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12th Annual Interdisciplinary Research Conference

Transforming Healthcare through Research and Education

9th & 10th November 2011

School of Nursing and Midwifery

Trinity College Dublin

Book of Abstracts

Book of Abstracts: 12th Annual Interdisciplinary Research Conference Transforming Healthcare through Research and Education: 9th & 10th November 2011

Presenter Page

Adams John 9

Arkins Brigid 10

Begley Cecily 11

Bergin Michael 12

Bourke Margaret 13

Bourke Rita & Tully Agnes 14

Boyd Fiona - concurrent paper 15

Boyd Fiona - poster 16

Brady Anne-Marie 17

Brady Vivienne 18

Breen Marianne 19

Brown Mary Jane 20

Buckley Sinead 21

Carlisle Susan 22

Cleary-Holdforth Joanne & Leufer Therese 23

Collins Rita 24

Comiskey Catherine 25

Connor Ballard Patricia 26

Corry Margarita 27

Coyne Imelda 28

Daly Deirdre 29

Davis Theresa Marie 30

Day Alison & Oldroyd Carol 31

Denieffe Suzanne 32


Presenter Page

Devlin Breige 33

Doody Owen 34

Dowling Maura 35

Doyle Carmel 36

Doyle Louise 37

Doyle Yvonne 38

Ellilä Heikki 39

Flood Bernadette 40

Friesen Mary Ann 41

Grimes Patricia 42

Hahessy Sinead 43

Harnett Gerardina 44

Hayes Anne 45

Hegarty Josephine 46

Herron Maria 47

Hickey Philip 48

Hollywood Eleanor 49

Houlihan Derry 50

Hughes Ben 51

Huntley-Moore Sylvia 52

Kane Fiona 53

Kennedy Jane 54

Keogh Brian 55

King Carole B 56

Kirwan Marcia 57


Presenter Page

Lamminpää Reeta 58

Lawlor Anne 59

Ling Julie 60

Lourenço Alfredo Cruz 61

Mc Partland Alaine 62

McCann Margaret 63

McCollum Patricia 64

McDonald Marilyn 65

McGrath Deirdre 66

McKiernan Dee 67

McKinney Aidín 68

Mee Lorraine 69

Meskell Pauline 70

Mooney Mary 71

Morrissey Jean 72

Muldoon Kathryn 73

Mulkerrins James 74

Murphy Maryanne - concurrent paper 75

Murphy Maryanne – poster 76

Nevin Mary 77

Nicholl Honor 78

O’Brien Frances 79

O’Connell Rhona 80


Presenter Page

O’Donnell Sharon 81

O’Grady Tom 82

Ohaja Magdalena 83

Oldroyd Carol & Day Alison 84

O’Mahony Máirín 85

O’Reilly Aileen 86

O’Reilly Maeve 87

O’Sullivan Karin 88

O’Toole Doris 89

Quigley Carmel Anne 90

Quinn Claire 91

Quirke Mary Brigid 92

Ryan Withero Philippa 93

Sharoff Leighsa 94

Sheehan Orla 95

Smith Valerie 96

Smyth Siobhan & Jordan Fionnuala 97

Speroni Karen Gabel 98

Stewart Jessica 99

Stoutt Anne 100

Suchicital Liliana 101

Sweetman Susannah & Dunlea Margaret 102

Synnott Robyn 103

Thompson Emer 105

Tobin Kathryn Marie 106


Presenter Page

Tully Agnes & Conway Yvonne 107

Walls Aisling 108

Watts Mike 109

Wills Teresa - concurrent paper 110

Wills Teresa – poster 111

Wood Maggie 112

Wynne Ciara 113

Zeni Mary Beth 114

Index of all authors 115


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Return to contents page

Transatlantic influences on mental health nursing practice: a UK case study Author: John Adams RN MPhil PhD Affiliation: Anglia Ruskin University, Peterborough, UK Email: [email protected] Background It is widely known that Hildegard Peplau was influenced by developments in British mental health care during her service with the Army Nurse Corps at the 312th Field Station Hospital in England during the Second World War. In this paper it is argued that in the post-War period, American influences on UK mental health care were both profound and long-lasting. Aim To explore the impact of American ideas on medical and nursing practices in one UK hospital. Method This doctoral historical study used documentary analysis of published and manuscript sources, together with 27 oral history interviews, to explore the conceptual basis of care practices in one English mental health hospital. Ethical permission to conduct the interviews was obtained from the relevant NHS local research ethics committee and the university ethics committee. Findings The influence of American researchers of the 1950s, such as Stanton, Schwartz, Dunham and Belknap, was apparent in the early adoption of a ‘social model’ of care in the hospital. Their ideas also influenced its commitment to using social science research strategies on a continuing basis. During the 1960s, contacts made with Erikson, Goffman, Kesey and Rogers further reinforced transatlantic influences on care practices in the hospital. Maxwell Jones, who worked on both sides of the Atlantic, helped to facilitate the transformation of conventional wards in the hospital into ‘therapeutic communities’. Aspects of nursing practice which were influenced by American ideas ranged from the regular ward meetings to the early adoption of research and publishing strategies. Conclusion The development of mental health nursing practice in the UK in the second half of the twentieth century owed much to American influences.


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Underlining Risk Factors in Young People Presenting to the Emergency Department with Trauma or Deliberate Self Harm Brigid Arkins, Catherine McAuley School of Nursing and Midwifery, University College Cork. E.mail: [email protected], Tel: 021 4901516 Mark Tyrrell, Catherine McAuley School of Nursing and Midwifery, Eddie Herlihy, North Lee Mental Health Service Title & Background: Underlining risk factors in young people presenting to the emergency department with trauma or deliberate self harm. Trauma and deliberate self harm (DSH) in the 15-24 year old age group are two of the major presenting groups to the Emergency Department (ED). 60% of deaths in young Irish people were due to accidents or suicide. A history of trauma and / or DSH has been identified as two major risk factors for these types of deaths. Aim and Objectives: The aim of the study was to examine the existence and nature of the main risk factors in young people presenting to the ED. The main risk factors were identified as, high risk taking behaviour, poor interpersonal conflict resolution and hazardous substance use. The study also aimed to examine the difference in these risk factors in young people presenting to ED with DSH in comparison to young people presenting to the ED with trauma. Methodology: A quantitative descriptive correlational design was used. 230 16-24 year olds presenting to the ED with DSH or trauma were selected. Data was analysed using SPSS. Descriptive and inferential statistics were employed. Ethical approval was given. Key Findings: The underlining risk factors for trauma and DSH presentations to the ED were similar. 50% of both groups had repeat presentations to the ED within the previous year. Risk taking behaviour was high between both groups. Substance misuse in this population was hazardous. Both groups predominate conflict resolution style was poor. Conclusion & Implications: High risk taking behaviour in combination with hazardous substance misuse and poor conflict resolution styles are predisposing factors for repeat presentation to the ED with DSH or trauma in young people. Psychosocial assessments and management in the ED are necessary to accurately identify the issues which the young person are presenting with in order to avoid repeat presentation.


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Midwives’ Expertise in Expectant management of the Third stage of labour in Ireland and New Zealand: the ‘MEET’ study. Cecily M Begley1, Karen Guilliland 2, Lesley Dixon2, Mary Reilly3, Caroline Keegan4 1School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland ([email protected]), 2 New Zealand College of Midwives,3 Cavan General Hospital, Cavan, Ireland, 4 Midwifery-led Unit, Our Lady of Lourdes Hospital, Drogheda, Ireland Background: Two main methods of third stage management exist, active (AMTSL), with oxytocics given routinely to prevent postpartum haemorrhage (PPH), and expectant (EMTSL), where no routine oxytocics are used. Observational studies in Ireland and New Zealand suggest that, when EMTSL is employed for women with normal labour and birth and care is given by midwives skilled in EMTSL, blood loss is low. Aim: To explore the views of expert midwives in Ireland and New Zealand of why they use EMTSL, what skills they employ, and how they obtain such good maternal outcomes. Methods: Ethical approval was granted by the lead author’s institution. A qualitative descriptive approach used semi-structured, recorded interviews with 27 expert, consenting midwives in Ireland and New Zealand in 2010. “Expert” midwives were those who used EMTSL in 30% or more of births, and had PPH rates of <4%. The constant comparative method of analysis was applied. Findings: Most participants considered EMTSL, with no intervention unless necessary, to be best for normal, healthy women. Their role was one of “watchful waiting,” and letting parent-baby relationships develop in a time of rest and quiet. The main features of EMTSL were: listening to how women felt, skin-to-skin contact, breast-feeding, avoiding touching the uterus or clamping the cord, using upright positions and maternal effort. These midwives were not unduly concerned about PPH, and believed that AMTSL, which they used for high-risk women, produced more blood loss. Conclusions and implications: Some aspects of EMTSL described are not documented in midwifery or obstetric text-books and need to be emphasised to improve care given in the third stage. Midwifery students should be taught to use EMTSL correctly in theory and practice situations. A randomised trial is necessary to compare AMTSL with EMTSL, in women with physiologically normal labours, using the correct methods shown here.

mailto:[email protected]


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The Case for ‘Social Domains Theory’ as a Social Ontology and ‘Adaptive Theory’ as a Methodological Approach for the study of Gender and Mental Health Authors: Michael Bergin, MMedSc, BSc (Hons), RPN, RGN Lecturer in Nursing, Department of Nursing, School of Health Sciences, Waterford Institute of Technology, Cork Road, Waterford, Ireland [email protected] Professor John S. G. Wells, PhD, MSc, BA (Hons), PGDip(Ed), RPN, RNT Head of the Department of Nursing, School of Health Sciences, Waterford Institute of Technology, Cork Road, Waterford, Ireland [email protected] Professor Sara Owen, PhD, BA, BEd, RMN, SRN, RNT Dean of Faculty and Professor of Nursing, University of Lincoln, Faculty of Health, Life and Social Science Brayford Pool Lincoln LN6 7TS [email protected] Background: Adaptive theory presumes a stratified social world and focuses on the diverse interconnections between human agency, social activities and social organizations (structures and systems). Adaptive theory accommodates other approaches, such as relativism and empiricism but is not restricted by their epistemological precepts. It stresses that social research should concern itself with understanding agency-structure relationships against the background of multiple social domains - ‘psychobiography’, ‘situated activity’ (subjective) ‘social settings’ and ‘contextual resources’ (objective). Aim: To explore how adaptive theory may facilitate exploration of gender and mental health care provision. Description: This paper reports on the use and value of adaptive theory in a study conducted on gender and care provision in one mental health service over a two year period. Evaluation: Adaptive theory facilitates exploration at a subjective and objective level. For this study adaptive theory facilitated the researcher to capture the inter-dependent and independent properties of service users’ and providers’ subjective experience of services and gendered service structures. The study explored how mental health care practices were sustained and sometimes changed over time by individuals. It also explored how social settings and contextual resources (such as knowledge, norms, values and power) exist and influence successive generations of service providers and users to reproduce and sustain existing practices. Equally, service providers and users may exert influence and transform existing social settings based on changing contextual resources (new knowledge, increased equality for women and men, changing norms and values). Conclusion: Gender and mental health care represent a complex social reality that operates at intra/interpersonal and organisational/institutional levels. Adaptive theory allows the researcher to shift towards and between all levels with none having analytical primacy. Its blend of inductive and deductive procedures challenges many of the current qualitative methodological approaches that pre-occupy nursing research in particular.


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‘Mental Health Nurses Experiences of Caring for Adolescents Who Engage in Deliberate Self Harm’ Margaret Bourke, (R.P.N.) (Student in Msc. Mental Health (Child, Adolescent & Family Strand) Trinity College, Dublin. Email: [email protected] Pádraig Mc Bennett (R.P.N. R.G.N.) B.Sc (hons). M.Sc. Lecturer, Trinity College, Dublin. Email: [email protected] Background: According to the literature, deliberate self harm (DSH) among young people is a major concern to health, social, educational and criminal justice services across Europe (Anderson et al 2007). The literature identifies that there are strong links between suicide and previous attempts of deliberate self harm. Hawton et al, (2003) report that between a quarter and a half of those committing suicide have previously carried out a non-fatal act. Mental Health Nurses working within adolescent Mental Health units experience constant interaction with young people who engage in deliberate self harm. Anderson (1999) identifies that they are at the forefront of contributing to future ways of intervening and working with this group of individuals. How mental health nurses intervene at this point of contact may have a significant influence on how an adolescent responds to the support they are offered. Aim & Objective: There is a paucity of research on this subject in an Irish context. Therefore, the aim of the research study was to investigate mental health nurses experiences of caring for young people who engage in deliberate self harm within an Irish mental health inpatient setting. Method: Ethical approval was sought and obtained by the author’s institution. The study was conducted using a qualitative descriptive approach. A purposeful sample of six Mental Health Nurses was used. Data was collected using semi-structured interviews. Findings: The findings of this study highlight the lack of support that Mental Health Nurses experience within their clinical environment. Thus, this can leave nurses feeling frustrated and unable to carry out their nursing practice duties effectively and confidently. Furthermore, this study revealed that nurses had a strong desire to expand their knowledge of this subject as they felt they had not received enough education on how to manage this area at undergraduate level. Conclusion and Implications: It is hoped that that the findings of this study will facilitate nurses to reflect on their care giving, and will provide knowledge to inform future practice development and evaluation of services. It is also anticipated that this study will contribute to the current body of knowledge for nurses and act as a catalyst for future discussion and debate about this phenomenon.


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THE INTEGRATION OF CLINICAL SUPERVISION IN A PRE-REGISTRATION MENTAL HEALTH PROGRAMME 1Siobhan Smyth, [email protected]; 2Rita Bourke, [email protected] 1Steve Bradley, [email protected]; 2Geraldine Freeman, [email protected]; 1Andrew Hunter , [email protected] 2Lucy Scanlon [email protected]; 1Agnes Tully , [email protected] 1School of Nursing and Midwifery, National University of Ireland, Galway 2Health Service Executive (West), Galway Background During the 2nd Semester of the mental health nursing student’s final year, a 36 week clinical internship is undertaken. This involves students working full time in mental health settings. The students are guaranteed four hours of reflective practice every week. The reflective practice format is similar to models of clinical supervision (CS). The proposal was to formalise this process to benefit the students. Introducing CS at this transitional stage of the students’ career is aimed at increasing their professional development and openness to receiving and delivering CS in the future. In spite of international evidence that CS has an overwhelmingly positive response from nurses, who welcome the structured opportunity to discuss clinical issues, there is still a limited uptake and development of CS amongst MHNs in Ireland. Aims and Objectives The paper aims to describe the psychiatric student nurses’ experience of partaking in CS during the internship year of the four year Bachelor of Nursing degree programme. Method Following participation in CS for six months, 19 student nurses were interviewed within three focus groups. A semi-structured interview schedule was used to guide the focus group discussions. The study was approved by the University’s Research Ethics Committee. Findings Three main themes that were identified from the data were (1) Transitions, (2) Support/sharing and (3) Safety. It is envisaged that the outcomes of the study will assist educators and clinicians who are considering introducing CS in the undergraduate programmes. The findings indicate that CS is a possible strategy, within the internship reflective practice sessions, to complement and enhance the learning experience for preparation for future roles as a MHN. Conclusions and implications Overall, the students greatly valued the experience. They identified many gains from the process, and they advocated for CS to be included as an integral part of the internship experience for future cohorts.


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From trauma to recovery: A life course study of experiencing a mental disorder Author: Fiona Boyd, M.Soc.Sc, School of Nursing & Midwifery, Trinity College Dublin. email: [email protected] Background: The initial aim of this study was to investigate the relationship between socio-economic circumstances and mental health from the perspective of mental health care users themselves. However, this transformed into a life course study informed by the stories that emerged during fieldwork. Aims and objectives of the study: To give voice to mental health service users and to make sense of the relationship between their traumatic life event, the onset of their mental disorder and their path to recovery. Method: Unstructured, in-depth interviews were conducted with a convenience sample of five people who had recovered from a mental disorder. The institution in which this thesis was conducted did not require ethical approval to be observed. However, ethical considerations regarding confidentiality, informed consent and participation were strictly adhered to. Grounded theory and the Nudist computer programme were found to be an inadequate response to the complex issues revealed through the interviews. A life course approach was thus adopted. Findings: A life course approach allowed for sequential relationships to be established, that both enable and constrain participants well-being. Negative factors that proceeded mental disorder included trauma, inappropriate and inadequate treatment and care, structural impediments to housing and education/employment and unstable family relationships. Positive influences that were identified as enabling mental health and establishment of self worth were productivity and creativity, strong social bonds and resistance and resilience to the dominant biomedical model of mental disorders. Conclusions and implications: The findings indicate that traumatic events can be a contributory factor to the onset of a mental disorder. Future research in this area needs to be cognisant of the fact that some qualitative research methods can be overly restrictive to fully encapsulate the complexity of human experience


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Involving mental health service users in research: Developing a benchmarking tool for best practice. Authors: Fiona Boyd, MSocSc, Dr. Marianne Breen, Dr. David Hevey & Prof. Agnes Higgins, Trinity College Dublin. [email protected]. Background: Both national and international policy documents and organisations such as National Institute for Clinical Excellence and the Mental Health Commission Ireland strongly endorse partnership between clinicians and service users in the development and delivery of services and in all stages of the research process. Involving mental health service users in the evaluation of services and as equal partners in the research process is a relatively new development in the Irish context. During an evaluation of a collaborative peer and clinician led development of a psychoeducation intervention, the authors identified the need for a benchmarking tool for examining and ensuring that the principles of optimum service user participation are being adhered to. Aims and objectives: This paper discusses a model of best practice for mental health service user involvement in research that was developed by the authors. This guiding tool aims to maximise meaningful service user involvement and minimise tokenism. Description of innovation: A model of participation in decision-making from a community development perspective was identified in the literature and mapped to the research context. This model by Sherry Arnstein conceptualises participation in terms of a levels on a ladder, ranging from level one (no participation) to level eight (citizen power). Evaluation of innovation: A ‘ladder of service-user participation in research’ emerged from this mapping. The lowest ‘rungs’ on the ladder identify tokenistic involvement (e.g. member of research consultative committee only). The top ‘rung’ of the ladder is where service users are integral to establishing the research agenda, development of the research proposal, recruiting research team members, developing research design, and all levels of data collection, analysis and dissemination. At each stage of the authors’ research project, this ladder was successfully used as a benchmark to determine the level of service user involvement that was being engaged in. This process was supplemented through the use of reflective journals by the research team and regular reflective sessions, informed by the first person enquiry method. Conclusions and implications: This ‘ladder of participation’ tool will serve as an invaluable roadmap for those designing and implementing mental health service user research studies.


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Work conditions and factors that influence career intent of degree graduate nurses Dr Anne-Marie Brady BSN/MSc, PG Dip CHSE, PG Dip Stats, PhD, RGN, RNT Lecturer School of Nursing and Midwifery Trinity College Dublin 24 D'Olier Street Dublin 2 [email protected] Background The conversion to the four year degree as the exclusive entry point to the nursing profession in Ireland represents a major reform in nurse education, and has implications for the nursing work force. New graduate turnover rates are high and this study sought to gain understanding of the factors that influence this important employment indicator among degree graduates. Design A quantitative national survey using a census sample of degree nursing graduates (n=473) was undertaken in this sequential explanatory mixed method study. Ethical approval was secured from the researcher’s affiliated university. The European Nurses’ Early Exit study (NEXT) questionnaire was adapted for use with Irish degree graduates. The career intentions, employment profiles, occupational demands, and personal demands were examined to determine the factors that influence intent their intent to stay in or leave the profession. Findings Twelve percent of participants expressed intent to leave the profession in the next five years although 19% reported thinking about leaving nursing frequently. A number of explanatory factors had a ‘push or pull’ influence on intent to leave the profession. Job satisfaction and professional commitment were predictive of intent to stay in the profession while only ‘uncertainty regarding treatment’ was predictive of intent to leave the profession. Inadequate information and absence of doctors during medical emergencies were indicative of uncertainty for graduates. Conclusion Turnover rates are high among degree graduates and similar levels of employment instability have been found internationally. It is difficult to quantify the quality of care loss from high rates of new graduate turnover, but transient employment patterns may be associated with adverse effects on the continuity of care. Turnover at this stage of career is influenced by normal graduate desire to maximise their professional development opportunities and so it may not be as responsive to human resource strategies to reduce turnover and maximise retention.


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On Being Heard: Women Voicing their Needs in Preparation for Motherhood. Vivienne Brady, Doctoral Student HRB Clinical Research Fellow. RM, RGN, RNT, BSc (Hons), MSc. Email: [email protected]. Dr. Joan Lalor, School of Nursing and Midwifery, Trinity College Dublin. Background: Traditionally and also in the current context, minimal consultation with women exists in relation to planning and developing maternity services in Ireland. It is anticipated that research incorporating a Participatory Action Research (PAR) approach will work towards rectifying this serious deficit, by seeking women’s views and perceptions of their anticipated needs in preparation for motherhood. Aim: This research focuses on developing antenatal education in preparation for motherhood based on knowledge that is created in collaboration with mothers, mothers to be and antenatal educators, using a Participatory Action Research Approach (PAR). Methodology: The focus of PAR is to highlight the perspectives of individuals and groups who have been denied the opportunity to inform the policies and processes that affect them. The research participants form a collaborative inquiry group, which consists of pregnant and postnatal women, together with antenatal educators (midwives, physiotherapists and dieticians). Participants take part in an action research cycle (ARC) of gathering evidence or constructing, planning action, taking action and evaluating action. Knowledge is generated through individual and group discussion, field notes, and reflection, and conversations are analysed using a Voice Centred Relational Method (VCRM). Ethical Dimensions Ethical approval for this research was granted by the research and ethics committee of the relevant maternity care service and the Research Ethics Committee of the Faculty of Health Sciences, Trinity College Dublin. Informed consent and protection of participants applies. Findings The current paper focuses on pregnant women’s accounts of their anticipated needs and expectations in preparation for birth and motherhood, prior to attending antenatal education classes. Women voice feelings of vulnerability, isolation and fear regarding loss of control and personal autonomy during pregnancy, labour and birth. Reasons cited for hospital based class attendance include gaining knowledge of practices specific to the relevant maternity care setting and developing relationships with potential carers, which were considered essential to securing positive birth experiences. Implications for Practice It is anticipated that knowledge that is co-created by women will contribute towards antenatal education that is relevant and meaningful for women as new mothers.


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Peer-led psychoeducation for those with experience of psychosis: A systematic review of research evidence.

Authors: Dr. Marianne Breen, Fiona Boyd, MSocSc, Dr. David Hevey & Prof. Agnes Higgins, Trinity College Dublin. [email protected]. Aim of review: Psychoeducation interventions are structured information programmes, focusing on enhancing the emotional, social and behavioural well-being and the recovery journey of the individual with experience of psychosis. This paper is the first to assemble the main empirical findings in the area of peer led psychoeducation. It also underlines the existing gaps in the emergent literature.

Search and review methodology: A narrative literature review was undertaken by consulting a range of databases including Science Direct, Web of Science, PsychInfo, Pubmed, British Nursing Index, CINAHL, JSTOR and Academic Source Complete. Examples of search terms included: schizophrenia, bi-polar, severe mental health difficulties, education intervention, information programme, psychoeducation, peer-to-peer, peer-led, out-patient, community. These terms were used in various permutations to search the literature. Hand searches and scrutiny of references supplemented this process. This search also included the examination of 4 recent Cochrane systematic reviews of psychoeducation and other psychosocial interventions. Two authors assessed study quality and extracted data.

Findings: The vast majority of studies tend to focus on professionally developed and led interventions. In recent years however, there has been a notable increase in the number of studies examining peer-led psychoeducation interventions (i.e. developed and delivered by those with previous experience of using mental health services). Nine relevant studies were identified. Findings from the studies indicate that participation in peer-led psychoeducation enhances well being, as measured by both recovery and traditional clinical tools. Peer taught psychoeducation programs also increase knowledge of mental illness, the mental health system and self-care. Peer facilitators serve as credible and positive role models. Pre/Post-course surveys and structured interviews are the typical methodologies used. Longitudinal study designs would enable the long terms benefits of these interventions to be assessed.

Conclusions: This review collates the key findings from the literature on this emerging, invaluable intervention. In addition to providing a synthesis to guide the further refinement and development of such initiatives into the future, it also identifies the need for more longitudinal studies.


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Does the addition of motivational strategies to healthy lifestyle interventions for preventing obesity in pregnancy improve key clinical outcomes? A Systematic Review. Authors: Mary Jane Brown, Professor Marlene Sinclair, Dr. Dianne Liddle, Dr. Alyson Hill & Dr. Elaine Madden Contact details: [email protected] Aim of review: While past reviews focus on the effectiveness of multiple interventions to prevent excess weight gain in pregnancy; none have explored the unique effect of motivationally-designed interventions. The aim of this review is to explore the effect of psychology-based interventions on women’s behaviours to maintain optimal weight during pregnancy. Search and review methodology: Literature searches were conducted in 7 databases alongside hand searching of journal articles and citation tracking. Search terms included a combination of behavioural and theoretical terms. Selected studies were based on strict inclusion criteria e.g. studies of any design involving modification to diet and physical activity levels (alone or in combination) and report a weight related outcome. The PRISMA guidelines and Cochrane Collaboration Pregnancy and Childbirth Group Guidelines for Systematic Reviews were followed throughout. Methodological assessment according to criteria outlined in the Cochrane Handbook identified studies as ‘low’, ‘high’ or ‘unknown’ risk of bias. Outcome measures were assessed using the GRADE guidelines for assessing the quality of evidence; while theoretically the studies were classified according to four main motivational presuppositions. Findings: 11 studies met the set criteria for inclusion. Motivationally, the majority of interventions were cognitive and behavioural orientated interventions. Goal setting and problem solving were the most frequently applied motivational strategies. Delivery was mainly through one-to-one counselling sessions or telephone messaging; written educational materials were also cited as intervention components. Significant improvements in weight gain during and following pregnancy was noted as a result of the theoretical interventions. Despite these positive results, the overall quality of the studies was low. Conclusion and implications: Interventions incorporating underlying motivational theories can be successful in helping women to control their weight during pregnancy. Higher quality trials are needed to determine the most effective and replicable components of the motivational interventions to prevent excessive pregnancy weight gain.


