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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. [ABSTRACT FROM AUTHOR]

Restricting a child for a clinical procedure has been linked to negative physical and psychological sequelae. The practice of restriction remains an implicit and unquestioned aspect of care for children during a clinical procedure. In this study we aimed to describe the practice of restricting a child’s movement for a clinical procedure by conducting focus groups with children’s nurses. Data were analyzed using a thematic network analysis framework. The findings show that nurses are likely to restrict children based on particular characteristics of the child; for example, the child’s age. The findings indicate that there is no consistent approach to the practice of restricting a child for a clinical procedure, suggesting tension between nurses and other health care professionals, and nurses and parents, about this practice. The findings suggest the need for wider exploration of the practice of restriction at the organizational level and a need for children’s nurses to feel more empowered to act as advocates for those in their care. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the support experiences of older people who have been abused in Ireland. Design/methodology/approach – Recruited through dedicated elder abuse services, nine older people who had experienced elder abuse participated in in-depth, semi-structured interviews. The data were analysed using thematic content analysis. Findings – The study highlighted the help-seeking pathways of abused older people and revealed that few older people sought help for themselves and most were unaware of the services available to support and protect older people. Data analysis identified the range and type of help received from family, friends, voluntary and statutory services, as well as the perceived barriers to accessing help and support. Research limitations/implications – The research did not include abused older people who lacked mental capacity or who had experienced self-neglect, criminal victimisation by strangers or who had not received statutory support services. This field may benefit from future research that seeks to examine the support experiences of these groups. Practical implications – Family, staff and professionals who care for older people need to be cognisant of the signs of elder abuse, and bring them to the attention of older people should they have concerns, as older people may not always recognise that they are being abused. Originality/value – The paper contributes to our understanding of the support needs of older people in Ireland and the perceived barriers to accessing help and support. [ABSTRACT FROM AUTHOR]

fealy g.m., treacy m., drennan j., naughton c., butler m. & lyons i. (2011) A profile of older emergency department attendees: findings from an Irish study. Journal of Advanced Nursing 68(5), 1003-1013. Abstract Aims. This paper is a report of a study of older emergency department attendees' demographic, health and social profiles. Background. Relative to the general population, older people are higher users of hospital emergency departments. Attendance is most often associated with medical need, including a chronic condition and related morbidities. Method. A series of standardized health and social profiling questionnaires was administered to a non-probability sample of 307 older emergency department attendees. The sample was recruited during the spring-summer and autumn-winter periods in 2008 and 2009 at two hospitals in the city of Dublin. Subjects who met the inclusion criteria were recruited as they presented to the emergency department during the hours 8 am to midnight. The sample was stratified into those admitted and those discharged, with the aim of equally representing each stratum. Data were collected at the time of the index visit or shortly following hospital admission. Findings. Medical conditions accounted for almost half of all reasons for attendance and the health profile of the sample was characteristic of a population of chronically ill older people. Relative to the national picture for older people's social networks in Ireland, a proportion of the sample was at risk of social isolation. Conclusions. In the absence of other avenues to treatment and based on health profile and diagnostic category, older people's attendance at the emergency department was appropriate. The hospital emergency department remains a major arm of the Irish health service in dealing with the morbidity associated with enduring illness. [ABSTRACT FROM AUTHOR]

This paper reports a study of the risk factors for social and emotional loneliness among older people in Ireland. Using the 'Social and Emotional Scale for Adults', the social and emotional dimensions of loneliness were measured. Emotional loneliness was conceptualised as having elements of both family loneliness and romantic loneliness. The data were collected through a national telephone survey of loneliness in older people conducted in 2004 that completed interviews with 683 people aged 65 or more years. It was found that levels of social and family loneliness were low, but that romantic loneliness was relatively high. Predictors for social loneliness were identified as greater age, poorer health, living in a rural area, and lack of contact with friends. Living in a rural setting, gender (male), having a lower income, being widowed, no access to transport, infrequent contact with children and relatives and caring for a spouse or relative at home were significant predictors of family loneliness. Romantic loneliness was predicted by marital status, in particular being widowed. Never having married or being divorced or separated were also significant predictors for romantic loneliness. The findings indicate that loneliness for older people is variable, multi-dimensional and experienced differently according to life events, with, for example, the death of a partner being followed by the experience of emotional loneliness, or the loss of friends or declining health leading to social loneliness. [ABSTRACT FROM AUTHOR]

