FINAL BOOK OF ABSTRACTS 2019

School of Nursing and Midwifery Scoil an Altranais agus an Chnáimhseachais

19 th ANNUAL NURSING & MIDWIFERY RESEARCH CONFERENCE

November 28 th 2019

“Celebrating the Contribution of Nurses and Midwives: Learning from the Past and Looking to the Future”

BOOK OF ABSTRACTS

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About the School of Nursing and Midwifery

Located in the state-of-the-art Brookfield Health Sciences Complex, and only a few minutes’ walk from University College Cork's main campus and vibrant city centre, our School offers students the best possible nursing and midwifery education for a dynamic and rewarding career. The School offers an undergraduate programme in four branches of nursing: general, integrated children’s and general, intellectual disability and mental health. A direct entry undergraduate programme in midwifery is also offered. In addition, a range of postgraduate, clinical specialist and advanced programmes are offered, all delivered by our staff who are leading experts in their fields. We offer continuing professional development (CPD) modules, designed to meet your individual lifelong learning needs, with an emphasis on flexible approaches to study, which can be built upon at every stage of your career. We are proud of our first class teaching resources, exemplified by our technology enhanced simulation laboratory and our close partnerships with Ireland's largest and foremost teaching hospitals. For our nursing and midwifery international students, UCC is ranked within the top 2% of universities in the world for its supportive services and facilities, not to mention social life. Our research programme upholds an agenda of excellence in both the teaching of the core principles underpinning research, and in research collaborations with our national and international partners, as well as undertaking research of the very highest quality. Our research programmes are designed to enhance the lives of patients/clients and other service users and improve health outcomes and healthcare delivery.

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KEYNOTE PRESENTERS: BIOGRAPHICAL PROFILES

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First Session

Professor Geraldine Mc Carthy

Geraldine McCarthy is Emeritus Professor

at University College Cork and is Chair of

the South/South West Hospital Group

which has responsibility for 9 Acute

Hospitals in Munster. She holds degrees

from University College Dublin, Trinity

College Dublin and a PhD from Case

Western Reserve University, Cleveland

Ohio USA. She has held nursing and

managerial roles in Canada (Ontario), UK

(London), and USA (NY) and in Ireland (St Vincent’s, Beaumont and CUH). In

1994 she established the first educational programme for nurses at UCC – the

Diploma in Public Health Nursing.

In 1996 she became the founding Professor of Nursing at UCC, established a range of educational programs, and was involved in the development of the College of Medicine and Health which she led for a period of time. During her career she has been inherently involved in the health services – has held membership of a number of Boards including the INO, Southern Health Board, Marymount Hospital Board, Reconfiguration of the Health Services and Cork and Kerry and received Ministerial appointments to the Commission on Nursing, Health Information and Quality Authority (HIQA) and Fulbright Commission. She has published widely and supervised many Masters and Doctoral theses. At international level she maintains contact with Northwell Organisation in NY/Long Island, USA and Case Western Reserve University.

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Second Session

Professor Corina Naughton

Professor Corina Naughton is

Professor of Clinical Nursing in Older

Person’s Healthcare, a joint

appointment between University

College Cork and the Health Service

Executive South/South Western

Hospital group. Corina was a Senior

Lecture with specialist interest in

older people care in the Florence Nightingale Faculty of Nursing and Midwifery,

King’s College London and was a lecturer in the School of Nursing and

Midwifery, University College Dublin.

Corina’s work and research focuses on evidence translation into clinical practice to develop an age- attuned workforce and environment with a particular focus on frailty and dementia. Her current research activity includes developing and evaluating a multidisciplinary intervention to optimise the recovery potential of hospitalised older adults; testing an education-career pathway in gerontological nursing (ECHO) to increase retention of early career nurses in the speciality; evaluation of nutrition optimisation strategies in acute care; and testing a dementia communication intervention for pre-registration nurses. She has written on topics including gerontological nurse education, elder abuse, older people in emergency departments, prescribing and de-prescribing practice, and extended professional roles for nurses such as medication and ionising radiation prescribing

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Third Session

Professor M. Judith Lynam

Professor Judith Lynam is a Professor

Emeritus at the University of British

Columbia, in Vancouver Canada. She

studied at McGill (BScN), UBC, (MSN) &

King’s College London (PhD).

An overall goal of Dr. Lynam’s

programme of research has been to

enrich the discourses of inequities in

health and to explicate approaches that

improve population health outcomes.

A central concern of her work has been to understand issues nurses encounter in practice. Most recently, she has been focussed on the design and evaluation an innovative community based social pediatrics initiative that has fostered access to care and integrated services along the continuum from prevention to specialized services and improved health outcomes for some of Canada’s most vulnerable children and families. She has worked with teams of educators, practitioners and policy makers who share the goal of responding to adversities and improving inequities in countries throughout the world.

