Nursing and Midwifery

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Accommodating interruptions: a grounded theory of young people with asthma
(University College Cork, 2014) Hughes, Mary; Savage, Eileen; Andrews, Tom
Background: Accommodating Interruptions is a theory that emerged in the context of young people who have asthma. A background to the prevalence and management of asthma in Ireland is given to situate the theory. Ireland has the fourth highest incidence of asthma in the world, with almost one in five Irish young people having asthma. Although national and international asthma management guidelines exist it is accepted that the symptom control of asthma among the young people population is poor. Aim: The aim of this research is to investigate the lives of young people who have asthma, to allow for a deeper understanding of the issues affecting them. Methods: This research was undertaken using a Classic Grounded Theory approach. It is a systematic approach to allowing conceptual emergence from data in generating a theory that explains behaviour in resolving the participant’s main concern. The data were collected through in-depth interviews with young people aged 11-16 years who had asthma for over one year. Data were also collected from participant diaries. Constant comparative analysis, theoretical coding and memo writing were used to develop the theory. Results: The theory explains how young people resolve their main concern of being restricted, by maximizing their participation and inclusion in activities, events and relationships in spite of their asthma. They achieve this by accommodating interruptions in their lives in minimizing the effects of asthma on their everyday lives. Conclusion: The theory of accommodating interruptions explains young people’s asthma management behaviours in a new way. It allows us to understand how and why young people behave the way they do in order minimise the effect of asthma on their lives. The theory adds to the body of knowledge on young people with asthma and challenges some viewpoints regarding their behaviours.
Acknowledging the resilience of student nurses during COVID-19
(Elsevier Inc., 2021-06-17) Goodwin, John
Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric
(Wiley, 2019-04-01) Hegarty, Josephine; Howson, Victoria; Wills, Teresa; Creedon, Sile A.; Mc Cluskey, Pat; Lane, Aoife; Connolly, Aine; Walshe, Nuala; Noonan, Brendan; Guidera, Fiona; Gallagher, Anthony G.; Murphy, Siobhan; University College Cork
The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts.
Adaptation and resilience in families of children with 22q11.2 deletion syndrome: a mixed methods study
(University College Cork, 2019-11-19) Caples, Maria; Savage, Eileen; Mccarthy, Bridie
Background: 22q11.2 deletion syndrome is a rare multisystem genetic disorder with over 200 associated characteristics, occurring in various combinations and severity, with an estimated incidence of 1 in 4,000 live births. The phenotype of syndrome is much varied, with some people more seriously affected then others. In addition, a rare disease can bring a range of challenges for those affected and their families which can result in people becoming marginalised psychologically, socially, culturally and economically. Extensive biomedical research has been undertaken on 22q11.2 deletion syndrome, however, there is a dearth of research on families’ experiences. Study Aim: To investigate the relationship between resilience factors and adaptation in families of children with 22q11.2 deletion syndrome. Methods: An explanatory sequential mixed methods design was used to investigate adaptation and resilience in families of children with 22q11.2 deletion syndrome. Families participated in a survey (n=64) and qualitative interviews (n=9). Quantitative data were analysed using IBM SPSS Statistics (Version 18) and qualitative data were analysed using content analysis. Results:Three variables that best explained adaptation in families of children with 22q11.2 deletion syndrome were identified: family hardiness, condition management effort, and condition management ability. Adaptation scores increased by 0.57 points (95% CI: 0.19 to 0.94) for every one-point increase in family hardiness score, by 0.95 (95% CI: 0.33 to 1.56) for every one-point increase in condition management ability score and decreased by 0.84 (95% CI: -1.55 to -0.13) for every one-point increase in effort scores. The qualitative data provided additional insights to the independent variables that were found to be significantly associated with adaptation for families of children with 22q11.2 deletion syndrome. These variables were condition management effort, condition management ability and family hardiness. Conclusion: This study provides insight to adaptation and resilience specific to families of children with 22q11.2 deletion syndrome. A key implication of the findings is the need for a family centered, integrated approach to care for families of children with 22q11.2 deletion syndrome.
