Gallen, Anne, Finnegan, Leonie, Glasgow, Mary Ellen, White, Mark, White, Ciara, Kavanagh, Paula, Bell, Miriam, Killeen, Angela, and Barnard, Marlize

Subjects
111099 Nursing not elsewhere classified, 160807 Sociological Methodology and Research Methods, FOS: Health sciences, FOS: Sociology
Abstract

Supplemental material, sj-pdf-1-jrn-10.1177_17449871211021138 for Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care by Laserina O’Connor, Eilish McAuliffe, Mary Casey, Lisa Rogers, Anne Gallen, Leonie Finnegan, Mary Ellen Glasgow, Mark White, Ciara White, Paula Kavanagh, Miriam Bell, Angela Killeen and Marlize Barnard in Journal of Research in Nursing

Published
2022
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28. A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice

Author

Teeling, Sean Paul, primary, Davies, Carmel, additional, Barnard, Marlize, additional, O’Connor, Laserina, additional, Coffey, Alice, additional, Lambert, Veronica, additional, McNamara, Martin, additional, Tuohy, Dympna, additional, Frawley, Timothy, additional, Redmond, Catherine, additional, Somanadhan, Suja, additional, Casey, Mary, additional, Corcoran, Yvonne, additional, Doody, Owen, additional, O’Brien, Denise, additional, Noonan, Maria, additional, Smith, Rita, additional, Bradshaw, Carmel, additional, Murphy, Sylvia, additional, Dore, Liz, additional, Lyons, Rosemary, additional, McGeehan, Máire, additional, and Gallen, Anne, additional

Published
2021
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29. Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care.

Author

O'Connor, Laserina, McAuliffe, Eilish, Casey, Mary, Rogers, Lisa, Gallen, Anne, Finnegan, Leonie, Glasgow, Mary Ellen, White, Mark, White, Ciara, Kavanagh, Paula, Bell, Miriam, Killeen, Angela, and Barnard, Marlize

Abstract

Background: Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives: Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design: A modified four-round Delphi study. Methods: The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results: There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion: This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care. [ABSTRACT FROM AUTHOR]

Published
2022
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32. A Realist Review Protocol of the Role and Contribution of the Advanced Nurse Practitioner (ANP) in Gastroenterology Nursing

Author

Barnard, Marlize, Casey, Mary, and O'Connor, Laserina

Abstract

The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methodology A Realist Review will consolidate evidence on how, when, why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusion Due to the theory-oriented approach of Realist Reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

Published
2021
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33. Developing a new health-related policy analysis tool: An action research cooperative inquiry approach

Author

Casey, Mary, Rohde, Daniela, Brady, Anne-Marie, Fealy, Gerard M., Hegarty, Josephine-Mary, Kennedy, Catriona, McNamara, Martin, Nicholson, Emma, O'Connell, Rhona, O'Connor, Laserina, O'Leary, Denise, O'Reilly, Pauline, Stokes, Diarmuid, Casey, Mary, Rohde, Daniela, Brady, Anne-Marie, Fealy, Gerard M., Hegarty, Josephine-Mary, Kennedy, Catriona, McNamara, Martin, Nicholson, Emma, O'Connell, Rhona, O'Connor, Laserina, O'Leary, Denise, O'Reilly, Pauline, and Stokes, Diarmuid

Abstract

peer-reviewed, Aim To develop a tool for the analysis of nursing, midwifery and health‐related policy and professional guidance documents. Background Analysis tools can aid both policy evaluation and policy development. However, no framework for analysing the content of professional regulation and guidance documents among health care professionals currently exists. Method This study used an action research, cooperative inquiry design. Data were generated from two integrative literature reviews and discussions held during the cooperative inquiry meetings. Results A set of key themes to be considered in the development or evaluation of health policy or professional regulation and guidance documents were identified. These themes formed the basis of the six domains considered by the Health‐related Policy Analysis Tool (HrPAT): Context, Process, Content, Stakeholder Consultation, Implementation and Evaluation. Conclusion Use of the HrPAT can assist in policy development, evaluation and implementation, as well as providing some retrospective analytical insights into existing health policies. Implication for Nursing Management Professional regulation documents, guidelines and policy reports should be capable of being scrutinized for their content, quality and developmental process. The HrPAT can assist relevant stakeholders in the development, analysis and evaluation of such documents, including local, service‐level policies and guidelines., ACCEPTED, peer-reviewed

Published
2021

35. Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

Author

O'Connor, Laserina, primary, Coffey, Alice, additional, Lambert, Veronica, additional, Casey, Mary, additional, McNamara, Martin, additional, Teeling, Sean Paul, additional, O'Doherty, Jane, additional, Barnard, Marlize, additional, Corcoran, Yvonne, additional, Davies, Carmel, additional, Doody, Owen, additional, Frawley, Timothy, additional, O'Brien, Denise, additional, Redmond, Catherine, additional, Smith, Rita, additional, Somanadhan, Suja, additional, Noonan, Maria, additional, Bradshaw, Carmel, additional, Tuohy, Dympna, additional, and Gallen, Anne, additional

Published
2021
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36. Quality care metrics (QC-M) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