Despite efforts to prevent the onset of smoking, the rate among older children remains high. In this article, the authors report on a longitudinal, qualitative study of 11- to 16-year-old children describing children's construction of what it means to be a smoker, the reasons given for children smoking, and their views of smoking behavior. Findings indicate that children adopt broad interpretations of what constitutes smoking behavior; although they strongly disapprove of children who smoke, they are less disapproving of older children or adult smokers and are increasingly tolerant of smoking behavior as they get older. Children's disapproval of smoking acts as a protective mechanism against smoking for younger participants. Participants' broad interpretation of what it means to be a cigarette smoker, their association of smoking with adulthood, and their increasing tolerance of and exposure to smoking behavior as they move into adolescence appears to increase susceptibility to becoming cigarette smokers. [ABSTRACT FROM AUTHOR]

Abstract: Background: Medicine is recognised as a dominant source of governmentality and social regulation, and although nursing has been implicated in the same process, analytical work in this area has been sparse. Objectives: The article aims to present an analysis of nursing records in order to understand the structural and social processes that mediate the texts. Methods: 45 sets of nursing records drawn from four clinical sites in Ireland were subjected to a discourse analysis. Results: This article focuses on two main themes that were derived from data: (i) the manner in which nurses controlled, regulated and invigilated patients’ activities of daily living and (ii) the way in which activities of daily living were mediated by a biomedical worldview in the clinical settings. Through the organising framework of Activities of Daily Living (ADLs), normative social practices relating to hygiene, eating and drinking, sleeping and so forth were surveyed and monitored within clinical settings. We construct qualitative categories around a range of ways that nurses assessed and judged patients’ capacities at ADLs. Furthermore, it is argued that the framework of ADLs epitomises the medicalisation of normative social practices, whereupon the most mundane of normal functions become redefined as an actual or potential clinical pathology, legitimating nursing interventions. According to the nursing documentation, biochemical interventions in the form of various medications were the most dominant means through which nurses attempted to restore or improve the functional capacity of an ADL. Conclusion: We conclude by proposing that nurses’ invigilation of patients’ ADLs is not necessarily a repressive feature of nursing practice, but rather has the potential to be used to advocate on patients’ behalf in certain circumstances. [Copyright &y& Elsevier]

HYDE A, TREACY M, SCOTT A, BUTLER M, DRENNAN J, IRVING K, BYRNE A, MACNEELA P and HANRAHAN M. Nursing Inquiry 2005; 12: 66 – 77 Modes of rationality in nursing documentation: biology, biography, and the‘voice of nursing’ This article is based on a discourse analysis of the complete nursing records of 45 patients, and concerns the modes of rationality that mediated text-based accounts relating to patient care that nurses recorded. The analysis draws on the work of the critical theorist, Jürgen Habermas, who conceptualised rationality in the context of modernity according to two types: purposive rationality based on an instrumental logic, and value rationality based on ethical considerations and moral reasoning. Our analysis revealed that purposive rationality dominated the content of nursing documentation, as evidenced by a particularly bio-centric and modernist construction of the workings of the body within the texts. There was little reference in the documentation to central themes of contemporary nursing discourses, such as notions of partnership, autonomy, and self-determination, which are associated with value rationality. Drawing on Habermas, we argue that this nursing documentation depicted the colonisation of the sociocultural lifeworld by the bio-technocratic system. Where nurses recorded disagreements that patients had with medical regimes, the central struggle inherent in the project of modernity became transparent— the tension between the rational and instrumental control of people through scientific regulation and the autonomy of the subject. The article concludes by problematising communicative action within the context of nursing practice. [ABSTRACT FROM AUTHOR]