Adolescents’ perceptions of mental health services: an interpretive descriptive study
(University College Cork, 2021) Goodwin, John; Horgan, Aine Mairead; Savage, Eileen; Bradley, Stephen
Background: Adolescence is a peak period for the onset of mental distress, yet adolescents may not seek help from mental health services. While studies have been conducted on perceptions of mental distress from the perspectives of adolescents with no prior experience of accessing mental health services, little research has been conducted on their perceptions of mental health services. Aim: To explore adolescents’ perceptions of mental health services, including mental health care environments, staff, and treatment. Methods: An interpretive description approach guided this study. Data were collected through individual interviews with 30 students in the Transition Year (4th year) of secondary school in Ireland. The students had no prior experience of accessing mental health services. To complement interviews, participants drew images of mental health care environments and mental health staff members. The narratives arising out of these drawings were analysed. Interview data were analysed using qualitative content analysis. Manifest (surface level) data are presented in categories and sub-categories. Latent (underlying meaning) data are presented in themes. Findings: Five themes were identified. “Mental health” and “psychiatric” were perceived as different concepts. Participants were aware of mental health issues and associated services but held more stigmatising perceptions of psychiatric services. Participants were uncertain about how to access services, and about what form such services take. Mental health care environments were positively regarded, as were the staff who worked there; less positive attitudes were noted for psychiatric care environments and staff. It was suggested that, to work in mental health services, one would need to have completed a vast amount of study. It was also suggested that the experience of mental distress may influence people to pursue a career in mental health services. Perceptions of services were influenced by multimedia, in particular, television programmes and film. This mode of influence (i.e. multimedia) was also recommended as an education strategy that could be used to enhance adolescent awareness about mental health services. Conclusion: Adolescents hold stigmatising perceptions of mental health and are uncertain about how mental health services operate. Adolescents need to be educated about mental health services. It is suggested that traditional modes of education, such as leaflets and posters are ineffective, and a more modern format (i.e. multimedia) would enhance this education. It is expected that provision of education in this area would reduce stigma and improve help-seeking behaviours. This education may also help to demystify the role of mental health staff and enhance service recruitment at a time when staff issues are a major service concern.
Advance care planning within survivorship care plans for older cancer survivors: a systematic review
(Elsevier, 2017-06-23) O'Caoimh, Rónán; Cornally, Nicola; O'Sullivan, Ronan; Hally, Ruth; Weathers, Elizabeth; Lavan, Amanda H.; Kearns, Tara; Coffey, Alice; McGlade, Ciara; Molloy, D. William
Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care. This paper systematically reviews evaluations of ACP within SCPs among older (≥65 years) cancer survivors. No studies meeting the inclusion criteria were identified by search strategies conducted in PubMed/MEDLINE and the Cochrane databases. One paper examined cancer survivors’ mainly positive views of ACP. Another discussed the use of a SCP supported by a ‘distress inventory’ that included an advance care directive (living will) as an issue, though no formal evaluation was reported. Although ACP is important for older adults, no study was found that evaluated its role within survivorship care planning. Despite the risk of recurrence and the potential for morbidity and mortality, especially among older cancer survivors, ACP is not yet a feature of SCPs.
Advanced practice nursing for enduring health needs management: a global perspective
(Elsevier, 2012-07) Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D.; Richardson, Jim; Savage, Eileen; Schorn, Mavis
Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.