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ORAL PRESENTATIONS: ABSTRACT

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Integrity Eroding: A Grounded Theory of Acute Hospital Nursing; Part 2

Author(s) Dr Aoife Lane Affiliation(s) Nursing and Midwifery Planning and Development Unit. HSE South(Cork/Kerry) Abstract

Background: There is evidence of missed nursing care (Kalisch et al. 2011, Papastavrou et al. 2016, Ball et al. 2018), rationed nursing care (Schubert et al. 2013, Ausserhofer et al. 2013) and of poor patient outcomes (Francis 2013, Kang et al. 2016) in acute hospitals. This study was prompted by the concern that nurses in acute hospitals are not basing their daily activities primarily on the nursing requirements of their patients. Aim: To explore the main influences on the work of clinical nurses in acute care settings. Methods: A Classic Grounded Theory (GT) methodology was used. The sample comprised experienced acute care nurses (n=24) from a large tertiary hospital. Theoretical sampling and the constant comparison method of data analysis were used in accordance with GT methodology. Results: The theory of nebulous intentioning explains how clinical nurses in acute care resolve their main problem which is the perennial deferral of core nursing care. This paper explains the second of its two sub-core categories; integrity eroding. Nurses in acute care repeatedly deprioritize their core nursing work as a result of accommodating ; undertaking multiple professionally undifferentiated activities which ensure safe, cohesive patient care from the whole MDT, and integrity eroding ; undermining the importance of nursing compared to the work of other health professionals Conclusion : Integrity eroding contributes to nurses’ willingness to engage in accommodating activities at the expense of nursing activities. This theory contributes to the understanding of findings from studies in the areas of missed and rationed nursing care.

Newly Qualified Nurses: Support and Learning Needs during the Transition Period

Author(s)

Ms. Sarah Cullinan, Third Year General Nursing Student, Department of Nursing and Health Care, Waterford Institute of Technology Ms. Orla Kavanagh, Interim Director of Nursing, University Hospital Waterford. Dr. Martina Gooney, Department of nursing and Health Care, Waterford Institute of Technology Dr. Sara Kennedy, Head of Department of Nursing and Health Care, Waterford Institute of Technology

Affiliation(s) Waterford Institute of technology Abstract

Background: Every nurse has transitioned from student to staff nurse. This transitional period can be fraught with stress when dealing with the challenges of the busy healthcare environment. Research suggests that the provision of emotional supports could positively impact retention and attrition while also improving

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competence. Furthermore, this group of nurses has no dedicated programme to enable a smooth transition from student to staff nurse within the Irish healthcare system. Aim: The aim of the study is to explore the experience and needs of newly qualified nursing graduates during their transition from student to nurse Methods: The pilot study was undertaken using a quantitative, descriptive, cross sectional design. A questionnaire was developed from the literature and distributed to newly qualified nurses in one hospital site . Results: Overall, 71% of newly graduated nurses reported feeling supported by their colleagues and nurse managers. However, less than half of the respondents agreed that they received adequate support from organisational management. Results from open- ended questions indicated a need for a (clinical) new graduate nurse support role. Additional training and education were welcomed for clinical skills, ethical issues, policy and professional development, with career planning viewed as a high priority. Conclusion: Data has been provided from an Irish perspective, to draw wider inference in the development of supports for new graduate nurses. The addition of a clinical nurse support role and a transition period may relieve stress, with further education on career planning essential for the survival of nursing, and retention of new nurse graduates. Josephine Hegarty 1 , Heloise Agreli 1 , Fiona Barry 2 , Aileen Burton 1 , Sile Creedon 1 , Jonathan Drennan 1 , Dinah Gould 3 , Carl May 4 , Maura Smiddy 2 , Michael Murphy 1 , Siobhan Murphy 1 , Eileen Savage 1 , Teresa Wills 1 , 1 Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland. 2 School of Public Health, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. 3 School of Healthcare Sciences, Cardiff University, Cardiff, Wales. 4 London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom. Background: Clinical guidelines aim to improve the efficiency, quality and outcomes of patient care by ensuring that treatment recommendations are based on the best available evidence. Acquisition of a healthcare associated infection (HCAI) is one of the most frequent harmful events threatening patient safety globally. Thus healthcare systems seek to counteract this by implementing evidence based guidelines which aim to prevent HCAIs. Aim: The aim of this study was to explore how Infection Prevention and Control (IPC) guidelines are used and understood by healthcare professionals, patients and their families. Methods: Using an ethnographic approach, 59 hours of non-participant observations and 57 conversational interviews across four hospital sites, the team sought to explore the factors that contribute to, or complicate, appropriate implementation of HCAI

Implementation of infection prevention and control guidelines: an ethnographic study using Normalization Process Theory

Author(s)

Affiliation(s)