Abstract This paper presents qualitative data from Irish children and adolescents on their experiences in relation to alcohol consumption. A sample of 78 participants (average age 11.5 years) was selected. A proportion of this initial sample were interviewed at intervals over a period of 3 years. The participants’ consumption patterns were analyzed and four categories were generated: covert unsanctioned, overt unsanctioned, overt sanctioned, and peer unsanctioned. As the children got older, peer drinking became a stronger feature of the data; however, it mediated other patterns of behavior. Although the children displayed agency in circumventing adult rules relating to alcohol consumption, the participants were subjected to structural constraints by virtue of their status as children. Moreover, the agentic powers of the participants were procured through their social network rather than arising from an essentialist agency possessed by each individual child. The impact of childhood as a structural dimension weakened to some extent as the participants got older and had more freedom to circumvent adult-defined barriers to alcohol consumption. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the reported predictors of the practice of restricting a child for a clinical procedure in hospital. Background Previous work in this area is dominated by discussion papers and suggestions for addressing the issue of restriction. This is the first study to explore reported predictors of this practice with a view to implementing change based on research findings. Design A factorial survey was developed, which incorporated the use of vignettes with various scenarios. The factorial design enabled exploration of the interaction of multiple factors on the practice of restriction. Methods One hundred and sixty-six nurses caring for children were each sent 10 vignettes and asked to rate their likelihood to restrict a child based on the vignettes. A total of 105 nurses responded to the survey, representing a response rate of 63%. Hierarchical linear regression was used to identify reported predictors of restriction. Results Nurses were more likely to restrict a child if they had prior instruction on safe holding, if there was no play therapist available, if the nurse was a registered general nurse with no other registration qualification, if the child required cannulation or if the child was less than five years of age. Conclusion This study identified predictors of restriction from the perspective of practicing nurses; the evidence needs to be used in developing clinical guidelines and in multidisciplinary education. Relevance to clinical practice There is a need to move from any presumption of restriction towards more critical consideration of the individual requirements of the child. There is a need to increase the numbers of nurses receiving specialist training on the care of a child in hospital. The importance of a well-resourced play therapy service is supported, and there is a need for multidisciplinary work to explore alternatives to restriction. [ABSTRACT FROM AUTHOR]

Public discourses concerning older people are available in a variety of texts, including popular media, and these discourses position older people with particular age identities. This study examined discursive formations of ageing and age identities in print media in Ireland. Constituting a single media event, newspaper texts concerned with revised welfare provision for older people were subjected to critical discourse analysis and revealed particular ways of naming and referencing older people and distinct constructions of ageing and age identities. The use of nouns and phrases to name and reference older people positioned them as a distinct demographic group and a latent ageism was discernible in texts that deployed collective names like ‘grannies and grandads’ and ‘little old ladies’. Five distinct identity types were available in the texts, variously constructing older people as ‘victims’; ‘frail, infirm and vulnerable’; ‘radicalised citizens’; ‘deserving old’ and ‘undeserving old’. The discourses made available subject positions that collectively produced identities of implied dependency and otherness, thereby placing older people outside mainstream Irish society. The proposition that older people might be healthy, self-reliant and capable of autonomous living was largely absent in the discourses. Newspaper discourses betray taken-for-granted assumptions and reveal dominant social constructions of ageing and age identity that have consequences for older people's behaviour and for the way that society behaves towards them. [ABSTRACT FROM PUBLISHER]