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Mental Health Conditions on a Children’s Ward; Lessons for the Children’s Nurse Sinéad Buckley, School of Nursing & Midwifery, Trinity College Dublin. [email protected] Title and background: Failure to provide effective, appropriate and timely interventions to young people experiencing mental health difficulties can have profound and lasting consequences. In Ireland, up to 20% of young people experience mental health distress. Nursing staff practicing in general paediatric settings need to be prepared to nurse young people with mental health problems. Aims and objectives of the study Then aim of the study was to highlight the experiences of children’s nurses who care for young people with mental health conditions in general paediatric settings. The objectives of this study were to: explore the nursing needs, highlight the mental health conditions and identify the general satisfaction children’s nurses had when nursing young people with mental health conditions in paediatric wards. Method An exploratory descriptive methodology was implemented. Ethical approval was granted by appropriate committees. Response rate of 56% (n= 39) registered nurses employed in two Irish general paediatrics wards. A questionnaire entitled ‘Nurses’ Experiences of Nursing Young People with Mental Health Problems in the Paediatric Ward Setting’ was used for data collection. The questionnaire was predominately quantitative with three open-ended questions to generate qualitative data. SPSS and content analysis was used for data analysis. Findings Overall 67% of nurses were dissatisfied with having to nurse young people with mental health problems. 68% of nurses had inadequate educational preparation in the area of young people’s mental health conditions. 81% of nurses believed that in-service courses in their relevant hospitals did not facilitate mental health issues in young people. Anorexia Nervosa, Depression and Suicidal Tendencies were the three commonest problems identified. Conclusion and implementations The study highlighted that registered nurses had concerns in relation to management issues with 87% of nurses implying that young people with mental health problems should be nursed by mental health nurses in separate adolescent units.


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Supporting nursing students acquire essential clinical skills Susan Carlisle Nurse Lecturer School of Nursing and Midwifery Queen’s University Belfast, BT9 7BL. Email: [email protected] Background: NMC state Registered Nurses must have the knowledge and skills necessary for safe and effective practice when working. The aim of undergraduate curricula is to produce safe, competent, knowledgeable caring practitioners. Aims and Objectives: To support students in acquiring essential clinical skills in year one undergraduate curricula. Description of Innovation: Embedded in the School curricula is the importance of Clinical skills teaching which encompasses the psychomotor, cognitive and affective components of the nursing skill. In year one, the theory relating to each skill is taught as a lecture. Practical classes are held in the Skills Centre. This is essential to allow students to acquire confidence prior to practising these skills on placements. The teacher demonstrates the skill to small groups of students and each individual is given an opportunity to practise in a safe controlled environment under supervision. Students in these classes practise on each other where appropriate which helps give them insight into how the patient/client may feel and this helps to address the affective component. To reinforce this, students may refer to the School’s online Video clips of the skills. They are also directed to a workbook and pocket-sized ‘Clinical Skills Quick Reference Guide.’ developed in-house. Students may to refer to this booklet on placement, prior to carrying out any of these essential nursing skills. Mentors are aware of this resource and together with the workbook, these are effective resources for linking theory to practice. Evaluation: Students have evaluated all the resources positively, particularly the videos and the reference guide as valuable learning resources in preparing for practice placements and the Objective Structured Clinical Examination (OSCE). Conclusions and implications: The resources we have developed equip our students with the skills and confidence to link skills theory to practice and improve their nursing skills effectively when on placement.


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Education for Excellence – Transforming Healthcare through Education and Evidence Based Practice. Joanne Cleary-Holdforth RGN, RM, Cert in Renal Nursing, BSc (Hons), MSc (Hons), PG Dip in Third Level Learning & Teaching. Cert in EBP Mentorship (ASU) Ms. Therese Leufer RGN, BSc (Hons), PG Dip HEd, MA HEd, RNT, ILTM, EdD candidate (Bris). Cert in EBP Mentorship (ASU) School of Nursing, Dublin City University, Glasnevin, Dublin 9. Telephone: 00 353 1 700 8522 Email: [email protected] Background In order to promote excellence in healthcare, it is essential to engender a culture of evidence-based practice (EBP). In the current climate, demands on healthcare professionals to ensure that the care they deliver is based on the best available evidence is now more crucial than ever. Frequently we are confronted with incidents in patient care that result in serious consequences which undermine the public’s confidence in the healthcare system. This clearly has implications for nurse education and nurses in practice. Aim of the Study To introduce EBP in a pre-registration undergraduate nursing research module and evaluate its impact on subsequent practice. Research Methodology Descriptive exploratory design with non-probability convenience sampling. Two separate questionnaires were distributed to the same group on two separate occasions (pre-test data on commencement of research module / post-test data upon its completion). The sampling frame comprised 174 students currently pursuing a nursing degree, which yielded a response rate of greater than 60% both pre- and post-data collection. Ethical approval obtained. Findings Among other preliminary findings, participants strongly agreed that EBP results in the best clinical care for patients. Pre-test scores reveal a positive predisposition amongst students towards EBP. However, pre-test implementation scores were particularly poor, indicating very low utilisation of evidence in practice. More encouragingly, post-test results demonstrated a continued positive attitude and belief in EBP in addition to a statistically significant improvement in the post-test implementation scores. Conclusions and Implications Results from this study reinforce the evidence that advocates the integration of EBP into nursing curricula. As previously by the same authors, the positive pre-disposition to EBP is generally present amongst nurses. However, it is the prevailing poor utilisation of EBP in practice that is potentially a hindrance to achieving clinical excellence. Equipping nurses with the necessary knowledge and skills to operationalise EBP at the bedside is key to transforming healthcare.


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Using Blended Learning to Teach Computer Skills in a Residential Care Setting Dr Rita Collins, UCD School of Nursing, Midwifery & Health Systems, UCD, Belfield. D 4. [email protected] Ph 01 7166406 Ms Aine Mc Hugh UCD School of Nursing, Midwifery & Health Systems, UCD, Belfield. D 4. PRIMER-ICT was a European funded project to teach computer skills to older people using a blended learning approach. It differs from other computer projects for older people in that it takes an intergenerational and health sector approach to teaching. The project used students from health and ICT related fields (community nurses, nurses in elderly homes, volunteers), to educate older people in the use of computers. As well as teaching older people to use computers the project also aimed to contribute to the reduction of isolation within the older population through the promotion of ICT channels of communication. The project was executed by the consortium of four European partners University of Maribor, Faculty of Health Sciences (Coordinator), Slovenia, University of Surrey, University of Dublin, Carinthia University of Applied Sciences, Austria. In Ireland the course was delivered to residents within residential care settings. As this was not a data collection exercise but rather an educational delivery it was not necessary to seek ethical approval. However, permission was sought and gained from the relevant care home to implement the project. The entire content of the course was available online and the delivery method was one-to-one face-to-face between the older person and the teacher. Each country adapted the course to suit their population of older people. The fundamental similarity was the need to build a trusting relationship between the older people and those who taught them. The outcome of the implementation of the blended learning courses was the improvement of elderly ICT skills and the promotion of well being and social integration as measured by a course evaluation questionnaire administered after the educational input. This project also assists in meeting the HIQA standards for Residential Care Settings for promoting health behaviours and for providing social contact.


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A national longitudinal study modelling drug treatment outcomes for opioid users with and without children in their custodial care at intake Prof Catherine Comiskey BA(Mod), MSc, PhD. Director of Research and Associate Professor of Healthcare Statistics School of Nursing and Midwifery Trinity College Dublin 24 D’Olier St Dublin 2 Ireland [email protected] Background: The aim of this research was to investigate the effects of having children in a client’s custodial care on outcomes for opiate drug treatment. The objective was to provide specific measures and models for these effects. Method: A three year national, longitudinal prospective cohort study was implemented. Recruitment occurred in 44 settings. Outcomes were measured using the Maudsley Addiction Profile. Ethical approval was obtained from the National University of Ireland Maynooth. Analysis was completed using SPSS 16 and descriptive statistics and generalised linear models were explored. Findings: A total of 404 clients new to treatment were recruited and 97% were located at three years. Analysis revealed that there were only minor differences in outcomes for those with or without children in their care at intake. At one year significantly fewer of those with children in their care were using heroin, benzodiazepines and cannabis and these clients were also using heroin on significantly fewer days. However, having children in clients care at intake was a significant and positive predictor of using other opioids at one year. Analysis also revealed that there was a significant reduction in the proportion using alcohol in the last 90 days amongst those with no children in their care and also a significant reduction in the mean days alcohol was used by this group. No such significant reductions were found within the group who had children in their care. Conclusions and implications: Findings demonstrated that while clients with children in their care did demonstrate significantly better outcomes in terms of heroin and benzodiazepine use, these same clients failed to demonstrate significant improvements in their alcohol use. Service providers need to be aware of the challenges facing parents in opiate treatment and while these clients may improve they may be at risk of using other substitute drugs.


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Development of a Community Health System-based Nursing Research Center Patricia Connor Ballard APRN-BC, MSN, PhD Director, Inova Nursing Institute for Education and Research Inova Health System, Falls Church, Virginia 22042 USA Contact information: Dr. Patricia Connor Ballard, 4519 Lark Lane, Alexandria, Virginia 22310 USA. Telephone 001-703-822-9993 or [email protected] Background: A nursing research committee was transitioned into a health system-based nursing research center (NRC). Objectives: The NRC provided oversight for nursing research across the system, partnering with the multi-disciplinary research center and institutional review board (IRB). NRC objectives included dissemination/transfer of research into clinical practice and education, and promotion of research skills among nursing staff. Description: The NRC included monthly nursing research councils on both the system and hospital level. Staff nurses served on the five hospital councils, with hospital council chairs serving on the system-based council. Research priorities were selected and endorsed by senior nursing leadership. Multiple research designs were chosen to explore nursing as an art and a science. To promote research skill acquisition, an internship program was established to mentor staff nurses conducting research in alignment with NRC priorities. Interns attended a novice nursing research workshop, developed an IRB-approved proposal for implementation, and were expected to disseminate their findings through presentation and/or publication. A scholarship program was established to generate doctoral-prepared nurses in order to advance the nursing research program and enhance evidence-based nursing practice within the health system. Evaluation: In 2010, our nurse researchers presented study findings through podium or poster presentations at system, local, regional, national, and international forums. In addition, multiple manuscripts were published by peer-reviewed nursing journals and texts. To promote dissemination of nursing research findings, the health system hosted a two-day international nursing research conference in April 2011. The main theme of the conference, in alignment with NRC priorities, was symptom management and palliative care. Numerous NRC interns were selected by a blind peer review process as podium presenters for this conference. Conclusion: The establishment of a hospital-based nursing research center is an effective option for enhancing research skill acquisition, conduction of research, and dissemination of research findings.


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Measuring caregiver burden in Multiple Sclerosis: a literature review Author: Margarita Corry, School of Nursing & Midwifery, 24 D’Olier Street, Trinity College Dublin, Dublin 2. [email protected] Background The majority of care provided for people with multiple sclerosis (PwMS) is provided by partners or spouses. Research suggests that carers of PwMS experience caregiver burden. Although the concept of caregiver burden has been explored for caregivers in general, there is a lack of conceptual analysis of the concept from the perspective of carers of PwMS. This provides a challenge for researchers working with this carer population as quality research outcomes are dependent on choosing an instrument with good psychometric properties. Aim To present an overview of the instruments used to measure the concept of burden in research with carers of PwMS. Search and review methodology Databases searched include: CINAHL, ProQuest, PubMed, PsychINFO, AMED, Web of Knowledge, Nursing and Allied Health resources, Nursing at OVID database, Academic Science Premiere Search. No search limits were applied. Key words used in the search included multiple sclerosis, carer(s)/caregiver(s), burden, strain, stress. Papers were included if they used an instrument to measure caregiver burden in PwMS. Findings Ten studies used structured measures of caregiver burden. A total of seven different tools were used. These included the caregiver Strain Index (CSI), caregiver Reaction Assessment (CRA), carer perceived burden visual analogue scale, caregiver burden Scale, caregiver self-reported burden (SRB), the Zarit Caregiver Burden interview, the Spanish version of the Zarit Caregiver Burden Interview and the Maslach Burnout Inventory (adapted to care for an ill spouse). Most of the studies report previously published psychometric properties of the instruments as justification for their use in this population. Conclusion The findings provide evidence that the CRA is a psychometrically sound instrument for measuring caregiver burden in MS and is the only tool that has been tested and found responsive to change over time, supporting its use in longitudinal and experimental research studies.


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A qualitative study of professional-parent-child interaction in healthcare decision-making. Authors Prof. Imelda Coyne, Associate Professor, Trinity College Dublin [email protected] Ms Ana Martins, Doctoral candidate, Trinity College Dublin Dr Gemma Kiernan, Lecturer, Dublin City University Dr Veronica Lambert, Lecturer, Dublin City University Background: Through voice it is argued, children’s views can be asserted and represented as valid in their own right with respect to their perspectives and understanding of the social world. There is now greater recognition of the power imbalances between adults and children which has led to increased focus on uncovering the different roles parents, children and health professionals occupy in triadic healthcare interactions. Aim: To investigate children’s participation in decision-making from the perspectives of children and adolescents, their parents, and healthcare professionals. Methods Data were obtained from 70 participants via interviews, observations and focus groups. The sample consisted of hospitalised children aged 7-16 years (n=22), their parents (n=16) and healthcare professionals (n= 32). Ethical approval was obtained for this study. Findings Although there appeared to be support for children’s participation, the level of involvement allowed varied considerably. The child was not perceived to be an equal or regular participant by adults. The data revealed important relational and structural aspects that mediated or obstructed children’s voices. Although children’s preferences for involvement varied, their participation existed on a continuum that was influenced and controlled by parents primarily and latterly by healthcare professionals. Parents acted as gatekeepers, therefore their support was essential for enabling the child’s voice to be heard. Involvement was mainly seen as primarily a means to achieve the child’s cooperation and not as something that conferred significant benefits on the child. Little attention has been paid to the actual content of the participants’ linguistic behaviour in healthcare encounters and this study contributes critical new information to this area.


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The multiple meanings of maternal morbidity Authors: Daly Déirdre , Begley Professor Cecily , Clarke Professor Mike . School of Nursing and Midwifery, Trinity College Dublin Contact details: Déirdre Daly, PhD student, School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2. Tel. (01) 8962604. Email: [email protected] Aim of review: This is a systematic review on maternal morbidities experienced by postpartum women. Search and review methodology: The search terms were used: pregnancy; labour; birth; childbirth; parturition; pregnancy outcome; postnatal; postpartum and were linked with (maternal) morbidity and complications. The databases searched were: Pubmed, Cinahl, Cochrane and Midirs Maternity and infant health. The search was last updated in May 2011. Findings: Searching the literature on the general health morbidities experienced by postpartum women is not without its challenge. Many terms are used interchangeably and the findings of the search included many studies focused on underlying maternal disease, case studies and case reports, severe morbidities, near miss events as well as neonatal outcomes. Whilst initial studies reported on the prevalence a single morbidity or on the range of morbidities experienced at a point in time, more recent studies tend to be longitudinal and report on prevalence and resolution or persistence over time. The studies have shown that some of these morbidities are associated with mode of delivery whilst many are concomitant. The general health morbidities reported are varied and include backache, headache, tiredness, perineal pain, urinary incontinence, bowel problems and faecal incontinence, dyspareunia and other sexual problems, and depression. An increased risk of readmission to hospital following caesarean section with wound infection has also been reported. Conclusions and recommendations: The review revealed the multiple meanings of the term ‘morbidity’ and the many and varied morbidities experienced by women during the postpartum years. Agreement on the meaning of terms to be used when reporting on maternal morbidities, similar to what has been achieved in the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology), would aid clarity, eliminate omissions and enhance the dissemination of research on the general health morbidities experienced by postpartum women.


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Integrating Telemedicine for Disaster Response: Testing the Emergency Telemedicine Technology Acceptance Model (ETTAM) Theresa Marie Davis RN, MSN Operations Director enVision eICU Inova Health System Falls Church, Virginia PhD Candidate George Mason University Fairfax, Virginia [email protected] 703-289-8608 Background: This study explores technology acceptance when introducing mobile telemedicine into emergency departments during a simulated mass casualty incident (MCI). The use of teleICU leverages remote physicians and nurses to multiple hospitals to provide secondary decision support and triage of critical patients. Aim: The purpose of this study is to test the Emergency Telemedicine Technology Acceptance Model in predicting technology acceptance scores. Ethical Considerations: IRB approval was granted for an exempt multi-site study. All subjects were de-identified. An informed consent was attached to each evaluation, the study was explained and risks were identified. Methodology: The Theory of Planned Behavior (TPB) and the Technology Acceptance Model (TAM) were used as a theoretical foundation. Design: A quasi-experimental, retrospective, prospective, comparative design was used to test the effect of the Emergency Telemedicine Technology Acceptance Model to predict technology acceptance scores. Subjects: Subjects consisted of a purposive sample of 85 subjects consisting of leaders, clinicians, paramedics and administrative support that practice at the remote site and/or in the hospital. Exclusion criteria are individuals less than 18 years of age. Measurement: An evaluation tool was adapted to analyze technology acceptance using constructs of TAM and TPB. The tool consisted of 39 questions using a 5-point Likert scale. Training methods were the interventions in the analysis. Analysis: SPSS is used to analyze the data. Preliminary mean score results from phase one of the project prior to training show: perceived usefulness: 3.98; ease of use: 3.62; process understanding: 3.59; attitude toward using: 4.27; intention to use: 4.2; total average mean score: 3.93. Mean scores after training: perceived usefulness: 4.45; ease of use: 4.34; process understanding: 4.03; attitude: 4.78; intention to use: 4.77; total average mean score: 4.47. The Likert scale consisted of elements from 1 strongly disagree, to 5 strongly agree. The number of participating hospitals increased from three to thirteen.


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Developing, implementing and evaluating an NHS Health Check learning tool Alison Day Carol Oldroyd MSc, PGCE, BSc (Hons), RN, RGN MSc, BSc (Hons), PGCE, RGN, RNT Senior Lecturer in Emergency Nursing Senior Lecturer in Adult Nursing [email protected] [email protected] Sonia Godfrey MSc, BSc (Hons) Nursing, SRN, OND, NDN, Cert Ed, PWT Associate Head of Nursing [email protected] Richard Crossman Building, Coventry University, Jordan Well, Coventry, CV1 5RW, United Kingdom Background A scoping exercise undertaken within a UK regional health authority indicated considerable variation in the training that individuals received to conduct Government initiated Free Health Checks. This programme aims at identifying and reducing cardiovascular disease in 40 - 74 year olds. Collaborative working with practitioners resulted in the development of an e-learning tool which prepares individuals to undertake this training. Aim and objectives To develop and evaluate a learning tool to prepare health trainers, pharmacy staff and health care assistants to undertake Free Health Checks. Description of innovation The tool begins with a real-time demonstration of a health check, followed by a step by step breakdown of the clinical skills. Health behaviour experts provide information on how to advise patients regarding lifestyle changes. The learning experience concludes with a multiple choice self-test. The final product is accessed via an on-line portal or DVD. Evaluation of innovation An evaluation questionnaire was sent out to 17 clinical leads. 7 responded (response rate 41%). One area also undertook a more detailed evaluation. The project complied with clinical audit practices and the anonymity of all participants was assured. Both DVD and on-line formats have been utilised with no major issues, although a couple of respondents noted that the videos were slow to load. This is most likely an issue with IT at a local level but could be overcome by accessing the DVD version. When questioned regarding the assessment strategy, respondents commented that the level of the MCQ questions were less challenging than expected, but this was in relation to qualified nurses rather than non-nursing personnel. Conclusion and implications Overall the package appears to have been well received, with Trusts viewing it as a beneficial supplement to pre-existing training. Implementation of the package has now commenced and evaluation is on-going.


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A review of symptoms and cytokine activity in women with breast cancer: Implications for nursing practice. Suzanne Denieffe, Department of Nursing, Waterford Institute of Technology. Cork Road, Waterford. E-mail: [email protected] Professor Seamus Cowman, Head of Department, Faulty of Nursing and Midwifery Royal College of Surgeons. Dr Martina Gooney, Department of Nursing, Waterford. Context and Aim of Review In women with breast cancer, research has identified that cytokines may be linked to cancer progression as the critical mediators of an inflammatory response. In animals, sickness behaviour symptoms such as fatigue, mood and sleep disturbance have been shown to be as a result of the actions of cytokines. It is proposed that the occurrence of these symptoms in women with breast cancer might also be arising as a result of cytokine deregulation. This paper offers an examination of the literature on cytokine activity and symptom presentation in women with breast cancer and implications for nursing practice. Search and Review Methodology Databases were searched; Medline; Cinahl; Embase; Web of Science. Search terms used were cytokine, interleukin, TNF, Interferon, breast cancer, breast neoplasm, symptom, fatigue, depression, mood disturbance, sleep disturbance and insomnia. Studies were eligible for inclusion in the review if there was concurrent measurement of cytokines and symptom assessment. Findings The search identified 20 studies for inclusion in the review. These studies examined the trajectory of the breast cancer journey including from time of diagnosis to survivorship. Symptoms assessed included fatigue, depression and anxiety. A diverse range of cytokines were measured using different protocols. The results of these studies showed evidence of cytokine dysregulation and were promising in identifying cytokines that might be implicated in the causation of symptoms in women with breast cancer. Conclusions and Implications There were many methodological issues in the studies that might be the reason for apparent inconsistencies in the results. There has been speculation regarding the possible usefulness of targeting cytokines in breast cancer patients as a monitoring and/or treatment modality. From a nursing perspective, this might also have the positive effect of reducing the symptom burden in these women and result in overall improvement in quality of life.


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The art of healing - transforming lives through art Breige Devlin MSc Health Promotion University of Ulster; Advanced Diploma in Teaching Studies University of Ulster RN N. Ireland SAA (The Society For All Artists) Member Practice Educator Marie Curie Hospice 1A Kensington Road Belfast BT56NF 02890882029 07540675680 [email protected] Aim: to examine the value of art work in improving expression of feelings and general health. Literature review and clinical practice Findings: art work can increase self-esteem, creativity, understanding; and expression of feelings, thus contributing to an increase in general well-being. Facilities for art work should be provided in health care. Art work does not require artistic skill; rather encouragement in a psychologically safe environment. Abstract Art work has been shown to be beneficial in health care. It can be used as a channel for communication. The process of art work can bring to consciousness that which is unconscious. It is particularly helpful where individuals are unable to express feelings, due to cognitive impairment, dysphasia or because the person does not have the vocabulary to express their feelings. It also addresses the existential dimension, in that it can also help in the search for meaning. This is especially important when one is faced with impaired health or a life threatening condition. Art can improve one’s sense of self-worth as creativity is enhanced. Examples of art work produced by those who have faced illness and its consequences clearly demonstrate some of the feelings and emotions they experienced. Randomized Controlled Trials demonstrate the value of art work in enhancing health and the quality of life. This is not a research study hence ethical approval is not required. Findings are based on clinical practice-working with bereaved children and adults; and a literature review.


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The provision of community nursing support for persons with an intellectual disability and palliative care needs: a descriptive survey. Authors 1Bailey, Maria E.. 1 Doody, Owen.,1 Lyons, Rosemary., 2Walsh, Jackie. 1University of Limerick 2Mid-Western Regional Hospital Dooradoyle, Limerick Contact details for presenting author/s: Dept. of Nursing & Midwifery, Health Science Building, North Bank Campus, University of Limerick, Castletroy, and Limerick. Email: [email protected] Background: The trend for institutional care for persons with intellectual disability has been superseded by a move to community living based on the principle of normalisation and a rights based society. Contrary to this principle, anecdotal evidence suggests a trend towards a return to institutional care for such persons at the end of life. Aim: To describe the incidence and experience of community nurses supporting patients with intellectual disability and palliative care needs. Objectives: Identify referring patterns, reasons for referral and factors that affect provision of community palliative care for persons with an intellectual disability. Method: Ethical approval granted by the author’s institution. 26 item self-administered questionnaires were administered to community nurses employed in research site and engaged in aspects of palliative/end of life care. Data obtained was coded and inputted into PASW 18. Descriptive analysis was conducted to describe frequencies and association between the variables and measured using Chi square tests and symmetric tests. Findings: 32% response was achieved. Of the (n=94) respondents 31.9% had cared for persons with intellectual disability in the last three years. 59.2% of patients were living with family, 20.4% in community houses, 8.2% within intellectual disability services, 12.2% either living alone, in high support units or nursing homes. Reasons for referral included support, therapeutic intervention, assessment and end of life care. Factors impacting on provision of palliative care included nurse’s knowledge and experience in intellectual disability or palliative care, previous knowledge of the family and patient, professional skills and attributes and teamwork. 87.2% of respondents reported requiring education in developing understanding and communicating with persons with intellectual disability and 64.9% requested palliative care education. Conclusions and implications: This study adds to and supports national research knowledge in this area, highlighting challenges and opportunities for community specialist and non-specialist nurses caring for this patient group.


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Transforming nurses/midwives’ research into publication: lessons learnt from a pilot e-learning module. Dr. Maura Dowling, School of Nursing and Midwifery, Aras Moyola, National University of Ireland, Galway. [email protected] Prof. Kathy Murphy, Dr. Adeline Cooney, Dr. Declan Devane, Dr. Pauline Meskell, Dr. Catherine Houghton, National University of Ireland, Galway. Mary Frances O’Reilly, NMPDU HSE West. Background: The development of this e-learning module was in response to the nursing/midwifery research requirements in clinical practice. While many nurses and midwives are engaged in research and audit, the big challenge is getting this work published and sharing knowledge on a national and international forum. Aim and objectives: The aim of this e-learning module was to primarily support but not exclusively, Clinical Nurse/Midwife Specialists and Advanced Nurse/Midwife Practitioners get their research and/or clinical innovations published. The content of module provides participants with the knowledge and skills necessary to publish in peer-reviewed journals. Description: The pilot programme was delivered via the Blackboard Learning System (Version 7), an on-line learning system. Participants (n=30) were divided into six groups, with each group facilitated on-line by a lecturer with experience of publishing in peer-reviewed journals. The module consisted of three units: how the publishing process works, developing skills of writing for publication and the reviewing process. Participants were also supported by their facilitator in writing their paper and choosing a journal. Evaluation: The module’s success is evaluated by: a) Number of papers in draft format at the end of the programme; b) number of papers under peer-review three months after programme ends; c) number of papers published one year after programme ends; d) number of papers published two years after programme ends. Conclusions and implications: While the ‘mystery’ of getting published was resolved for participants, many underestimated the time commitment needed to write for publication. The on-line discussion board did not engage participants as hoped with most participants more comfortable communicating with their facilitator via email or phone. In light of these experiences, our use of the discussion board will be different for the next cohort of participants.