Advanced practitioners’ experience of interprofessional collaboration when implementing evidence-based practice into routine care: an Interpretative phenomenological analysis
(University College Cork, 2021-09-30) Clarke, Vanessa; Lehane, Elaine A.; Mulcahy, Helen; Cotter, Patrick
Background: Implementation of Evidence-based Practice (EBP) is essential in ensuring high quality healthcare at minimum cost. Nurse practitioners as clinical leaders are responsible for leading and collaborating with interprofessional teams to implement EBP across patient groups and embed practice change into routine care. Interprofessional collaboration has been identified as an essential element for the successful implementation of EBP into routine care. Limited evidence from previous literature findings indicated that collaborative practice issues impeded nurse practitioners in implementing EBP into routine care. However, findings were not adequate to inform specific practice and policy recommendations nationally and internationally. Further research was therefore required into this aspect of the nurse practitioner role. Aim: To understand Registered Advanced Nurse and Midwife practitioners’ experience of interprofessional collaboration in implementing EBP into routine care in the Republic of Ireland. Methods: Qualitative Interpretative Phenomenological Analysis (IPA) was used for this study. A purposeful sample of ten Registered Advanced Nurse and Advanced Midwife Practitioners from a range of practice settings participated in semi-structured interviews which were audio recorded and then transcribed verbatim. NVivo version 12 was used for data management purposes. Data were analysed using IPA. Findings: Six superordinate themes emerged from the interpretative analysis. Advanced practitioners perceived that at times “Understanding of Advanced Practice” was limited. Advanced practitioners described being “Treated as an equal and as a nurse”. Being treated as a “nurse” was associated with being treated as subordinate to other professionals. The extent to which advanced practitioners enjoyed “Nursing Management Support” varied. Some advanced practitioners described having opportunities to participate in their organisation’s executive and decision-making forums which afforded them the opportunity to have “A Voice to Implement Anything New.”. However, others were unable to avail of these opportunities. Levels of participant “Confidence” and “Emotional Intelligence” impacted relationships with members of the interprofessional team. The issues identified in the six superordinate themes influenced the extent to which advanced practitioners could collaborate effectively to implement EBP into routine care. Conclusion and Implications: There is scope to improve advanced practitioners’ ability to collaborate with the interprofessional team in implementing EBP into routine care. Ameliorative measures should focus on increasing understanding of the advanced practitioner role; facilitating advanced practitioner access to organisational decision-making forums; and developing skills and attributes necessary for interprofessional collaboration and the implementation of EBP into routine care.
Age, job characteristics and coronary health
(Oxford University Press, 2012-08-27) McCarthy, Vera J. C.; Perry, Ivan J.; Greiner, Birgit A.
Background: Workplace demographics are changing in many European countries with a higher proportion of older workers in employment. Research has shown that there is an association between job strain and cardiovascular disease, but this relationship is unclear for the older worker. Aims: To investigate the association between job strain and a coronary event comparing younger and older male workers. Methods: Cases with a first-time coronary event were recruited from four coronary/intensive care units (1999-2001). Matched controls were recruited from the case's general practitioner surgery. Physical measurements were taken and self-administered questionnaires completed with questions on job characteristics, job demands and control. Unconditional logistic regression was carried out adjusting for classical cardiovascular risk factors. Results: There were 227 cases and 277 matched controls. Age stratified analyses showed a clear difference between younger (= 50 years) workers with regard to the exposure of job strain (job demands and control) and the association between these factors and cardiovascular disease. Older workers who had a coronary event were four times as likely to have high job strain [OR = 4.09 (1.29-13.02)] and more likely to report low job control [ OR = 0.83 (0.72-0.95)]. Conclusions: Job control emerged as a potential protective factor for heart disease and this evidence was stronger in the older male worker. Nevertheless, they were significantly more likely to have job strain. These results suggest that older workers may be more susceptible to job strain.
Anticipatory vigilance: A classic grounded theory of risk reduction and management in the perioperative setting
(University College Cork, 2014) O'Brien, Bridget; Andrews, Tom; Savage, Eileen
This research aimed to investigate the main concern facing nurses in minimising risk within the perioperative setting and to generate an explanatory substantive theory of how they resolve this through anticipatory vigilance. In the context of the perioperative setting, nurses encounter challenges in minimising risks for their patients on a continuous basis. Current explanations of minimising risk in the perioperative setting offers insights into how perioperative nurses undertake their work. Currently research in minimising risk is broadly related to dealing with errors as opposed to preventing them. To date, little is known about how perioperative nurses practice and maintain safety. This study was guided by the principles of classic grounded theory as described by Glaser (1978, 1998, 2001). Data was collected through individual unstructured interviews with thirty seven perioperative nurses (with varying lengths of experiences of working in the area) and thirty three hours of non-participant observation within eight different perioperative settings in the Republic of Ireland. Data was simultaneously collected and analysed. The theory of anticipatory vigilance emerged as the pattern of behaviour through which nurse’s deal with their main concern of minimising risk in a high risk setting. Anticipatory vigilance is enacted through orchestrating, routinising and momentary adapting within a spirit of trusting relations within the substantive area of the perioperative setting. This theory of offers an explanation on how nurses resolve their main concern of minimising risk within the perioperative setting. The theory of anticipatory vigilance will be useful to nurses in providing a comprehensive framework of explanation and understanding on how nurses deal with minimising risk in the perioperative setting. The theory links perioperative nursing, risk and vigilance together. Clinical improvements through understanding and awareness of the theory of anticipatory vigilance will result in an improved quality environment, leading to safe patient outcomes.