This article concerns the meanings that a sample of nurse teachers ascribed to the concepts of reflection and reflective practice as aspects of an undergraduate nursing curriculum. It represents one of the major findings in a qualitative study that set out to explore nurse teachers' perceptions and experiences of using reflection with diploma nursing students in the Republic of Ireland. Eleven nurse teachers were interviewed intensively, and data were analysed using a strategy resembling grounded theory. Two major themes were identified: reflection and reflective practice as a way of reviewing clinical experiences, and reflection and reflective practice as a way of valuing, developing and professionalising nursing practice knowledge. There was evidence that reflective practice was compartmentalised on nursing curricula, and some participants reported having limited knowledge of reflection. A number of participants alluded to the potential for reflective practice to uncover the hidden wealth of knowledge in everyday nursing practice. There appeared, however, to be a risk that this perceived wealth may be a conceptualisation of the teachers, rather than the students. Reflective learning through the affective domain was perceived as central to caring. [ABSTRACT FROM AUTHOR]

Objective: to measure the 12-month prevalence of elder abuse and neglect in community-dwelling older people in Ireland and examine the risk profile of people who experienced mistreatment and that of the perpetrators.Design: cross-sectional general population survey.Setting: community.Participants: people aged 65 years or older living in the community.Methods: information was collected in face-to-face interviews on abuse types, socioeconomic, health, and social support characteristics of the population. Data were examined using descriptive statistics and logistic regression, odds ratios (OR) and 95% confidence intervals (95% CI) are presented.Results: the prevalence of elder abuse and neglect was 2.2% (95% CI: 1.41–2.94) in the previous 12 months. The frequency of mistreatment type was financial 1.3%, psychological 1.2%, physical abuse 0.5%, neglect 0.3%, and sexual abuse 0.05%. In the univariate analysis lower income OR 2.39 (95% CI: 1.01–5.69), impaired physical health OR 3.41 (95% CI: 1.74–6.65), mental health OR 6.33 (95% CI: 3.33–12.0), and poor social support OR 4.91 (95% CI: 2.1–11.5) were associated with a higher risk of mistreatment but only social support and mental health remained independent predictors. Among perpetrators adult children (50%) were most frequently identified. Unemployment (50%) and addiction (20%) were characteristics of this group. [ABSTRACT FROM PUBLISHER]

To describe self-reported barriers to clinical leadership development among nurses and midwives in Ireland. Effective clinical leadership is essential for optimising care and improving patient outcomes. Clinical leadership development is concerned with intrapersonal and interpersonal capabilities and is context bound. Barriers to clinical leadership development among nurses and midwives are associated with interdisciplinary and organisational factors, such as lack of influence in interdisciplinary care planning and policy. A national postal survey of nurses and midwives was administered to a simple random sample of 3000 nurses and midwives in Ireland. The method of data collection was the Clinical Leadership Analysis of Need Questionnaire (CLAN-Q) Barriers Scale (CLAN-QBS©), a self-administered, self-report questionnaire developed to measure the barriers to clinical leadership development. Mean scores for the CLAN-Q barriers subscales showed that barriers to clinical leadership development were perceived as lower in the dimension 'quality care factors', when compared with the dimensions 'interdisciplinary relationships, recognition and influence'. Staff and other promotional grades differed significantly in self-perceived barriers related to interdisciplinary working, influence and recognition of the disciplinary contribution. Differential experiences of barriers among higher and lower grades suggest that grade level may influence ability to negotiate work-related and organisational barriers to clinical leadership development. Overcoming the barriers to clinical leadership development requires attention to interdisciplinary relationships in the practicum and to the actual and perceived degree of relative influence that nurses and midwives have at wider departmental and organisational levels. [ABSTRACT FROM AUTHOR]

