Nursing and Midwifery - Masters by Research Theses

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    An exploration of joint working between intellectual disability and acute service providers when people with intellectual disabilities access acute care services: findings from a qualitative study
    (University College Cork, 2023) Kelleher, Eileen; Martin, Dr Anne-Marie; Caples, Dr Maria; Wills, Dr Teresa
    Background: People with intellectual disabilities often avail of/use intellectual disability services within the community. However, they experience more health needs and are therefore twice as likely to access acute services compared to the general population. Several reports and enquiries have highlighted the sub-optimal care provided to this group while accessing care in acute services. Joint working between intellectual disability and acute services has repeatedly been identified as one measure to address the issues faced by people with intellectual disabilities in acute services. Aim: The research aimed to explore joint working between intellectual disability and acute service providers when adults and children with intellectual disabilities access acute care services. Method: A review protocol was first conducted which guided a mixed-method systematic review which explored current evidence of joint working compared to non-joint working. Data were analysed thematically. The findings of this review informed a qualitative descriptive study, which explored intellectual disability service providers experiences of joint working with acute service providers. Ten healthcare professionals took part in semi-structured interviews which were analysed using thematic analysis. Findings: When present, joint working was found to promote continuity of care. However, both studies found an absence of joint working between acute and intellectual disability services. Joint working was influenced by inter-service communication and both studies identified poor communication and information-sharing between services despite measures being in place to facilitate communication. Confusion regarding the role and responsibilities of service providers was found to negatively impact joint working, and the absence of specific intellectual disability policies and procedures contributed to this confusion. Healthcare professionals in acute services were found to have limited knowledge on the needs of those with intellectual disabilities and the supports available in intellectual disability services. Trust between services was considered important to ensure the future success of joint working. Conclusion: Benefits and challenges of joint working between both services were identified. Joint working creates better understanding between services and ensures continuity of care for those with intellectual disability. There is a need to strengthen joint working between services by improving communication between services providers to ensure better information-sharing. There is a need to establish the role and responsibilities of each service provider to improve joint working.
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    The influence of gender on paternal involvement in the treatment process of a child or adolescent with an eating disorder
    (University College Cork, 2022-06-29) O'Sullivan, Hazel; O'Donovan, Áine; Goodwin, John
    Aim: To identify factors that influence paternal engagement in the treatment process of a child or adolescent with an eating disorder. Background: Eating disorders are complex mental health issues and are exacerbated by a high mortality rate. Adolescence is the period of development when an eating disorder typically commences. International and national guidelines recommend the involvement of the family in the treatment process. However, barriers can exist on both an organisational and on an individual level. The family is an important source of support, yet there is a lack of research pertaining to the factors that facilitate or prevent fathers from participating in the treatment process. Method: A scoping review of the literature was undertaken to identify what key information existed within the current literature and research pertaining to the topic under examination. Thirteen studies were identified as pertinent to the research question posed. Following analysis, these studies identified the importance of parental involvement in the treatment process but pointed to fathers assuming a more peripheral role. Thus, to further understand the processes that contributed to paternal engagement this research sought to further examine the paternal role within the treatment process. It was determined that a qualitative descriptive approach would best suit the research aim. Data were obtained by conducting focus groups with a total of seven fathers agreeing to participate in two focus groups. Both focus groups were guided by a semi-structured interview guide. A qualitative content analysis approach was used to analyse the data regarding paternal experiences of engagement in the treatment process. Findings: Four themes were generated from the data. These were; fathers didn’t see this coming, no one place for one person to go alone, we are not as in touch with our children and the eating disorder as a mental illness. Conclusion: Fathers described themselves as on the periphery of the family, they identified themselves as experiencing things differently to mothers with a belief their role was to provide support to their wives and children within the treatment process. Impact: Healthcare providers need to be aware of the contribution of gendered roles within the family system, and the need to consider this when working with families within the treatment process.