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Which piece? The types of technology used by children with complex needs at home. 1Dr. Honor Nicholl PhD, MEd, RGN, RSCN,RCNT, RNT; 1Carmel Doyle MSc, BNS, Pg Dip, RNT, RNID, RCN; 1Yvonne Lecky MA, BA; 2Sinead Moran Liaison Nurse; 2MaryJoe Guilfoyle Liaison Nurse 1The School of Nursing and Midwifery, University of Dublin, Trinity College, DUBLIN. 2Jack and Jill Children’s Foundation [email protected] Background As many children with complex needs are increasingly dependent on technology in their care, it is essential that technology is identified and quantified. Aim and objectives of the study The aim of this study was to identify the types of technology used by children with complex needs receiving care at home. Objectives: to identify;

• the equipment that is in use within the home in the care of children with complex needs. • the medications that children in the study were currently receiving • key concerns of parents regarding equipment use at home

Method (research design, sample, analysis and ethical approval A 2 phase mixed method qualitative and quantitative research design was adopted. Purposeful sampling was used for Phase 1 which comprised a focus group interview with nurses (n=9) involved in providing services from Jack & Jill Children’s Foundation. Census sampling was used for Phase 2. A questionnaire was administered to parents of children with complex needs. A total of 177 families responded in Phase 2. Quantitative data was analysed using SPSS Version 17 while qualitative data was analysed through simple thematic analysis. Ethical permission was received from the Faculty of Health Sciences at Trinity College Dublin. Findings Many children had multiple diagnoses and co-morbidities including congenital abnormalities, syndromes and cerebral palsy. An overview of the equipment used by children with complex needs in the home were itemised within 7 categories ranging from sleeping to eating and drinking equipment. On average families identified 22 pieces of equipment that were used by the child with mobilisation equipment the most commonly reported. Conclusions and Implications The findings provide a comprehensive account of technology managed by parents of 178 children with complex needs at home. Data gathered provides an important baseline and identifies gaps in equipment provision to these children.


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The identification of adolescent self-harm and an exploration of help-seeking for serious emotional/psychological problems and self-harm. Louise Doyle. School of Nursing and Midwifery, Trinity College Dublin. [email protected]. 8963102 Background: Deliberate self-harm and suicidal behaviour often emerge during adolescence. Community studies identify adolescent self-harm as a relatively common occurrence. Seeking formal help however for psychological problems and self-harm is not common and little is known about the barriers and facilitators to adolescent help-seeking in Ireland. Aim: To identify adolescent self-harm and to explore the barriers and facilitators to seeking help for emotional/psychological problems and self-harm. Objectives: 1. To report the rate of self-harm as identified by adolescents. 2. To determine the factors associated with adolescent self-harm. 3. To identify the help-seeking behaviours for those who have engaged in self-harm. 4. To explore willingness to seek help for emotional/psychological problems and self-harm. 5. To identify the barriers and facilitating factors to help-seeking. Method: This was a two-part sequential explanatory mixed methods study. Part 1 involved the administration of the ‘Lifestyle and Coping’ questionnaire to 856 post-primary school students across 11 schools in Dublin. Descriptive and inferential statistics were produced and a logistic regression model was developed to identify factors predictive of self-harm. Part 2 consisted of four vignette-based focus group interviews with a sub sample of adolescents. Qualitative data were analysed using thematic analysis. Ethical approval was obtained for this study. Findings: Deliberate self-harm was reported by 12% (n=103) of adolescents. The factors most strongly related to self-harm were worries about sexual orientation followed by the deliberate self-harm of a friend. Only a minority of adolescents sought professional help before or after an incident of deliberate self-harm. Findings from the focus groups suggest that fears about being judged, concerns about confidentiality and a perceived generation gap are the main barriers that dissuade an adolescent from seeking professional help. Conclusion and implications: This study has identified the low level of professional help-seeking for serious problems amongst adolescents and the reasons behind their reluctance to seek help. Identifying barriers and facilitators to formal help-seeking can contribute towards the development of a more adolescent friendly help/health service.


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How do we maintain skills in a low volume ECLS centre? Yvonne Doyle RN/RCN, BSc (Hons) ECLS Programme Coordinator, OLCHC, Dublin 12 Mr.Lars Nőlke FRCS-C-Th ECLS Programme Director, OLCHC, Dublin 12 Contact details Yvonne Doyle, ECLS Coordinator, ECLS Department, PICU2, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland. [email protected] +353 1 4096048 Background Extracorporeal Life Support (ECLS) is a form of long-term heart-lung bypass used to treat infants, children, and adults in respiratory and/or cardiac failure despite maximal medical therapy. The term ECLS is literally a temporary artificial lung +/- heart for the patient and is a modification of conventional cardio-pulmonary bypass used for open-heart surgery. Aims and Objectives A significant challenge encountered by the Coordinator was maintaining the skills of those trained specialist nurses whilst only treating 10 patients per year. An imaginative continuing professional development protocol was devised. Description of Innovation An initial preceptorship period of 40hrs was achieved under the supervision of the ECLS coordinator and the perfusion team. All preceptored hours have been gained here at OLCHC, due to imaginative rostering and the total flexibility of the nursing staff. Competence is maintained by performing 72 clinical pump hours every year though this is availability dependent. Bi-monthly Morbidity, Mortality & Improvement (MM&I) meetings, Waterlabs session every 8 weeks with the ECLS Coordinator and a yearly written exam. Evaluation of Innovation As part of the review process it was recommended that a yearly refresher day be included, the content of which would be determined by the ECLS specialist nurses. Conclusions and Implications The educational programme for specialists has recently been awarded the ELSO Award for Excellence in Life Support which is an international award that acknowledges excellence in training and education.


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The Middle-aged Hair - A project to improve the health and well-being of middle-aged by training and playing a musical. Maisa Kuusela, MD, Service director Department of Health Care and Social Services, City of Turku. Heikki Ellilä, RMN, PhD, Principal Lecturer, Department of Health Care, Turku University of Applied Sciences, Katariina Felixson, Project co-ordinator, Lecturer, Faculty of Well-Being Services, Turku University of Applied Sciences Contact: Heikki Ellilä, heikki.ellila(at)turkuamk.fi, +358505050930, Tammikallionpolku b6 20660 Littoinen Finland Introduction: In February 2011 Hair-musical had seven performances for full houses; altogether 7500 audience. The 122 actors who didn’t have earlier musical theatre experience were ordinary middle aged people from Turku area who had had 16 months rehearsal period leaded by professionals. The project was produced by the department of Health of Turku City establishing a part of the European Cultural Capital program. All the participants had also possibility to participate Empowerment/Coping-courses, which were led by students of three different faculties of Turku University of Applied Sciences (arts academy, health care and well-being services). Health checks were also offered to the participants, including coaching with giving up smoking and weight watching. Aim: To promote health and well-being through culture and to find connections between culture, health and well-being. Methods: Both quantitative and qualitative study of web-questionnaire, essays written by participants and material of health status and laboratory tests done by nurse students before and after project. The results of the questionnaire and tests were analysed statistically and essays by the mean of content analysis. The project was documented in digital form (DVD). Findings: Altogether 200 volunteers participated, 122 continued at the end of the project. 61 % of them answered the web-questionnaire, about one third wrote an essay and 35 participated in the health control in the beginning of the project. 34 % of the participants who answered the web questionnaire agreed that their health has improved and 73 % felt that their general well-being has increased during the project. Feeling of togetherness and possibility to cross one’s own limits were among the most important reasons to stay in the project. Increased social interaction and improved self-esteem were often mentioned as positive side-effects of the participation. Conclusions: Musical project for middle aged improves health and well-being.


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Audit of Bone Health Medication Dispensed by a Pharmacist in Long Term Care for People Ageing with Intellectual Disability. Bernadette Flood. Senior Pharmacist, Daughters of Charity, Clonsilla, Dublin 15. [email protected] Background: Clinical audit has been defined as ‘The process by which doctors, nurses and other health professionals regularly and systematically review, and where necessary change their clinical practice’. Aim & Objectives: To ensure that people with intellectual disability have optimal access to bone health medication the pharmacist in a LTC centre, undertook to audit the dispensing of bone health medication in the centre. The Chairperson of the Research Ethics Committee (REC) of the service provider indicated that approval was not required from the REC for clinical audit. Description of the Innovation: The pharmacist provided a targeted medication report after each reported fall. The pharmacist (a.) obtained details of all prescribed medications and previous falls and/or fractures for each faller, (b.) provided a pharmaceutical care report, using a structured communication tool detailing any fall / injury related medication issues identified by the pharmacist. The issues identified in the reports included where appropriate, recommendations in the professional opinion of the pharmacist, that the prescriber consider prescribing calcium & Vitamin D and / or a bisphosphonate, for the faller. Evaluation of the Innovation: Following this innovation (a.) bisphosphonate medication /strontium / raloxifene dispensed increased from 8% to 46% of residents and (b.) Calcium & Vitamin D dispensed increased from 23% to 81% of residents. The results of this audit may be looked at under 7 domains of pharmaceutical care - safety, communication, effectiveness, governance, patient focus, accessible responsive care and public health. Conclusion & Implications: Harm from falls can be dramatically reduced with appropriate interventions. Pharmacists must be willing to participate in safety culture change by demonstrating their own commitment to safety and providing the resources, such as targeted pharmaceutical care, to achieve results that will help ensure quality care and quality life years for those ageing with intellectual disability in long term care.


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A Pilot Project -Perceptions of the Shift to Shift Handoff Process Using the ISHAPED Strategy and Implications for Nursing Communication Authors Mary Ann Friesen PhD, RN, CPHQ, Inova Health System; Robert Watson MS, Monica Work MSN, RN, Barbara Harrison BSN, RN, Patricia Connor-Ballard APRN-BC, MSN, PhD, Karen Gabel Speroni, PhD, RN, Jeanine Turner PhD, Georgetown University James D. Robinson, PhD, University of Dayton. Background Handoffs are one of the most complex communication processes encountered by nurses in the provision of patient care. Ineffective handoffs place patients at risk for safety breaches that disrupt continuity of care and increase the risk of serious adverse outcomes. Analysis of the healthcare institution’s handoff policies and procedures indicated variance in definitions across the system and opportunities for improvement. A Kaizen Performance Improvement Team, including nurses from hospitals in the system, was convened to address handoff issues. The team developed a handoff strategy entitled ISHAPED: I=Introduce; S=Story; H=History; A=Assessment=Plan; E=Error Prevention D=Dialogue. The strategy was based on best practices and evidence-based strategies described in the literature and utilized in “high risk” industries. Aim and Objectives of the Study The purpose of this study was to explore nurses’ perception of the shift to shift handoff process before and after the implementation of the bedside ISHAPED process in guiding nursing communication. Method A web based survey was administered to nurses. The survey included 20 closed ended questions with 2 open ended questions. A total of 423 nurses were recruited to participate in the study. Sample Size Pre-implementation: Phase 1 n=155 Phase 2 n=45 Sample Size Post-implementation: Phase 1 n=129 Phase 2 n=42 Pre and post survey data sets were compared utilizing non-parametric statistics. Open ended questions were studied using qualitative content analysis. This study was approved by the Institutional Review Board. Findings Statistically significant differences for several questions pre and post implementation were observed. Qualitative findings highlighted handoff challenges and described opportunities for improvement related to the handoff process. Conclusions and Implications The results indicated a need for modifications to the ISHAPED tool for clinical specialty and ease of use and the importance of involving the bedside nurse in designing, developing, and implementing effective handoffs.


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Bereavement in people with severe intellectual disability - Healthcare workers experiences. Authors Patricia Grimes & Paul Michael Keenan Patricia Grimes Clinical Nurse Manager II Stewarts Care Ltd Palmerstown Dublin Tel. 01-6264444 E-mail; [email protected] Background: Working as a RNID and facilitating service-users with Severe Intellectual Disability (SID) through many lifespan experiences lead the researcher to explore the experiences of healthcare workers in managing bereavement in people with a SID. Death, dying and bereavement in the generic population has received detailed research attention, however little is found on the experiences of people with SID and the best practices healthcare workers should utilize. Aim: To examine how healthcare workers (nursing and care staff) facilitate service-users with SID experiencing bereavement.

Objectives:

• To identify healthcare workers knowledge base of bereavement and SID. • To examine current care practice of healthcare workers in facilitating service-users with SID

through bereavement. • To identify ways in which the current care practice of healthcare workers facilitating

service-users with SID through bereavement may be developed Methods: A qualitative descriptive study was conducted. Data were collected from 12 people (n.8 qualified nursing staff and n.4 care-staff) through semi-structured interviews. A review of the literature informed the design of the interview schedule. Data were analysed using a five step framework proposed by Colaizzi (1978). A reflective journal documented and guided the research process. Ethical approval was received from Trinity College Dublin and the relevant health service provider. Findings: Key finding to be presented include the knowledge base of healthcare workers with regards to bereavement in this client group, the strategies utilized to facilitate service-users, the value of client-professional relationship, and barriers to developing facilitation. Discussion; The implications of the findings to care practice and future research will also be explored, as will the researcher’s experience of managing the research.


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Poetry: A Pedagogical Tool for Enhancing Critical Thinking and Reflective Practice in Higher Education in Healthcare. Sinead Hahessy, School of Nursing & Midwifery, National University of Ireland, Galway. [email protected] Graham Carr, Faculty of Health & Social Care, South Bank University, London. Higher education aims to foster critical thinking that is purposeful, goal-directed and ethical. It should aim to use inductive and deductive judgements based upon evidence rather than guesswork and should employ the principles of science and scientific methods of logic, probability and causality. As educators one way we try to do this is by facilitating and encouraging reflection and reflective writing. Within healthcare, reflection is used as a description of how we see our environment, and the emphasis being placed upon our subjective experience. The crucial aspects that distinguish reflection from analysis of other kinds of problem-solving is that it involves the self and leads to a changed perspective. Reflection and reflective practice are both a learning strategy and a means of promoting professional practice. Because writing is a creative act, it can function as a form of reflective practice enabling us not only to recount but understand our knowledge, in essence we construct it as we write, so that it is not until it is written, do we actually know what we knew? Reflection helps us make sense of what we already know. This ‘tacit’ knowledge forms the basis of all vocational practice (Polyani 1958) a body of knowledge often not made explicit inside the scientific literature but one known and used by experts inside a discipline (Benner 1984). Woods (1982) argues that; tacit knowledge… is usually not given in texts but is known by experts in the discipline. The centrality of language in healthcare practice has been extensively discussed by Schaefer (2006) Cody (1994) Oiler (1983) McKoy (1984) and Barleben (1993). Poetry was analysed by these writers and is presented as a means of understanding healthcare discourse and interaction. By using poetry as a pedagogical teaching tool it becomes a means of liberating vocational discourse. The writing of a poem encourages creativity in word and language play, whilst it stimulates the imagination and develops a sense of rhythm and sound as it extends the vocabulary of practice. It draws upon many intelligences, thinking, feeling, listening, experiencing and is therefore appealing to many different learning styles. This presentation will be in workshop format where the participants will be introduced to the skills necessary to develop critical thinking skills and meaningful reflective accounts through the use of poetry. An opportunity to compose a short poem is facilitated.


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Return to contents page Transforming Learning and Practice: Production process Gerardina Harnett, Institute of Technology, Tralee Miriam O Donovan, Bantry General Hospital Anne Stoutt, Bantry General Hospital Contact details of presenting author Department of Nursing and Health Care Studies, Institute of Technology, Tralee. 353 66 7191961 [email protected] Background A gap between best evidence and contemporary practice in intramuscular injection (IMI) administration was identified through research and nursing student evaluations. Having identified learning needs from both nursing student and staff nurse perspectives a hybrid space incorporating a face2face and virtual components were developed with the aim of facilitating learning. Aim To enhance quality of patient safety and care provision relating to IMI technique Objectives To facilitate leaning from level 6 – 8 in a clinical skill (IMI administration) To facilitate expertise development across professional boundaries Description of innovation Using a psychomotor skill framework based on 5 steps ranging from imitation to naturalisation a learning resource pack including face2face and virtual learning resources were designed and created. 1. Face2face processes and materials:

• Standard operating procedures • Standardised policy development • Skill verification processes • IMI peer and champion support system • Feedback loops

2. Virtual – Reusable Learning Object: • Subject content in form of text • Pictures • Videos of real life simulations of IMI administration • Interactive learning exercises

Evaluation of innovation Promotes autonomous learning of registered health care professional and student Positively impacts on individuality of learning styles Facilitates learning inside and outside the work/learning environment Enables more effective resource planning for health care and education facility Promotes confidence and competence in IMI administration Promotes health and safety within clinical environments Conclusion and implications Enhancement of learning that subsequently enhances quality of patient care provision. This learning resource pack is transferable within professional groups, organisations and within developing world.


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The essential elements of team clinical supervision: A study of the lived experiences of palliative home-care nurses Anne Hayes, M.Sc. (Clinical Supervision), R.G.N, R.M, R.N.T, Dip. Psychosynthesis Dr. Mary Creaner, School of Psychology, Trinity College, Dublin 2 email address: [email protected] Background There is evidence of interest in clinical supervision by palliative home-care nurses. Clinical supervision is a multi-faceted concept. The range of conceptualizations that exist and the well-documented confusion that many nurses have concerning its nature and purpose, support the need to give thought to the particular elements perceived to be important for team clinical supervision by palliative home-care nurses in an Irish context. Objectives The aim of the study was to identify and describe the essential elements of team clinical supervision for palliative home-care nurses. Method A phenomenological qualitative inquiry was indicated by the research question and the aim of the study. Interpretative Phenomenological Analysis facilitated a detailed examination and analysis of the interview data, elicited through semi-structured interviews which were transcribed and coded. The study was conducted in three palliative home-care teams in the Irish Republic. Participants were specialist palliative home-care nurses who had attended clinical supervision for six months or longer in the previous two years. Ethical approval was granted by the author’s institution and each of the research sites. Findings Interpretative Phenomenological Analysis generated three key master themes, each containing a cluster of sub-themes, revealing the essential elements of team clinical supervision as perceived by palliative home-care nurses. The identified master themes were, engaging the framework; creating a supportive environment; promoting reflection. Conclusion and Implications The identified elements were congruent with normative, formative and restorative functions of clinical supervision. Fundamental to establishing clinical supervision is the need to give attention to contract issues. While reflection is the core element, the supportive containment provided by supervisory and team relationships, is essential in facilitating this. In seeking to advance the practice of clinical supervision, this study offers organisations, supervisors and palliative home-care teams critical factors for consideration when setting up, developing and engaging in clinical supervision.


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The journey from the diagnosis of prostate cancer, having a radical prostatectomy and beyond Professor Josephine Hegarty Catherine McAuley School of Nursing and Midwifery, University College Cork. [email protected] Ella Walsh, Registered Nurse, Cork University Hospital. Background: Continued investigation into the health concerns of men prior to and post treatments for prostate cancer is required. This type of research will provide healthcare professionals with a solid foundation upon which to base treatment recommendations. Aim: The aim of this study was to provide a retrospective picture of men’s experiences of surgery for prostate cancer from initial diagnosis, through their surgery and beyond. Methods: A qualitative, descriptive design was employed. Ethical approval was obtained. A volunteer sample (n=8) of men 15 years or less post radical prostatectomy were interviewed. Data was analysed using qualitative thematic content analysis. Trustworthiness of data was established through prolonged engagement, member checking and review of transcripts for creation of themes by two researchers independently. Findings: Men identified a number of themes related to their prostate cancer journey. Important concerns for men pre operatively included the process of ‘getting diagnosed’. Men also spoke at length in relation to their very real need for information and the need for peer, family and healthcare professional support. Post-surgery a number of important themes also emerged. Specifically a number of participants spoke of their quest to return to normal life. Physical side-effects of surgery (urinary incontinence and erectile dysfunction) emerged as major concerns post-surgery. In addition men were fearful of the possibility of reoccurrence of cancer. Conclusions and implications: In a healthcare system which increasingly values the ‘patients view’ this type of information is vital in order to tailor healthcare services to meet the unique needs of each patient. Increased emphasis needs to be placed on supporting men post prostatectomy in the longer term. Acknowledgements: Men Against Cancer (MAC) peer support group and The Irish Cancer Society for their support of this research study. Thank you to the men who took part in the interviews for this study.


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Content Analysis of an Online Breastfeeding Support Forum Authors: Maria Herron BA, Marlene Sinclair PhD MEd DASE BSc RNT RM RGN, W George Kernohan PhD CPhys CMath FIMA BSc, Janine Stockdale PhD PG Dip CHSE BSc RM RN. Contact details: Maria Herron, Doctoral Student, Institute of Nursing Research, University of Ulster at Jordanstown, Newtownabbey BT37 0QB Northern Ireland. email: [email protected] Background: Women who have struggled with breastfeeding often say they feel unsupported by health professionals and society in general. The potential of the internet to motivate women to breastfeed has been identified in recent research. Pregnant women are particularly active online health information seekers and there are indications that approximately 30% of new mothers seek online breastfeeding support. The global breastfeeding community have an active and diverse online presence however there appears to be very little evidence or assessment of the effectiveness of online breastfeeding support or online breastfeeding interventions in the literature. Aim and objectives of the study: This study aims to understand the phenomenon of online breastfeeding support by exploring the behaviour of those who are seeking, finding and creating such support. Method: Following ethical approval, permission was obtained from the moderators of a parenting website to undertake online research of archived discussions. A website enabled search identified all discussion thread titles containing the word ‘breastfeeding’ over a three month period. Discussion threads were then subject to both quantitative analysis to identify attributes of online breastfeeding support and qualitative analysis to identify key themes. Findings: 126 valid threads containing the word ‘breastfeeding’ elicited 1104 replies and 40,537 views from other website members. Over half of the posts received a response within 1 hour, while 92% of posts received replies within 24 hours. Original posters mainly sought information and replies contained informational, emotional and esteem support. Unlike previous studies of online support which found little evidence of network or tangible support, both of these types of support were evident in the support offered. Key themes raised by information seekers confirm underlying difficulties in dealing with breastfeeding challenges as well as reference to ongoing inconsistent information and support from health providers. Conclusions and implications: This analysis provides evidence of women’s motivated information seeking behaviours for breastfeeding support in the online environment; focusing on the nature of the support offered and utilised. These findings will be useful to all stakeholders engaged in breastfeeding advocacy.


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An exploration of nurses’ views on the risk assessment process of forensic mental health patients Philip Hickey National Forensic Mental Health Service Central Mental Hospital Dublin 14. [email protected] Background: The shift to community based mental health care espoused and recommended within the Mental Health Policy document “A Vision for Change” published by the Department of Health and Children (2006) has resulted in risk assessments of forensic mental health (FMH) patients being central to FMH practice. The risk assessment process of FMH patients appeared to be multi-faceted with apparent social, legal, ethical and practice implications for FMH professionals, including nurses. Aims: The aim was to explore the views of nurses practicing within the author’s institution in relation to the risk assessment process of FMH patients. The research objectives were to: describe what views and insights nurses held on the risk assessment process of FMH patients and to contribute to the current knowledge on the risk assessment process. Method: A qualitative descriptive approach was chosen. A purposive sample of nurses was interviewed from a target population of approximately 140 nurses practicing within the author’s institution utilising a semi-structured interview guide. Interviews were analysed employing Newell & Burnard’s (2006) six step thematic analysis framework. Ethical approval was granted by the Faculty of Health Sciences Research Ethics Committee, University of Dublin, Trinity College. Findings: Findings suggested that the overall risk assessment process was perceived as beneficial in a FMH setting. Communication was viewed as integral to the process. The nurse-patient therapeutic relationship could however result in areas of perceived uncertainty within the nurse’s role in the process. Collaborative information, utilizing nurses’ experience practicing with this client group was viewed as a significant factor within the process. Ongoing training, education and support was perceived as a means of developing areas that nurses viewed as requiring clarification and enhancement. Conclusion: This qualitative descriptive study provided straight descriptions of the phenomena under study and contributed additional knowledge to what is currently known on the topic.


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Measuring and modelling Body Mass Index (BMI) among a cohort of Irish children living in an urban disadvantaged area. Author details: Ms. Eleanor Hollywood, Prof. Catherine Comiskey, Ms. Anne Snel, School of Nursing and Midwifery, Trinity College Dublin. [email protected] Background: A health promoting manualised initiative was developed for implementation into schools that are located in certain RAPID (Revitalising Areas by Planning, Investment and Development) areas located in West Dublin, Republic of Ireland. The initiative identifies and targets seven primary child health and well-being outcomes, three of which relate specifically to children’s physical development. The outcomes were developed from previous research into the specific needs of children and families who live in RAPID areas. Aim & objective: To provide a longitudinal comparative evaluation of a school based health promoting initiative, focusing specifically on three of the seven targeted child health and wellbeing outcomes. The study objective was to measure and analyse the BMI of each participating child on an annual basis for three years. Method: A three year longitudinal evaluation was carried out in five intervention and two comparison schools between 2009 and 2011. As part of the evaluation quantitative health data was collected on each child to determine their BMI on year 1 (baseline), year 2 and year 3. The relevant institutional ethics committee approved the study. SPSS version 17 was used to analyse data. Baseline BMI is analysed and report here. Findings: Participation rates within schools were over 50%. Overall within the intervention schools it was observed that over one quarter (27.8% = 19.1%+8.7%) of all children were either overweight or obese. Similar results were observed within the comparison schools which found that 28.9% of all children were either overweight or obese. Conclusions: Longitudinal outcomes are still in progress however; baseline results show that BMI rates among young girls are concerning. Implications for practice & policy: Further research is needed to generate interventions for the management of obesity. Interventions need to be targeted towards children at various levels; in the home, in the community and at school.