Anxiety in fathers in the perinatal period: a systematic review
(Elsevier, 2019-05-28) Philpott, Lloyd F.; Savage, Eileen; FitzGerald, Serena M.; Leahy-Warren, Patricia
Background: Fatherhood in the perinatal period can be a time of great excitement, happiness and joy. However, a growing body of literature indicates that fathers are at risk for elevated levels of anxiety symptoms during the perinatal period. Purpose: The purpose of this systematic review is to determine the prevalence and levels of anxiety in fathers during the perinatal period, identify the risk factors and impact of anxiety, and establish if there are effective interventions that reduce father's anxiety. Design: Systematic review. Methods: A systematic review protocol was developed and registered with PROSPERO (reference number: CRD42017073760). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, Embase, the Cochrane Library, PsycARTICLES, PsycINFO, and Psychology were searched to identify eligible studies. Studies that researched fathers during the perinatal period were included if anxiety was the primary focus of the research or was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures. Findings: Thirty-four studies met the inclusion criteria. Findings from these studies indicate that fathers experience anxiety in the perinatal period, particularly at the time of birth. Anxiety increased from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. The prevalence of anxiety ranged between 3.4% and 25.0% during the antenatal period and 2.4% and 51.0% during the postnatal period. Factors contributing to anxiety included lower education levels, lower income levels, lower co-parenting support, lower social support, work-family conflict, a partner’ anxiety and depression, and being present during a previous birth. Anxiety had a negative impact on fathers’ mental health, physical health, social relationships and parenting skills. Anxiety contributed to stress, depression, fatigue and lower paternal self-efficacy. Five studies reported on interventions to reduce anxiety and all the studies found that anxiety significantly decreased following the intervention. Key conclusion: Fathers experience increased anxiety from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. Anxiety during the perinatal period that can impact negatively on fathers physical and mental health, and social relationships.
Barriers and facilitators to the choice of active surveillance for low-risk papillary thyroid cancer in China: A qualitative study examining patient perspectives
(Mary Ann Liebert Inc., 2023-01-31) Zhu, Pingting; Zhang, Qianqian; Wu, Qiwei; Shi, Guanghui; Wang, Wen; Xu, Huiwen; Zhang, Li; Qian, Meiyan; Hegarty, Josephine; National Natural Science Foundation of China; Yangzhou University
Background: Internationally, several clinical practice guidelines recommend active surveillance as a non-surgical management strategy for select patients with low-risk papillary thyroid carcinoma. However, patient's decision making when choosing active surveillance as a management approach is not well understood. Thus, our aim was to examine the barriers and facilitators to selecting active surveillance amongst patients with low-risk papillary thyroid carcinoma in China. Methods: Thirty-nine participants diagnosed with low-risk papillary thyroid carcinoma were purposively recruited between July-Nov 2021 for semi-structured interviews; 24 of whom rejected and 15 patients chose 'active surveillance' as a management approach in our sample. Inductive content analysis illustrated emerging themes. Audit trails, member checks and thematic discussions were used to assert rigor. Results: Barriers and facilitators were classified as patient-related, disease-related, and external factors. Patient-related factors included patient's knowledge, attitudes and emotions. Disease-related factors included the response to having cancer, the constant state of being diseased and perceived value of the thyroid gland. External factors included the residual effects of surgery, the active surveillance protocol and physicians' recommendations. Conclusions: Patient's the acceptability of the active surveillance as a management approach are complex with many influencing factors. The public acceptance of active surveillance as a disease management approach needs to be improved, through the presentation of active surveillance as an evidence-based and optimized dynamic management strategy. Clinicians must address their patients' psychological struggles when patients choosing active surveillance and patients require more attention and supportive intervention.
