Nursing and Midwifery - Journal Articles

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Home birth in Ireland 1993 - 1997: a review of community midwifery practice
(TM&D Press Ltd., 2002) O'Connell, Rhona; Cronin, Mary
To date little is known about the practices of domiciliary midwives and the outcomes of home birth in Ireland. The purpose of this review is to provide some background information on the situation for women seeking a home birth and to document the outcomes of home births in Ireland between 1993 -1997. Design: Descriptive analysis of prospective data collected from domiciliary midwives regarding women who requested a home birth between 1993 and 1997. Participants: The questionnaire was distributed to 15 domiciliary midwives; this included all the domiciliary midwives known to the authors to be practising in Ireland at that time. Findings: During this period, 585 women planned to give birth in their home with the assistance of midwives, 500 women achieved this. The spontaneous vaginal delivery rate for women who commenced their labour at home was 96.9% (n = 554). These women gave birth without medications or other interventions. 544 (93%) of the women breastfed their babies and 538 (92%) were still breastfeeding at 6 weeks. This is the first review of domiciliary midwifery practice in Ireland in recent years. They obtained data from 11 independent midwives on 585 women who planned home births. Findings showed high rates of spontaneous vaginal delivery and breastfeeding. There were 500 babies born at home with three perinatal deaths, including one undiagnosed breech delivery, one infant with abnormal lungs on post-mortem and one infant with Potter's Syndrome who was stillborn.
Principlism or narrative ethics: must we choose between them?
(BMJ Publishing Group, Institute of Medical Ethics, 2003-12) McCarthy, Joan
This paper addresses a current debate in the bioethics community between principlists, who consider that principles are at the heart of moral life, and narrativists, who see communication at its core. Using a case study entitled "The forgetful mourner" to introduce the tensions between each of these positions, I go on to explain the central tenets of both principlism and narrative ethics. Rather than focus on their respective weaknesses, which many theorists do, I emphasise instead, the contribution that each approach can make to understanding moral life and the process of ethical decision making in health care situations. My ultimate aim is to identify the, sometimes overlapping, skills that both principlism and narrative ethics require on the part of health professionals who deploy them. I conclude that a good principlist has narrativist tendencies and a good narrativist is inclined toward principlism.
Clinic consultations with children and parents on the dietary management of cystic fibrosis
(Elsevier, 2007) Savage, Eileen; Callery, Peter; Nursing and Midwifery Board of Ireland; Health Research Board
The aim of this paper is to examine clinic consultations on the dietary management of cystic fibrosis with particular consideration to the role of children. The role of parents is also examined to determine how their involvement impacts on the role of children during consultations. The data are drawn from interviews with 32 Irish school aged children with cystic fibrosis and their parents, and participant observations during clinic consultations with a sub-group of 21 children. Data were analysed concurrently with data collection using a method of constant comparison, which involved comparing and contrasting incidents in the data to develop themes. Theoretical sampling was used to further explore and develop emergent themes. Discourse analysis was applied to clinic conversations. Children were seen to have little active involvement during consultations leaving them marginalised as conversations were directed at parents primarily and their accounts were privileged over those of children. A surveillance approach to consultations involving interrogative style questioning and generally closed conversations was seen to contribute to the marginalised position of children. In addition, dietary advice limited children s involvement because it was of little relevance to children s understandings of being healthy and to the dietary implications of these. The findings highlight a need to acknowledge children as active participants in their dietary care. Implications for developing a child-centred approach to dietary consultations are discussed including implications for working with children towards improved health outcomes of managing CF diet.
Hand hygiene audit: A tool for clinical practice MIDIRS Midwifery Digest
(MIDIRS Midwifery Digest, 2007-01) Murphy, Margaret M.; Sweeney, John F.
Healthcare delivery in 2006 demands the highest possible standards from all healthcare professionals. Quality in healthcare is equated with safe practice by professional regulators (An Bord Altranais 2000, NMC 2004). In light of recently published controversial reports, high standards of quality and audit of professional practice are demanded by key stakeholders.