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Attitudes and practice of psychiatric nurses towards the support needs of children whose parent has a mental health problem. Derry Houlihan MSC; BNS(hons);RGN, RPN. Community Mental Health Nurse, HSE Dublin North Central [email protected] Prof Agnes Higgins School of Nursing & Midwifery, Trinity College Dublin Background International research recognises that children are vulnerable to the potential negative impact of parental mental ill-health and possible parental separation through hospitalization. Mental health policy within Ireland directs adult mental health care providers to foster child-centered practices that are supportive and protective of these children’s health and wellbeing. Despite this there is limited published research internationally and within Ireland that explores psychiatric nurses’ attitudes and practice towards the support needs of children whose parent has a mental health problem. Aim of the study This study sought to establish the current knowledge, attitudes and practice of Irish psychiatric nurses towards the support needs of children whose parent has a mental health problem. Method A survey design, using a self reporting, anonymous, postal questionnaire was sent to 180 RPNs (Registered Psychiatric Nurses) working in an integrated Mental Health Service in Ireland. 109 (60.5%) people returned the questionnaire. Ethical approval in line with the Helsinki agreement was granted by the ethics committee of the University and the local research ethics committee of the service where the study was conducted. Quantitative data were analyzed using SPSS and thematic analysis was used for qualitative comments. Findings Findings indicate that although psychiatric nurses are mindful of documenting if service users are parents, the children often do not form part of the ill parents nursing care plan. Nurses lacked knowledge of, and confidence in, how best to answer a child’s questions regarding their parent’s illness or explain issues to children. Nurses were of the view that hospital visiting spaces or arraignments were not child friendly and considered their education and training in this area inadequate. Conclusions and implications The findings of the study highlight a need to increase knowledge among psychiatric nurses on the impact of a parental mental health problem on a child and their support needs.


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CLINICAL TRAINING AND EDUCATION IN SEXUALITY FOR THE HEALTH PROFESSIONAL Ben Hughes School of Social Work and Social Policy, Trinity College Dublin, IRELAND. Aim This study examines the educational and training needs of treatment providers in the context of their clinical practice with self identified sexual addicts. Method A qualitative approach was used and data collection includes: pilot study, focus groups, questionnaires and individual interviews involving 87 adult participants consisting of 44 self-identified sexual addicts and 43 treatment providers who work with this phenomenon in clinical practice. Ethical approval was obtained and Interpretative Phenomenological Analysis (IPA) is used for data analysis. Findings Treatment providers report that inadequate training in the area of sexuality may inhibit their clinical work with the self identified sexual addict. They state that a greater level of education is required to ensure recognition, assessment, diagnosis and treatment of sexual addiction. Arising from clinical practice a number of effective and ineffective educational interventions are identified. Additional factors including communication skills, empathy, and personal comfort with sexuality are equally challenging issues when dealing with this topic. Treatment providers recommend the need for comprehensive sexual education skills training for clinicians engaged in the work of supporting individuals recover from and manage addictive sexual behavior. Treatment providers anticipate that education specifically focused on sexual addictive behavior will benefit the clinician and the addict. Conclusions Effective therapeutic interventions will improve as a result of a focused educational programme regarding sexual addiction. Education will increase the treatment provider’s level of competence with this issue and equip them to create prevention strategies which are expected to lessen the development of sexual addiction. Such strategies would also have the effect of minimizing the negative impact of sexual addiction. Increased levels of education will help to identify predisposing factors and presenting behaviors of sexual addiction. As a consequence this will ensure that every individual is enabled to pursue a healthy sexual life which is central to sexual health.


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How Do Students Spend their Time? Administering the National Survey of Student Engagement to Undergraduate Students in a Faculty of Health Sciences Ms Sylvia Huntley-Moore, School of Nursing and Midwifery, Trinity College Dublin. [email protected] 8963704 Dr Aileen Patterson School of Medicine, Trinity College Dublin. Background: Student engagement is used internationally to measure quality of degree programmes. Student engagement encompasses the amount of time and effort students put into their studies and other educationally purposeful activities and way institutions deploy resources and organize curricula to provide students with opportunities to participate in activities that improve their learning. Aim and Objectives: To determine the level of student engagement in 5 undergraduate degree programmes in the Faculty of Health Sciences in an Irish university. 1)To compare the level of student engagement between programmes. 2) To compare the level of student engagement of each programme with international benchmarks. 3) To identify aspects of the undergraduate experience in the formal and informal curriculum that may be improved through changes in policies and practices at both the school and institutional levels. Method: A descriptive quantitative cross sectional survey design was employed. Ethical approval for the study was obtained from the Faculty Research Ethics Committee. The National Survey of Student Engagement (NSSE) an internationally recognised questionnaire identifying five scales contributing to student engagement - level of academic challenge; active and collaborative learning; student-staff interaction; enriching educational experiences and a supportive campus environment - was administered during lectures to students in all years of medicine, nursing, pharmacy, dentistry and physiotherapy degree programmes. 1, 325 students completed questionnaires. Results for 3 out of 5 scales were comparable with those published for research intensive universities. 4 out of 5 programmes scored significantly lower in the Student-Staff interaction scale. One programme’s scores were in line with international results. Student scores regarding the supportive campus environment were also lower than international benchmarks. In all cases the scores declined over the course of the programmes. Conclusions: The NSSE is a useful tool for determining how students use their time and identifying areas requiring educational, academic and institutional development.


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Midwives experiences in providing care to obese women in the antenatal period. Name: Fiona Kane, Midwife in Our Lady’s of Lourdes, Drogheda. Contact details: Ph. (01) 8712818; e-mail [email protected] Background: Obesity is widely recognised as an escalating problem that poses a serious threat to global health. Consequently the proportion of women who are obese on becoming pregnant has, and is continuing to rise. Obesity in pregnancy is one of the major challenges for maternity services yet currently there are no evidence based studies pertaining to midwives experiences in providing care to this high risk group of women, particularly within an Irish context. Aim and objectives: The objective of this study was to explore midwives experiences in caring for women who are obese in the antenatal period. Method: A qualitative descriptive approach with a feminist philosophical underpinning was employed for this research study. Semi-structured interviews were conducted with a sample of six midwives. The data generated from these interviews was analysed using the seven procedural steps of Colaizzi’s framework. Ethical approval was obtained from the author’s university and from the hospital in which the research was conducted. Findings: Four major themes, with 11 encompassing categories, emerged. The first theme centred on communication and the midwife. This theme included the issue of sensitivity when communicating and discussing the subject of weight with obese women. It also recognised the special relationship between the woman and the midwife and how it can facilitate communication with the women. The second theme, practical implications, encompasses the barriers and difficulties midwives identified in providing antenatal care to obese women. The third theme, midwives insight of obesity in pregnancy, explores midwives perceptions and insight into what it is like to be obese in pregnancy. It focused on the social pressures on obese women and on equality in the provision of care. The final theme, midwifery recommendations, relates to the insightful and well-informed recommendations pertaining to obesity in pregnancy that the midwives made based on their experiences and interaction with obese women. Conclusions and implications: This study creates a new understanding and knowledge into midwives experiences in providing antenatal care to obese women. It highlights the social sensitivity this subject holds for midwives and how this can impact the provision of care. This study offers suggestions and recommendations as to how midwives needs in meeting the challenges of this area of care can be established. Finally, this study provides a foundation to bridge the vast knowledge gap which exists today within Irish maternity services concerning maternal obesity and the midwife.


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Nurses experiences of providing inpatient care for patients with borderline personality disorder who express chronic suicidality. Jane Kennedy RPN, BSc (Hons), MSc MH, Suicidology Nurse, HSE, Dublin West/South West, Mental Health Service, St Loman’s Hospital, Palmerstown, D.20 [email protected] Background: The researcher in her own practice had encountered a group of patients who posed a number of dilemmas to both the newly qualified and the experienced mental health nurse. Patients with Borderline Personality Disorder are admitted frequently to the acute mental health setting, with repeated suicidal ideation and behaviour. The researchers own lack of understanding and knowledge combined with the observation that colleagues generally referred to these patients in a negative manner prompted further exploration. Aim & Objectives of the study: The aim of the study was to describe nurses’ experiences of providing inpatient care for patients with borderline personality disorder who express chronic suicidality. Specifically the objectives of the study were to explore the following: 1 The impact of the repeated expression of suicidality by this group of service users on the nurse. 2 The responses of the nurse to the expression of chronic suicidality by their patients. 3 The effect if any, this has on the nurse patient relationship. 4 Nurses view of current service provision for this group of service users. Method: Using a qualitative descriptive design, ten registered psychiatric nurses in three different acute inpatient settings were interviewed using a semi structured format. Findings emerged following content analysis. Ethical approval was sought and granted by the author’s university and also by one of the healthcare institutions involved in the study. Findings: These were in keeping with international and national research in the area. Nurses developed negative perceptions of patients with BPD who expressed chronic suicidality. Participants did endeavour to establish a therapeutic alliance with patients with BPD but encountered many barriers which ultimately led to the break down of the nurse patient relationship. They viewed current service provision as inadequate. Conclusion & Implications: The findings of this study suggest that these registered psychiatric nurses struggled to find a way to interact positively with patients with BPD. They perceived the expression of chronic suicidality as a relentless force which signals the rejection of their interventions by patients. The nurses grapple to find an understanding of the behaviours exhibited by these patients, often labelling them as manipulative and dishonest. The experience of sometimes intense emotional reactions by nurses in response to these behaviours can be said to lead to the unconscious development of pejorative and even prejudicial attitudes.


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‘Managing Preconceived Expectations’: Mental Health Service Users’ Experiences of Going Home from Hospital. Brian Keogh School of Nursing & Midwifery, 24 D’Olier Street, Trinity College, Dublin 2, [email protected] 01 8963109 Prof. Agnes Higgins: Trinity College Dublin Prof. Patrick Callaghan: University of Nottingham Background: Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. In 2009, there were 20,195 admissions to psychiatric hospitals in Ireland. Seventy percent (n=14,223) of these admissions were readmissions suggesting an unsuccessful transition for a high number of people. Aim & Objectives of the Study: The aim of this study was to explore service users’ experiences of being discharged from the acute mental health services. Methods: Interviews were used to collect the data and the processes associated with grounded theory were used to analyse the data. Thirty five interviews with mental health service users who had been discharged from hospital were completed. Ethical approval was granted from the relevant authorities. Findings: The data analysis process culminated in the development of a theory called ‘Managing Preconceived Expectations’. This theory contains seven categories which describe the participants’ heightened awareness of the negative assumptions held about people with mental health problems once they came into contact with the mental health services. Furthermore, the theory describes the processes that the participants used to manage the negative assumptions that were applied to them when they were discharged. Conclusion & Implications: The theory reveals that stigma continues to be a significant issue for users of the mental health services. Psychiatric nurses and other mental health professionals need to be aware of the negative impact that stigma has on service users. Moreover, service users need to equipped with strategies to effectively manage the negative attitudes that they encounter when they are discharged from hospital.


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A Study of Relentless Suffering; A Retrospective Documentary Review and Analysis of the Commission to Inquire into Child Abuse Report (2009): (The Ryan Report). Carole B. King MSc. R.C.N. R.G.N R.C.T R.N.T. Lecturer in Children’s Nursing The School of Nursing and Midwifery The University of Dublin Trinity College. Dublin 2. [email protected] This documentary review was undertaken to consider the findings of the Commission to Inquire into Child Abuse Report (2009) (The Ryan Report) in order to provide an insight into the relentless suffering of victims of child abuse, and to consider the implications for child protection in Ireland in the future. The Ryan report (2009), considered the occurrence of institutional child abuse in Ireland from (1914-2000) The review, first considered the report in relation to the following areas, structure and function, historical background and context, testimony, findings and recommendations, this extensive report consists of five volumes. The report was then analyzed in relation to emerging themes, commonalities and implications for child protection practice in the future. Contemporary issues, arising from the emerging themes are also identified and discussed. In line with the documentation reviewed, pseudonyms are used throughout this review. Ethical approval was not required as these documents are in the public domain. Methodology Documentary analysis was selected to carry out this review of the Ryan report (2009).This methodology allows for thematic analysis from the documentation in relation to the “naturally occurring themes” These themes are specific to the documentation reviewed and may not be generaliseable, but capture the essence of the specific lived experiences under review. The report was reviewed and emerging themes were grouped and analyzed in the discussion section in order to gain insight into the world of children’s experiences within Industrial schools in Ireland. Because of the vast amount of documentation involved in the Ryan Report, this review concentrated on four schools, two in urban settings and two in rural settings. The Christian Brothers Industrial Schools in Artane, Dublin and Letterfrack in Connemara and The Sisters of Mercy Industrial School in Goldenbridge, Dublin and St Michael’s Industrial School in Cappoquin in Waterford were selected to include the perspectives of schools managed by male and female religious orders. The chapter on emerging themes is related to the specific themes arising from the documentation only and a literature review on the related themes. The chapter on contemporary issues takes a wider look at the issues of child protection in the future and included new concepts including restorative justice and abuse related to internet usage.


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The Impact of the Work Environment of Nurses on Patient Safety Outcomes. Marcia Kirwan, Dr Anne Matthews, Prof Anne Scott, Daniela Lehwaldt, Roisin Morris and Prof Anthony Staines. School of Nursing, Dublin City University. [email protected] Abstract: The importance of the nurse’s role in patient safety has been established. Nurses due their proximity to, and relationship with, the patient, are in a key position to identify adverse events or near misses and to implement solutions which result in safer patient care. Effective staffing levels can reduce the number of adverse events occurring to patients and positively impact on mortality rates.This research seeks to explore the relationship between the environment in which nurses practice and specific patient safety outcomes. The study was carried out within a European FP7 project: Nurse Forecasting: Human Resources Planning in Nursing (RN4CAST) project. Data were gathered from 1,406 nurses in direct patient care, in 112 general medical and surgical units in 30 hospitals throughout Ireland. A nurse survey was carried out using a questionnaire incorporating the Nursing Work Index and the Maslach Burnout Inventory. Three additional data sources were used in the study: patient outcome data (HIPE), organisational data and a patient survey. Ethical approval was obtained from the author’s institution and a further 18 research ethics committees representing the 30 hospitals included in the study. Initial results support other research findings indicating that a positive practice environment and a supportive organisational culture positively impact on patient safety outcomes. Initially regression was undertaken to predict if nurse perceptions of patient safety culture were impacted by organisational and environmental factors. The model explained 35% of the variance with nurse leadership within the organisation making the largest contribution. Further analysis using Structural Equation Modelling is ongoing to examine the relationship between the practice environment and patient outcomes including mortality rates and adverse event occurrence. The results are expected to enhance patient safety within hospitals by demonstrating factors which enable nurses, as key players in patient safety, to effectively carry out this aspect of their role.


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Characteristics of pregnant Finnish women of advanced maternal age – a register based study *Reeta Lampinen, doctoral candidate, Department of Nursing Science, University of Eastern Finland, Katri Vehviläinen-Julkunen, professor, Department of Nursing Science, University of Eastern Finland and Kuopio University Hospital, Mika Gissler, professor, National Institute for Health and Welfare (THL) Helsinki, Finland and Nordic School for Public Health, Gothenburg, Sweden and Seppo Heinonen, professor, Department of Obstetrics and Gynaecology, Kuopio University Hospital and University of Eastern Finland *PO. Box. 1627, FI-70211 Kuopio, Finland. [email protected] Background and aim: Maternal age has increased in many Western countries. The maternal age over 35 years at the time of delivery has been defined as advanced maternal age (AMA). Several studies have shown association with older maternal age and poor pregnancy outcomes. Increased risk for certain pregnancy complications has been discovered as well. In 2009, there were 60 794 births in Finland. The mean age of all parturients giving birth has long been around 30 years and the number of women aged ≥ 35 in 2009 was 18.7%. The aim of this paper is to describe characteristics of Finnish pregnant women of AMA. Material and method: The data for the study is a population based cohort consisting of three national registers: Medical Birth Register, Hospital Discharge Register and Register of Congenital Malformations. The permission to use the data was gained from The National Institute for Health and Welfare. In register-based studies ethical approval is not required. The data includes information of 690 555 women and their newborns between the years 1997-2008. The data were analyzed statistically and presented with cross tabulation. Findings and conclusion: There were 128 265 (18,6%) women of AMA out of 690 555. More women of AMA compared to women under the age of 35 were married or had a registered relationship. There were less smokers in the women of AMA (9,1%) than in the group of younger women (12,7%). Older pregnant women were also more obese than their younger counterparts when we looked at BMI>25. Women of AMA had more maternal diabetes (6,0%) than younger women (3,4%) and Cesarean rate was significantly higher (22,8%) compared to younger women (15.5%). In conclusion, it seems that special attention should be given to care practices of pregnant women of AMA due to age-related potential complications.


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Promoting innovation in research–What are experiences of user involvement? Ms Anne Lawlor, BA in Theology and Psychology; MA in Management of Voluntary and Community Groups/Chairperson of the 22Q11Ireland support group. [email protected] Dr Honor Nicholl, PhD, RCN, School of Nursing and Midwifery, University of Dublin, Trinity College, 24 D’Olier Street Dublin 2, Ireland. Ms Carmel Doyle, School of Nursing and Midwifery, University of Dublin, Trinity College, 24 D’Olier Street Dublin 2, Ireland. Aim: The aim of this presentation is to explore the issues that users face when involved in nursing research and the experiences of the researchers who involve them. Background: There has been an increasing focus on user involvement in health care research and it is becoming central to good practice standards. The contribution of service users in research studies is consequently the focus of interest of ethics committees, as well as research funders. However, the interpretation of user involvement, the interpretation of the concept, and the importance of user involvement, can vary. Based on perspectives on current and recent research studies, this presentation will focus on the realities of user involvement, highlight critical issues and provide a platform for discussion on strategies that can promote active and meaningful involvement. Methods: Based on their involvement in three qualitative and quantitative research studies as participant, service user and researchers, the presenters will explore issues that can emerge for all parties during the research process. These include issues of differing perspectives, ensuring common understanding and promoting dialogue which is required for successful outcomes. What can go wrong potentially, and why, will also be explored using experiences from research studies in child and young people’s health care research. Findings: With reference to research experiences as researchers and user, the presenters will highlight specific challenges that face those who plan to involve users and the challenges users face. Recommendations on the types of involvement that can occur and how participation can be encouraged will be reported. Conclusions: Key issues in user involvement from both the perspective of a service user and researcher will be outlined, and how they may be resolved will be explored.


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Respite in Paediatric Palliative Care: Making the case for case study methodology. Authors: Julie Ling, School of Nursing and Midwifery, Trinity College Dublin, Ireland; Professor Mary McCarron, School of Nursing and Midwifery, Trinity College Dublin, Ireland; Dr Kevin Connaire, St Francis Hospice, Dublin, Ireland; Professor Sheila Payne, International Observatory on End of Life Care, Lancaster University, UK Contact details of presenting author: [email protected] Background: The complex nature of palliative care practice challenges researchers to seek alternative methodological approaches to capture the multiple “emic” perspectives inherent in those receiving palliative care and their families. Researching respite in children’s palliative care is one such challenge. Methodology: Case study has been described as an empirical inquiry that investigates a contemporary phenomenon in depth and within its real life context, especially where the boundaries between phenomenon and context are not clearly evident. Case study methodology can be used in context dependent complex situations where multiple perspectives exist, and where other research methods are difficult to use such as palliative care. Aim: This presentation will focus on methodological challenges of conducting research with parents of children with life-limiting conditions. It aims to demonstrate how the use of case study methodology can help overcome these challenges in palliative care research. Findings: Case study is rigorous and yet flexible, using a theoretical framework to guide data collection and analysis. It incorporates multiple perspectives (parents, healthcare professionals etc.) capturing both processes and outcomes. Study design is dynamic and continues throughout the research process. Data may be collected longitudinally, thus tracking changes throughout the disease trajectory. Multiple data sources are incorporated including both quantitative and qualitative methods. The use of multiple case studies enhances credibility of findings. Conclusion: Limitations to using case study methodology include: poor basis for generalisation, limited by the selection of only a few cases and whether these cases are representative. However, case study methodology possesses attributes that should provide answers some palliative care research questions including the respite needs and experiences of families caring for a child with a life-limiting condition.


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Nursing students' perception of stress and coping on clinical teachings Lourenço, Alfredo Cruz, Coordinating Professor, Nursing School of Coimbra, 3001-901, Coimbra, Portugal; Telephone: 00351239802850 E-mail: [email protected] Background: On the initial nursing formation, clinical teachings are formal and structured processes that imply that the student mobilizes knowledge and competences, takes on new roles and reflects about himself and his experiences, sometimes leading to some anxiety and associated stressors. Aim and objectives: The aim of this study is to identify those stressors associated with clinical teachings. As an objective, we sought to determine the stress levels of the students, to know the relation between stress factors and the use of coping strategies, and to relate that to some socio-demographic variables. Method: We employed an exploratory, transversal and co-relational study, performed with a sample of 1085 students, from the bachelor in nursing that answered a survey concerning stressors in nursing students (KEZKAK) and the Toulousaine Coping Scale. We performed the factorial analysis of the instruments and the descriptive analysis of stress perception. We also analyzed the relation between the use of coping strategies, stress perception and socio-demographic variables. Ethical approval was granted by the Directors Board of the Nursing School of Coimbra. Findings: Our analysis allowed to test the psychometric quality of the instruments, proving them adequate. The scores obtained reflect an elevated perception of stress among students in more than 60% of the items that constitute the survey regarding stress (>1.5 in 25 of 41 items). The coping strategies more utilized were Control, Distraction and Social Support. From the relation between stressors and gender, we verified that female students show greater stress indexes both in global terms and in sub-scales. Students with below the average grades show greater stress indexes. Conclusions: From these results we conclude that there is a need to implement integration an helping programs about how to deal with stress, fear and anguish on practical classes.






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A qualitative study exploring nurses’ perceptions and experiences of person-centredness in a residential care setting for older people in Ireland. Alaine Mc Partland Staff Nurse. MSc, Hdip (Gerontology), BNSc, DipHE Nursing, RGN Anne-Marie Malone, MBA, BNS, RNT, RM, RGN, RCN, Trinity College Dublin. Alaine Mc Partland, Our Lady’s Hospital, Manorhamilton, Co Leitrim Email: [email protected] Background The Health Information and Quality Authority and An Bord Altranais endorse a person-centred ethos and culture that should govern the provision of nursing care in residential settings for older people in Ireland. It is proposed that person-centredness provides a framework on which practice with older people can be built. The evidence from many studies suggests that care is not yet person-centred. Aim and objectives To explore nurses’ perceptions and experiences of person-centredness and their perceptions of the factors that facilitates or hinders person-centred care in a residential care setting for older people in Ireland. Methodology A qualitative descriptive design was employed to collect data utilising semi-structured interviews from nine registered nurses with at least six months experience working in a residential care unit in Ireland. Ethical approval and permission was sought and granted from the respective ethics committees/ personnel. Data were analysed using a thematic analysis approach drawing upon the work of Colaizzi (1978). Findings Respondents identified challenges and areas for development in gerontological nursing, to enable care practices to evolve from a service dominated by custodial care to one that emphasises person-centredness in practice. Concerns and frustrations were expressed in relation to the provision of person-centred care not least due to lack of time, inadequate staffing, lack of support from management, lack of financial investment and dominant routine approach. These nurses’ perceptions and experieniences of person-centredness correspond with those identified in previous studies. Conclusion and recommendations Calls for person-centered care have emerged from policy makers, health care managers and researchers alike. These calls reflect the ethos of nursing. Nurses best efforts to implemented person-centeredness appear to be besieged by rigid care routines and organisational constraints. In the abscence of leadership and resouces to implement person-centered care, it seems only legitimate to question the relevance of the call itself.






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The challenges encountered while undertaking a clinical drug trial: A nursing perspective Authors: • Ms. Margaret McCann, School of Nursing and Midwifery, Trinity College Dublin • Professor Michael Clarke, Adjunct Professor, School of Nursing and Midwifery, Trinity College

Dublin • Dr. Fidelma Fitzpatrick, Consultant Microbiologist, Health Protection Surveillance Centre Presenting author Ms. Margaret McCann School of Nursing and Midwifery, Trinity College Dublin , 24 D’Olier Street , Dublin 2 Email address: [email protected] Tel: 018968542 Background As part of my PhD studies I undertake a randomised controlled trial that compared the effects different preparations of chlorhexidine gluconate have, as an antiseptic cleansing agent, on central venous catheter-related infections in haemodialysis patients. During the development of the trial protocol and following initial enquires with the Irish Medicine Board (IMB), it came to light that these antiseptic agents were medicinal products for human use. The proposed trial was, therefore, classified a clinical trial of a medicinal product and had to be planned and implemented in accordance with national and EU legislation. This paper explores the various challenges encountered during the planning and implementation of this trial. Aim of Paper • To highlight to nurse researchers strategies that can be utilised in overcoming challenges

encountered when engaging in a clinical trial of a medicinal product. Description of innovation A number of challenges were encountered, such as:

• Under EU legislation a clinical trial of a medicinal product is required to have a sponsor and an investigator (medical practitioner or a dentist);

• Authorisations from both the National Competent Authority (IMB) and Department of Health and Children approved Research Ethics Committee (REC) is required;

• Suspected Unexpected Serious Adverse Reactions are to be reported to the Eurovigilance database.

Evaluation of innovation As part of planning and implementing the trial I kept a reflective diary, which enabled me to critically analysis the challenges encountered and the actions taken to address these issues. Conclusion and implications Nurse researchers undertaking a clinical trial of a medicinal product are at a considerable disadvantage when planning such trials, when compared to those from the medical profession. This paper highlights various strategies that can be utilised in overcoming challenges encountered when conducting such clinical trials.