Abstract

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guidelines. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework. Results: Five themes reflective of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring) emerged through data analysis. Our findings revealed the existence of a ‘dissonance between IPC guidelines and the reality of clinical practice’ (theme 1) and ‘challenges to legitimatise guideline recommendations in practice’ (theme 3). These elements contributed to ‘symbolic implementation of IPC guidelines’ (theme 2), which was also determined by a ‘lack of shared reflection upon IPC practices’ (theme 4) and a clinical context of ‘workforce fragmentation, and time pressure and lack of prioritisation of IPC’ (theme 5). Conclusion: Study findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. This study reiterates the importance of understanding the effect of guideline dissemination and implementation strategies on work processes and ultimately patient outcomes. Elaine Meehan, Catherine Sweeney, Tony Foley, Elaine Lehane, Art Burgess Kelleher, Ruth M. Hally, Deirdre Shanagher, Bettina Korn, Mary Rabbitte, Karen Detering, Nicola Cornally Background: The final years of life for individuals with chronic obstructive pulmonary disease (COPD) are often characterized by frequent acute exacerbations. Aim: To examine current practices, attitudes and levels of confidence related to advance care planning (ACP) in patients with chronic obstructive pulmonary disease (COPD) among healthcare professionals in Ireland. Methods: A cross-sectional survey of healthcare professionals. Results: There were 143 participants (109 general practitioners, 25 nurses, 7 physiotherapists, 2 consultant physicians). The majority (82%; n=117) cared for patients with COPD weekly, but only 23 %( n=33) had initiated ACP with a patient with COPD over the previous 6 months. Overall, 59 %( n=85) answered ≥6 of 8 general knowledge questions correctly. Participants demonstrated positive attitudes towards ACP (mean score 3.6/5.0), but confidence levels were low (2.2/4.0). Most thought ACP was appropriate for patients with severe-very severe COPD, but were unsure or felt that it was not appropriate for those with mild-moderate COPD. Almost all participants (97%; n=139) stated that if a patient expressed a desire to have ACP discussions, they would comply. Topics most likely to be discussed related to diagnosis and treatment options, with death and end-of-life rarely discussed. The death of a family member or friend and participation in support groups were identified as new ‘triggers’ for initiating ACP. Conclusion: Targeted education to improve knowledge and confidence levels among healthcare professionals, together with initiatives to increase public awareness of ACP so that patients themselves might be more inclined to initiate discussions, may increase the uptake of ACP in this group.

Developing guidance for healthcare professionals on advance care planning in COPD

Author(s)

Affiliation(s) School of Nursing & Midwifery, University College Cork Abstract

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Baby’s First Hug: Establishing skin-to-skin contact during caesarean birth using Participatory Action Research

Author(s)

Alex Campbell

Affiliation(s) CUMH Abstract

Background: Research to date has indicated that the benefits of skin-to-skin contact during caesarean birth include lower infection and NICU admission rates for new- borns, and better birth and breastfeeding experiences for mothers (Posthuma et al. 2017, Schneider et al. 2017, Vila-Candel et al. 2017, Stevens et al. 2019). While it can be a challenging transition for staff, research indicates the results are worth it, with more women-centred care leading to greater job satisfaction for midwives and healthcare staff (Koopman et al. 2016, Stevens et al. 2016). Aim: To introduce and establish skin-to-skin contact as routine care during caesarean birth and to explore staff and maternal perceptions to the practice in a large, tertiary maternity hospital in Ireland. Methods: Participatory Action Research design to collect data from theatre staff and women having elective caesarean births. One-to-one interviews, focus groups, field observations and clinical audits were carried out with staff. Content analysis was used to explore staff attitudes to the introduction of skin-to-skin contact and to changing practice. Mothers were asked to complete questionnaires which were analysed with IBM SPSS_25. Results: Skin-to-skin contact in theatre increased from 0% in 2018 to 77% in 2019 for elective caesarean births. Overall rates in the first hour of life rose from 28.9% to 87.5% for all caesarean births. Staff are motivated to overcome barriers such as equipment restrictions, busy theatre lists, and cultural norms when exposed to education, hospital support, and positive feedback from mothers and birth partners. Mothers have better birth experiences when facilitated to have skin-to-skin contact and want minimal separation from their babies to be standard practice during caesarean birth. Conclusion: It is safe and feasible to establish skin-to-skin contact in theatre for all well mothers and babies, and the practice is recommended to promote better birth experiences and outcomes.

Students’ experiences from a refugee camp: promoting new perspectives on nursing

Author(s) Kirsti Henriksen Affiliation(s) The arctic university of Norway, UiT Abstract

Background: Increasing numbers of students have international placements both in developed and developing countries. Previous studies found that students gain in international understanding and personal development. Do these placements help to develop better nurses? Clinical placements in refugee camps are not yet described in literature. Aim: To explore how clinical placements in a Palestinian refugee camp in Lebanon may contribute in developing nursing competence.

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Methods: The design of this empirical research study is hermeneutical. Students’ texts related to this placement was collected and analysed Results: Key learning outcomes were acknowledgement of differences, enhanced cultural sensitivity and enhanced capacity for empathy. Furthermore, limited resources combined with language barriers challenged the students’ perceptions of nursing as problem solving and led to a broader view of nursing, rediscovering the importance of caring. Conclusion: Clinical placements in a refugee camp have potential to contribute in developing nursing competence through promoting personal education and leading to discoveries of core elements in nursing.