Becoming a father of a child with an intellectual disability- a narrative inquiry of Irish fathers’ stories
(University College Cork, 2014) Marsh, Lynne; Savage, Eileen
Background: This thesis explored men’s experiences of becoming a father of a child with an intellectual disability in the early years. In Ireland, it is estimated that there are almost 97% (n= 9,914) children with intellectual disabilities living at home in the care of parents, siblings, relatives or foster parents. While mothers and fathers are the primary caregivers, mothers’ experiences are well documented in comparison to the dearth of reports on fathers’ experiences. This descriptive narrative study aims to redress this gap in knowledge and understanding of men’s experiences of becoming a father of a child with an intellectual disability in the early years. Method: Narrative inquiry was employed for this study as it allows stories told by fathers to be collected as a means of exploring men’s transition to becoming a father of a child with an intellectual disability. A sample of 10 fathers of children with intellectual disabilities aged between thirteen months and five years of age were recruited from a large intellectual disability Health Service Provider (HSP) in the South of Ireland. Data were collected through semi-structured interviews which were audio-recorded, transcribed, and analysed using a narrative thematic approach. Findings: Findings are presented in four themes: i) ‘becoming a father’, ii) ‘something wrong with my child’, iii) ‘entering the world of disability’ and iv) ‘living a different life’. For all 10 fathers the time of being told that their child had an intellectual disability was laden with negative emotional responses irrespective of whether the diagnosis was at birth or more gradual over the child’s early developmental period. When fathers found out that ‘something was wrong’ they spoke of ‘moving on’ and entering the world of disability. In their narratives, becoming the father of a child with an intellectual disability had changed their lives and would inevitably change their futures. Fathers’ positivity was clearly evident with many fathers identifying that the diagnosis of their child with an intellectual disability was not a life ending event but rather a life changing event. Conclusions: Healthcare professionals have a critical role in supporting fathers during the transition to becoming a father of a child with an intellectual disability. Factors which require consideration include recognising that each father’s experience is unique; that fathers require support; and that fathers achieve personal growth because of their experiences of their transition to becoming a father of a child with an intellectual disability in the early years.
Bedside handover: structure, process and content - a mixed methods study
(University College Cork, 2018) Forde, Mary; Hegarty, Josephine; Coffey, Alice
Background: The handover (also termed handoff) of patient information and patient care is an essential, albeit risk laden and time consuming activity in clinical nursing practice. Therefore, this nursing practice is both of importance and concern for patient safety and nursing management. The continuity of care and patient safety are dependent on the accuracy and completeness of the information exchanged during the transfer of responsibility for patient care from one nursing shift to another. A desire to increase patient participation, improve effective communication and minimise risk, are the primary driving forces for implementing bedside handover. Aim: The aim of this study was to describe the structures, processes and content of bedside handover at the change of nursing shift. Methods: A mixed methods design was used. Data were collected via observation and audio recording 30 episodes of bedside handover. The study was conducted in a private acute-care hospital, and included six diverse clinical areas, encompassing both medical and surgical wards. Utilising the dedicated HoW4 tool, designed to capture the discrete factors unique to bedside handover, the observations were documented. The audio recordings of the episodes of handover were analysed using content analysis. The five domains of the British Medical Association’s Safe Handover – Safe Patients framework (BMA 2004) were used to structure the observations. The quantitative and qualitative data generated, were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient’s bedside during the change of nursing shift. Findings: The HoW4 tool, modelled on the BMA framework, established a clear plan for describing the structure, process and content of bedside handover at the change of nursing shift. Triangulation of the quantitative and qualitative datasets exposed areas of importance. How information is shared at the patient’s bedside during the change of nursing shift is of particular relevance. There is a reliance on both verbal and nonverbal communication skills. Large volumes of complex patient information are shared at a fast pace between nurses in the presence of the patient. The outgoing nurse leads the dialogue during the handover and influences the degree of patient participation. Furthermore, handover at the bedside is an opportunity for the development of a caring connection between the nurse and the patient. Conclusion: Bedside handover is a multifaceted nursing skill that encompasses the exchange of a large volume of complex patient information, the transfer of responsibility from the outgoing to the oncoming nurse necessitating intricate human interactions within a limited timeframe. Bedside handover does not infer patient participation; however, it does have potential to involve the patient. Greater clarity is need in defining the patient’s roles in handover. Bedside handover needs to be aligned with strategic goals and be supported by an organisational culture that values patient participation. Healthcare organisations need to consider the support structures that are required to balance the competing the objectives of implementing bedside handover, which are: improved communication, increased patient participation, reduced risk and increased efficiency.
