Co-worker relationships and their impact on nurses in Irish public healthcare settings.

This article presents the findings of a secondary analysis of data arising from a quantitative study of 3769 nurses on co-worker relationships and their impact on nurses working in public healthcare settings in Ireland. The overall findings from this analysis suggest moderate to high levels of satisfaction with co-worker relationships, with an average scale mean of 77%. Statistically significant lower scale means were identified in respect of nurses whose basic nursing qualification was awarded in a country outside the EU, among students and among those working in the west of Ireland. Respondents intending to leave the healthcare workforce reported significantly lower scores (74%) on this index compared with those intending to stay (79%). Significant positive correlations between co-worker relationships and workplace engagement (0.233), job satisfaction (0.225), organisational commitment (0.221) and perception of managers (0.259) were identified. These findings have implications for the retention of nurses working in Irish public healthcare services.

Burnout and its prevalence among public health nurses in Ireland.

This paper presents the findings from an analysis of survey data which was collected from public health nurses (N = 136) as part of a larger study with more than 4000 nurses and midwives in Ireland. The purpose of the study was to examine the prevalence of burnout using the Oldenburg Burnout Inventory and to compare relationships between burnout, demographic and work characteristics across this group of nurses. Younger PHNs were most likely to report feeling burnout (68%) compared with those aged 51 or over (47%) who reported the lowest levels. PHNs whose highest level of qualification was a primary degree were least likely to report feeling burnout (31%) compared with those who held a Masters / Doctoral degree (54.5%). PHNs who reported working on a fixed-term full-time contract were most likely to report feeling burnout (70%) compared with those who were on a permanent part-time contract (49%). Quantitative analysis, using both descriptive and inferential statistics, was carried out and the findings show that PHNs reported moderate levels of burnout. The findings also show that burnout among PHNs is strongly correlated with the physical demands placed on individuals during work, having constant time pressures, too much being expected of individuals, the work environment being too demanding and dissatisfaction with the physical conditions.

Implementation science: issues of fidelity to consider in community nursing.

Programme implementation is a complex process, and literature around the area of implementation science is growing, particularly with respect to programme fidelity (Dusenbury et al, 2003; Carroll et al, 2007). This paper draws on the findings from an evaluation in one area involving restructuring of the Public Health Nursing service from a generalist, geographically based service, to a team-based specialist approach. From this evaluation, it is clear that careful consideration must be given to a number of key issues that could arise in moving from a pilot project to a more mainstream or widescale implementation. These issues could relate to workforce planning; the role of the team leader; formation, maintenance, and development of teams; expertise and knowledge, including knowledge of local communities; active caseload management; continuity across a range of areas; alignment with primary care teams; co-location; and the need for support, particularly in the IT infrastructure.

Multiple stakeholder views on changes in delivery of public health nursing services in Ireland.

In contrast with community nursing services in the UK and other parts of the world, the public health nursing service in the Republic of Ireland operates as a generalist service, providing both public health and wellbeing services in addition to clinical nursing services to a wide range of patient groups. While much discussion has taken place over the years about the benefits and challenges of a generalist service, little consensus has emerged about whether the current generalist approach should be maintained or whether a more specialised approach is required. This article presents key findings from an evaluation, using research methods, of a community nursing service that was restructured from a generalist, geographically based service, to a more specialist team-based model. The findings across multiple stakeholders show a number of positive effects in the areas of quality, safety, risk, governance, active caseload management, and finances. Some challenges were also identified, particularly with respect to continuity of services, loss of expertise, role of the team leader, and engagement in population-based activities.

Supporting the use of evidence in community nursing: a national strategic approach.

While there is an acceptance across all stakeholders that nursing practice should be informed by evidence, there is a substantial literature on the challenges this creates for nurses in the delivery of services. These challenges are accentuated for nurses in community settings, where accessible, up-to-date research evidence is more problematic because of the decentralised organisation and delivery of these services. Recognising this gap, and the consequent needs of its members, the Institute of Community Health Nursing (ICHN) in Ireland has commenced a national strategic development in this area. The purpose of the strategy is to actively support and facilitate public health and community nurses to provide services to individuals, families and communities that are based on the best available research evidence. This article provides a brief overview of the development and key components of the ICHN strategy.

Child protection reports: key issues arising for public health nurses.

Similar to other countries, there have been a number of high-profile reports into past and recent cases of child abuse and neglect in Ireland. The most recent of these have been the Monageer Inquiry, the Ryan Report, the Roscommon Child Care Case and the Report of the Independent Child Death Review Group. An analysis of these reports highlights the critical role played by public health nurses with troubled families. It also makes explicit key issues that consistently emerge as problematic in terms of professional practice. This paper summarises the main findings of the reports as they relate to the public health nursing service and identifies key themes emerging along with recommendations arising. The emerging themes relate to assessment, early intervention, record keeping, communication and interdisciplinary working and the role of public health nursing management.

A whole-child perspective assessment guide for early years settings.