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    Examining fathers’ feeding practices with their children
    (University College Cork, 2021-12-21) O'Connor, Simone; Mulcahy, Helen; Leahy-Warren, Patricia
    Background: The prevalence of obesity is increasing globally at a rapid rate resulting in a significant threat to public health. Only thirty-seven percent of the Irish population have a normal Body Mass Index (BMI), while 25% of children in Ireland are overweight or obese (Department of Health 2016). Gregory (2015) identified that fathers wish to be more involved in the care of their children than what they currently are. Fathers remain underrepresented in the literature relating to their children’s health outcomes. Aim: The aim of this research is to examine fathers’ feeding practices with their children. Methods: A cross-sectional quantitative research design was utilized. A convenience sample of fathers (n=129) in Ireland who had children 18 years or younger prior to the commencement of the study were recruited through various online platforms. Data were collected using a demographic questionnaire and the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007). A cross-sectional quantitative research design was utilized. A convenience sample of fathers (n=129) in Ireland who had children 18 years or younger prior to the commencement of the study were recruited through various online platforms. Data were collected using a demographic questionnaire and the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007). Once data collection was completed the data were coded using the guidelines from Musher-Eizenman & Holub (2007). The response options utilized a 5-point response scale. A Microsoft Excel Sheet was prepared, and data were entered into it. SPSS version 25 was used for analysis. The mean and standard deviation per subscale of the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007) were calculated, Spearman's rank correlation coefficient (p value) was used to examine the relationship between age of child and each subscale of the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007) and the Mann–Whitney U test was used to exam the relationship between child gender and each subscale of the Comprehensive Feeding Practices Questionnaire. Results: Of 129 respondents, almost half were in the 35-44 age range, only 5.4% were between the ages of 18-25 years. The majority identified as white and had achieved third level qualifications. Most responses were based on children ages 2 to 10 years old, and forty-five percent answered in relation to male children. Ninety-three percent of respondents were not concerned about their child’s weight, while 89% categorised their child’s weight as ‘average’. The feeding practices used most frequently by respondents were Encourage Balance and Variety (M 4.66(SD 0.5)), Modelling (M 4.3(SD 0.8)) and Monitoring (M 4.01(SD 0.91)). Fathers’ feeding practices were found to be the similar regardless of gender. Conclusion: Fathers have become more involved in the routine tasks of childcare which were once seen as the mother’s role (Taylor et al., 2013). Despite this the Mixed Methods Systematic Review (MMSR) showed that fathers were underrepresented in the literature. The MMSR found that fathers did have concerns regarding their children maintaining a healthy weight. In the current study most respondents were not concerned about their child’s weight. Fathers’ feeding practices were found to be similar regardless of gender, while they varied with child age. The majority of respondents (93.8%) were not concerned about their child’s weight. Fathers’ feeding practices were found to be similar across both genders. Findings of this study should be used to inform healthcare professionals’ interventions with fathers with regard to their feeding practices and ensure that they are included in all parenting interventions. Based on these findings it is recommended that future studies using the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007) with a larger probability sample would further inform the application of appropriate clinical and parenting interventions. Implications for clinical practice: Healthcare Professionals should provide education to both fathers and mothers involved in relation to their children’s health. If both parents attend their child’s healthcare visits, healthcare professionals should focus advice, information, and questions equally towards both parents.