Children dependent on medical technology: Knowledge & challenges for Advanced Community Care Nurses’

Author(s)

Cora O’Leary. Clinical Practice Specialist

Affiliation(s) UCC Abstract

Background: In 1981, a child in the US was discharged home dependent on medical technology. Since then, it is widely acknowledged this cohort of children should live at home. However, most countries are still reactive in their approach to care. Aim: The aim of this research proposal is to gain a better understanding of nurses’ knowledge and the challenges they encounter caring for children who are dependent on medical technology living at home. Methods: As this is an evolving area of paediatric nursing, a survey was sent to advanced home care nurses. This had 10 multiple choice questions about tracheostomy tube and enteral feeding. There was an addition 10 questions that were free text to gain an insight into the challenges, nurses’ face working in the home care setting. These challenges were further discussed in focus groups. Results: There was 67% return rate on the questionnaires and following 3 focus groups the common themes identified were the ‘nurse parent relationship’, ‘family dependency’ on services and nurses in the home and ‘competency and care planning’ Conclusion: Advanced Community Care nurses’ find working in the home care setting both rewarding and challenging in equal measures. Education and training is vital to ensure nurses are competent to care for a child who is dependent on medical technology which will help build a trusting relationship with the family. Some of the recommendations included the role of an educator to support staff and managers, placements for student nurses and greater emphasis on the team in the community

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Redefining the concept of Humanisation in pregnancy and Childbirth – a concept for all women.

Author(s)

Mary Curtin

Affiliation(s) UCC Abstract

Background: Humanisation in pregnancy and childbirth has historically been considered in contrast to the biomedical model and has therefore in the sphere of low risk and non- medicalised birth. Regardless of medical need, all women are entitled to safe, evidence based and humanised care. Aim: To clarify the concept of humanised care during pregnancy and childbirth Methods: Concept analysis using Walker and Avant’s eight step method. Results: Humanised care encompasses the attitudes and behaviours of healthcare professionals in clinical practice. This model of care can be broad in scope to include all women regardless of their medical or psychological need and/or their risk status. Pregnant women, midwives and obstetricians consider humanised care to be in concordance with the biomedical model. Conclusion: The physical outcome of pregnancy should not be considered in isolation or above the holistic care of the woman. Both pregnant women and healthcare professionals need to be up informed on the rights of women in pregnancy and childbirth. Women need the support and facilitation of relevant midwifery and obstetric health care professionals to work in partnership with them to ensure a safe and positive birth experience. Midwives perceptions and experiences of caring for women's emotional/mental well-being in the antenatal period Author(s) Antoinette Fletcher (Midwifery Tutor) and Dr Patricia Leahy-Warren (Senior Lecturer, University College Cork Affiliation(s) Centre for Midwifery Education, Located at Coombe Hospital Abstract Background: Pregnancy and childbirth is a life changing transition for women, and can be a time when emotional difficulties may occur. Approximately 15-25% of women will experience a Perinatal Mental Health (PMH) problem which can have serious consequences for women and their families if not identified and treated appropriately. Midwives are in a key position to provide psychological support to mothers throughout their perinatal journey, as identified in the 2016 Irish national maternity strategy. However, there is a paucity of qualitative research exploring midwives’ experiences of caring for women’s emotional health throughout pregnancy, therefore this study addressed this gap in the literature. Aim: To explore midwives’ perceptions and experiences of caring for women’s emotional/mental well-being during pregnancy. Methods: A qualitative descriptive study design was undertaken with midwives (n=10), using one-to-one semi-structured interviews after ethical approval was granted. Data

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were digitally recorded, transcribed and analysed using thematic analysis guided by Burnard’s (1991) framework Results: Three main themes emerged: -‘awareness of Perinatal Mental Health’, ‘discussing emotional well-being’, and ‘the woman has something (like) to divulge’. The themes convey midwives awareness/recognition and perceptions of PMH. How midwives discuss/assess emotional well-being, the observational skills they utilise, along with what they perceive are the barriers and facilitators to discussing mental well-being are all identified in the themes. Conclusion: Midwives reported an awareness and acceptance that women’s emotional health was as important as their physical health. Midwives utilised every antenatal opportunity to raise awareness about PMH, despite challenges in getting women to open up.

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5-IN-5 PRESENTATIONS: ABSTRACTS

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Nurse Practitioners’ Implementation of Evidence Based Practice

Author(s)

Vanessa Clarke , Assistant Director of Nursing

Affiliation(s) University College Cork Abstract

Background: Implementation of evidence based practice (EBP) is essential in ensuring high quality healthcare at minimum cost. Whilst all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners as clinical leaders have additional responsibilities in implementing EBP into routine care within their local healthcare setting. Aim: The aim of this scoping review was to explore the factors affecting nurse practitioners’ implementation of EBP into routine care. Methods: The first five steps of the Arskey and O’ Malley Scoping Review Framework were used as follows:  Identification of the research question  Identification of relevant studies  Study selection  Charting the data  Collating, summarising and reporting the results Results: S even studies, published over the ten year period between 2009 -2018, were included in the review. Findings show that nurse practitioners value EBP and believe it to be important in improving patient outcomes. The review found no data specifically relating to nurse practitioners’ beliefs of their ability to implement EBP into routine care. Nurse practitioners’ implementation of all of the steps in the EBP process is relatively low. There is conflicting evidence regarding the personal and professional variables influencing EBP implementation. Nurse practitioners experience similar barriers to EBP implementation as do nurse generalists. In particular nurse practitioners identified conflict within interprofessional relationships, social factors and the need to maintain political boundaries within the collaborative team as barriers to EBP implementation. Conclusion: Further research is required to explore nurse practitioners’ experience of interprofessional collaboration when implementing EBP into routine care.