An observational study on the open-system endotracheal suctioning practices of critical care nurses
(Blackwell Publishing Ltd,, 2008-02) Kelleher, Seán J.; Andrews, Tom
Aim and objectives. The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses' practices prior to, during and post-ETS and to compare nurses' ETS practices with current research recommendations.. Background. ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life-threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis.. Design and method. In March 2005, a structured observational study was conducted using a piloted 20-item observational schedule on two adult intensive-care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to.. Results. The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower-quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions.. Conclusion. The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses' daily suctioning practices.. Relevance to clinical practice. As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses' ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures..
Participation in everyday activities and quality of life in pre-teenage children living with cerebral palsy in South West Ireland
(BioMed Central Ltd., 2008-10-31) McManus, Vicki; Corcoran, Paul; Perry, Ivan J.; European Commission
Background: Cerebral palsy (CP) is the most common cause of physical disability in children but its impact on quality of life is not well understood. This study examined participation in everyday activities among children without CP and children with mild, moderate and severe impairment due to CP. We then examined ten domains of quality of life in children with CP and investigated whether participation in everyday activities was associated with improved quality of life independent of gender, age and level of impairment. Methods: This was a cross-sectional study of children aged 8–12 years based on two questionnaires, frequency of participation (FPQ) and KIDSCREEN, completed by parents of 98 children on the South of Ireland Cerebral Palsy Register (response rate = 82%) and parents of 448 children attending two Cork city schools (response rate = 69%) who completed one questionnaire (FPQ). Multiple linear regression was used: firstly to estimate the effect of severity of CP on participation in everyday activities independent of age and gender and secondly we estimated the effect of participation on quality of life independent of age gender and level of impairment. Results: Participation in 11 of the 14 everyday activities examined varied across the children without CP and the children with varying severity of CP. In general, increased impairment decreased participation. Independent of age and gender, there was a highly significant decrease in overall participation with a fall of -6.0 (95% CI = -6.9 to -5.2) with each increasing level of impairment. The children with CP generally had high quality of life. Increased impairment was associated with diminished quality of life in just two domains – Physical well-being and Social support and peers. Overall participation in everyday activities was significantly associated with quality of life in 3 of the 10 domains (Physical well-being, Social support and peers & Moods and emotions) in analysis adjusted for gender age and level of impairment. Conclusion: While increased impairment due to CP restricts participation in the majority of everyday activities, the level of participation has a limited effect on the quality of life of the children with CP in age 8–12 years.
Quality of life in children with acute lymphoblastic leukaemia: A systematic review
(Elsevier, 2009-02) Savage, Eileen; O'Riordan, A.; Hughes, Mary
Quality of life (QOL) in children with acute lymphoblastic leukaemia (ALL) is now considered an important outcome measure of treatment for this disease. The aim of this paper is to systematically review studies on QOL in children during treatment for ALL with consideration to methodological details and quality of studies, empirical findings on QOL as reported by children and parents, and whether children and parents differ in their reports on QOL. Searches were conducted in biomedical, psychological and behavioural science databases. Six papers met inclusion criteria for review: 4 cross-sectional studies and 2 qualitative studies. There was little consistency in how QOL was measured or qualitatively assessed across studies. The quality of most studies was limited by small sample sizes and cross-sectional designs. Children's reports on QOL were represented in 3 studies and discrepancies were found between children's and parent's accounts of QOL. There is a need for ongoing research on QOL in children with ALL that use longitudinal designs, large sample sizes, and child reports of QOL. There is a need for theoretical development of the concept of QOL through concept analysis, grounded theory research and empirical validation of developing theory of QOL. Theoretical development of the concept of QOL will contribute to greater clarification of what is meant by QOL than currently exists which in turn has the potential to advance the methodology of measuring this concept in children.
Service users experiences of a therapeutic group programme in an acute psychiatric inpatient unit.