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Developing strategies to assist nursing students improve their numeracy and drug calculations skills. Patricia McCollum1, Nurse Lecturer, School of Nursing and Midwifery, Queen’s University Belfast; Katherine M.A. Rogers, Teaching Fellow, School of Nursing and Midwifery, Queen’s University Belfast. 1 School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Tel: +44 28 9097 5853; Email: [email protected] Background NMC Essential Cluster Skills stipulate the standards of numeracy and calculation skills before student nurses are deemed competent to be Registered Nurses. Therefore it needs to be addressed across the curriculum. Aim and Objectives To improve student nurses numeracy and drug calculation skills. Description of innovation The students’ mathematical abilities were tested in the pre-semester week and those who scored less than 80% were directed to the Student Guidance Centre for two revision sessions. During their CFP at weeks 14 and 28 students’ were given a drug calculation test. Feedback was given within two weeks and students’ who scored less than 80% or had a problem with specific types of calculations were given one to one feedback. As part of their Clinical Module 1 and in keeping with the NMC guidelines the students were tested formally at the end the CFP. Evaluation of innovation The periodic testing identified students with poor mathematical skills but more importantly those who had difficulties in applying mathematical concepts. Practice appeared to improve the student’s drug calculation skills which are in keeping with the findings from a number of research studies. The testing also appeared to address the issues of ‘maths anxiety’ and ‘lack of practice’ that some studies have alluded. Interestingly the student’s performance in the pre-semester test was not an accurate predictor of how the student progressed in subsequent tests. Conclusions and implications It is important not to judge students’ ability on a one-off numeracy test and evidence-based findings would support this. There is also evidence to suggest more use should be made of practice based strategies to help students who are having problems with applying mathematical concepts.


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Teaching and Information Technology: Faculty Experiences and Perceptions Marilyn McDonald DHSc, RN Associate Professor of Nursing, Franklin Pierce University. W. Lebanon, NH, USA Contact Details – Marilyn McDonald, 137 Town Line Rd, Mendon, Vermont 05701, USA Background The use of information technology has dramatically changed the classroom and clinical experiences of nursing students. Knowledge of faculty use and experiences with information technology and faculty perceptions of information technology and teaching are scant in the nursing literature. Aim and objectives of the study This descriptive study quantitatively and qualitatively explored faculty experiences and perceptions of information technology and teaching in nursing. The aim of the study was to describe and explore faculty experiences with a variety of information technologies. The study also identified the strengths, challenges and resources available to nursing faculty utilizing information technology in teaching. The objective of the study was to identify deficits in faculty use of technology to find the most effective ways of utilizing technology in future teaching. Methods Mixed methods were used. A quantitative descriptive survey was used to elicit data. A 10 question Likert scale and a 10 question true / false survey was used. A qualitative questionnaire was also used. Four open ended questions were asked on the qualitative survey. Sample Snowball sampling was used to collect the data. 20 nurse faculty comprised the sample. Analysis Descriptive and inferential statistics were used to analyze the demographic and quantitative data. A coding scheme and conceptual files were used to analyze themes in the qualitative data. Ethical Approval Ethical approval was not necessary as the research was not conducted at the university. Participation was voluntary. All surveys and questionnaires were anonymous. There were no risks in participation. Conclusions and implications Conflicting reports were found in the quantitative analysis. The majority of faculty felt that face to face teaching was more effective than online or hybrid teaching. Qualitative analysis revealed a lack of comfort in the use of information technology by nursing faculty. The analysis also reported a lack of training and support for faculty. Faculty perceived discomfort in the use of information technology and teaching. The study identified a need for a systematic plan in nursing education programs to train and support the use of information technology for faculty.


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Introducing Problem-based learning (PBL) into a traditional taught Applied Biomedical Science module – the experiences of facilitators. Aidin Mc Kinney – Teaching Fellow in Nursing, Deirdre Mc Grath – Teaching Fellow in Nursing, Karen Page – Teaching Fellow in Nursing, Beverly Mc Clean – Teaching Fellow in Nursing Contact details of presenting author: [email protected] Background: Knowledge of pathophysiology is essential for nurses. However the literature highlights that students have difficulty applying it to practice. It is suggested that by teaching this in a traditional way, students don’t readily see the link to practice. In view of this, it was decided to change our approach of module delivery, to a PBL approach. This also required the lecturers to adapt their role from being a teacher to being a facilitator. On completion of the module, the lecturing staff evaluated the change in delivery style. Aim and objectives: The aim of this study is to discuss the experiences of facilitators in changing their teaching delivery style from a traditional approach to a PBL approach. Method A qualitative research design was implemented in this study. The sample size was ten participants. Qualitative research analysis was used. Ethical approval was not deemed necessary as the sample group consisted of education facilitators. However, all participants were given written and verbal information in relation to the study and asked if they would like to participate. Description: The Applied Biomedical Science module lasted twelve weeks and the staff were asked to contribute their views in relation to the change in delivery approach following the delivery of the module. Findings: Overall it was felt that PBL was a valuable teaching/learning method however some issues were highlighted by the facilitators that they felt impinged on the module being more successful. These can be summarised under the three themes of; Facilitator centred difficulties, curriculum centred difficulties and student centred difficulties. Conclusions and implications: Literature emphasises benefits of PBL however this evaluation highlights that implementing it into a largely traditional curriculum is very challenging from a facilitator viewpoint. However despite the challenges the facilitators experienced overall they did feel it was useful teaching/learning method.


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Quality Care for Day Hospice Patients: a pilot study. Screening for Distress in Palliative Cancer Patients; Referral and Care Pathways Authors: McKiernan, D. (MSc Counselling Psychology, Trinity College Dublin), Hevey, D. (School of Psychology, Trinity College Dublin), Bates, U. (Principal Clinical Psychologist, Blackrock Hospice), Waldron, N (Day Care Manager, Blackrock Hospice). Dee McKiernan, Counselling Psychologist, Oscailt Integrative Health Centre, 8 Pembroke Road, Dublin 4 Phone: 087 622 5011 / 01 896 4394

Background: As demonstrated by Holland (1999), there exists a tendency among cancer patients to refrain from reporting feelings of psychological distress arising from their condition. This is associated with a range of negative outcomes, including reductions in quality of life (Noyes and Kathol, 1986) and psychological well being (Bottomley et al., 1996). In light of such findings, it has been recommended that routine screening of patient distress be implemented, beginning with their first visit to a healthcare professional (Practice Guidelines in Oncology, 2008). The National Comprehensive Cancer Network (NCCN) has developed the Distress Management Screening Measure (DMSM, 2007) to rapidly assess cancer patient distress. Aims and Objective: The aim of the study was to explore the feasibility of introducing a distress screening tool in a day hospice setting and to explore the professional staff’s experiences of using the tool and whether it supports current multidisciplinary care pathways. Method: A mixed methodology design was used; quantitative analysis of the NCCN DMSM and MQoL and qualitative analysis of the focus group. Participants were recruited from a target population comprised of cancer patients in “author’s institution”. Ethical approval was obtained from the St. Vincent’s University Hospital Ethics and Medical research committee, Our Lady’s Hospice ethics committee and the Ethical Review Board of Trinity College Dublin. Findings: The results suggested that the Distress Thermometer on the DMSM could be effective in detecting distress in cancer patients that would recommend interdisciplinary professional referral. Advantages and disadvantages of the tool were outlined by professional staff along with its influence on patient care and any changes to clinical practice. Conclusions and Implications: Implications for future research would include further studies on the implementation of screening tools in clinical practice; research investigating distress at certain points of the cancer trajectory; and the use of different clinical populations


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Addressing sepsis awareness amongst undergraduate nursing students – an educational initiative Author details: Aidín McKinney, Teaching Fellow, School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Rd, Belfast, BT9 7BL and Karen Page, Teaching Fellow, School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Rd, Belfast, BT9 7B. [email protected] Background: Early diagnosis and management of sepsis is crucial. Unfortunately it appears that sepsis is still not recognised soon enough and mortality associated with severe sepsis and septic shock remains unacceptably high. Various initiatives such as the Surviving Sepsis Campaign have been developed to improve the treatment of sepsis and reduce mortality however no specific role for nurses is described in the guidelines. Moreover the literature has indicated that nurses’ knowledge of sepsis and recognition of signs and symptoms has not always been adequate (Robson et al 2007). Therefore, an educational initiative was developed that specifically focused on nurses and their role in the recognition and treatment of patients with sepsis. Aim and objectives: To discuss an educational initiative that was introduced to improve undergraduate nursing students’ awareness of the signs of sepsis and the importance of early intervention. Description of innovation: In a final year module, a sepsis workshop was developed and provided students with an opportunity to work through a real life case scenario that focused on early recognition of sepsis, the Surviving Sepsis Campaign recommendations of care and the importance of monitoring and detecting further deterioration. Evaluation: Evaluations of the workshop were carried out as part of a required university module review and therefore ethical approval was not deemed necessary. The evaluations highlighted that students considered that they had not fully appreciated all of the early signs of sepsis and the importance of seeking early intervention. Students indicated that they felt the workshop broadened their awareness of sepsis and reemphasised the importance of interpreting patient observations and prompt reporting of symptoms. Conclusions and implications: It is hoped that this educational initiative will contribute in some small measure towards identifying patients at risk of sepsis and reducing mortality rates.


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Using a computer assisted qualitative data analysis software package to manage and support group data analysis Lorraine Mee ;Dr Adeline Cooney; Professor Kathy Murphy; Dr Dympna Casey: School of Nursing and Midwifery, Aras Moyola, National University of Ireland, Galway Contact details: Lorraine.mee@nuigalway Tel: 091492830 Background The qualitative data analysis software package QRS Nvivo is frequently used to support and manage data analysis. However, utilising Nvivo in a group analysis project can be very challenging, especially for a novice researcher. Aim This poster describes the data management, retrieval, analysis and quality assurance processes used by a group of researchers responsible for the qualitative element of the PRINCE (Pulmonary Rehabilitation in Nurse- led Community Environments) study. Ethical approval was obtained from the University ethics committee Description of innovation The focus of this longitudinal study was to examine participant’s experiences of participating on a structured education pulmonary rehabilitation programme. Data was collected from 24 participants at three time points: prior to the programme, two to four and 12 weeks after the programme. Four researchers were involved in the data analysis process, with one researcher (the author) taking the lead. An analysis strategy was developed which focused on data coding as well as how the analysed data would be managed, accessed and stored by each researcher working online from a different remote location. This poster describes how the data base was created, and how the integrity and rigour of the data was maintained and enhanced. Evaluation of innovation Using Nvivo to support qualitative data analysis is a challenge for the first time user. However, when large data sets and a number of researchers are involved, as was the case in this study, a computer assisted data analysis package is vital. It permits accurate recording and storage of data, creates a clear audit trial, facilitates group coding and enhances inter coder reliability. Conclusions and implications This poster demonstrates how a computer assisted qualitative data analysis software package can be used successfully to support data analysis so that rigour is maintained and enhanced.


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An overview of the key diabetes prevention trials for high risk population groups: Lessons to be learned. Name of authors: Pauline Meskell , Department of Nursing & Midwifery, Faculty of Education and health Sciences, North Campus, University of Limerick; Dr. Dympna Casey, School of Nursing & Midwifery, Aras Moyola, National University of Ireland Galway, Galway. Professor Kathy Murphy, School of Nursing & Midwifery, Aras Moyola, National University of Ireland Galway, Galway. Contact details for presenting author: 0035361234214. [email protected] Background: The incidence of Type 2 diabetes is rapidly increasing worldwide. Obesity and physical inactivity are two major modifiable lifestyle factors for type 2 diabetes. Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. The Finnish Diabetes Prevention Study has clearly shown that reducing weight and increasing physical activity can prevent or at least delay the onset of type 2 diabetes in individuals with impaired glucose tolerance. Intervention studies around the globe have used the Finnish Model to determine whether such programmes are effective and feasible. Aim: To examine intervention studies using the Finnish model of diabetes prevention, to determine the effectiveness of preventative programmes for type 2 diabetes. Methodology: A recent government report on chronic diseases in Ireland concluded that a stronger focus on disease prevention is required, together with an increase in the early diagnosis of chronic conditions such as diabetes. A review of studies that used the Finnish prevention programme conducted in Japan, Italy, China, Australia, America, India, Sweden, Canada and the UK was undertaken. Studies were categorised in terms of sample size, interventions, programme evaluation and statistical analysis. Results were examined for cumulative incidence of diabetes, Absolute Risk Reduction (ARR) and Relative Risk Reduction. Summary of key findings: Ireland has many lessons that it can learn from studies conducted elsewhere that used the Finnish model of diabetes prevention. Simply providing written guidelines is not sufficient to effect significant change in dietary and physical activity behaviour. Lifestyle interventions, including a body mass index (BMI) and waist reduction, substantially affected the prevalence of metabolic syndrome and its components. Conclusions: Community or population level intervention studies need to be simple and inexpensive to be cost effective.


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An RCT to test the effectiveness of an educational intervention on pre-hospital delay time in patients with acute coronary syndrome (ACS). Mary Mooney1, Gabrielle McKee1, Frances O’ Brien1, Sharon O’ Donnell1, Debra Moser2

1School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2. Phone: 353-1-8962692 E-mail: [email protected] 2College of Nursing, University of Kentucky. Background: Patient delay in seeking treatment for acute cardiac symptoms is the major factor that limits timely use of definitive therapies for ACS. Aim & objective: This multi-site RCT was conducted to determine whether patients randomised to an intervention group would have a reduced pre-hospital delay time if they subsequently had another ACS event, compared to those in the control group. Method: Following receipt of ethical approval, patients diagnosed with ACS were recruited across five Dublin hospitals. Baseline pre-hospital delay time, among other parameters, was measured. Those randomised to the intervention group were given a 30-minute individualised education session. This focused on: motivating behavioural change, addressing misconceptions about heart disease and the development of an individualised action plan related to pre-hospital delay. The education was reinforced one month later when those in the intervention group were telephoned. When patients from either group were re-admitted to an emergency department with ACS symptoms, their pre-hospital delay times were again measured. Data were analysed using PASW v.18 using repeated measures ANOVA on log transformed delay-time. Findings: Of the 2,037 patients enrolled in the study, 1,947 had a confirmed diagnosis of ACS. Total sample mean age was 63.9 ± 11.6 years; 1,402 (72%) were male. Baseline comparisons between groups revealed no significant differences in pre-hospital delay time. Of the sample, 162 (16.6%) in the intervention group and 126 (13.0%) in the control group were readmitted to an emergency department with a further ACS event. Those in the intervention group demonstrated a significant decrease in delay time compared to both their own baseline and to that of the control group (p = 0.020). Conclusion & implications: Pre-hospital delay time can be reduced through the delivery of a simple, practical patient education programme. This has the potential to reduce morbidity and mortality associated with ACS.


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The Darkness of Hope? A study of nurses’ responses to clients with suicidal behaviour Jean Morrissey & Prof Agnes Higgins School of Nursing & Midwifery Trinity College Dublin [email protected] Background Hope is a multidimensional construct that has received increasing attention in mental health practice. As an intervention, its use when addressing hopelessness in people with suicidal behaviour appears to be gaining recognition with respect to its therapeutic potential and importance within a person’s life. Despite this, there remains a paucity of empirical evidence pertaining to how psychiatric nurses communicate hope and hoping when working with clients who feel hopelessness. Notwithstanding the need for more investigation to evaluate psychiatric nurses’ use of hope with clients with suicidal behaviour, the authors would argue that hope can be the focus for some of the most potent and dynamic interventions within the nurse-client relationship provided that it is used with a full understanding of its complexity and an awareness of all the issues pertaining to its utility at the time. Aim of the study This paper will examine some of the key issues surrounding the use of hope between psychiatric nurses and clients with suicidal behaviour. Method This paper is based on the findings of a grounded theory study (Glaser and Strauss, 1967) with thirty three qualified psychiatric nurses, selected by means of theoretical sampling working in hospital and community settings within a large urban area. Ethical approval in line with the Helsinki agreement has been granted by the ethics committee of the University and the local research ethics committee of the service where the study was conducted. Data were analyzed using the constant comparative method of data analysis. Findings Findings indicate that psychiatric nurses’ use of hope is influenced by their struggle to protect both the client and professional self while at the same time to contain their anxieties when faced with the enormity of such responsibilities. Conclusions and implications These issues provide a fundamental backdrop for understanding the use of hope and suicidal behaviour and are an important consideration in guiding the nursing care of the suicidal person.


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An Exploratory Study of Midwifery Students’ Experience of the Use of Poster Presentation for Learning and Assessment Authors: Margaret Dunlea, Lecturer TCD, Kathryn Muldoon Lecturer TCD, Magda Ohaja Lecturer TCD Presenting author: Kathryn Muldoon Lecturer in Midwifery, School of Nursing & Midwifery Trinity College Dublin E.Mail [email protected] Phone 01 8962073 Background The utilization of a variety of assessment strategies in higher education programmes is widely acknowledged as a means of facilitating different ways of learning. This gives all students the opportunity to demonstrate their abilities and develop to their full potential. Poster presentations, popularly used as a method of disseminating research findings at health care conferences, are increasingly being used as an innovative assessment strategy in higher education. To date there is no Irish published study on midwifery student’s experiences of group poster presentation. Aim To explore the findings of a recently completed study of midwifery students’ experiences of the use of poster presentation for learning and assessment Method Ethical approval was obtained from the Faculty and University Ethics committees. Individual semi-structured interviews were conducted with students who participated in group poster presentation. Data analysis will be achieved by transcribing the data verbatim and identifying key themes that emerge. Findings This paper will discuss the themes which emerge from the data. Some of the findings of the study include:

• Students value the opportunity to learn skills such as communication, delegation and negotiation, all of which are transferable to practice. However not all students had the same positive experience.

• The challenges with group marking and how to ensure that a fair assessment strategy has been employed will be explored.

• The difficulties and challenges of peer assessment will also be discussed.

• Conclusion and implications Poster presentation, as a method of learning and assessment, encapsulates the notion of the adult learner, is self-regulating, and highly interactive and is for the most part, valued as an alternative assessment strategy. The opportunity to learn skills that are transferable to practice, for students in a practice based profession is valued. However, awarding a group mark is not without its problems. If assessment is the key driver for learning for most students, assessment that does not reflect individual contribution is open to misuse by ‘free-riders’ who do not put in equal effort. This raises issues of validity and reliability of the assessment process. Possible ways of overcoming this will be discussed. Also students’ experiences’ of peer marking is not always a positive one. Possible ways of preparing students for peer marking will be explored.


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An Evaluation of a Simulated Learning Package for Undergraduate Nursing Students Mary Nevin, Clinical Nurse Tutor, School of Nursing and Midwifery, Trinity College Dublin. Email: [email protected] James Mulkerrins, Clinical Nurse Tutor, School of Nursing and Midwifery, Trinity College Dublin. Email: [email protected] Freda Neill, Clinical Skills Manager, School of Nursing and Midwifery, Trinity College Dublin Background: A clinical simulation is an event or a situation made to resemble clinical practice as closely as possible (Seropian 2003), and the use of high fidelity simulators can bridge the gap between practice and clinical experience (Leigh & Hurst 2008). For the purposes of this study a simulated learning package utilising a high fidelity simulator (SIM-man) was developed by clinical nurse tutors to enhance students’ critical care clinical skills as they progress to the internship of the BSc general nursing undergraduate programme. Aim and objectives of the study: This study aimed to evaluate a simulated learning support package which utilised SIM-man in a clinical skills laboratory for undergraduate nursing students. The objectives were to ascertain the perceived benefits of the learning package; to compare the learning package with more traditional classroom based teaching methods; and to identify whether the students found this learning experience provided them with an opportunity to evaluate their practice. Research methodology: A questionnaire was developed which included likert scales and open ended questions. Ethical Approval was granted by the Faculty of Health Sciences Committee in the University where the study took place. A purposive sample of 134 third year undergraduate student nurses in one university was recruited for the survey. The Statistical Package for Social Science (SPSS) version 16 was used to analyse the data. 87 questionnaires were returned which represented a response rate of 64.9%. Findings: Overall participants found this a valuable learning experience. Over 98% either strongly agreed or agreed that the simulation process was helpful in understanding the core clinical skills involved in managing a critically ill patient in a safe environment. The vast majority of participants reported increased knowledge and confidence in their ability to demonstrate clinical decision making for a critically ill patient. Negative comments related principally to the large group sizes where participants commented that they would like further sessions in smaller groups. Conclusions and implications: This experience and feedback from the evaluation will prove useful in the development and allocation of resources for future simulation learning packages.


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Developing an information resource for health professionals on 22qdeletion syndrome (22qDS) (The PTP22q Project). 1Dr Honor Nicholl, [email protected] , 01-8963702 1Ms Maryanne Murphy, [email protected] 01-8962619 2Ms.Anne Lawlor, MA, Chairperson. [email protected] 1Ms Helen Malone, Research assistant, 1Ms Carmel Doyle, [email protected], 01-8963952 1Ms Thelma Begley, , [email protected], 01-8964041 1School of Nursing and Midwifery Trinity College Dublin 222q 11 Ireland Support Group, Dublin Background 22qDS (Di George syndrome, VCFS) is a genetic disorder caused by deletion of a small segment of chromosome 22. It causes variable characteristics including cardiac, immune, palate, renal, respiratory and muscular abnormalities. It is also linked with psychological and mental health problems. As a consequence the children with this syndrome require repeated admissions to hospitals during childhood and have many encounters with healthcare professionals. Aim and objectives The aim of this study was to develop a parent to professional information resource for health professionals who are caring for children with 22qDS. The objectives were to:

1. Identify information from parents of children with 22qDS that they perceive is required by healthcare professionals caring for their child

2. Design and implement an information leaflet for healthcare professionals who are caring for children with 22qDS

Description of innovation Data were collected by focus group and questionnaire. Ethical approval was obtained. The sample was 90 parents of children with 22qDS who are recorded on the 22qDS Ireland Support Group database. Findings from the focus group indicated key areas that concern parents. These include repeated story telling and a lack of specific knowledge on the syndrome amongst health professionals. Evalauation of innovation An information leaflet has been developed based on the focus group and questionnaire data obtained from parents of children with 22qDS. This newly developed information resource for health care professionals is unique as it is parent led. Conclusions and implications This information resource enables parents of individuals with 22qDS to communicate efficiently with healthcare professionals. It emphasises that the individual with 22qDS may have an individualised set of anomalies within the broad spectrum of reported anomalies. The information leaflet will be distributed to clinical colleagues in the three Dublin Children’s hospitals and in Northern Ireland hospital facilities.


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Nursing Children with Complex Needs in the Home: A Model of Care Sinéad Buckley, Carmel Doyle, Thelma Begley, Maryanne Murphy, School of Nursing & Midwifery, Trinity College Dublin. [email protected] Title and background Currently in Ireland, it is documented that over 1,300 children have complex health needs. The child’s home is the preferred place for all nursing care of these children. The majority of these children will be dependent on technology for survival and this leads to the child requiring complex nursing care. Aims and objectives The aim of this poster is to emphasise the relevance of implementing a model of care to frame an approach to paediatric nursing care of children will complex care needs in the child’s home. The objective is to adapt Peplau’s (1988) ‘Interpersonal Relations in Nursing’ as this model of care. Description of innovation Peplau’s (1988) ‘Interpersonal Relations in Nursing’ model of care has been embraced as an appropriate model of nursing for a children’s nurse to utilise when caring for the child with a complex health condition in the home. The roles of the children’s nurse have been incorporated when implementing Peplau’s model of care. Peplau’s model consists of various roles which include; role of stranger, resource, teacher, counselling, surrogate, leadership and technical expert role. Within this poster, each of these roles are presented and key challenges from current practices will be highlighted. Evaluation of innovation Within this poster, the roles of Children’s nurses are presented and key challenges from current paediatric nursing practices are highlighted. A summary of these nursing roles is provided as applicable to the continuing nursing care which is required for the child with complex health care needs in the home. Conclusions and implementations This poster identifies that using a model of care is essential in meeting the child and family needs within the home. This poster demonstrates how one specific model of care can be adopted in order to promote excellence in paediatric nursing practice.


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Continuous Competency Development toolkit for nurses and midwives: Views and concerns of nurses and midwives in practice. Mary Nevin, Clinical Nurse Tutor, School of Nursing and Midwifery, Trinity College Dublin. Email: [email protected]. Prof. Agnes Higgins, School of Nursing and Midwifery, Trinity College Dublin Prof. Cecily Begley, School of Nursing and Midwifery, Trinity College Dublin Dr. Fiona Timmins, School of Nursing and Midwifery, Trinity College Dublin Background: Nurses and midwives work within highly complex clinical environments, with high levels of patient dependency and acuity. Consequently competence determination and development is necessary to ensure good quality care and improved health care outcomes. In the Republic of Ireland the responsibility for maintenance of ongoing competence lies within the individual nurse’s and midwife’s scope of practice, and is influenced by a range of organisational, professional and legal responsibilities. Aim/objectives of the study: To develop and evaluate a continuous competency development resource toolkit in collaboration with clinical staff which will assist nurses and midwives to determine and maintain ongoing competency. Research Methodology: The toolkit was developed in collaboration with nurses and midwives working in practice and evaluated using questionnaires and focus group interviews in 16 sites around the country. A purposive sample of 455 registered nurses or midwives was recruited for the survey aspect of the study and 45 were involved in focus group interviews, 208 (46%) questionnaires were returned. Statistical Package for the Social Sciences (SPSS) version 16 was used to analyse the quantitative data. Qualitative data was analysed using thematic analysis. Ethical approval to conduct the evaluation was granted from the Faculty of Health Sciences Ethics Committee and the local research ethics committees for the services involved. Key Findings: Participants were very positive and welcomed the introduction of a toolkit. They were of the view that it simplified the process of competency determination and assessment and demystified language and concepts. Participants reported that reading the toolkit and participating in the activities increased their knowledge and motivation towards competence assessment and continuous professional development. Concerns raised related to time constraints for implementation in clinical practice, negative attitudes of staff towards competency determination and a resistance to competency assessment. Conclusions/Implications: The findings from the evaluation indicated that nurses and midwives recognised the need to maintain and develop their competence on a regular basis. Potential barriers to implementation were identified by participants and a number of supports required were identified in the evaluation.