Author

O'Connor, Laserina, primary, Coffey, Alice, additional, Lambert, Veronica, additional, Casey, Mary, additional, McNamara, Martin, additional, Teeling, Sean Paul, additional, O'Doherty, Jane, additional, Barnard, Marlize, additional, Corcoran, Yvonne, additional, Davies, Carmel, additional, Doody, Owen, additional, Frawley, Timothy, additional, O'Brien, Denise, additional, Redmond, Catherine, additional, Smith, Rita, additional, Somanadhan, Suja, additional, Noonan, Maria, additional, Bradshaw, Carmel, additional, Tuohy, Dympna, additional, and Gallen, Anne, additional

Published
2020
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38. Developing a new health‐related policy analysis tool: An action research cooperative inquiry approach

Author

Casey, Mary, primary, Rohde, Daniela, additional, Brady, Anne‐Marie, additional, Fealy, Gerard, additional, Hegarty, Josephine, additional, Kennedy, Catriona, additional, McNamara, Martin, additional, Nicholson, Emma, additional, O'Connell, Rhona, additional, O'Connor, Laserina, additional, O'Leary, Denise, additional, O'Reilly, Pauline, additional, and Stokes, Diarmuid, additional

Published
2019
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41. Using Rapid Reviews in Nursing and Midwifery Research: An Example From a Study Commissioned to Inform Policy-Making

Author

O'Leary, Denise, Casey, Mary, O’Connor, Laserina, Stokes, Diarmuid, Fealy, Gerard, O’Brien, Denise, Smith, Rita, McNamara, Martin, and Egan, Claire

Subjects
Health and Medical Administration, meta analyses, Health Information Technology, Systematic reviews, policy
Abstract

Aim: To illustrate the potential use of rapid review approaches in nursing and midwifery research by presenting a worked example from a study conducted to inform policy decision making. Background: Rapid reviews, which can be defined as outputs of a knowledge synthesis approach that involves modifying or omitting elements of a systematic review process due to limited time or resources, are becoming increasingly popular in health research. This paper provides guidance on how a rapid review can be undertaken and discusses the strengths and challenges of the approach. Data source and research design: Data from a rapid review of the literature undertaken in 2015 is used as a worked example to highlight one method of undertaking a rapid review. Implications for nursing: Seeking evidence to inform health policy making or evidence based practice is a process that can be limited by time constraints, making it difficult to conduct comprehensive systematic reviews.

Published
2017

46. Nurses, midwives and key stakeholders experiences and perceptions on requirements to demonstrate the maintenance of professional competence: an Irish study

Author

Casey, Mary, Cooney, Adeline, O'Connell, Rhona, Hegarty, Josephine, Brady, Anne-Marie, O'Reilly, Pauline, Kennedy, Catriona, Heffernan, Elizabeth, Fealy, Gerard M., McNamara, Martin, O'Connor, Laserina, Casey, Mary, Cooney, Adeline, O'Connell, Rhona, Hegarty, Josephine, Brady, Anne-Marie, O'Reilly, Pauline, Kennedy, Catriona, Heffernan, Elizabeth, Fealy, Gerard M., McNamara, Martin, and O'Connor, Laserina

Abstract

peer-reviewed, Aim: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Background: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintenance of professional competence have application to nurses, midwives and regulatory bodies and healthcare employers worldwide. Design: A mixed methods approach was used. This included an online survey of nurses and midwives and focus groups with nurses and midwives and other key stakeholders. The qualitative data are reported in this study. Methods: Focus groups were conducted among a purposive sample of nurses, midwives and key stakeholders from January–May 2015. A total of 13 focus groups with 91 participants contributed to the study. Findings: Four major themes were identified: Definitions and Characteristics of Competence; Continuing Professional Development and Demonstrating Competence; Assessment of Competence; The Nursing and Midwifery Board of Ireland and employers as regulators and enablers of maintaining professional competence. Conclusion: Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse's/midwife's role, organizational needs, patient's needs and the individual nurse's/midwife's learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice., ACCEPTED, peer-reviewed

Published
2017

50. Enablers and challenges to advanced nursing and midwifery practice roles.

Author

Casey, Mary, O'Connor, Laserina, Cashin, Andrew, Fealy, Gerard, Smith, Rita, O'Brien, Denise, Stokes, Diarmuid, McNamara, Martin, O'Leary, Denise, and Glasgow, Mary Ellen

Subjects
*INTERPERSONAL relations, *INTERVIEWING, *LEADERSHIP, *RESEARCH methodology, *NURSE administrators, *NURSES, *NURSES' attitudes, *NURSING specialties, *RESEARCH funding, *MIDWIFERY, *QUALITATIVE research, *PROFESSIONAL standards, *JUDGMENT sampling, *OCCUPATIONAL roles, *DATA analysis software, *MIDWIVES, *ATTITUDE (Psychology)
Abstract

Aim: To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland. Background: Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles. Method: A descriptive qualitative approach using semi‐structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education. Results: Participant's perspectives on the enablers and challenges to enacting specialist and advanced practice roles resulted in the generation of three themes: organisational factors; collegial, interprofessional and interpersonal support; and role clarity, economic and regulatory contexts. Conclusion: Addressing organisational factors, encouraging collegial and interprofessional support and establishing role clarity contribute to the effective development and implementation of the role of advanced practitioners. Implications for nursing and midwifery management: Managers of nursing services need to provide leadership in developing strategies to enhance the enablers and overcome the challenges to advanced practice role development in their own organisation. [ABSTRACT FROM AUTHOR]

Published
2019
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