This paper describes the development of a national assessment guide to assist the Irish Pre-School Inspectorate in evaluating support for child development in early childhood care and education settings. The development arose as a direct result of changes to the regulations governing pre-school childcare provision in Ireland. Revised regulations, published in 2006, built on previous regulations and made explicit the whole-child perspective within them. This places an important and overt focus on support for children's development within the inspection process, and is based on a socio-ecological understanding of children's lives. Using a collaborative approach with the Pre-School Inspectorate, an assessment guide was developed to enhance practitioners' understanding of the whole-child perspective element of the revised regulations, and to ensure consistency in the inspection process.

Quality in preventive and health-promoting services: constructing an understanding through process.

AIM: To develop a model of service quality for health-promoting services. In assessing quality, there are difficulties in taking account of the views of multiple stakeholders, the process of the service and the organizational context within which the service is provided. This study set out to address these difficulties. METHODS: A collective case study that incorporated national data from public health nurses (n = 946; response rate 54%) and public health nurse managers (n = 24; response rate 75%) and four case study sites which included data collected from 27 mothers with infants. RESULTS: A model of service quality that takes account of multiple stakeholder constructions, organizational context, service process and consequences was developed. CONCLUSIONS: Seven steps of process coupled with five concepts around which quality is judged can provide a basis for understanding service quality in a predominantly preventive and health-promoting type service.

Service configuration and quality of Irish public health nursing.

This paper presents findings from a national study of the Irish public health nursing service and focuses, in particular, on issues relating to service configuration. The findings are drawn mainly from a national questionnaire of public health nurses (PHNs) working with families with infants (n=613; response rate 54 per cent) and the data were gathered in 1999/2000. The average ratio of public health nurse (PHN) to population size was found to be 1:3997 with a range between 500 and 16,500. The vast majority of respondents (85 per cent) had responsibility for five or more client groups including the elderly, those requiring clinical nursing care, terminal nursing care, psychiatric care, school nursing and the organisation of the home help service. Statistically significant differences between and within health board areas in the extent to which other nurses were available to the service led to a conclusion that in these circumstances a standardised service across individual PHN areas is not possible. The findings highlight the importance of the principle of vertical equity where service configuration is determined by population composition and need.

Multidisciplinary communication in the Irish public health nursing service: a study.

Public health nurses (PHNs) in the Republic of Ireland work as part of a multidisciplinary team in the delivery of community care services. Good interdisciplinary communication is therefore vital to enable them to offer the best possible care to their clients. This article reports on one section of a national survey of PHNs who work with families with infants. The findings suggest that although in general, PHNs reported good working relationships with other professionals - particularly with speech therapists, area medical officers and community welfare officers - the same could not be said for hearing and eye specialists. Feedback also varied according to professional groups, with less than one third of PHNs reporting they always received feedback from GPs, eye specialists or social workers. A significant statistical correlation was found between reported working relationships and the frequency that feedback was received. These findings have implications for communication and teamworking in primary care in the Republic of Ireland and elsewhere.

Vertical equity in service provision: a model for the Irish public health nursing service.

AIMS: This paper analyses the policy and conceptual basis of public health nursing service provision in the Republic of Ireland and situates it within an international context. It draws on the principles of horizontal and vertical equity in proposing a new model of public health nursing service provision. It gives the reader an understanding of a model of service delivery underpinned by the principle of vertical equity. BACKGROUND ISSUES: The Public Health Nurse in the Republic of Ireland has a wide remit encompassing primary, secondary and tertiary care at the level of the individual, family and community. The changing sociological and demographic nature of society in Ireland has impacted on a service that has largely remained unchanged since 1966. Since 1997 four review bodies have provided recommendations that are incompatible with each other. There remains a need to find a solution to the overwhelming demands placed on the public health nursing service in the Republic of Ireland. KEY ISSUES: The public health nursing service goes beyond the provision of a purely clinical nursing service. Communities differ in demography, epidemiology, environment, history, composition, support and most importantly needs. Using three exemplars a new model for the public health nursing service is explicated. This model has as its main focus the needs of the community it serves. CONCLUSIONS: A service underpinned by the principle of vertical equity can be used to deliver locally based, needs driven public health nursing services. The application of such a model would make the public health nursing service more flexible and responsive to local need. Public health nursing composition and provision must be determined using the principal of vertical equity determined by the needs of the community it serves.

Does pacifier use cause ear infections in young children?

The aim of this review was to identify whether, in children under 2 years of age, pacifier (dummy) use results in an increased risk of ear infection (acute otitis media). The Cochrane Library, Medline, CINAHL and Embase databases were searched for cohort studies and randomised controlled trials that compared infants who used pacifiers with those who didn't or examined the effect of reducing pacifier use in a group of infants. One cluster randomised trial and two cohort studies met the review criteria and were available to be included in the body of the review. These studies show a clear increase in risk of ear infection to be associated with use of a pacifier that may well be causal. The risk of ear infections is up to three times higher in those who use a pacifier and there does appear to be a 'dose response' with continual users more at risk than occasional users. However, this relationship may be confounded by socio-demographic factors. Rather than advising a parent not to use a pacifier for fear of causing otitis media, advice in relation to this issue might best be restricted to pacifier users suffering from the problem in order to reduce the chances of recurrence.