Birth as a neuro-psycho-social event: an integrative model of maternal experiences and their relation to neurohormonal events during childbirth
(Public Library of Science, 2020-07) Olza, Ibone; Uvnas-Moberg, Kerstin; Ekstrom-Bergstrom, Anette; Leahy-Warren, Patricia; Karlsdottir, Sigfridur Inga; Nieuwenhuijze, Marianne; Villarmea, Stella; Hadjigeorgiou, Eleni; Kazmierczak, Maria; Spyridou, Andria; Buckley, Sarah; European Commission
Background: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. Methodology: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women's subjective experiences of physiological childbirth. Findings: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. Conclusion: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.
Born and raised into homelessness, overcrowding and substandard housing: Experiences of families engaged with the Young Knocknaheeny Home Visiting Programme
(Young Knocknaheeny ABC, 2019) Martin, Shirley; Curtin, Margaret
This report examines the experiences of a number of families engaged with the Young Knocknaheeny Area Based Childhood Programme (YK). It demonstrates the lived reality of homelessness, housing insecurity and sub-standard home environments as experienced by some of the families participating in YK’s pre-birth to three Infant Mental Health (IMH) Home-visiting Programme. The report offers insight into homelessness, overcrowding and sub-standard housing as experienced by babies, young children and their parents.
Born too soon: preterm birth in Europe trends, causes and prevention
(World Health Organization Regional Office for Europe, 2015) Murphy, Margaret M.; McLoughlin, Geraldine; United Nations Population Fund, United States
It is estimated that 15 million babies annually are born too soon, which is before 37 completed weeks of gestation and that this number is rising (1). Complications of preterm birth are the leading cause of death among children less than 5 years of age and this accounted for nearly one million preventable deaths in 2013 (1). The United Nations Millennium Development Goal (MDG) 4 targeted a two-thirds’ reduction of under five deaths by 2015 and recommended interventions to prevent preterm birth and to improve survival for preterm newborns (2). While infant and maternal mortality rates have witnessed some improvements, the burden of mortality and morbidity in the perinatal period remains a major concern (3). This is due in part to the high number of births per year, the young age of the maternal and infant population harmed by adverse perinatal events and the long-term sequelae of adverse pregnancy events such as very preterm birth or severe hypoxia (4).
Bowel symptom experiences and management following sphincter saving surgery for rectal cancer: A qualitative perspective
(Elsevier, 2012-07) Landers, Margaret; McCarthy, Geraldine; Savage, Eileen; Health Research Board
The aim of this research was to explore participants’ qualitative perspectives on bowel symptom experiences and management strategies following sphincter saving surgery for rectal cancer. Methods and sample The data presented in this paper were gleaned from a semi-structured question that formed part of a larger multi-site quantitative correlational study. From a sample of 143 participants, a total of 77 (62.6%) males and 46 (37.3%) females provided qualitative comments. Participants were aged 30–70 years and over, had undergone sphincter saving surgery for rectal cancer in the past 3–42 months. Data were analysed using pre-determined semi-structured categories. Key results The study demonstrated the subjective nature of the bowel symptoms experienced. It also highlighted the bowel symptoms that were most problematic and the effect of these symptoms on participants’ daily lives. In addition, the self-care strategies that worked best for individual participants in the management of bowel symptoms were identified. Conclusions There is a need to educate patients on the short-term as well as the long-term bowel symptoms experienced following sphincter saving surgery for rectal cancer. Nurses have an important contribution to make in facilitating patients to choose from a range of self-care strategies to help them manage their bowel symptoms postoperatively.