Introduction of the Careful Nursing Philosophy & Professional Practice

Author(s)

Michelle Howard

Affiliation(s) Mallow General Hospital Abstract Background:

A nursing documentation project was undertaken in Mallow General Hospital (MGH) which was part of a larger documentation project throughout the South-South West Hospital Group (SSWHG). Aim: The aim of the project was to introduce the Careful Nursing & Professional Practice Model at MGH and standardise nursing documentation in the in-patient medical areas. Methods:

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The introduction of the Careful Nursing & Professional Practice Model was a change in practice therefore, it was important to ensure staff engagement. Resilience training for nursing staff was introduced and attended by a large number of staff. The SSWHG project lead provided a presentation to the CNM group and worked closely with the senior nurse management team and practice development to assist develop and formulate care plans specific to the patient profile at MGH. Nursing staff and CNM’s were also involved in the development of care plans. Education Sessions were facilitated in small groups, providing a mixture of theory and interactive documentation workshops. The new nursing documentation and model of nursing was launched in June 2018. Results: Audit was carried out to assess compliance with the new documentation. Audit results were presented to the clinical areas. The audit results were positive. It was found that staff were completing the documentation within the appropriate timeframe. The care plans correlated with the nursing diagnosis in over 95% of charts audited which was a very satisfactory result. Audit remains on-going to monitor for compliance. Progress continues to be made on the development of the Careful nursing model at MGH Conclusion: The project has been successfully implemented at MGH. Successful implementation at MGH has inspired and influenced other organisations within the SSWHG to implement the model and the nursing documentation. Support and assistance has been provided by the senior nurse management team from MGH. Can We Make De-Escalation a First Resort Intervention for Managing Aggression Occurring in Nursing Homes? An exploration of Nursing Home Staff’s Perspectives on Effective De-Escalation Techniques, Strategies and Skills Author(s) Ms. Malgorzata (Gosia) Ochocka ; Dr Annette Murphy ; Dr Martina Gooney and Psychological Symptom of Dementia (BPSD)) occurring in nursing homes. Within the healthcare literature, however, there is no consistent definition of de-escalation for the population of residents with dementia Aim: To explore how nursing home staff describe effective de-escalation techniques, strategies and skills used for managing responsive behaviours/BPSD Methods: A qualitative approach using 8 semi-structured interviews was used with the use of an inductive content analysis framework (Elo and Kyngäs 2008) for analysis. Preliminary Results: Two major themes emerged from the data: ‘short-term behavioural management’ and ‘long-term behavioural management’ with further subthemes. Preliminary Conclusions: Affiliation(s) Waterford Institute of Technology Abstract Background: In Ireland de-escalation is a recommended first resort intervention for managing aggression (considered currently as a responsive behaviour or Behavioural

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The effective de-escalation as a component of a multidimensional strategy aiming to prevent and manage responsive behaviours/BPSD occurring in nursing homes, amongst suggestions. research participants conceptualised

Delphi Survey: Exploring what education is priority for voluntary organisations who deliver supports to parents who experience perinatal loss

Author(s)

Stacey Power

Affiliation(s) INFANT Centre, University College Cork Abstract

Background: Following pregnancy loss parents require various levels of support during their bereavement. There is a reliance on voluntary organisations to provide supports. While willing to fill these gaps in care, some may lack the expertise to provide the level of care required by families. Education is essential in healthcare in order to keep up-to-date with best practice. Aim: To explore what education was priority for support groups who provide supports to parents who experience pregnancy/perinatal loss. To develop, deliver and evaluate an education day. Methods: A modified Delphi study was undertaken to identify education needs. There were two Delphi rounds, inclusive of free text, where participants reflected on responses in order to develop a consensus among the expert group. The education day was evaluated using a likert scale and free text. Results: All 23 organisations offered supports to parents who experienced various types of pregnancy/perinatal loss. There were 12 responses to round one and 7 responses to round two of the Delphi study. Round one identified 64 sub-topics which were then determined as essential, desirable or not relevant in round two by the expert group. The final 56 sub-topics were themed together and were chosen for inclusion in the education day. The education day was positively evaluated. Conclusion: This study identified educational needs of voluntary support groups. A standardised approach was necessary to guide the development of an education day responsive to voluntary support groups learning needs. Thus, assisting them in supporting parents who experience pregnancy/perinatal loss

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POSTER PRESENTATIONS: ABSTRACTS

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What implies registered nurses’ leadership close to older adults in municipal home health care?

Author(s) Maria Claesson, RN, Doctoral; Student. maria.claesson@hb.se Lise-Lotte Jonasson, RN, PhD, Senior lecturer lise-lotte.jonasson@hb.se Elisabeth Lindberg, RN, PhD,Senior lecturer elisabeth.lindberg@hb.se Karin Josefsson, RNT, PhD, Professor, karin.josefsson@hb.se All authors works at the Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden. Affiliation(s) University of Borås Abstract Background: Home health care in Sweden and worldwide is concerned by an increasing number of older adults, 65 years and over. The primary task of care is to support and strengthen people’s health processes. There is a common agreement that registered nurses’ leadership is important. However, research is limited of what implies registered nurses’ leadership close to older adults in municipal home health care. Aim: To explore how the literature describes the leadership of registered nurses close to older adults in municipal home health care. Methods: A systematic literature review based on the PRISMA statement performed in April 2018. Totally 37 articles were identified in Cinahl and PubMed. Nine articles were screened in full text. Quality valuation and analyses of articles were performed via qualitative research synthesis in four stages. A protocol is registered in PROSPERO database (ID# CRD42019109206). Results: Registered nurses’ leadership close to older adults in municipal home health care implies; personal characteristics, own learning, competence through knowledge and ability, nursing responsibility, use skills, see individual's needs and wholeness, teach others, support each other, mutual relations, collaborate on an organizational and interpersonal level and facing challenges Conclusion: To lead close to older adults in municipal home health care, implies that registered nurses are multiartists. This is a complex and challenging involving creative and learning process, which requires competence in many areas.