Abstract: Background: Prescriptive authority for nurses and midwives was introduced in Ireland in 2007. This allows nurses and midwives who have completed a prescribing preparation programme to independently prescribe a wide-range of medications. To date little is known of patient outcomes such as satisfaction with the consultation process and intention to comply as a consequence of the introduction of nurse and midwife prescribing. Objectives: There are four principal objectives within this study: (1) to measure the level of patients’ satisfaction with education and advice received from a nurse or midwife with a prescribing remit; (2) to measure patients’ satisfaction with the consultation process; (3) to measure patients’ self-reports of their intention to comply with the prescriber''s prescription and advice; and (4) to identify the variables that predict patients’ intention to comply with the prescription and advice provided by a nurse or midwife with prescriptive authority. Design: Cross-sectional descriptive survey. Participants and setting: A total of one hundred and forty respondents completed the survey. Respondents consisted of adult patients who had received a prescription from a nurse prescriber in a general hospital, women who had received a prescription from a midwife in a maternity hospital and parents whose child received a prescription from a nurse in a children''s hospital. Methods: Instruments used to measure patient outcomes included the Consultation Satisfaction Questionnaire (CSQ) and the compliance intent subscale of the Medical Interview Satisfaction Scale (MISS). A linear multiple regression model was performed to identify the variables that predicted patients’ intent to comply. Results: Patients and parents surveyed were highly satisfied with the care they received from nurses and midwives with prescriptive authority. Respondents also reported that they received comprehensive education and advice. Predictors of compliance intent included patient satisfaction with the time spent with the nurse or midwife during the prescribing consultation, overall satisfaction with the consultation process and patients’ health status. Conclusions: Extending a prescribing remit to nurses and midwives has been an effective addition to the provision of health care. Providing patients with time to address their questions and concerns during the consultation process impacts positively on patient outcomes and develops a philosophy of concordance between the patient and nurse/midwife prescriber. [ABSTRACT FROM AUTHOR]

Abstract: Background: Prescriptive authority for nurses and midwives was introduced in Ireland in 2007. This allows nurses and midwives who have completed a prescribing preparation programme to independently prescribe a wide-range of medications. To date little is known of patient outcomes such as satisfaction with the consultation process and intention to comply as a consequence of the introduction of nurse and midwife prescribing. Objectives: There are four principal objectives within this study: (1) to measure the level of patients’ satisfaction with education and advice received from a nurse or midwife with a prescribing remit; (2) to measure patients’ satisfaction with the consultation process; (3) to measure patients’ self-reports of their intention to comply with the prescriber''s prescription and advice; and (4) to identify the variables that predict patients’ intention to comply with the prescription and advice provided by a nurse or midwife with prescriptive authority. Design: Cross-sectional descriptive survey. Participants and setting: A total of one hundred and forty respondents completed the survey. Respondents consisted of adult patients who had received a prescription from a nurse prescriber in a general hospital, women who had received a prescription from a midwife in a maternity hospital and parents whose child received a prescription from a nurse in a children''s hospital. Methods: Instruments used to measure patient outcomes included the Consultation Satisfaction Questionnaire (CSQ) and the compliance intent subscale of the Medical Interview Satisfaction Scale (MISS). A linear multiple regression model was performed to identify the variables that predicted patients’ intent to comply. Results: Patients and parents surveyed were highly satisfied with the care they received from nurses and midwives with prescriptive authority. Respondents also reported that they received comprehensive education and advice. Predictors of compliance intent included patient satisfaction with the time spent with the nurse or midwife during the prescribing consultation, overall satisfaction with the consultation process and patients’ health status. Conclusions: Extending a prescribing remit to nurses and midwives has been an effective addition to the provision of health care. Providing patients with time to address their questions and concerns during the consultation process impacts positively on patient outcomes and develops a philosophy of concordance between the patient and nurse/midwife prescriber. [Copyright &y& Elsevier]