Bowel symptom management following sphincter-sparing surgery for rectal cancer
(University College Cork, 2019-10-07) O'Sullivan, Mairéad; Landers, Margaret; Hegarty, Josephine
Aims: The aim of this study is to determine the content, format and mode of delivery of an intervention for patients following sphincter-sparing surgery who have experienced altered bowel function. Background: The treatment of rectal cancer often causes the development of life-altering bowel symptoms. Healthcare professionals play a pivotal role in supporting patients in their management of symptoms but increasingly it is recognised that care often becomes the patients’ sole responsibility. Numerous studies have identified the need to support patients in the self-care of their bowel symptoms and to develop interventions to facilitate same. Yet there is a dearth of literature around interventions to support patients with the symptoms specific to rectal cancer treatment, to self-care for their bowel symptoms, which do not involve the use of invasive techniques or continuous health-care professional input. Design: A qualitative descriptive design. Methods: To determine the content, format and mode of delivery of an intervention a purposeful sample of five patients and ten healthcare professionals were interviewed through individual semi-structured, audio-recorded interviews. Participants included those who had undergone sphincter-sparing surgery for rectal cancer and those involved in their care. An initial pilot study was carried out prior to conducting the main study. Data were analysed utilising deductive content analysis and data coded according to pre-determined categories. The research was underpinned by the Symptom Management Theory and also utilised the Medical Research Council Framework Guidance for the Development of Complex Interventions. Findings: Participants acknowledged the existence and impact of bowel dysfunction following surgery for rectal cancer, often continuing for a number of years post-treatment and varying from frequency, urgency and tenesmus to skin irritation and pain, in addition data analysis revealed multiple symptoms which occurred and in addition the variability of these symptoms in relation to severity, duration and associated degree of bother. The psychological and social impact of symptoms was also evident. All participants (n=15) acknowledged issues within the current practice around educating patients about the incidence, treatment and self-care of bowel symptoms, often resulting in prolonged periods of symptom experience or use of unhelpful or unsafe self-care strategies. Additionally, participants identified the need for the development of an intervention to support patients. Patients and healthcare professionals identified a phone application as a convenient and accessible method but also acknowledged the need for a booklet/written mode to cater for those less able to utilise technological formats. Of interest some healthcare professionals felt that a leaflet format would be preferable as a means of intervention delivery, this contrasted with the views of patients who felt an online or phone application format would allow greater accessibility and convenience. The intervention proposed is a multi-modal format which provided patients with information around medication, diet, skin care, resources, alternative therapies and pelvic floor exercises. Finally, throughout all interviews the need for a human contact, i.e. ability to access a healthcare professional, was highlighted as a pivotal and important feature of any intervention. Conclusion: This research has provided insights into the bowel symptoms experienced by patients following sphincter-sparing surgery for rectal cancer, the impact of these symptoms, the strategies utilised to manage these symptoms. Importantly, this study identified the need to create an intervention to allow patients to manage their symptoms in a safe and evidence-based manner and determined the appropriate content, format and mode of delivery using the findings of interviews with both affected patients and those involved in their care.
Bullying in schools: an evaluation of the use of drama in bullying prevention
(Taylor & Francis Group, 2019-06-18) Goodwin, John; Bradley, Stephen K.; Donohoe, Peadar; Queen, Katie; O'Shea, Maev; Horgan, Aine M.
Bullying can have a severe effect on the physical and mental health of young people. This qualitative descriptive research aimed to develop an understanding of young peoples? experiences of an educational, interactive theatre-based workshop (the Bullying Prevention Session) which focused on developing strategies to address school bullying. Focus group interviews were conducted with students from six schools. Students reported that the workshop improved their understanding of the complexities of bullying, including appreciating the situation from the perspectives of both bullies and bystanders. Students noted their dissatisfaction with the schools? efforts to implement bullying reduction strategies that they suggested at the workshop.

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