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Creating the evidence to underpin children’s palliative care- Using an ABCD model Dr Honor Nicholl PhD RCN, School of Nursing and Midwifery, University of Dublin, Trinity College, 24 D’Olier Street Dublin 2, Ireland. Dr Jayne Price PhD, RN (Child), School of Nursing and Midwifery, Queen’s University Belfast, N. Ireland. Aim: Drawing on the experiences gained from two separate qualitative Doctoral studies (Study a & b) the presenters will examine a range of complex issues that can emerge when undertaking research in children’s palliative care. Recommendations on how these issues can be managed will be discussed using a proposed ABCD model. Background: It has been recognised that palliative care for children has a limited evidence basis (Pfund, 2007) and those who are attempting to develop evidence are faced with challenges specific to this type of research. The number of children with long term health conditions, which includes those requiring palliative care, is increasing and the need to examine parent’s experiences of caring for these children is fundamental to understanding the impact of care delivery and service provision. In doing research in this specialist area complex issues that can emerge require particular attention. This includes obtaining access (A), being in the field (B), closing the interview relationship(C) and dealing with the data (D). Based on research experiences an ABCD model has been developed to help others considering undertaking similar research studies. Design and method: Study (a) used a qualitative interpretive approach to investigate bereaved parents (n=25) (both mothers and fathers) experiences of providing palliative care. Study (b) adopted a phenomenological approach to investigate care-giving by mothers (n=15) in children with complex needs. Data were collected using interviews. Ethical approval was obtained. Findings: With reference to research experiences, the presenters will highlight specific challenges. Recommendations on how to address access, being in the field, closing the interview relationship and dealing with the data will be discussed. The potential for the use of this model will be outlined. Conclusions: Key issues in children’s palliative care research studies, and how they may be resolved, will be fully explored.


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The effectiveness of an educational intervention on ACS patients’ knowledge, attitudes and beliefs about heart disease: a randomised controlled trial. Frances O’Brien, Sharon O’ Donnell1, Gabrielle McKee1, Mary Mooney1, Debra Moser2

1School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2. Phone: 353-1-8963107 E-mail: [email protected] 2College of Nursing, University of Kentucky. Background: Knowledge of symptoms of acute coronary syndrome (ACS) is essential so that individuals can correctly identify symptoms of significance and thus seek care promptly. Aim: The aim of this RCT was to examine the impact of an individualised educational intervention (designed to decrease patient delay in seeking treatment for acute cardiac symptoms) on knowledge, attitudes and beliefs about heart disease among patients diagnosed with ACS. Methods: This multi-site RCT recruited patients admitted with a diagnosis of ACS across five hospitals in Dublin. Ethical approval was obtained from each site. Following randomisation, all patients were interviewed and completed the ACS Response Index questionnaire. This measured their knowledge, attitudes and beliefs about heart disease. Those in the intervention group received a 30-minute individualised education session which focused on altering misconceptions about heart disease, providing essential information and enhancing positive attitudes towards seeking prompt assistance if acute symptoms recurred. The questionnaire was re-administered at 3 and 12 months. Both groups were compared in a pre-test, post-test analysis. Data were analysed using PASW v18, using repeated measures ANOVA. Findings: A total of 2,037 were enrolled in the study. Of these, 1,947 had a confirmed diagnosis of ACS. The sample mean age was 63.9+ 11.6 years; Male: 72%. Knowledge, attitudes and belief scores were similar between groups at baseline. Following the intervention there was a significant increase in knowledge (p= 0.04), attitudes (p = 0.03) and beliefs (p=0.02) about heart disease in the intervention group, which was sustained at 12 months. There were no changes in the control group. Conclusions and implications: These results demonstrate that knowledge, attitudes and beliefs can be improved through focused education. This is critical to societal changes towards cardiovascular health as these attributes will determine how an individual will act and behave in the face of a health threat.


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The paradox of size in a mega maternity unit Rhona O’Connell MEd. BA, RNT, RM, RGN School of Nursing and Midwifery, University College Cork [email protected] Professor Soo Downe RM, BA (Hons) MSc, PhD, University of Central Lancashire Fiona Dykes, PhD, MA, RGN, RM, ADM, PG Cert Ed. UCLan Patricia Donovan RM MA (Ed) MPhil, UCLan Background Midwives purport to be the guardians of normal birth yet normal birth is a rare event in hospital environments. Aim To explore midwives’ experience of midwifery as they moved to a new large maternity hospital. Methodology Hermeneutic phenomenology selected with Van Manen used for analysis. Six midwives were interviewed before the move about their experiences of caring for women in labour. One year later, 17 midwives were interviewed about their experience in the new unit and the impact that this had on their practice. Ethical approval was obtained. Findings and implications The first phase data was consistent with previous studies. The midwives worked in an environment where intervention was the norm, yet stated their preferences in caring for women who give birth without intervention. Street level bureaucracy was apparent in their practice, the management of labour was routinised following a biomedical approach with a range of technologies and interventions expected to be used. Normal births occurred but these were due to luck. Foucault’s work on the nature of power and surveillance was evident and revealed the impact the environment for childbirth had on midwifery identities. The second phase identified a paradox whereby, due to the increased workload of all staff, the labour ward midwives escaped from the Foucauldian Panopticon of obstetric (and midwifery) surveillance. This enabled nascent midwifery practices to emerge. In providing uninterrupted one to one care, authentic relationships were formed with women leading to midwives to sharing in the beauty of birth, particularly when an ‘optimal’ birth was achieved. Midwives had greater opportunities to enact ‘real midwifery’ and normalise birth for women. The paradox of this mega maternity unit enabled authentic midwifery to emerge.


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Slow-onset myocardial infarction (MI): an important determinant of patient decision-delay Dr. Sharon O’Donnell, School of Nursing and Midwifery, University of Dublin, Trinity College [email protected] Background: There are numerous factors which contribute to delays along the pathway of care for patients with (MI) however none is more modifiable than those associated with patient decision delay. Despite this, efforts to reduce pre-hospital delays in patients with (MI) have had minimal success. This is due in part to lack of understanding about complex socio-psychological and clinical dimensions associated with help-seeking behaviour. Aims: The aim of this study was to (1) perform an in-depth examination of patients’ MI symptom experiences and (2) describe their help-seeking behaviour in response to these symptoms. Method: A qualitative descriptive design was used to examine the symptom experiences and help-seeking behaviour of patients with MI. Participants (N=42) were interviewed 2-4 days following their admission to one of two Dublin hospitals in Ireland. Ethical approval was received from Trinity College Dublin. NVivo was utilized to organize data Findings: Two new distinct MI phenomena emerged from the findings – 'slow-onset MI' and 'fast-onset MI'. Slow-onset MI is characterised by the gradual onset of mild intermittent symptoms, whilst fast-onset MI describes the sudden onset of severe and continuous chest pain. The majority of participants (n=27) experienced slow-onset MI symptoms but expected the symptom presentation associated with fast-onset MI. The mismatch of expected and experienced symptoms for participants with slow-onset MI, led to the incorrect naming of symptoms to a benign cause and protracted help-seeking delays. Participants with fast-MI (n=15) quickly matched their symptoms to those of a heart attack, thus expediting appropriate help-seeking behaviours. Conclusions: Definitions of MI and educational information pertaining to MI symptoms need to be reviewed. Slow-onset MI and fast-onset-MI provide more authentic versions of real MI events and plausible definition alternatives than what is currently used. They also present new ‘delay’ perspectives which may inform future educational interventions targeted at delay reduction.


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"Forgotten Grievers. An Exploration of the Grief Experiences of Bereaved Grandparents." Authors Ursula Gilrane-Mc Garry, Lecturer, Department of Nursing and Health Studies, St. Angela’s College, Lough Gill, Sligo. Tom O’Grady, Lecturer, Department of Nursing and Health Studies, St. Angela’s College, Lough Gill, Sligo. Presenting Author Tom O’Grady, 071-9135624, [email protected] Current knowledge about bereavement has been derived from the experiences of survivors in traditional societal roles of spouse, parent or child. A paucity of studies ensures that little is known about the grief of grandparents. The aims of this national study were to identify and describe the bereavement experience of grandparents following the death of their grandchild and to explore the needs and supports of grandparents throughout this experience. A qualitative exploratory descriptive design was employed. Upon receipt of ethical approval, a multi-pronged sampling strategy was employed to access participants. Seventeen persons participated in in-depth interviews. Data was subjected to thematic field analysis. Previous literature noted that grandparents experience ‘double pain’, meaning that they concurrently experience feelings of loss, worthlessness and inadequacy for their grandchild in addition to observing the pain of their own adult child’s grief (Gerner, 1990; Reed, 2000). However, our findings revealed that grandparents experience ‘cumulative pain’. In addition to the ‘double pain’, they also experience many other sources of pain. The study found that the resolution of this pain can be either ‘inhibited’ or ‘facilitated’ by a broad range of factors/events that take place before, at the time of or following the death of the grandchild. There is a need for bereaved grandparents to be recognized, acknowledged and supported by healthcare professionals and society in general.


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The place of feminists in hermeneutic phenomenology Magdalena Ohaja, Dr. Jo Murphy-Lawless. School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2. Email: [email protected] Background: In non-western countries, becoming a mother can be a complex process yet most studies into making motherhood safer are from a medical interventionist perspective that focuses mainly on the outcome of this process. The research questions, “What are women’s and midwives experiences of safe motherhood”, “What is the meaning of safe motherhood for women and midwives?” require a framework that creates a deeper understanding of the participants’ perspectives. It also enables us to understand better the social structures that inform and shape their experiences and how they construct the meaning of ‘safe motherhood’. Aims and objective: To examine the benefits and challenges of conducting a feminist-inspired hermeneutic phenomenological study in the culturally distinct southeast Nigeria. Description of innovation: Can one be a non-western feminist and at the same time a phenomenologist? Overall health researchers have made limited attempts to combine insights of feminism and phenomenology. This presentation focuses on the opportunities and challenges encountered when conducting a feminist-inspired hermeneutic phenomenological inquiry within midwifery research. Traditionally feminist researchers have been sceptical of the contribution of phenomenology to feminism, as most phenomenologists are male, and women-related issues were not explicit in phenomenological debates. However, recent years have witnessed several publications in this area. The present study (ongoing) utilises both approaches, and thus provides an epistemological advancement. Evaluation: Evidence from the literature suggests that both approaches can be used together to explore a phenomenon. Women’s well-being is largely influenced by their position in the society. This also applies to Igboland, the research location. Here the society is highly patriarchal. A combination of feminism and phenomenology will help reveal the impact of power disproportion, and thus contribute profoundly to how my research findings will empower women and midwives. Conclusions and implications: The integration of feminist and phenomenological approaches brings about a critical academic partnership, constructing new forms of knowledge. This places the issue at stake, gender relations, within the context of social forces. It is a starting point for other feminist researchers considering the value of a joint approach.


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Evaluating an interactive e-learning 12-lead electrocardiogram recording package with pre-registration nursing students Carol Oldroyd Alison Day MSc, BSc (Hons), PGCE, RGN, RNT MSc, PGCE, BSc (Hons), RN, RGN Senior Lecturer in Adult Nursing Senior Lecturer in Emergency Nursing [email protected] [email protected] RC407, Richard Crossman Building Coventry University Jordan Well Coventry, CV1 5RW United Kingdom Background Previous research conducted in collaboration with a local Cardiac Network indicated a lack of standardised guidelines in the recording of 12-lead ECGs within the primary care setting. In response, an interactive e-learning package was developed to promote consistency. As lecturers in a higher education institution (HEI), it was evident that this training tool could be utilised by our own pre-registration nursing students who were undertaking an acute and critical care module. Aim and objectives To evaluate the usability, content and application of the self-directed e-learning package using 103 2nd year pre-registration adult nursing students via a structured questionnaire. Description of innovation The package consists of on-line learning objects including video, cartoons and supporting materials to promote the recording of accurate, standardised 12-lead ECGs. Assessment is via multiple choice questions and an interactive lead placement exercise. Evaluation of innovation Of 103 students enrolled on the module, 76 responded to the questionnaire (response rate 74%). The process was part of the in-house module evaluation so ethical approval was not required and consent was assumed via return of the completed form. 90% of respondents indicated the package was easy to use, with 83% believing that the package promotes consistency in ECG recording. 88% thought that the content was current and accurate, although 32% thought additional content could be included. Suggestions for additional material included ECG interpretation and analysis, although this was clearly outside the intended learning outcomes of the package. Conclusion and implications The evaluation indicates that the package is perceived as beneficial in promoting understanding and consistency of ECG recording, thereby promoting evidence-based clinical guidelines. Whilst it is acknowledged that this innovation does not assess competence, the evaluation indicates that it could still be utilised as an integral part of a validated training programme.


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Discovery of breast symptoms: women’s help seeking behaviour Ms Máirín O’Mahony MSc, BNS, RNT, RM, RGN Professor Josephine Hegarty, PhD, MSc, BSc, RNT, RGN.

Professor Geraldine McCarthy, PhD, MSN, MEd, DIPN, RNT, RGN. Catherine McAuley School of Nursing & Midwifery Brookfield Health Sciences Complex University College Cork Ireland Email: [email protected] Background: Breast cancer is a major public health problem globally. In Ireland, an average of 3,095 cases with approximately 947 deaths, are reported annually. Early diagnosis of breast cancer is linked to more favourable outcomes and longer survival. Nonetheless, a considerable number of women wait for three months or longer before presenting to a health care professional (HCP) with a breast symptom. The majority of symptoms are detected by women themselves, therefore, a study to investigate women’s help seeking behaviour (HSB) following self discovery of a breast symptom and the associated influencing factors was deemed necessary. Method: A descriptive correlational design was used. Following ethical approval, data were collected from women (n=449) attending a breast clinic within the Republic of Ireland. The literature review informed the development of a multi-scale questionnaire package, focusing on the key issues impacting on HSB for cancer symptoms. Data were analysed using descriptive and inferential statistics. Findings: The majority of women (69.9%; n=314) sought help within one month, however, 30.1% (n=135) delayed help seeking for more than one month following symptom discovery. The factors most significantly associated with delayed HSB were knowledge around symptom identity; (p = 0.005) ‘ignoring the symptom and hoping it would go away’ (p < 0.001) and the perception/ belief in longer symptom duration (p = 0.023). Being ‘afraid’ on symptom discovery (p = 0.005) was associated with prompt HSB. Conclusion This study highlights that HSB is influenced by multiple factors which can have a significant impact on outcomes in terms of delayed or prompt HSB. Additionally, delayed HSB persists amongst women with self discovered breast symptoms. Implications for continued emphasis on the promotion of breast awareness, prompt help seeking and early detection and treatment of breast cancer, amongst women of all ages are emphasised.


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Evaluation of a Psychoeducational/Psychosocial Intervention for People with Recurrent Suicide Attempts (PISA): A Pilot Randomised Control Trial Presenting Author: Dr Aileen O’Reilly, Phd, BA (Hons), School of Nursing, Dublin City University (DCU). Authors: Dr Evelyn Gordon, PhD, MSc, RPN, Registered Therapist and Supervisor, School of Nursing, DCU Gerry Moore, RPN, RGN, BA (Hons), MSc, School of Nursing, DCU Maeve Kenny, MA, BA, Cert, Dip, St Vincent’s Hospital, Fairview Dr Rob O’Connor, Post Doctorate, PhD, BSc. School of Nursing, DCU Dr Michael Parkinson, PhD, BSc. School of Biotechnology, DCU Prof Chris Stevenson, BSc (Hons), MSc, PhD, RMN, CPsych, Chartered Psychologist/Family Therapist Background: Rates of suicide have increased significantly in recent years in many countries, including Ireland. However, despite investment in suicide prevention programmes and research, there is a lack of evidence-based interventions for people who repeatedly attempt suicide, even though studies have shown that these individuals are more likely to die by suicide. Aims and Objectives: The present project is a Health Research Board (HRB) funded project supported by four clinical sites nationally. It aims to evaluate the effectiveness of PISA (Psychosocial/psychoeducational Intervention for people with recurrent Suicide Attempts), which was developed in Canada. In addition, the project is interested in examining the acceptability of PISA in an Irish context and how people receiving PISA respond individually to the treatment. Method: Participants in this project are over 18 years of age, have made two or more self-reported suicide attempts over their lifetime (one of which was in the last three years) and are availing of Irish public mental health services. Over the course of the project, 216 participants will be recruited. The project is using a pilot randomised control trial (RCT) method to compare PISA and treatment as usual (TAU) with TAU. Randomisation is conducted centrally using a computer-generated randomisation schedule. The primary outcome in this project is the number of (self-reported) suicide attempts. In addition, changes in suicidal ideation, emotional literacy, attitudes problem solving and hope will be assessed. The RCT methodology is supplemented by a single case design which will explore possible associations between demographics, personality and outcome of PISA. Ethical approval for the PISA Project was obtained from the author’s University Research Ethics Committee and the Ethics Committees at each of the clinical sites involved in the project. Findings: This presentation will provide an overview of the PISA project and focus on the progress of the project to date.


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Trisomy 18 Referrals to a Children’s Palliative Care Service. Ms Valerie Jennings, Dr B. Hannon, Dr Maeve O’Reilly, Dr Marie Twomey, (Department of Palliative Medicine) & Dr Eleanor Molloy (Department of Neonatology). Our Lady’s Children's Hospital, Crumlin , Dublin 12, Ireland Valerie Jennings, Palliative Care Nurse Specialist. [email protected] Dr Maeve O’Reilly, Consultant in Palliative Medicine, maeve.o'[email protected] Trisomy 18 is the second most common autosomal trisomy in liveborn infants after trisomy 21. It is characterised by severe psychomotor and growth retardation. Clinical features including microcephaly, malformed ears, microphthalmia, micro- or retrognathia, microstomia and distinctively clenched fingers amongst others. Cardiac, pulmonary, gastrointestinal, genitourinary and endocrine complications are also common. The frequency of trisomy 18 in the US is approximately 1 in 6-8000 live births. In the UK, approximately 37 live births were recorded in 2008/2009. The median survival time is 19 days (3-43), with only 5-8% of children surviving their first year of life. Irish data is currently unavailable. Despite recognising that trisomy 18 is almost invariably associated with death in infancy or early childhood, there is a significant dearth of information in the literature regarding the palliative care needs of these patients. The aim of this retrospective chart review was to quantify referrals and identify the unique palliative care needs of this group. Ethical approval and permission was obtained from the relevant institutions. A proforma was developed to document relevant data. Demographic findings include number of referrals, gender, maternal age and antenatal diagnosis. The most common reason for referral included feeding difficulties (85%), followed by breathing difficulties (76%), discharge planning (50%) and irritability/pain (20%). In terms of outcomes 57% of infants died at home with the remaining 38% dying in hospital. Age of death ranged from 3 to 217 days, with a median of 52 days. In conclusion this group of infants has significant palliative care needs. This is the first Irish study of its type to identify these needs and to report place of death. This review illustrates the importance of a co-coordinated interdisciplinary approach to care. The development of a neonatal palliative care pathway would be appropriate to meet the care needs of this group.


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Realistic Evaluation as a learning tool for informing complex community based programme implementation: evidence from a Health Promoting Schools programme evaluation Karin O’Sullivan, School of Nursing & Midwifery, TCD Prof. Catherine Comiskey, School of Nursing & Midwifery, TCD Ciara Wynne, School of Nursing & Midwifery, TCD Mary Quirke, Department of Psychology, NUI Maynooth Dr. Sinead McGilloway, Department of Psychology, NUI Maynooth Presenting Author: Karin O’Sullivan, School of Nursing & Midwifery, TCD, 24 D’Olier Street, Dublin 2 email: [email protected] Background This paper draws from a large scale three year longitudinal study evaluating the implementation and outcomes of a Health Promoting Schools (HPS) programme in a community context. A HPS is a school that is guided by health promoting processes and principles and as such aspires to be a democratic, participative, and inclusive environment for the entire school community. A key component of the study is mapping the complex processes that the school community undergoes during the process of becoming a HPS. Aim and objectives This paper will discuss the benefits of using a realistic evaluation approach as a learning tool during programme implementation. It will set out the methods of data collection, and the approach to data analysis that followed. Key findings from the interim stage will be explored as examples of how the methodology is useful as a learning tool for feeding into practice during programme implementation. Description of innovation Realistic evaluation is a theory-based approach to evaluation which is used for exploring ‘what works’ in programme implementation. This approach examines evaluation data for configurations that comprise of context-mechanisms-outcomes and which can highlight aspects of practice that are working well in the local context, the reasons why, and the outcomes that result. Evaluation of innovation* A realistic evaluation approach is a useful method for identifying tangible, locally contextualised examples of what works well and why in the implementation of complex inter-sectoral programmes. This is particularly beneficial for communicating across the research/practitioner divide and contributing to the enhancement of programme implementation at various stages in the process. Conclusions and implications Realistic evaluation is a method that is particularly suited for use in the evaluation of complex community based programmes. It facilitates communication between research and practice, and can contribute to a more thorough understanding of programme implementation in practice for all stakeholders involved.


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Pre-Registration Nursing Student’s Experiences of Medication Management in a Paediatric Setting Doris O’ Toole, Clinical Placement Co-ordinator Children’s University Hospital, Temple Street. Doris.o’[email protected] Background A Children’s and General integrated nursing degree programme re-emerged recently in Ireland. As novices, students are faced with many challenges learning new skills in an effort to translate theory to practice. Consequently, it is necessary to explore how students are developing their knowledge of medications in the paediatric setting owing to significant variances across disciplines. Aims & Objectives The study aims to a) explore student’s knowledge acquisition of medication management in the paediatric setting b) gain an understanding of how students perceive their education / training prepares them for their role c) gain an understanding of changing needs experienced by students and d) generate data that will be valuable to clinical staff in supporting students. Methodology A qualitative design was used. A focus group was conducted at the end of the students third year of training. A further focus group will be conducted on completion of the internship. Purposive sampling was selected (n= 10). The data was transcribed verbatim and analysed following identification of key themes which emerged. Ethical approval was obtained. Findings The preliminary findings indicate that student participation in medication rounds was primarily self-initiated. ‘Third-checker’ role proved challenging as other nursing activities were often deemed more important. Ward activity and registered nurse’s attitudes impacted significantly on student participation. While resources including workbooks and workshops were viewed positively, students identified the need for formal continual assessment and simulated drug rounds. A more explicit integration of pharmacology within the curriculum and an increased partnership model underpinned their views. Conclusion & Implications The development of appropriate knowledge pertinent to medication management has far reaching implications to patient safety. The processes and structures which contribute to nurse education therefore may need to be examined. A review of local policies may also be warranted to support students to enhance their knowledge in practice.


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Return to contents page Arterial blood sampling practices: A survey of intensive care nurses practices’

Authors: Carmel Quigley MSc, BNS, H-Dip Nursing, PG Dip CHSE, RGN, RNT. RGN, RNT, Mater Misericordiae University Hospital, Dublin. E-mail:[email protected] Anne-Marie Malone MBA, BNS, RNT, RM, RGN, RCN School of Nursing and Midwifery, Trinity College Dublin Background: Drawing arterial blood samples (ABS) is an essential component of the nursing and medical management of patients in intensive care units, (ICU’S) as ABS’s are necessary for diagnostic investigations. Research has demonstrated this practice may contribute to iatrogenic anaemia. Several strategies have been developed to minimise blood loss from ABS. Research has demonstrated these strategies are not always implemented. Aim and objectives: The aim of the study was to ascertain, intensive care nurses’ self-reported, arterial blood sampling practices and utilisation of blood conservation measures, in five major academic teaching hospitals, in the Republic of Ireland. Methodology: A quantitative descriptive exploratory survey design was used to collect data from ICU nurses in 2005. Ethical approval and permission was obtained from the university, hospital ethics committees and relevant personnel, as required. Data was collected using a self-administered questionnaire from all qualified staff who met the inclusion criteria (N=320), with a response rate of 77% (n=248). Data was analysed using SPSS Version 14. Findings: The rationale for taking arterial blood samples related to the patient’s medical condition, with respondents making the decision to draw ABS’s in 93% of cases (n=231). Variations were evident in the volumes of blood that were used to clear the arterial lines. Some respondents were unaware of some strategies that may be used to minimise blood loss. 67% (n=165) were aware of ABS guidelines in their ICU. Minimal evidence was found between years of experience, educational qualification and self-reported practice regarding ABS. Recommendations: The recommendations included heightening awareness of blood loss in this cohort of patients, implementing all available strategies to minimise blood loss and continuing education for nurses.


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The Views of Community Specialist Palliative Care Nurses on Caring for Children and Families with Palliative Needs – a Qualitative Descriptive Study Quinn, Claire. Milford Care Centre, Limerick / National University of Ireland, Galway Bailey, M. Department of Nursing and Midwifery, University of Limerick Contact details: [email protected] Background: The publication of the Irish Palliative Care Needs Assessment for Children (2005) revealed home as the preferred place of care for the majority. Yet, current statistics indicate that many children still do not die at home. This disparity suggests that policy planners and current providers of Palliative Care services have significant hurdles to overcome in responding to parental aspirations. The recent publication of the national policy for Palliative Care for Children with Life Limiting Conditions in Ireland (2010) indicates potential for ongoing and increased collaboration between primary, paediatric and palliative care teams. Aim and Objectives of the study: Study aimed to describe the views of Irish Clinical Nurse Specialists (CNS) in one community palliative care team caring for children and families. A literature review examined national and international research relating to the experience of nurses and health professionals providing palliative care to children and families. Methodology: Utilising a qualitative descriptive design 7 Community Palliative Care CNSs participated in a focus group interview. Data analysis was facilitated by Burnard (2006) Framework for Data Analysis. Ethical approval was granted by the local HSE Scientific research Ethics Committee. Findings: Comprehension of both palliative care services and the role of the CNS in paediatric palliative care featured significantly in the findings. Challenges in gaining access to children were also described, as were organisational and advanced planning issues. In addition to the above, feelings of isolation experienced by the CNS in caring for these children and families were described. Conclusion and recommendations: Recommendations suggest important implications for existing (adult) palliative care teams who are increasingly invited to collaborate in the care of a child with a palliative condition. Further exploration into present day service provision for children with palliative care needs is required towards the development of inclusive community palliative care services into the future. Requirements for onsite education, psychological support and role clarity were among the recommendations made in light of study limitations.