Exploring the Complexity of Dementia and Loneliness in Ireland.

Author(s) Irene Hartigan 1 , Nicola Cornally 1 , Tony Foley 1,2 , Suzanne Timmons 1,2 , Aisling Jennings 1 , Dominika Lisiecka 1 , Nicole Müller 1

1 University College Cork, Cork, Ireland 2 Health Service Executive, Cork, Ireland

Affiliation(s) SONM, UCC

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Discrepancies in Recording of Comfort Scores between Nurses and Endoscopists in the Mercy University Hospital Author(s) A.Carroll, M. Lucey, C. Judge, M. Buckley, J. McCarthy , H. Zaid ,

Department of Gastroenterology, Mercy University Hospital

Affiliation(s) Hull University UK

Abstract Background:  Patient comfort during endoscopy is a quality control measure in endoscopy performance.  The Modified Gloucester Comfort Scale is used to assess discomfort experienced by patients undergoing colonoscopies.  This is a scale from one to five with one being indicative of no discomfort and five being indicative of severe discomfort.  National guidelines recommend that the comfort score should be assessed by a 3rd party (usually the endoscopy nurse) and the score agreed with the endoscopist before recording in the final report. Aim:  This audit was performed retrospectively to assess the accuracy of recording of comfort scores between the nurse and the endoscopist Methods:  The most recent 110 colonoscopies recorded on EndoRAAD were included in the audit.  This number is representative of colonoscopies performed by different endoscopists across specialties and grades in the endoscopy department.  Endoscopists were not aware of the data collection prior to procedures.  Comfort scores were recorded by the nurse for the procedure and recorded in the nursing records. The endoscopist was informed of the comfort score and then recorded it on the colonoscopy report. Results:  The average nursing score was 2.35  The average endoscopist score was 2.26.  54.6% of all colonoscopies had equal recording of comfort scores between the nurse and endoscopist with an average comfort score of 2.42 Conclusion: It should be brought the attention of all endoscopists and nurses in the endoscopy department that documented final nursing comfort scores should be relayed to the endoscopist prior to the patient being brought out to recovery.

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School of Nursing and Midwifery Scoil an Altranais agus an Chnáimhseachais

Health and well-being across boundaries revisited– experiences from Ireland, Norway and Zambia Author(s) Dr Helen Mulcahy, School of Nursing and Midwifery, UCC, Ireland, Ms Anne Gerd Karlsen, Associate Professor, UiT The Arctic University of Norway, Mrs. Loveness Moonde Livingstone School of Nursing and Midwifery (LSNM), Zambia Prof. Anne Clancy, Professor, UiT The Arctic University of Norway Affiliation(s) UCC Abstract Background: Evidence suggests nurse educators collaborating across international boundaries and cultures can promote the exchange of knowledge and experiences and thus increase a sense of global responsibility. This initiative describes how public health nursing educators from three countries, Ireland, Zambia and Norway, work together to collaborate on educating diploma, postgraduate and master`s level public health nursing students. Aim: To promote international networking and to enhance awareness of global health and public health nursing practices in different contexts. Methods: The initiative began with an Erasmus exchange from Norway to Ireland by one the authors (AC) in 2012 and has blossomed since then. Teaching exchanges and publications already completed seek to understand public health nursing concerns across boundaries and increase awareness of how health and well-being are understood in different contexts. Results: Working across international boundaries and cultures promotes the exchange of knowledge and increase a sense of global responsibility and solidarity. Reciprocal Erasmus staff training visits and joint publications have been achieved. Planning is ongoing to support Erasmus exchange of nursing and public health student nurses between Ireland and Norway. Online learning opportunities are proposed for 2019, linked to specific content, such as cultural awareness, ethics, evidence-based practice and having a global perspective. Conclusion: The three institutions are currently processing inter-institutional agreements and are continuing visits and research collaboration. International networking and collaboration among nurse educators enhances existing programme. Ultimately, the initiative contributes to understanding health from a global perspective. In February 2013, the Minister for Health Dr James Reilly Issued Ireland’s First National Clinical Guideline- the National Early Warning Score For Ireland (NEWS),DOH, (2013),. Early Warning Scores facilitate the early detection of a patient’s deterioration by classifying a patient’s severity of illness – through the presentation of a ‘score’ that triggers a specific care pathway and prompts nursing staff to request a medical review at specific trigger points (Mitchell et al., 2010) The Current NEWS system relies on the recording of a number of patient measurements by nurses; these are recorded on a standard NEWS paper document and a calculation of score is made by the nurses. This enables a more timely response through a common language by using this structured tool and plan. This study proposed to use a digital version of the paper NEWS document- where nurses input the NEWS measurements onto a tablet containing a digital version of the chart. These measurements were either manually entered by the nurse typing in the measurement or automatically transferred from the vital sign medical device. The NEWS score was calculated automatically and the appropriate escalation/response displayed. This removes a large percentage of potential errors compared with a paper observation. This has been backed up by an independent Six Sigma investigation and by independent hospitals analysis into the paper system (see Figure 1 and Figure 2). The platform allows the nurses, nurse managers at the nurse’s station to have sight of all patient NEWS scores on a single screen (currently these are only available by checking the patient charts). The aims of this study were (1) to measure the impact on transcription errors compared to the paper version (2) to measure compliance rate for The Good News and the Bad News Author(s) Noreen Lynch RGN, CNS, NURSE LIASON MANAGER HEALTH INNOVATION HUB CORK Affiliation(s) Health Innovation hub Ireland, UCC AbstractAim: Introduction