(Wiley Blackwell, 2009-05-11) Horgan, Aine M.; O'Mahony, James
Psychiatric nurses have been facilitating therapeutic groups in acute psychiatric inpatient units for many years; however, there is a lack of nursing research related to this important aspect of care. This paper reports the findings of a study which aimed to gain an understanding of service users' experiences in relation to therapeutic group activities in an acute inpatient unit. A qualitative descriptive study was undertaken with eight service users in one acute psychiatric inpatient unit in Ireland. Data were collected using in-depth semi-structured interviews and analysed using Burnard's method of thematic content analysis. Several themes emerged from the findings which are presented in this paper.
Obstetric surgery for perioperative staff and midwives
(The Association for Perioperative Practice, 2009-06) O'Connell, Rhona
Where a pregnant woman experiences trauma or has acute surgical needs there are additional concerns for the well being of both the woman and her foetus. This article explores obstetric procedures for the pregnant woman and discusses the implications for perioperative staff and midwives.
Young students' use of the internet for mental health information and support
(Wiley Blackwell, 2009-09-24) Horgan, Aine M.; Sweeney, John F.
It is recognized that young people experience difficulties in accessing mainstream mental health services particularly because of the stigma that remains associated with mental health problems. One potential solution is to use the many websites available offering information and support for mental health problems, such support and information could be offered by Psychiatric Nurses. However, young peoples' usage and views on using the Internet for this purpose has yet to be examined. This quantitative descriptive study aimed to elicit the views of 922 University students, aged between 18 and 24 years, on using the Internet for mental health information and support. Data were collected using a 30-item self-designed questionnaire and analysed using descriptive statistics. The findings indicated that 72.4% of participants used the Internet several times a day. In addition, 30.8% had previously searched for mental health information online, predominantly on depression. While it was found that 68% of participants indicated that they would use the Internet for mental health support if they needed to, 79.4% would still prefer face to face support. It is concluded that young people are willing to use the Internet for mental health information and that it represents a viable source of support for this age group.
Conversations with the Irish public about death and dying
(Irish Province of the Society of Jesus, 2009-12) McCarthy, Joan; Loughrey, Mark; Weafer, John; Dooley, Dolores
Irish views on death and dying: a national survey
(BMJ Publishing Group, 2010) McCarthy, Joan; Weafer, John A.; Loughrey, Mark; Irish Hospice Foundation
Objective: To determine the public's understanding of and views about a range of ethical issues in relation to death and dying. Design: Random, digit-dialling, telephone interview. Setting: Ireland. Participants: 667 adult individuals. Results: The general public are unfamiliar with terms associated with end-of-life care. Although most want to be informed if they have a terminal illness, they also value family support in this regard. Most of the respondents believe that competent patients have the right to refuse life-saving treatment. Most also (mistakenly) believe that families, either alone or with physicians, have the authority to make decisions about starting or stopping treatment for incompetent patients. Most Irish people are more concerned about the quality of their dying than death itself. Religious commitment is important to most Irish people, and this impacts on their views about medical treatment and care at the end of life. Conclusions: The study paints a picture of a general public that is not very comfortable with or informed about the processes of dying and death. Great sensitivity is required of health professionals who must negotiate the timing and the context of breaking of bad news with patients and families. Educational interventions, public and organisational policies and legislation need to address the uncertainty that surrounds the role of professionals and families in making decisions for dying patients.
The science of intervention development for type 1 diabetes in childhood: a systematic review
(Blackwell Publishing Ltd., 2010) Savage, Eileen; Farrell, Dawn; McManus, Vicki; Grey, Margaret
This paper is a report of a review of the science of intervention development for type 1 diabetes in childhood and its implications for improving health outcomes in children, adolescents, and/or their families.
A study of the situations, features, and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress
(John Wiley & Sons, Inc, 2010-04-29) Deady, Richard; McCarthy, Joan
Purpose: The purpose of this study was toinvestigate moral distress in Irish psychiatric nurses. Design: A qualitative descriptive methodology was used. Findings: The study confirmed the presence of moral distress and the situations that gave rise to moral distress within psychiatric nurses working in acute care settings. Practice Implications: The findings indicate that while multidisciplinary teams appear to function well on the surface, situations that give rise to moral distress are not always acknowledged or dealt with effectively. Furthermore, unresolved moral conflict impacts upon the quality of clinical decision-making by not allowing open and transparent discussions that allow clinicians the opportunity to address their concerns adequately.