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Exploring the psychological health of primary school-aged children attending DEIS band 1 schools Authors details: Mary Quirke: Trinity College Dublin/ National University of Ireland, Maynooth Sinead McGilloway: National University of Ireland, Maynooth Catherine Comiskey: Trinity College Dublin Ciara Wynne: Trinity College Dublin Karin O’Sullivan: Trinity College Dublin Contact details for presenting author: Mary Quirke, School of Nursing & Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2. 01 896 3101. [email protected] Background: The current study builds upon previous national and European data to provide more comprehensive information on self-reported psychological health of primary school-aged children attending DEIS band 1 schools (schools identified as situated in socially disadvantaged areas).

Aim and objectives of the study: The aim of this study is to inform health policy in relation to DEIS band 1 primary schools and improve children’s psychological health outcomes. The objectives are to measure children’s health outcomes and explore similarities and differences amongst children attending these schools with national and European samples.

Method: Self-reported health related assessments were completed as part of a larger prospective, 24-month follow-up, comparative study. Measures included: The Kidscreen-27; The Child Depression Inventory-Short and; Questions adapted from the Health Related Behaviour Questionnaire. A total of 338 participants (53% male, 47% female 8-12yrs) from 7 DEIS band 1 schools completed the questionnaires. Ethical approval was granted from Trinity College Dublin.

Findings: Results indicate that this sample displayed lower mean T-scores on four of five dimensions of the Kidscreen-27 when compared to European normative scores. The mean CDI-S score was marginally higher than previous Irish normative studies, but lower than observed in an American age-equivalent group. Negative affect also correlated negatively with several health indicators including weight satisfaction and reported occurrence of bullying. More than 40% indicated they had been bullied at or near the school in the last year which is, in line with, or higher than previous national studies.

Conclusions and implications: Overall, the findings from this study suggest a number of differences between the current sample and national and International norms. The current paper builds upon previous studies examining children’s psychological health. This information may help to provide support to the development of school based policies and services relating to children’s health.


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Nursing Quality and Outcome Measurement: An Irish Initiative to measure the contribution of nursing care Authors: 1. Mrs. P. Ryan Withero Nurse Practice Development Advisor, Nurse Practice Development Department, AMNCH, Phone: 01 4144130 email: [email protected] 2 Ms. G. Hiney Informatics Nurse, AMNCH. Background There is a growing body of evidence to support the need for measurement of the nursing contribution to patient outcome. Whilst this evidence exists with examples in the international context, there is a dearth of Irish literature on practice. This innovation undertaken in an academic teaching hospital outlines the implementation of a robust mechanism to measure nursing contribution to patient care and its impact on patient outcomes. Aims and Objectives The aim was to implement a process to measure nursing outcomes and care quality. The objectives included: identification of the most appropriate measures of nursing care outcome within an Irish context; design and test a systematic process to capture nursing quality and outcome measures; create awareness of the importance of measuring nursing care whilst embedding accountability for nursing care. Description of innovation A review of the literature identified 9 nursing outcome measures. To frame the process a quality measurement framework and audit tool were designed to measure care relevant to the appropriate best practice standards coupled with monitoring data on incident rates. Hence the standard of care quality in combination to patient outcome is captured to inform the impact of practice standards on patient outcome. Measurement is undertaken every two months in in-patient clinical areas. Evaluation of innovation The innovation is highly successful yielding valuable information on the standard of nursing care and its impact to patient outcome. This information is used to inform practice improvements with ownership by nurse leaders to affect change. Data analysis reveals upward trends within each cycle harnessed by implemented improvements in practice. Conclusions and implications This innovation is an example of simple nursing innovations delivering significant patient benefits. Ethical approval was not required due to the audit nature of this innovation however adherence to professional practice standards in audit were assured.


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Simulation Preparation, Clinical Judgment and Reflective Process: A Pilot Study Leighsa Sharoff, EdD, RN, NPP, AHN-BC City University of New York, Hunter College School of Nursing 425 East 25th Street, Room HS 410 New York, NY 10010 USA [email protected] Title and Background: High-fidelity human patient simulation (HFS) provides an environment that as realistically as possible reflects a clinical setting. Clinical judgment and reflection are essential to the development of student nurses. How these processes are enhanced and integrated with the use of simulation is an area that requires exploration in addition to how best prepare faculty and students for this experience. Aim and Objectives: The primary aim of this pilot study was to explore the efficacy of the preparatory material that is currently being utilized by faculty and students for the simulation experience in an urban undergraduate School of Nursing (SON) program. Method: This triangulated evaluation pilot study was designed to assess the efficacy of materials handed out prior to the simulation lab in producing the outcomes of interest; improved simulation learning outcomes; enhanced clinical judgment and improved reflective practice. Purposefully sampling of participants (junior, senior level students and faculty) received preparatory material in advance of the scheduled simulation and all received an email with a link to the online surveys via Survey Monkey. Qualitative and quantitative data was analyzed. University IRB approval obtained and a $5.00 donation to the American Cancer Society will be made for each completed survey battery. Findings: The majority of the pilot participants felt the preparatory material prepared them for the simulation experience. The simulation experience enhanced their clinical judgment and reflective practice as professional care givers. Conclusions and Implications: Preparing students and faculty for a simulation experience is an important element to this technological teaching tool. Further studies are required to determine the most efficient method to integrate simulation into nursing curricula.


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Sucrose use during procedural pain: Examining neonatal nurses’ knowledge of pain and attitudes to sucrose Orla Sheehan MSc Student, PG Dip (Neonatology), H Dip (Sick Children’s Nurs), Grad Cert (PICU), BSc, Dip Nurs, RCN, RGN Dr. Patricia Leahy-Warren PhD, MSc, H Dip PHN, BSc, RPHN, RM, RGN Purpose of this paper: The aim of this paper is to present the findings of research that examined nurses’ knowledge of neonatal pain, their attitudes and use of sucrose. Background: The effectiveness of sucrose as an analgesic during minor painful procedures in neonates has been extensively documented in literature worldwide. A sucrose solution administered onto the anterior tip of the tongue reduces the behavioural and often physiological responses to pain during heel lancing and other painful procedures. However, the use of sucrose has been documented at very low levels in NICU’s during minor painful procedures despite its proven effectiveness in clinical trials. Pain management in the NICU is influenced by nursing knowledge and attitudes. Therefore, neonatal nurses were the chosen population for this study as their knowledge and attitudes of pain and sucrose use was undocumented to date in the Irish setting. Aim and Objectives: (1) To describe neonatal nurses’ knowledge of neonatal pain (2) To describe neonatal nurses’ attitudes to sucrose and (3) to identify the use of sucrose during painful procedures. Method: A quantitative descriptive study was undertaken. Data were collected using a previously validated questionnaire with a convenience sample of 82 neonatal nurses. Data from the questionnaires were analysed using the Statistical Package for Social Scientists (SPSS) using descriptive statistics. Ethical approval was granted from the Clinical Research Ethics Committee. Findings: A 90% response rate (n=74) in this study demonstrated that neonatal nurses were knowledgeable regarding neonatal pain and showed positive attitudes to sucrose being safe and effective. Sucrose combined with non-nutritive sucking was found to be the most common intervention during many painful procedures in the neonatal unit and these results show higher rates than previously documented in the Irish setting. Woodward et al (2008) reported sucrose being used 5 % of the time for heel lancing in Irish NICU’s whereas this study found 42% of NICU nurses’ use sucrose often for heel lancing. Sucrose use during painful procedures in the neonatal unit is higher than previously demonstrated in earlier international studies such as Robbins (2007) in a UK study reporting that 75-80% of units do not administer analgesia prior to some painful procedures. Although, some more recent studies reported high utilisation of sucrose such as Taddio et al (2009) and Losacco et al (2011) with usage of up to 66-100%, this study revealed a regular use of sucrose for painful procedures at 42-60%. Conclusion: Sucrose is a solution that is within a nurses’ scope of practice to use but some international studies demonstrate under utilisation with paucity of evidence as to the reason. This study identified possible uncertainty regarding the dose/volume and concentration of sucrose and has shown higher utilisation than previously reported in Irish NICU’s.


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The Predictive Ability of Admission Cardiotocography (ACTG) for Adverse Labour and Birth Outcomes: A Systematic Review of Fourteen Non-Randomised Studies Valerie Smith Clinical Midwife Tutor School of Nursing & Midwifery University of Dublin, Trinity College Dublin 24 D’Olier Street Dublin 2 Background A systematic review of four randomised trials evaluating admission cardiotocography (ACTG) versus Intermittent Auscultation (IA) of the fetal heart rate in low-risk women demonstrated no evidence of benefit for ACTG use. Considering the possibility of additional empirical evidence from non-randomised studies, a systematic review of all non-randomised studies on this topic was performed. Aim of Review To evaluate the predictive ability of ACTG for adverse labour and birth outcomes Search and Review Methodology Computerized searches of MEDLINE, CINAHL and Maternity and Infant Care: MIDIRS were conducted in January 2010. A manual search of reference lists and personal communication with experts was also performed. Eligible participants were pregnant women at term. Outcome measures included the incidence of caesarean section, obstetric intervention and neonatal morbidity. A quality assessment of included studies was performed using the QUADAS tool. The extracted data for each outcome measure was entered into 2 x 2 tables according to the results of the ACTG and according to the presence or absence of the outcome measure in each individual study. Findings Fourteen studies, (6,668 women), were included. The likelihood ratio (LR) and 95% CI for positive and negative ACTG tests for each reported outcome were calculated. The predictive ability of a positive ACTG was > 10 for: fetal distress (1 study), Apgar score of < 7 at five minutes (2 studies) and meconium stained liquor (1 study). For all other outcomes, the LR was below 10. For a negative ACTG test the LR values for reported outcomes were either 1 or less than 1. Conclusions & Implications The results of this review demonstrate a poor predictive ability of a positive ACTG test for adverse labour and birth outcomes. This review supports the findings of the systematic review of randomised studies and further supports recommendations for IA use in low-risk pregnant women.


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The health improvement profile (HIP) can be a valuable tool in supporting the mental health nurse (MHN) to identify the physical health needs of people with serious mental illness (SMI) Siobhan Smyth Fionnuala Jordan [email protected] [email protected] 00 353 913432 00 353 913432 Agnes Tully [email protected] 00 353 912832 School of Nursing and Midwifery, National University of Ireland, Galway. Background The physical health needs of people with SMI are a cause of growing concern for clinicians. People with SMI have higher morbidity and mortality rates of cardiovascular disease, non-insulin-dependent diabetes, specific cancers and respiratory diseases than the general population. It has been estimated that the life expectancy of people with SMI is 20% lower than in the general population. In Ireland, mental illness is one of the leading causes of morbidity and approximately 50% of people with SMI have a co-morbid physical condition. Metabolic disorders are very common in this population, exceeding 50% in some studies. The HIP tool has been identified to address the inequalities of physical health care experienced by people with SMI. The HIP has 27 items and the male and female versions are slightly different. The HIP is undertaken annually and takes approximately 30 minutes to complete, drawing information from multiple sources. This specific tool will enable MHNs to identify the physical health needs of the SMI patients and direct them towards the evidence-based interventions. Aims and Objectives The aim of this paper is to review how the MHN can use HIP to address the physical health needs of people with SMI. Search Methodology A systematic search of the following databases was conducted for the period of January 2000 to January 2011: Medline, EMBASE, Psychlit, CINAHL, Cochrane Database of Systematic Reviews and Google scholar. Grey literature and reference lists were also sourced. Conclusions and implications The general consensus is that the MHN is in the prime position to positively effect the physical health of people with SMI. The use of the HIP tool can assist the MHN in the overall identification of the physical health needs and improve clinical outcomes for this client group.


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Effect of Nurses Living Fit™ Exercise and Nutrition Intervention on Body Mass Index in Nurses Karen Gabel Speroni, BSN, MHSA, PhD, RN [email protected] Director, Nursing Research & Chair, Research Council Inova Loudoun Hospital & Inova Fair Oaks Hospital 44045 Riverside Parkway 3600 Joseph Siewick Drive Leesburg, Virginia 20176 Fairfax, Virginia 22033 United States of America United States of America Background: Approximately 65% of Americans are overweight. Evidence-based programs are needed that educate nurses on exercise and nutrition for normal weight. The hospital-based Nurses Living Fit™ (NLF) intervention was developed and researched by nurses for this purpose. Aim and Objectives of the Study: The aim of this study was to determine the effect of the NLF intervention on Body Mass Index (BMI). The objective of this study was to quantify differences in BMI and waist circumference and participant evaluations by study group, from baseline to Weeks 12 and 24. Methods: This prospective, quasi-experimental, multi-center study included two self selected convenience samples of nurses from seven hospitals. Nurses participating were physically active and provided consent. The NLF intervention included 12 weeks of exercise, and monthly yoga and nutrition sessions, all emphasizing healthy lifestyle principles. Diaries were completed for exercise (pedometer steps, exercise and yoga time), nutrition (food group servings, fast food meals, and water consumed), and sleeping. The BMI and waist measures were completed at Baseline, Week 12 and 24. This study received Institutional Review Board Approval. Findings: A total of 217 nurses participated in this study (NLF=108; Contrast/No intervention=109). The NLF group participants had a greater mean reduction in BMI (-0.5) (p<.04) than contrast group participants (-0.3), and in waist circumference (NLF = -.9”; contrast = -0.2”). Ninety three percent of the NLF participants recommended overall that the NLF program should be provided to other nurses (94.9%) and to health care professionals (92.3%). Participants ranked the NLF program as helpful regarding healthy lifestyle principles. Conclusions and Implications: Hospitals can provide an evidence-based program like NLF to educate nurses on healthy lifestyle principles. Ideally, nurses can utilize these principles to achieve or maintain normal weight and to better educate their patients, families, and community, on healthy lifestyle principles targeting normal weight.


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Mental Health Nurses experiences of developing Therapeutic Relationships with the Families of Service Users experiencing an Eating Disorder. Jessica Stewart RPN BSc MSc email: [email protected] Clinical Placement Coordinator Kildare West Wicklow Mental Health Services Nurse Practice Development Unit HSE Mid Leinster 2nd Floor, Block E, Nangor Road, Dublin 12, Ireland. Background: There is National & International support for collaboration between Mental Health Nurse’s (MHN’s) and families in Mental Health (MH) and the area of Eating Disorders (ED). Irish Policy encourages family involvement in Mental Health Services (MHS); while Family Involvement is recommended in the treatment of EDs. For collaboration to exist, a relationship must exist and to benefit all (Service User (SU); Family; MHN’s), this researcher advocates that the relationship should be therapeutic in nature. Aim & Objective: The aim of this study is to explore MHN’s experiences of developing Therapeutic Relationships (TR) with the Families of SU’s experiencing an ED. Method: Using a qualitative descriptive design. Two focus groups of 4 MHN’s with experience working with SU’s experiencing an ED and their Families were held. The groups were audio recorded and transcribed verbatim using a transcription service. Data was analysed using Colaizzi’s (1978) framework and managed with the aid of NVivo Version8.0 Qualitative Analysis computer software. Ethical approval was granted by Trinity College Dublin. Findings: Four themes emerged from the data: A Consistent Approach to the Common Goal; An Uneven Collaboration; The Challenge of Expressed Emotion (EE) and MHN’s Awareness. In developing a TR with families the participants aimed to involve and support families, however challenges existed; EE, Inconsistent Approach, Ineffective Collaboration, Severity of the ED and Confidentiality. The MHN’s also identified both they and families needed more education and support. Conclusion and Implications: The concept of developing a TR with SUs is a second language to MHN’s; Developing TRs with families may be a more alien concept to MHN’s. This would give rise to the chicken or the egg question; which comes first- the TR or the collaboration? To improve the overall healthcare experience for Families and encourage Collaborative Care, MHN’s should be aware of their relationship with Families.


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Identifying the Gap: Recommended and current practice in intramuscular injection administration Anne Stoutt, Bantry General Hospital; Miriam O Donovan, Bantry General Hospital; Gerardina Harnett, Institute of Technology, Tralee Contact details of presenting author Education Department, Bantry General Hospital, Co. Cork. 353 27 53421 [email protected] Background Background for this research emanates from introducing a practice change guided by hospital policy. Anecdotal evidence points to predominant selection by nurses of the dorsogluteal rather than the recommended ventrogluteal muscle when administering an intramuscular injection (IMI). Considered selection of the appropriate needle based on clinical observation of the patient is advocated as best practice. Despite this anecdotal evidence suggests that nurses select a ‘green’ coloured needle in withdrawing medication and a ‘blue’ needle for administration. Aim To promote patient safety in implementing best practice in IMI administration To describe elements of the skill applied by nurses in IMI administration Objectives To determine muscle site and technique used when administering IMIs. To determine needle sizes selected in IMI administration. Method: Research design A descriptive design was used in describing elements of skills applied by nurses in IMI administration Sample A convenience sample of 69 nurses who attended an information session on IMI policy guidelines was included in this research study. There was a 74% (n=51) response rate. 94% (n=48) respondents were from the staff nurse grade and the remainder from the clinical nurse manager grade. Findings 51% (n=26) of nurses predominately select the ventrogluteal, 43% (n=22) the dorsogluteal and 0.5% (n=1) the vastus lateralis muscles when administering IMI. Only 25% (n=13) of nurses use finer bore needles when withdrawing medication whereas 39% (n=20) use 21g 40mm needle on administering an IMI. Interestingly no nurse selected the 50mm 21g needle yet this needle length is recommended for patients whose BMI >24.9. 53% (n=27) selected 30mm 23g needle when administering IMI and 6% (n=3) of nurses indicated that they would decide based on clinical observation of patients. Ethical approval Ethical approval was granted by the Teaching Hospitals Research Ethics Committee. Conclusion and implications Practice variations exist in administering IMI. Innovation when advancing best practice is needed in enabling change.


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Prospective, Randomized, Pilot Study Evaluating the Effect of Ice Chip Administration versus None on the Bitterness of Crushed Medication Author: Liliana G. Suchichtal RN4, BSN, CBN,Principal Investigator, Harpreet Gujral, RN, MSN,CRNP, CBN, Clinical Specialist/Bariatric Program Coordinator, Sub-Investigator Karen Gabel Speroni, PhD, RN, Director, Nursing Research Fair Oaks Hospital, Sub-Investigator,Diane Eldridge, RN3, Sub-Investigator & Martin Atherton, DrPH, Biostatistician. Fair Oaks Hospital, Fairfax, Virginia. USA Contact: Liliana Suchicital RN4, BSN, CBN [email protected] Phone # 703-3914550 Background: Providing bariatric patients crushed medications post-operatively is challenging. This research evaluates a method designed to improve patients’ bitterness and /or taste perception.

Aim and Objectives of the Study: The aim of the studies was to test whether a nursing intervention of administering ice chips to post-operative bariatric patient’s tongues before and after administering crushed medications would result in improved patient perception of bitterness and /or taste. Methods: This prospective, randomized pilot study included 100 patients. Procedures were conducted on the first post-operative day. Subjects were randomized in a 1:1 ratio in blocks of four to one of the two following groups: Group 1 (n=50) [ice chips group]; or Group 2 (n=50) [no ice chips group]. Randomization was stratified by restrictive surgery type. Data was collected on patient demographics and medical history. The intervention group subjects provided pre and post-ice scores for bitterness and taste. Ratings were documented on a validated 5 point categorical scale [bitterness (1=Least bitter; 2=Less bitter; 3=Neutral; 4=More bitter; 5=Most bitter); and taste (1=Least unpleasant; 2=Less unpleasant; 3=Neutral; 4=More unpleasant; 5=Most unpleasant)]. Control group subjects provided ratings after medication administration only. Data analysis was conducted in SAS. Intervention procedures were standardized for all subjects. Institutional Review Board approval was received. Findings: There were 50 subjects in each study group. The majority was female Caucasians. In the intervention group, as a result of the ice chips intervention, there was a 1.16 point mean reduction in bitterness (3.66 to 2.62; t-stat=5.32 p<0.0001) and a 1.04 improvement in taste (3.86 to 2.70; t-stat= 4.72 p<0.0001). Conclusions and Implications: The hypothesis of this study was met as the ice chips intervention procedure significantly improved bitterness and taste. Nurses can implement this procedure to improve bariatric patient medication experiences post-operatively.


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Women’s Experiences of Vaginal Examination in Labour: A Meta-Study Author Details: Linda Biesty, Vivienne Brady, Margaret Dunlea, Denise Lawler, Susannah Sweetman, School of Nursing and Midwifery, TCD. Contact details: Susannah Sweetman [email protected] or Margaret Dunlea [email protected] Aim of review: The aim of this paper is to highlight women’s experience of vaginal examination in labour by using a Meta-study research approach. Meta-study combines analysis of theory, methods and findings of qualitative research and encompasses a synthesis of insights into new ways of thinking about a particular phenomenon. Background: The impetus for this work came about through group attendance at a meta-study workshop with Dr. Barbara Paterson and Professor Therese Bondas in Norway in November 2010. Women worldwide routinely experience vaginal examination during labour. While this practice has become standard from the perspective of health care professionals, it can have a profound effect on women as recipients of maternity care. Conclusive evidence to support the ongoing use of this invasive technique in labour is absent, and research exploring women’s experiences of vaginal examination in labour is surprisingly limited. The purpose of this paper therefore, is to highlight an extremely important issue for women and clinicians by gathering and presenting existing evidence on this topic from women’s perspectives. Search and review methodology Meta-study is a systematic and rigorous process and consists of three analytic components (meta-data-analysis, metamethod, and metatheory), followed by synthesis of findings to generate new knowledge about a phenomenon. Qualitative researchers who have attempted metasynthesis have focused traditionally on analysis, which includes identifying commonalities, differences, patterns, and themes of primary research findings; however, in meta-study, analysis and synthesis are separate. A modified version of a primary appraisal tool developed by Paterson et al. (2001) has been used to appraise original research articles for the purpose of the current work. Anticipated Findings Preliminary findings suggest that vaginal examination in labour causes significant distress and discomfort for women and precipitates feelings of exposure, ambivalence, the loss of dignity, and the expectation of compliance. Conclusions and implications Implications of these anticipated findings include greater questioning among health professionals of the merit of routine vaginal examination during labour, and increased consideration of the views and preferences of women with regard to this procedure.


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A Practice Nurse-led Model of Care for Managing Chronic Disease in Australian General Practice Robyn L Synnott BA (Psych), SocSci (Hons), Grad Cert (Health Studies), Research Officer, The University of Queensland, School of Medicine, 288 Herston Road, Brisbane QLD Australia 4006 [email protected], Tel +61 (0)414740240, Fax +61 7 3365 5433 Diann S Eley MSc, PhD, A/Prof, MBBS Research Coordinator, The University of Queensland, School of Medicine, Australia Paul P Fahey BSc MMedStat, Adjunct Lecturer, The University of Queensland, School of Nursing and Midwifery, Australia Elizabeth Patterson BSc, MHSc (Nursing), PhD, Head, Nursing and Midwifery, RMIT University, Melbourne, VIC Australia Chris B Del Mar MD FRACGP, Professor of Primary Care Research, Bond University, Gold Coast QLD Australia Desley G Hegney RN, BA (hons), PhD, Professor and Director of Research, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Paul A Scuffham PhD, Professor of Health Economics, School of Medicine, Griffith University QLD Australia Jacqui Young RN, BN, MN (Edu), PhD candidate, Lecturer, The University of Queensland, School of Nursing and Midwifery, Australia Rosemary Mahomed MComHlthPrac (Hons) PhD, Practice Nurse, School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Australia Peter G Baker MD FRACGP, Head of Rural Clinical School, The University of Queensland, Rural Clinical School, Toowoomba, QLD Australia Aims and objectives: To trial the feasibility and acceptability of a new model of nurse-led chronic disease management in general practice in Australia Background: Managing chronic disease is a major concern for most developed countries including Australia. The Australian government’s commitment to health service reform has placed general practice at the centre of its agenda to address this challenge. Concerns about the capacity of medical practitioners in this sector to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise nurses. Design: Prospective mixed methods using a randomised controlled trial to test the equivalence of PN-led care with GP- led care with the collection of qualitative data before, during and after the intervention.


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Methods: Patients from 3 general practices, 1 regional, 1 rural and 1 metropolitan, over 18 years of age, with Type 2 diabetes, hypertension or stable ischemic heart disease were randomised into practice nurse-led or standard (general practitioner-led) care. Primary outcomes were clinical data, quality of life (QoL), and perceptions of the model’s feasibility and acceptability from the perspective of patients and general practice staff. Results: There were no clinically significant differences between nurse-led (n=131) and GP-led (n=142) patients. Overall QoL decreased over 12 months but the trend of deterioration between groups was not different. The nurses undertook more tests or assessments than the GPs. Qualitative data suggest that the nurse-led model was acceptable and feasible to all stakeholders before and after the study. Conclusions: This study has piloted a nurse-led model of collaborative chronic disease care in three diverse general practice settings in Australia and demonstrates a methodology to further test nurse-led care in this setting. Relevance to clinical practice: There is no contra-indication for PN-led care among the parameters we measured and importantly the model was perceived to be acceptable and feasible by practice staff and participating patients. Ethics Approval: Ethics approval was obtained from the four participating Australian Universities – The University of Queensland, Bond University, Griffith University and The University of Southern Queensland.