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    Determining the biopsychosocial factors of chronic pain in older adults to inform the development of a risk appraisal checklist for use in long term care: a Delphi study
    (University College Cork, 2021) Clifford, Michelle; Cornally, Nicola; Fitzgerald, Serena
    Background: In long term care (LTC), the prevalence of pain is 43% (van Kooten et al., 2017), and this, coupled with the high prevalence of dementia (Zimmerman et al., 2014), lends itself to complex practice issues in terms of pain assessment. The American Society of Pain Management Nursing published the hierarchy of pain assessment techniques developed by Pasero and McCaffery (2011) to guide pain assessment in people unable to self-report. The first step of this framework focuses on awareness of potential causes of pain, hence the importance of identifying the biopsychosocial factors associated with chronic pain in older adults. Improving pain assessment can improve older adults' quality of care and the ultimate quality of life. However, very little research has supported the early identification of older persons at risk of unreported chronic pain due to communication impairment or a neurodegenerative disease such as dementia. Using a multi-dimensional lens, this research aims to identify the biopsychosocial factors of chronic pain in older adults to inform the development of a risk appraisal checklist for use in long-term care. Methods: Chen et al. (2016) proposed a four-phase process when employing a Delphi technique to develop a quality instrument. These phases include identifying an expert panel, generating initial factors, and identifying the final factors and instrument development. The first three phases were the focus of this study. Following the identification of an expert panel in chronic pain, phase two involved completing a scoping review to create a list of the initial factors. There was a total of fifty-nine biopsychosocial factors identified from the empirical literature. These factors were used to inform round one of the modified e-Delphi surveys. A consensus agreement rate of 50% was applied for this study for round one, median ≥4 for round 2 and ≥90% agreement for inclusion in round three. Thematic analysis of open-ended responses also took place. Results: Thirteen experts in gerontology and chronic pain participated in a minimum of two rounds. There was a desirable international spread from eight countries, and 68.4% of the experts had >21 years of experience in their field of expertise. The 59 initial factors identified from the scoping review were presented to the experts in round one. Fifty (84.7%) biopsychosocial factors achieved a 50% or greater agreement of factor importance. Sixty-three factors were presented to the expert panel in round two, 33 factors were rerated from round one, nine factors were modified, and the experts identified 21 new factors. The results from round two, a total of fifty-one factors, achieved a median of ≥4 and were presented in round three. The final twenty-two factors that achieved ≥90% consensus agreement in round three for inclusion included; age, female gender, arthritis, lower back pain, malignancy, family history of chronic pain, multiple comorbidities, trauma and/or accident, multiple sites, anxiety and depression, social isolation/loneliness, post-traumatic stress, childhood physical/sexual abuse, maladaptive beliefs, poor sleep hygiene and/or insomnia, substance abuse, low socioeconomic background, chemotherapy medication, history of opioid use and poor access to health care. Conclusion: This study has laid the foundations for future research and innovation in comprehensive pain assessment in older adults, focusing on identifying risk factors in older persons for whom accurate self-report of chronic pain is challenging due to communication and/or cognitive impairment. The twenty-two factors identified from this study will inform the development and testing of the Chronic Pain Risk Appraisal Checklist (C-PRAC) for LTC use.
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    The development of a dementia communication intervention for undergraduate nurses based on the VERA framework
    (University College Cork, 2020-08-17) Sisk, Ali-Rose; Naughton , Corina; University College Cork
    Background: Patients with dementia experience emotional distress due to difficulties communicating physical and social needs. This is compounded by inadequate dementia communication skills among qualified nurses and student nurses. Aim: The project aims were to adapt a dementia communication training intervention, examine acceptability among undergraduate nursing students and test the feasibility of designing a randomized controlled trial (RCT) to evaluate the intervention. Methods: The intervention involved a 1.5-hour dementia communication workshop based on the VERA framework and used information giving, role play, discussion and student manual. Study Design: A quasi-experimental pre-post control trial was used with mixed-methods data collection (student survey, semi-structured interview and non-participatory observations of students in clinical practice). Results: In total, 49 students completed the post intervention survey (i=26, c=23). There was a significant increase in awareness of person-centred response scores in the intervention group 13.1 (SD1.95), compared to the control group 10.6 (SD3.0), p=0.03, there was no other significant differences. Eleven students were observed interacting with patients with dementia (n=219 interactions). There was no significant difference between the groups with missed opportunity for positive interactions observed in both groups. Qualitative interviews with students (n=8) that received the intervention indicated they valued the training but inconsistently used the dementia communication skills in practice. Barriers to implementing the new skills were a lack of role modelling from qualified staff, busy environment and little emphasis on person-centred interactions in clinical practice. Conclusion: The VERA dementia communication intervention was well received by students and may increase their ability to identify person-centred responses, but this may not change communication behaviour. This feasibility study, suggest that a RCT may not be possible and other pragmatic trail designs should be used to evaluate this education intervention.