Nursing and Midwifery - Journal Articles
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Item Treatment effect analysis of the Frailty Care Bundle (FCB) in a cohort of patients in acute care settings(Springer, 2024) Crowe, Colum; Naughton, Corina; de Foubert, Marguerite; Cummins, Helen; McCullagh, Ruth; Skelton, Dawn A.; Dahly, Darren L.; Palmer, Brendan A.; O'Flynn, Brendan; Tedesco, Salvatore; Health Research Board; South South-West Hospital; Science Foundation IrelandPurpose: The aim of this study is to explore the feasibility of using machine learning approaches to objectively differentiate the mobilization patterns, measured via accelerometer sensors, of patients pre- and post-intervention. Methods: The intervention tested the implementation of a Frailty Care Bundle to improve mobilization, nutrition and cognition in older orthopedic patients. The study recruited 120 participants, a sub-group analysis was undertaken on 113 patients with accelerometer data (57 pre-intervention and 56 post-intervention), the median age was 78 years and the majority were female. Physical activity data from an ankle-worn accelerometer (StepWatch 4) was collected for each patient during their hospital stay. These data contained daily aggregated gait variables. Data preprocessing included the standardization of step counts and feature computation. Subsequently, a binary classification model was trained. A systematic hyperparameter optimization approach was applied, and feature selection was performed. Two classifier models, logistic regression and Random Forest, were investigated and Shapley values were used to explain model predictions. Results: The Random Forest classifier demonstrated an average balanced accuracy of 82.3% (± 1.7%) during training and 74.7% (± 8.2%) for the test set. In comparison, the logistic regression classifier achieved a training accuracy of 79.7% (± 1.9%) and a test accuracy of 77.6% (± 5.5%). The logistic regression model demonstrated less overfitting compared to the Random Forest model and better performance on the hold-out test set. Stride length was consistently chosen as a key feature in all iterations for both models, along with features related to stride velocity, gait speed, and Lyapunov exponent, indicating their significance in the classification. Conclusion: The best performing classifier was able to distinguish between patients pre- and post-intervention with greater than 75% accuracy. The intervention showed a correlation with higher gait speed and reduced stride length. However, the question of whether these alterations are part of an adaptive process that leads to improved outcomes over time remains.Item Staff experiences of working with children and adolescents engaging in behaviours that challenge in mental health and paediatric inpatient environments: A qualitative exploratory study across four European countries(Taylor & Francis, 2024-11-26) Goodwin, John; O'Malley, Maria; O'Donovan, Aine; Allen, Stephanie; Curtin, Margaret; Goulding, Ryan; Groen, Gunter; Heffernan, Sinead; Ivanova, Svetla; Korhonen, Joonas; Jörns-Presentati, Astrid; Kostadinov, Kostadin; Lalova, Valentina; O'Mahony, James; Petrova, Gergana; Vainio, Ville; Lahti, Mari; Erasmus+There has been a recent global increase in the number of young people experiencing mental health challenges in both child and adolescent mental health settings and acute paediatric settings. In many of these settings, restrictive practices are used to manage behaviours that challenge, such as aggression and violence. However, little is known about staff’s experiences with responding to behaviours that challenge in these settings. A qualitative descriptive design was adopted, with participants engaging in 1:1 interviews or focus groups in Ireland, Finland, Germany, and Bulgaria. Data were analysed using reflexive thematic analysis. Four themes were identified: (1) the importance of establishing a safe, therapeutic environment, (2) identified antecedents to behaviours that challenge, (3) how staff respond to behaviours that challenge, and (4) the needs of staff when maintaining a safe, therapeutic environment. Consideration needs to be given to the environments where young people are cared for, with an emphasis placed on safe, comfortable, therapeutic spaces to reduce behaviours that challenge. Staff should be better trained in trauma-informed practice, and both staff and service users should be provided with opportunities to de-brief following episodes of restrictive practices, with a focus on enhancing and maintaining therapeutic relationships.Item Trends, causes and factors associated with primary Postpartum Haemorrhage (PPH) in Ireland: A review of one million hospital childbirths(Elsevier, 2024-08-21) Fitzgerald, Imelda; Corcoran, Paul; McKernan, Joye; O'Connell, Rhona; Greene, Richard A.Objective: To analyse temporal trends for primary Postpartum Haemorrhage (PPH), Major Obstetric Haemorrhage (MOH) between 2005 and 2021 and to examine the causes and factors contributing to the risk of PPH during 2017–2021. Methods: International ICD-10-AM diagnostic codes from hospital discharge records were used to identify cases of PPH. Temporal trends in PPH and MOH incidence were illustrated graphically. Poisson regression was used to assess the time trends and to examine factors associated with the risk of PPH during 2017–2021. Results: A