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School of Nursing and Midwifery Scoil an Altranais agus an Chnáimhseachais

recording NEWS compared to the current rate with the paper version (3) through a survey- recording nurse and clinical team feedback on using the digital version versus the paper version. Study Background Study Background When acute hospitals implement the current Clinical Guideline for NEWS they record a number of standard patient measurements on a paper chart. They then calculate a NEWS score for the patient and this score is an indicator of patient deterioration. Depending on the score, a care escalation process is followed by the nurse. This clinical guideline was introduced in order to increase patient safety and to identify at risk patients early in the care pathway. A number of recent studies have demonstrated the power of implementing the digital NEWS system. Training was provided on digital News entry on a selected site and a study was undertaken to compare the paper NEWS scores compared to the digital nurse scores. Two nurses were selected and took 20 randomly selected charts and if a query arouse in a chart, the same chart was checked by both nurses. The clinical Lead for this project was identified. The clinical lead identified the critical team members who would be involved in this project. After an initial meeting with the project team, a HIHI Project Initiation Document was agreed. Ethics approval from Waterford CREC was submitted and approval received in January 2018. X Syncrophi units were installed in the AMAU. IT integration involved. Two lead users were trained on the system. The pilot was conducted over a period of one month. It was agreed that the digital system would not operate between the hours of 9pm and 8am- this is because the nursing and support staff on duty at those times are often agency staff who do not have signing authority and might not have been trained to use the system. In order to ensure continuity of NEWS recordings and to ensure no deviation from standard practice a paper version of the chart was printed daily and included in the patient charts. Entry Criteria: All AMAU Patients that were not pediatric and maternity patients that would usually get a NEWS score were included in the study. Exclusion Criteria : Pregnant Women, Children (those under 18 years of age). Results: 98% of the observations sets had errors from the 124 observations sets from the paper charts. This represents an error rate of 79% overall. Digital set had no errors found. Conclusion: 93% of the nurses involved in the trial reported that they found the KEWS300 digital system to be much better in terms of impact on patient care.7% no change. 71% ease of use was significant enhanced when compared to the use of paper. This survey demonstrated a digital system can increase productivity. Impact on patient care. This measured the compliance for recording News digitally compared to paper. Empowering nurses to deliver safe care is empowering NEWS The results were recorded Methods: Structure of Pilot The pilot was conducted in a site.

Investigation into the use of a digital platform for professional & educational communication for nurses in Injury Units in Ireland

Author(s) Kathryn Reid Clinical Nurse Manager 2 Affiliation(s) Injury Unit, Mallow General Hospital

Abstract Background: To continue to provide evidence-based care to their patients and to maintain registration Nurses must maintain CPD with some current courses awarding CEUs. To access relevant course for Injury Units can be difficult. Aim: To investigate if Nurses in Injury Units, in Ireland, would utilise and see as beneficial, a digital platform to access specific educational content for Injury Unit Nursing. To explore if a digital platform would be beneficial as a method to communicate professionally and finally, to examine potential content of a digital platform. Methods: A focus group (n=5) was held in Dublin, the participants being experienced Nurse Managers. Questionnaires were disseminated to all 11 Injury Units for Nurses to complete

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School of Nursing and Midwifery Scoil an Altranais agus an Chnáimhseachais