Cultural perspectives of interventions for managing diabetes and asthma in children and adolescents for ethnic minority groups
(Blackwell Publishing Ltd., 2010-09) McManus, Vicki; Savage, Eileen
Both diabetes and asthma are increasingly being recognized as health problems for ethnic groups. Because of cultural differences, ethnicity is reported to be a risk factor for poorer quality in healthcare, disease management and disease control. Ethnic groups are at risk for poorer quality of life and increased disease complications when compared with non-ethnic counterparts living in the same country. There is little known about how culture is addressed in interventions developed for ethnic groups. The aim of this paper is to systematically review the cultural perspectives of interventions for managing diabetes and asthma in children, adolescents and/or their families from ethnic minority groups. A total of 92 records were identified that were potentially relevant to this review following which, 61 papers were excluded. The full texts of remaining papers (n = 31) were then read independently by both authors, and agreement was reached to exclude a further 27 papers that did not meet inclusion criteria. A total of four papers were eligible for inclusion in this review. Findings indicate that despite growing concerns about health disparities between ethnic and non-ethnic groups in relation to both asthma and diabetes in childhood, there has been little effort to develop cultural specific interventions for ethnic groups. By systematically reviewing asthma and diabetes interventions we have highlighted that few interventions have been developed from a cultural perspective. There are a limited number of interventions published that add knowledge on the specific elements of intervention that is needed to effectively and sensitively educate other cultures.More work is required into identifying which strategies or components of cultural interventions are most effective in achieving positive health outcomes for children, adolescents and/or their families from ethnic groups.
Symptom burden in inflammatory bowel disease: Rethinking conceptual and theoretical underpinnings
(Blackwell Publishing Asia, 2010-10) Farrell, Dawn; Savage, Eileen
Symptom control is fundamental to the nursing management of inflammatory bowel disease (IBD). However, symptom control can be problematic for individuals with IBD, which could result in symptom burden. Symptom burden is an evolving concept in the discipline of nursing and to date little is known about how the defining characteristics of this concept have been applied to symptom research in IBD. In this discussion paper, the concept of symptom burden and the theory of unpleasant symptoms are explored as a basis for understanding symptom research in IBD. This is followed by a critical examination of previous symptom research in IBD. Our conclusion is that there is a need to rethink conceptual and theoretical underpinnings of symptom burden when researching IBD to take account of its defining characteristics, namely symptom severity, frequency and duration, quality and distress. Research knowledge on these defining characteristics will be important to inform nursing assessment of symptom burden in clinical practice.
Perceived occupational stress in nurses working in Ireland
(Oxford University Press, 2010-10-01) McCarthy, Vera J. C.; Power, S.; Greiner, Birgit A.
Background: This study examines perceived stress and its potential causal factors in nurses. Stress has been seen as a routine and accepted part of the healthcare worker’s role. The lack of research on stress in nurses in Ireland motivated this study. Aims: The aims of this study are to examine the level of stress experienced by nurses working in an Irish teaching hospital, and investigate differences in perceived stress levels by ward area and associations with work characteristics. Method: A cross-sectional study design was employed, with a two-stage cluster sampling process. A self-administered questionnaire was used to collect the data and nurses were investigated across ten different wards using the Nursing Stress Scale and the Demand Control Support Scales. Results: The response rate was 62%. Using outpatients as a reference ward, perceived stress levels were found to be significantly higher in the medical ward, accident and emergency, intensive care unit and paediatric wards (p<0.05). There was no significant difference between the wards with regard to job strain, however, differences did occur with levels of support; the day unit and paediatric ward reporting the lowest level of supervisor support (p<0.01). A significant association was seen between the wards and perceived stress even after adjustment (p<0.05). Conclusion: The findings suggest that perceived stress does vary within different work areas in the same hospital. Work factors, such as demand and support are important with regard to perceived stress. Job control was not found to play an important role.