Aims and objectives. To test the validity and reliability of the newly developed Irish Nursing Minimum Data Set for mental health (I-NMDS (MH)) to ensure its clinical usability. Background. Internationally, difficulties exist in defining the contribution mental health nursing makes to patient care. Structured information systems, like the Nursing Minimum Data Set, have been developed internationally to gather standardised information to increase the visibility of nursing in the health care system. Design. This study employed a quantitative, longitudinal research design. Method. A convenience sample of mental health nurses ( n = 184) collected data on the nursing care of patients ( n = 367) from care settings attached to 11 hospitals across Ireland. Exploratory factor analysis (EFA), ridit analysis and Cronbach’s alpha coefficient were used to establish the construct and discriminative validity and scale score reliability of the I-NMDS (MH). Results. Goodness of Fit scores indicated that the I-NMDS (MH) possesses good construct validity. Alpha coefficients for each factor were above the recommended 0·7 level. Ridit analysis inferred that the I-NMDS (MH) discriminated between elements of nursing care across acute inpatient and community based care settings. Conclusions. The I-NMDS (MH) possesses a sound theoretical base, has scale score reliability and possesses good discriminative validity. The valid and reliable I-NMDS (MH) is the first NMDS to be developed specifically for mental health. Relevance to clinical practice. Data collected using the I-NMDS (MH) will increase the visibility of the contribution mental health nurses make to healthcare delivery. In addition, it will support evidence based practice in mental health to improve further the effectiveness of nursing care in the future. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to identify and rate clinical, managerial, and educational nursing research priorities in Ireland. Design: The study design was a three-round, decision Delphi survey to identify and rate the importance of clinical, managerial, and educational research issues. A discussion group workshop was also undertaken to identify timeframes within which research on the issues identified should be conducted. A total of 1,695 nurses from all divisions of the nursing register in Ireland were initially surveyed. Response rates varied over the three rounds of the Delphi survey. A total of 122 nurses attended the discussion group workshop. This is the largest known survey of nurses to identify research priorities reported in the literature. Results: Twenty-four nursing research priorities were identified. The five highest priorities were three clinical issues: outcomes of care delivery, staffing issues in practice, communication in clinical practice; and two managerial issues: recruitment and retention of nurses, and nursing input into health policy and decision-making. Conclusions: These research priorities identified for nursing in Ireland indicate, to an extent, the nursing research priorities identified in other European countries and in North America. The research priorities identified in this survey indicate that outcomes of care and the need to make nursing visible are attaining a higher priority than seen in previous studies. Also evident is that nursing shortages and increasing skill-mix in the clinical area have indicated a need for research into nurse recruitment, staff turnover, and staffing levels and how these issues affect patient outcomes. The priorities suggest research programmes that target the health service concerns identified in the national health agenda, such as the need to identify protocols and procedures that improve patient and client care outcomes and to examine and test solutions to workforce problems. [ABSTRACT FROM AUTHOR]

Previous research has indicated that young people are under considerable social pressure to take up smoking. This study has therefore sought to explore and better understand the mechanisms through which peer-related social factors operate to encourage young people to smoke. Individual qualitative interviews were held with adolescent children aged 11-12 years (N=102) within youth clubs based in economically deprived areas of Northern Ireland, and then followed up on two occasions during the subsequent 3 years (N 51/39). The data implied that, although peers influence smoking uptake, this seldom happens through direct persuasion, but rather as the result of the young person striving to conform to the normative behaviour of the peer group with which they identify. The findings are consistent with social identity theory and self-categorization theory in that for both smoking and non-smoking 14-year-olds smoking activity appears to provide a means through which to define social groups, to accentuate similarity within groups and differences between groups. In-group favouritism was expressed in the sharing of cigarettes within the in-group and in the negative stereotyping of out-group members. There was some evidence that group affiliation may be negotiated differently for boys and girls. These findings imply that successful intervention needs to reconsider the normative processes that encourage young people to smoke. [ABSTRACT FROM AUTHOR]

Health behaviour and attitudes among young people can be interpreted within the context of personal and social identity. This paper explores ways in which 10- to 11-year-olds in Northern Ireland expressed perceptions of gender ideology while discussing the topic of smoking. The data were gathered by means of in-depth interviews (n = 85). Although few had tried smoking, the positive quality of their own gender appeared to be expressed through negative assessment of smokers of the opposite gender, and on different ideas of perceived gender dimensions in adult smoking. In order to deliver successful health promotion interventions, it is crucial to understand and address differences based on gender as it may partly explain differences in smoking experimentation and prevalence. [ABSTRACT FROM AUTHOR]

Investigates the views of children on smoking and addiction in Northern Ireland. Adoption of qualitative approach within the community; Conception between child smoking and adult smoking; Aim of health promotion.