total of 1,003,799 childbirth hospitalisations were recorded; 5.6% included a diagnosis of primary PPH. Risk increased almost fourfold from 2.5% in 2005 to 9.6% in 2021. The ICD-10 AM code for other immediate primary PPH was recorded for 85% of PPH cases in 2017–2021 whereas a diagnosis of uterine inertia/atony was associated with just 3.6% of the cases. Respectively, trauma-related, tissue-related and thrombin-related causes were associated with one third, 4.2% and 0.5% of cases. A wide range of factors relating to the woman including comorbidities, mode of delivery, labour-related interventions and associated traumas increased risk of PPH but placental complications, especially morbidly adherent placenta, were strong risk factors. Conclusions: Improvement in detection and anticipation of placental complications may be effective in addressing the increasing trend of PPH, however, the trends of increasing C-sections and other interventions may also need to be addressed while staff education and quality improvement projects will have a role to play.Item Identifying the needs of women following a severe postpartum hemorrhage(European Publishing, 2024-06) Fitzgerald, Imelda; McKernan, Joye; Greene, Richard; O'Connell, RhonaIntroduction: Childbirth is a unique experience for women. In Ireland, major obstetric hemorrhage (MOH) is the most frequently reported severe maternal morbidity (SMM) with an incidence of 3.27 per 1000 maternities. Much is known now about the management of postpartum hemorrhage (PPH), and there is some research on women and their partner's experience. Less is known about how the woman feels emotionally following a PPH or what informational needs and emotional support are required. The aim of this study was to understand how women felt after experiencing a severe PPH, to listen to their first-hand experience, and to learn what improvements could be made for future care for women who experience a PPH. Methods: A descriptive, quantitative approach was conducted using semi-structured interviews with women who had a severe hemorrhage (blood loss) of ≥2.5 L between four and fourteen months postpartum. Results: Five women took part in this study. The women identified a lack of information provided to them about the reason for the significant bleeding. The women voiced they could overhear information about the event discussed between healthcare professionals but not with the woman. The care the women received in the High Dependency Unit (HDU) was significantly different from the care they received in the postnatal wards, and the women were not informed they were clinically well for transfer to the postnatal ward. It was reported that the postnatal wards were busy and short-staffed, and the women looked for more emotional support from staff, which was not available. This had an effect on their recovery in the postnatal period. Conclusions: The women reported that they wanted more information in the early postnatal period following the event, and some still had unanswered questions at the time of the interviews several months later. Most of the participants did not receive adequate emotional support from the midwives caring for them, which resulted in the participants requesting early discharge home to get emotional support from members of their family.Item Healthcare professionals’ perspectives on use of PCSK9 inhibitors in cardiovascular disease: an in-depth qualitative study(Oxford University Press, 2024-05-24) Lee, Geraldine A.; Durante, Angela; Baker, Edward E.; Vellone, Ercole; Caggianelli, Gabriele; Dellafiore, Federica; Khan, Mutiba; Khatib, Rani; European Society of Cardiology; Amgen; Novo NordiskAim: Injectable medicines such as PCSK-9 inhibitors are increasingly used to manage risk factors for cardiovascular events with little information around the perceptions of healthcare professionals (HCPs) on the administrative and clinical practicalities. The aim was to identify the facilitators and barriers on the use of injectable therapies with CV benefits through interviews with HCPs. Methods and results: Qualitative interviews were conducted in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. A total of 38 HCPs were interviewed, 19 in each country composing of physicians (n = 18), pharmacists (n = 10), nurses (n = 9) and pharmacy technician (n = 1). Four themes emerged: (i) Clinicians’ previous experiences with injectable therapies (ii) Challenges with patients’ behaviours and beliefs (iii) Clinicians’ knowledge of injectable therapies and therapeutic inertia and (iv) Organisational and governance issues. The behaviour and beliefs from healthcare professionals focused on facilitating behaviour change as well as the poor interdisciplinary working and collaboration. Therapeutic inertia was raised where physicians either lacked awareness of injectable therapies or were unwilling to prescribe them. The importance of facilitating patient education on injection techniques was highlighted while organisational and governance issues identified the lack of guidance to inform practice. Clear pathways are required to identify those who were eligible for injectable therapies as well as on how injectables should be prescribed. Conclusion: If medicine optimisation is to be achieved, there needs to be structured processes in place to identify eligible patients and the development of educational material.