Results: Positive findings were indicated towards the use of a digital platform as an educational tool and a professional discussion board and chatroom. Issues identified in the study: 1. Organisational and patient negative perceptions towards the use of a smartphone and tablet in the workplace. 2. A wide spread lack of infrastructure, including WIFI, needed to support such developments. 3. The need for organisational support and policy development. Conclusion: The use of Digital Platforms, web-based, smart phone or tablet based, have the potential to enhance and support Injury Unit Nurses knowledge and professional communications in this evolving area of specialty within the acute floor setting. Author(s) Sylvia Hickey Affiliation(s) Mercy University hospital Abstract Background: improve patient flow, remove the bottlenecks and to increase efficacies between departments Aim: Improve ED to Ward patient Flow in MUH Methods: DMAIC (Define Measure Analysis Improve and Control) using Lean Six Sigma. Introduction of Fit to Sit/Not Fit to Sit (Bed Allocations), Mobile phone given to CNM/NIC to increase communication levels between departments. Improvement in ED to St Joseph’s Ward transfer time: using Lean Six Sigma Exploring the Information Needs of Families of Patients with Advanced Dementia on Discharge from Acute Care Author(s) Ms Sarah McAleer & Dr Nicola Cornally Affiliation(s) Cork University Hospital, UCC Abstract Background: Dementia is a term used to describe a category of disorders characterised by a gradual decline in both cognitive and functional capability (McCabe et al 2016).  In Ireland today, it is estimated that 55,000 people are living with the condition (HSE, 2018). It is predicted that this number will double over the next 20 years, with a projected 113,000 people expected to be living with dementia by 2036. Over the past 10 years published literature has highlighted the importance of information provision to carers as a means of optimising care in dementia. However, little is known regarding the specific information needs of informal caregivers of patients with advanced dementia on discharge from acute care.  Aim: The aim of this study was to explore the information needs of informal caregivers of people with advanced dementia on discharge from the acute setting Methods: A qualitative descriptive design was employed. A convenience sample of 6 informal carers of people with advanced dementia were recruited. Participants were interviewed face-to-face using a semi structured interview topic guide. Thematic analysis was used framed by the work of Braun & Clarke (2006) Results: Participants expressed a strong desire for more information. Three themes were seen following data analysis. 1) Understanding, experience and source of knowing in dementia 2) Information need and 3) Preferred type and source of information. A particular need for information on disease pathophysiology and managing changes in personality and cognition was highlighted with no preference as to who provides the information, once the individual is knowledgeable in the Results: Reduced delay times from the ED to the wards by 1hr 14minutes over 6-8 weeks Conclusion: Role out the changes made to reduce the delays to the rest of the hospital.

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School of Nursing and Midwifery Scoil an Altranais agus an Chnáimhseachais

area. Whilst written information was acknowledged as being useful, face-to-face conversations were consistently highlighted as being the optimal form of communication. Conclusion: Currently, informal carers of people with dementia do not receive adequate information regarding the illness. Healthcare professionals needs to provide information to carers across all stages of the disease.

An examination of patients’ expectations and experience of service. Author(s) Dr. Ruth Lernihan, Dr. Margaret Landers, Prof. Eileen Savage Affiliation(s) South Infirmary-Victoria University Hospital, UCC

Abstract Background: Blindness and vision loss is a global population health concern. A significant economic cost results fro service users are older persons. There is a growing increase in demand for ophthalmology services in Ireland which is consis a key issue for service providers and healthcare management. Service users’ perspectives and feedback are recognised as es service users’ expectations and experience determines perceived service quality. This gap can be positive or negative that is ophthalmology service is currently undergoing redesign therefore, it is advantageous to examine service users’ experience Aim: To examine patients’ expectations and experiences of service quality in the ophthalmology service. Method: Drawing on pragmatism a descriptive exploratory design was adopted. A purposeful sample of 10 patients attendi collected using semi-structured interviews which were audiotaped and transcribed. Thematic data analysis was employed. Findings: Four main themes emerged from the data: Deteriorating or disrupted vision, Entering the eye service, Getting visi A number of subthemes emerged from the main themes. In general, participants’ expectations were met or were exceeded access to the service and waiting for care. Conclusion: Eliciting participants’ expectations and experiences of the ophthalmology service is a valuable method of evalu experience in the main. Service users can inform service provision and highlight areas in need of improvement. These findin service users’ needs.

Exploring nurses’ perceptions towards nurse-led discharge in the acute hospital setting

Author(s) Ms. Jenny Lynch & Dr. Serena FitzGerald Affiliation(s) UCC

Abstract Background: Nurse-led discharge (NLD) can be defined as the delegation of responsibility to discharge patients in accordance with an agreed plan and determined criteria. Improving patient flow, reducing readmission rate and improving length of stay are essential objectives of the Health Service Executive, Department of Health and the National Acute Medicine Programme. NLD interventions are effective in improving readmission rates, reducing discharge delays and improving patient outcomes. NLD has been successfully implemented in acute care settings in England, Scotland and Australia. However, no formal measure of nurse perceptions towards NLD was explored in the literature. Aim: To explore nurses’ perceptions towards nurse-led discharge in an acute care setting

Methods: A qualitative descriptive design was utilised. Participants were recruited using non-probability purposive sampling Semi-structured interviews were used to interview nurses (n=8). Interviews were audio recorded and transcribed verbatim Thematic content analysis was used to analyse the data. Results: Nurses need to know their patient and have the experience to participate in the role of NLD. In order to progress i their profession, nurses need organisational support to facilitate the implementation of NLD in the current healthcare setting Discharge planning and facilitating the patients’ transition with effective communication and collaboration with th multidisciplinary team may help to improve the delivery of care if NLD is implemented. Conclusion: A NLD tool should be developed and piloted in the acute care setting. A NLD policy should be developed as resource guide for those involved in carrying out the role of NLD. Education and training is needed for nurses to enhance thei continual professional development for NLD. Further qualitative research should be conducted to explore patients an consultant physicians’ perceptions towards NLD and quantitative research should be conducted to observe the effectivenes of NLD once it has been implemented in the acute care setting.

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