Managing heart conditions in pregnancy
(MedMedia Group, 2010-11) Murphy, Margaret M.; Hunter, Niall
Healthcare professionals are encountering more andmore women with cardiac conditions contemplating pregnancyor when pregnant than ever before. Advances insurgical treatment of congenital cardiac anomalies meanmany more women are now reaching childbearing age andcontemplating pregnancy than would hitherto have beenseen.Due to the fact that Irish figures have not been availablethus far on the effects of cardiac disease on pregnancy andvice versa, we have come to rely on statistics from our nearestneighbour the UK. The Centre for Maternal and ChildEnquiries (CMACE) is an independent charity. Its missionis to improve the health of mothers, babies and children bycarrying out confidential enquiries and other related workon a UK wide basis and widely disseminating the results. Itproduces a report every three years into maternal fatalitiesin the previous three-year period. The most recent reportwas published in 2007, reflecting the deaths that occurredin 2002-2005. In the most recent CMACE triennial reportinto maternal mortality (2002-2005) for the first time cardiacdisease was found to be the leading cause of maternaldeath among women in the UK, with a maternal mortalityrate for heart disease of 2.27 per 100,000 maternities.
First time stroke survivors' perceptions of their health status and their goals for recovery
(Academic Journals, 2011-02-28) Hartigan, Irene; O'Connell, Elizabeth; McCarthy, Geraldine; O'Mahony, Denis; Irish Heart Foundation
Stroke is an intensely individual, complex and life changing experience. Stroke recovery has many dimensions, and perceptions of health status are thought to affect recovery. The purpose of this qualitative study was to describe patients' perceptions of their health status and their goals for recovery from early post stroke. Following ethical approval, semi structured interviews were conducted with patients (n=10) diagnosed with a first incident of stroke. Time following stroke onset ranged from 4 to 7 days. Gender difference was equal, and mean age of participants was 77 years. Participants considered themselves to be active and in excellent health prior to the stroke onset. All participants perceived that their health had declined since the stroke onset, but they were hopeful for the future. Two distinct themes emerged; "sudden fear and helplessness" and "regaining control in life". Participants reported wanting to quickly return to doing everyday things and identified individual goals for recovery. The patients' experience should be considered early post stroke to provide a complete picture of their role in recovery. Participants believed that the greatest challenge would be testing themselves at home. This study reinforces the importance of engaging with patients early post stroke so that recovery goals are identified that help restore meaning through the re-establishment of previous activities. Patient goals for recovery need to be discussed and devised in conjunction with health care professionals.
Making tough decisions at the end of life
(AIGNA, 2011-05) McCarthy, Joan
In end-of-life situations, health professionals, patients and families must often make difficult decisions in tense, demanding, emotionally fraught and constrained circumstances. Every day, caring for dying patients, nurses and doctors find themselves faced with moral questions and challenges: What is good care in this case? How can I be a good nurse or doctor? What do I say if this patient asks “Am I dying?” Should we start or stop treatments such as dialysis, ventilation or nutrition and hydration? Will treatment prolong life or hasten death? Should I document a Do Not Attempt Resuscitation Order (DNAR)? What should I do if there is no DNAR order? How much involvement should this patient and/or family have? How far do my professional and legal responsibilities extend? With medical technology we gain greater control over how and when we die. With greater control comes greater responsibility for the range of complex decisions medical technology makes available. The recently launched Ethical Framework for End-of-Life Care (McCarthy, Donnelly, Dooley, Campbell, Smith [2010] Dublin: Irish Hospice Foundation) is a set of educational resources that offers a constructive response to the challenges of such decision-making. The overall aim of the Framework is to foster and support ethically and legally sound clinical practice in end-of-life treatment and care in Irish hospitals and healthcare settings. It has emerged as part of a larger initiative, the Hospice Friendly Hospitals Programme (HfHP), of the Irish Hospice Foundation in collaboration with the Health Services Executive and with the support of The Atlantic Philanthropies.

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