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Newly qualified nurses’ perception of the rostered year as an experience that prepares them for the role of a registered nurse. Emer Thompson Sinead Flaherty (Institute of Technology Tralee). Contact [email protected] The poster will present findings from a study which examined student nurses experience of the rostered year in one institution in the south of Ireland. There has been a change in nurse education over the last number of years from traditionally trained nurse to diploma trained and now to degree trained. The rostered year is incorporated in the degree programme to consolidate clinical experience and theory. However, there is sparse research available on the rostered year and little available on degree trained nurses especially in Ireland. Aims and objectives of the study To discover newly qualified nurses’ perceptions of the rostered year as an experience that prepares them for the role of a registered general nurse. Research methodology A phenomenological Heideggerian approach was used for the study. The participants were co-constructors of their experience of the rostered year and helped attain a deeper understanding of the lived experience. Individual semi-structured interviews were undertaken on nine newly qualified nurses with less than one year post qualification. Data was analysed utilising Giorgio’s thematic analysis framework. Ethical approval was obtained by the local ethics committee. Key findings Overall the findings showed the rostered year to be beneficial in developing their skills in becoming a registered general nurse. The study highlighted that good interpersonal relationships with staff were positively correlated with clinical learning and preparedness for the role of Registered General Nurse. They felt prepared in relation to managing their own caseload and the organisational skill of time management and prioritisation. However, they felt a lack of confidence in undertaking drug and doctors rounds and in the skill of delegation. Conclusions and implications This study indicates that this rostered year and degree training is beneficial to nurse training but further research in this area is required. The findings are pertinent to all involved in nurse education.


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Modelling the spread of the Human Papillomavirus (HPV) and simulating the impact of a HPV immunisation programme on young women. Authors: Ms. Kathryn Marie Tobin and Professor Catherine Comiskey. School of Nursing and Midwifery, Trinity College Dublin. [email protected] Background: In 2010, the Health Service Executive (HSE) introduced HPV into Ireland’s National Immunisation Programme. This school-based programme targets all girls in their first year of second level schools, to protect them from cervical cancer. Disease control strategies such as vaccination programmes are often evaluated using mathematical models, as the carrying out of such experiments in a human population is unethical. Mathematical models can estimate the number needed to vaccinate in order to eradicate disease, and can investigate the herd immunity effect. Aims: The aim of this PhD research is to evaluate the impact of the HPV vaccine on the future dynamics of HPV in Ireland. Method: An SIR (Susceptible – Infectious – Recovered) model consisting of ordinary differential equations (ODEs) was developed to represent HPV transmission dynamics in Ireland. Ethical approval was not required since this project does not involve human participants or primary data. Parameter values for the model equations were derived from publicly available anonymised data on HPV prevalence, sexual behaviour and population statistics. The model was solved using classical biomathematical techniques, and simulated using Matlab and Berkeley Madonna software. Findings: The model was used to simulate the current dynamics of HPV in Ireland, and the results were found to be consistent with previously published models from other countries. Analytical and numerical solutions for the transmission parameter β and the WAIFW matrix have been evaluated using available data. Conclusions and implications: Results from the simulation of current HPV dynamics in Ireland confirms validity of our model. The vaccine will be introduced to the model population and simulated for a range of scenarios from a population with no vaccination, to a high vaccination uptake. Results from these model simulations will allow us to predict the percentage of the population that needs to be vaccinated to eradicate the infection. There are significant gaps in our knowledge of the virology of HPV, and our future studies will amend the current HPV models as new information becomes available.


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Challenges of data collection from medical records. Agnes Tully, Lecturer in Nursing at National University of Ireland, Galway. [email protected] Ph. 091 492833 Yvonne Conway, Lecturer in Nursing at National University of Ireland, Galway. [email protected] Collette Kirwin Research Project manager PRINCE study NUI Galway Background Medical records (physical charts or computer records) are a rich source of data, and are frequently used in clinical research. They are often the primary source of information for retrospective data collection. Reliability of medical record data is always a concern. The rigor of data collection methodology has been shown to correlate to data reliability. The potential for interpersonal variance is significant when data is abstracted by numerous individuals. A number of nurse researchers have recently been collecting data from General Practitioner patient records for a Cluster Randomised controlled trial evaluating the effectiveness of a structured pulmonary rehabilitation education programme for improving the health status of people with chronic obstructive pulmonary disease (COPD) The PRINCE study. Collection of data happened over a period of two years with up to seven different nurse researchers involved. Aim and objectives The purpose of this study is to report on challenges encountered by nurse researchers collecting data from medical records and strategies used to overcome these challenges. This paper will report on findings from a focus group of these nurse researchers. Method A qualitative interpretive descriptive design will be used to gather and analyse data. This methodology was chosen as straight descriptions of phenomena are desired. Focus group interviews will be the main method of data collection, utilizing open ended questions. A semi structured indicative question schedule for focus group facilitators will be provided. All nurse researchers (n=7) who participated in the data collection from medical records will be invited to attend the focus group interview. Findings and conclusions Findings revealed challenges associated with non-electronic recording systems where there were difficulties reading notes and where sometimes multiple family members records were kept in the same file. Also numerous different medical databases were encountered some of which were not so user friendly. In addition to this in the electronic system details were missing such as reasons for consultations etc. Not all databases kept files on those who had passed away. A number of measures were taken to overcome challenges such as checking queries with the Doctor in question or their practice nurse and sometimes spending extra time on the database to confirm details. A number of other measures were taken at study level to confirm rigor of the data.


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Participants evaluation of participating in the PRINCE structured education pulmonary rehabilitation programme. Ms Aisling Walls1, Ms Collette Kirwan1, Dr Dympna Casey1, Prof Kathy Murphy1, Dr Adeline Cooney1, Ms Lorraine Mee1. 1 School of Nursing & Midwifery, National University of Ireland, Galway

Contact Details of Presenting Author: Aisling Walls, 4th Year General Nursing Student, School of Nursing & Midwifery, National University of Ireland Galway, University Road, Galway. [email protected] Background: Pulmonary Rehabilitation (PR) programmes are key in improving the health of people with chronic obstructive pulmonary disease (COPD). These programmes normally consist of a patient assessment, exercise training, education and psychosocial support. Most PR programmes in Ireland are hospital based therefore the extent to which clients report that such programmes are effective is relatively unknown. PRINCE (Pulmonary Rehabilitation In Nurse led Community Environments) is a cluster randomised controlled trial, examining the impact of PR programmes in primary care. This paper reports on participant’s evaluation of participating in PRINCE. Aim: To evaluate participant’s experiences of the PRINCE structured education pulmonary rehabilitation programme (SEPRP). Method: SEPRP content included medication management, breathing techniques and exercise training. It was delivered 2 hours/week for 8 weeks. A quantitative descriptive survey using an evaluative questionnaire was used to collect the data from participants at the end of the programme. A 96.7% response rate was achieved overall. The Statistical Packages for the Social Sciences (SPSS) version 15.0 was used to analyse the data. Ethical approval was obtained from NUIG and ICGP Research Ethics Committees. Findings: Analysis of the data revealed that most participants found the sessions helpful (97%) and that the content was relevant and practical (98%). In particular they reported that the content was useful in their daily lives (95%). All participants positively evaluated the programme. Key factors which led to this positive evaluation included the fact that the programme content was clear and understandable and that being part of a group provided additional support. Conclusions and implications Participants positively evaluated the PRINCE SEPRP; they felt empowered to better self manage their condition and experienced improvements in their condition. The delivery of SEPRP in the Irish primary care setting is therefore acceptable to clients and has the potential to improve their health.


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Finding the way to recovery through mutual help Mike Watts BA MPsych Sc. (Psychotherapy) Current PhD Student. National Program Coordinator GROW in Ireland. [email protected] Prof Agnes Higgins School of Nursing & Midwifery Trinity College Dublin Background Recovery from mental illness is a topical issue. Irish mental health policy calls for a transformation of our health services from a medical to a recovery orientation. The paradox and difficulty of this radical conversion is that a medical definition of recovery dominates and infuses every level of the political, economic, academic and legislative discourse. Aim of the study This study sought to explore the experiences of people who attended GROW, an Irish based community mental health movement, who considered themselves to be recovered from mental illness. Method This study used a narrative methodology. Unstructured interviews were conducted with 26 seasoned members of GROW in Ireland seeking to better understand the nature, process and outcomes of recovery through mutual help. All participants had a diagnosis of mental illness, been prescribed psychiatric medication and/or hospitalized. Participants were recruited using GROW staff as gatekeepers. Ethical approval was granted by the University’s ethics committee GROW’s Board. The taped and transcribed interviews were systematically explored using inductive and deductive methods of thematic analysis, employing principles of narrative methodology. Findings Findings indicate that recovery from mental illness is an ongoing and active process taking place in three distinct but non linear phases. Initially recovery involves a decision to find a way out of a ‘place of terror’; a place where the physical body is joined to a polyphony of negative stories creating an emotional context of isolated pain. ‘A time of healing’ begins when the person experiences meaningful relationship with other(s). Recovery is sealed through a ‘realisation of choice’ and through finding meaningful involvements in society that provide new stories of personal value, meaning and the joy of life. Conclusions and implications This study clearly articulates a consistent story of recovery and provides a means of evaluating the usefulness of mutual and professional help as currently practiced in Ireland.


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Knowledge of Body Mass Index and Motivation to Change in Irish and American Older Adults Teresa Wills, Patricia Fehin, Dr Bonnie Callen, Catherine McAuley School of Nursing and Midwifery, University College Cork. Contact Details: Teresa Wills - [email protected] 00353 21 4901472 Background: Obesity is an emerging worldwide healthcare epidemic and the prevalence of obesity is rapidly increasing in older adults. Being overweight or obese is a complex chronic condition and has an impact on health-related quality of life. Aim: The aim of the study was to explore the knowledge of older adults in Ireland and the United States of America about their body mass index (BMI) and their motivation to change. Methodology: A quantitative descriptive research method was adopted for the study. A convenience sample of 70 (n=70) community dwelling older adults in Ireland and America participated in the study. Data was collected in the form of questionnaires and participants were weighed and Body Mass Index was calculated. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS). Ethical approval for the study was obtained from the research committees in both countries. Findings: Both groups self reported their BMI category as lower than the measured BMI. Only 3% of the older Irish adults and 7% of the Americans knew what their BMI was. When their BMI was calculated, 40% of the Irish were obese and 22% of the Americans were obese. Despite this high incidence of obesity, nearly half (46%) of the Irish population were happy with their weight in comparison to (19%) of the American population. Self-perceived health status was recorded as good by over half of the Irish participants (56.5%) with very few reporting their health as fair (30.4%). In contrast with the Americans, less than a quarter (21.4%) reported that their health was good, with two thirds (65.7%) stating their health was fair. Conclusion: Many older adults are unaware of their weight status and do not know that they are in a category with multiple health consequences.


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A study of the socio-demographic influences on food expenditure amongst community-dwelling older people in Ireland Teresa Wills, Eleanor Bantry White, Dr. Caitriona Ni Laoire , Dr. Eibhlis O’Connor, Dr. Ian Shuttleworth, Dr. Huan Yu . Catherine McAuley School of Nursing and Midwifery, University College Cork. Contact Details: Teresa Wills - [email protected] 00353 21 4901472 Background: Malnutrition in older people, arising from physical, economic and social factors, represents an important public health issue associated with increased morbidity and mortality (CARDI, 2010). Aim: The primary objective of this study was to examine the socioeconomic determinants of food expenditure in older people by conducting an empirical analysis of food expenditure patterns. Methodology: The influence of key socio-demographic variables was examined through analyses of existing data available in the Household Budget Survey (HBS) (Central Statistics Office)(total sample: n= 6884; older households (over 65years): n=1444). Food expenditure was examined for 298 food items. Findings: The majority of older households lived alone (N=678) or with a partner (N=602) and over a third fell below the poverty line (EU-SILC, 2005). Significant differences (p<0.001) in total expenditure and the proportion of income spent on primary food categories were found by age group, income level and family composition. Older households had lower expenditure on convenience foods, snacks and confectionary, meals out and alcohol. The performed inferential statistic analysis yielded a linear model with six statistically significant variables: gender, age, marital status, household composition, disposable household income, and geographical area. Moreover, the purchased quantity of fruit and vegetable, especially leafy green vegetables, were much lower than the daily recommended intake, implying older Irish adults have nutritional and dietary deficits for fruit/vegetable intake. Conclusion: Different food expenditure patterns exist across age groups suggesting consumption patterns are different for older people. Public health interventions need to consider the role of socio-economic factors in determining food access and choices.


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Investigation into the experience of the first two years of Internship in Final Year Bachelor of Science in General Nursing students in Ireland. Dr. Maggie Wood, Lecturer in Nursing and Health Sciences, Department of Nursing and Health Science, Galway Mayo Institute of Technology, [email protected] Ms. Anne Lavelle, Allocations Liaison Officer, HSE, Mayo General Hospital & Mayo Mental Health Service, RGN, RM Dip in Nursing, BSc (Hons), MSc in Nursing. Aims and objectives: This study investigated the experience of the internship of the first two groups of BSc (Hons) in General Nursing students who completed the internship placement in 2009 and 2010 in the authors’ institutions, and of nursing staff that facilitated the internship placements. Method Research design: Survey through questionnaire, collecting quantitative and qualitative data regarding the internship experience. Sample: All internship students and internship clinical sites in August 2009 and 2010 (Students T1- = 30, T2-N=37; Clinical sites: T1-N=15; T2-N=17). Analysis: Quantitative data was analysed through frequencies and means. χ2 was used to identify significant differences between each year. Qualitative data was analysed through thematic analysis. Ethical approval: As no patients were involved, ethical approval was not sought, but the study was agreed through the Combined Internship Group (a partnership group between the 3rd Level Institute and the HSE established to manage the Internship). An explanation was given to participants verbally by the distributers and by an explanatory letter. Completion of questionnaires was anonymous and voluntary. Findings Quantitative data analysis did not indicate any significant findings. However, qualitative data indicated that both groups of respondents (T1-2009) felt that students were hindered in providing holistic care, as they were not able to manage patients independently if their patients were receiving intravenous fluids, or if they were escorting patients from operating departments. Frameworks for the development of internship nursing students’ competencies in caring for patients with intravenous fluids, and for escorting patients independently from the operating department were implemented during the second internship. Results (T2-2010) indicated that both nursing staff and internship students felt that the second group of students were more able to manage patient care holistically. The first survey also indicated that respondents felt that longer placements would benefit students. Fewer placements of longer duration were introduced with positive effects. Conclusions and implications The ability to manage patients holistically is a vital skill in preparing for registration. The implementation of competency frameworks and longer placements appear to be beneficial in facilitating this.


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Overweight, Obesity, and Health-Related Quality of Life Among Children in Designated Disadvantaged Areas Authors. Ciara Wynne (IRCSET scholar, TCD), Prof. Catherine Comiskey (TCD), Mary Quirke (NUIM), Eleanor Hollywood (TCD), and Karin O Sullivan (TCD). Contact. [email protected] Background. In the past 2 decades the prevalence of childhood obesity has reached epidemic proportions worldwide, raising concerns about its physical and psychosocial consequences for children as they get older. Aims and Objectives. To investigate the association between obesity and health related quality of life in a sample of children living in designated disadvantaged urban areas. Methods. A cross-sectional analysis was conducted using data on children’s health from the 2009 Healthy Schools Programme Evaluation (TCD Health Sciences Ethically Approved study). Children aged 6 to 12 were recruited from designated disadvantaged schools (n = 410). Three body mass categories from the International Obesity Task Force (IOTF) growth charts were used: underweight/normal, overweight and obese. Overweight and obesity are based on the BMI centile curve passing through the cut-off point 25 and 30. These cut-off points are age and gender specific. Five dimensions of KIDSCREEN-27 health-related quality of life were measured: physical health, psychological health, autonomy and parent relations, social functioning and peer relations, and a school functioning. Findings. Preliminary findings show associations between BMI and physical health, social functioning and peer relations, but not psychological health, school functioning or autonomy and parent relations. Children who were overweight or obese were at greater risk of poorer physical health, social functioning and peer relations than children who were in the normal/underweight category. Conclusions and Implications. In a sample from designated disadvantaged areas, overweight and obesity in children was linked with poor physical health, social functioning and peer relations. However, preliminary findings of this population did not find links between above normal body mass and poorer emotional, autonomy, parent relations or school functioning. Additional analysis will be conducted to explore this further. Using the longitudinal data available, further analysis will also determine the causal relationship between elevated body mass and lower HRQoL.


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Determining Risks: The Use of Cohort Study Designs to Determine Risk Ratios of the Global Burden of Disease Mary Beth Zeni, ScD, RN Senior Nurse Researcher Cleveland Clinic 9500 Euclid Avenue/T4-49 Cleveland, Ohio 44195 [email protected] Background A cohort study method determines the incidence rate of a health outcome based on a group’s exposure to a specific event. A measure of association, the relative risk or risk ratio, is calculated to quantify the risk of developing the health outcome. Traditionally used to investigate the risk of disease associated with an exposure (i.e., incidence of lung cancer associated with tobacco use), this presentation will discuss the use of the cohort study design to determine the risk of mortality associated with exposure to socio-economic burden, defined as countries classified as low and middle-income by the World Health Organization (WHO). Aim and Objectives: 1) Review the basic design of a cohort study to calculate risk ratio; 2) Demonstrate how to conduct a cohort study; and 3) Describe advantages and disadvantages of a cohort study. Description of Innovation The World Health Organization (WHO) Global Burden of Disease dataset was used to explain a cohort study’s fourfold table and to calculate and interpret relative risk, or risk ratio (RR). This population-based dataset is easily accessible through the WHO website. Exposure was conceptualized as a group of people (the cohort) who resided in either high income or low and middle- income countries as defined by WHO. Rates and risk ratios for three mortality outcomes (perinatal, HIV/AIDS, and war injuries) were determined based on WHO’s income classification of a country. Perinatal mortality is a traditional measure of the health of a nation; HIV/AIDS and war mortality rates are contemporary indicators. Findings and Evaluation of Innovation Residing in a country classified as lower income presents a greater than ten-fold risk of mortality for perinatal (RR= 12), HIV/AIDS (RR = 13.3), or war injuries (RR = 15) compared to higher income countries. An estimation of the global burden of disease experienced by lower income country can be quantified through a cohort design, further highlighting vulnerable nations within the global community. Conclusion and Implications Cohort study design can quantify risk associated with socio-economic exposure. This traditional epidemiologic study design can assist researchers, educators, and practitioners in examining disease burden and developing global health policy.


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Index of authors Author Page Author Page Author Page Adams, J. 9 Arkins, B. 10 Atherton, M. 101 Bailey, M. 34 Bailey, M. 91 Baker, P.G. 103 Bantry White, E. 110 Bates, U. 67 Begley, C.M. 11 Begley, C.M. 29 Begley, C.M. 77 Begley, T. 75 Bergin, M. 12 Biesty, L. 102 Bourke, M. 13 Bourke, R. 14 Boyd, F. 15 Boyd, F. 16 Boyd, F. 19 Bradley, S. 14 Brady, A-M. 17 Brady, V. 18 Brady, V. 102 Breen, M. 16 Breen, M. 19 Brown, M.J. 20 Buckley, S. 21 Buckley, S. 76 Callaghan, P. 55 Callen, B. 110 Carlisle, S. 22 Carr, G. 43 Casey, D. 69 Casey, D. 70 Casey, D. 108 Clarke, M. 29 Clarke, M. 63 Cleary-Holdforth, J. 23 Collins, R. 24 Comiskey, C. 25 Comiskey, C. 49 Comiskey, C. 88 Comiskey, C. 92 Comiskey, C. 106 Comiskey, C. 113 Conniare, K. 60 Connor Ballard, P. 26 Connor Ballard, P. 41

Conway, Y. 107 Cooney, A. 35 Cooney, A. 69 Cooney, A. 108 Corry, M. 27 Cowman, S. 32 Coyne, I. 28 Creaner, M. 45 Daly, D. 29 Davis, T.M. 30 Day, A. 31 Day, A. 84 Del Mar, C.B. 103 Denieffe, S. 32 Devane, D. 35 Devlin, B. 33 Dixon, L. 11 Donovan, P. 80 Doody, O. 34 Dowling, M. 35 Downe, S. 80 Doyle, C. 36 Doyle, C. 59 Doyle, C. 75 Doyle, C. 76 Doyle, L. 37 Doyle, Y. 38 Dunlea, M. 73 Dunlea, M. 102 Dykes, F. 80 Eldridge, D. 101 Eley, D.S. 103 Ellilä, H. 39 Fahey, P.P. 103 Fehin, P. 110 Felixson, K. 39 Fitzpatrick, F. 63 Flaherty, S. 105 Flood, B. 40 Freeman, G. 14 Friesen, M.A. 41 Gilrane-McGarry, U. 82 Gissler, M. 58 Godfrey, S. 31 Gooney, M. 32 Gordon, E. 86 Grimes, P. 42 Guilfoyle, M. 36

Guilliland, K. 11 Hahessy, S. 43 Hannon, B. 87 Harnett, G. 44 Harnett, G. 100 Harpreet, G. 101 Harrison, B. 41 Hayes, A. 45 Hegarty, J. 46 Hegarty, J. 85 Hegney, D. G. 103 Heinonen, S. 58 Herlihy, E. 10 Herron, M. 47 Hevey, D. 16 Hevey, D. 19 Hevey, D. 67 Hickey, P. 48 Higgins, A. 16 Higgins, A. 19 Higgins, A. 50 Higgins, A. 57 Higgins, A. 72 Higgins, A. 67 Higgins, A. 110 Hill, A. 20 Hiney, G. 93 Hollywood, E. 49 Hollywood, E. 113 Houghton, C. 35 Houlihan, D. 50 Hughes, B. 51 Hunter, A. 14 Huntley-Moore, S. 52 Jennings, V. 87 Jordan, F. 97 Kane, F. 53 Keegan, C. 11 Keenan, P.M. 41 Kennedy, J. 54 Kenny, M. 86 Keogh, B. 55 Kernohan, W.G. 47 Kiernan, G. 28 King, C.B. 56 Kirwan, C. 107 Kirwan, C. 108 Kirwan, M. 57


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Return to contents page Author Page Author Page Author Page Kuusela, M. 39 Lalor, J. 18 Lambert, V. 28 Lamminpää, R. 58 Lavelle, A. 112 Lawler, D. 102 Lawlor, A. 59 Lawlor, A. 75 Leahy-Warren, P. 95 Lecky, Y. 36 Lehwaldt, D. 57 Leufer, T. 23 Liddle, D. 20 Ling, J. 60 Lourenço, A. C. 61 Lyons, R. 34 Madden, E. 20 Mahomed, R. 103 Malone, A-M. 62 Malone, A-M. 90 Malone, H. 75 Martins, A. 28 Matthews, A. 57 Mc Partland, A. 62 McBennett, P. 13 McCann, M. 63 McCarron, M. 60 McCarthy, G. 85 McClean, B. 66 McCollum, P. 64 McDonald, M. 65 McGilloway, S. 88 McGilloway, S. 92 McGrath, D. 66 McHugh, A. 24 McKee, G. 71 McKee, G. 79 McKiernan, D. 67 McKinney, A. 66 MCKinney, A. 68 Mee, L. 69 Mee, L. 108 Meskell, P. 35 Meskell, P. 70 Molloy, E. 87 Mooney, M. 71 Mooney, M. 79 Moore, G. 86 Moran, S. 36 Morris, R. 57

Morrissey, J. 72 Moser, D. 71 Moser, D. 79 Muldoon, K. 73 Mulkerrins, J. 74 Murphy, K. 35 Murphy, K. 69 Murphy, K. 70 Murphy, K. 108 Murphy, M. 75 Murphy, M. 76 Murphy-Lawless, J. 83 Neill, F. 74 Nevin, M. 74 Nevin, M. 77 Ni Laoire, C. 110 Nicholl, H. 36 Nicholl, H. 59 Nicholl, H. 75 Nicholl, H. 78 Nőlke, L. 38 O Donovan, M. 44 O Donovan, M. 100 O’Brien, F. 71 O’Brien, F. 79 O’Connell, R. 80 O’Connor, E. 110 O’Connor, R. 86 O’Donnell, S. 71 O’Donnell, S. 79 O’Donnell, S. 81 O’Grady, T. 82 O’Keeffe, C. 54 O’Mahony, M. 85 O’Reilly, A. 86 O’Reilly, M. 87 O’Reilly, M.F. 35 O’Sullivan, K. 90 O’Sullivan, K. 92 O’Sullivan, K. 113 O’Toole, D. 89 Ohaja, M. 73 Ohaja, M. 83 Oldroyd, C. 31 Oldroyd, C. 84 Owen, S. 12 Page, K. 66 Page, K. 68 Parkinson, M. 86 Patterson, A. 52

Patterson, E. 103 Payne, S. 60 Price, J. 78 Quigley, C. 90 Quinn, C. 91 Quirke, M. 113 Quirke, M. 88 Quirke, M. 92 Reilly, M. 11 Robinson, J.D. 41 Rogers, K.M.A. 64 Ryan Withero, P. 93 Scanlon, L. 14 Scott, A. 57 Scuffham, P.A. 103 Sharoff, L. 94 Sheehan, O. 95 Shuttleworth, I. 110 Sinclair, M. 20 Sinclair, M. 47 Smith, V. 96 Smyth, S. 197 Smyth, S. 14 Snel, A. 49 Speroni, K.G. 98 Speroni, K.G. 101 Speroni, K.G. 41 Staines, A. 57 Stevenson, C. 86 Stewart, J. 99 Stockdale, J. 47 Stoutt, A. 100 Stoutt, A. 44 Suchicital, L. 101 Sweetman, S. 102 Synnott, R. 103 Thompson, E. 105 Timmins, F. 77 Tobin, K.M. 106 Tully, A. 97 Tully, A. 107 Tully, A. 14 Turner, J. 41 Twomey, M. 87 Tyrrell, M. 10 Vehviläinen-Julkunen, K. 58 Waldron, N. 67 Walls, A. 108 Walsh, E. 46 Walsh, J. 34

Return to contents page Author Page Watson, R. 41 Watts, M. 109 Wells, J.S.G. 12 Wills, T. 110 Wills, T. 110 Wood, M 112 Work, M. 41 Wynne, C. 87 Wynne, C. 92 Wynne, C. 113 Yarnell, L. 51 Young, J. 103 Yu, H. 110 Zeni, M.B. 114

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