'Ageing well': Discursive constructions of ageing and health in the public reach of a national longitudinal study on ageing.

Established in 2006, the Irish Longitudinal Study on Ageing (TILDA) investigates the health, economic and social circumstances of a nationally-representative sample of people aged fifty years and older in a series of biennial data collection waves. Irish newspapers have been reporting the results of TILDA for over a decade and a half, and their texts represent reports of scientific research distilled through the pen of journalists. In their totality, their texts constitute a public discourse on ageing and health. Using critical discourse analysis, we examined the discourse within the texts of a purposive sample of two national daily newspapers. As sites of public discourse, newspapers reflect social life and are influential in forming and legitimating public attitudes. Like other sites of discourse, their language-in-use is contextually located, is rarely neutral and may employ strategies to discursively construct, sustain and privilege particular social identities, including ageing identities. Discursively constructed as 'ageing well', our analysis of newspaper texts revealed a discernible meta-discourse on ageing and health in which ageing was framed as a life course stage that may be cultivated, diligently self-nurtured and exploited for its positive aspects. When considered in light of literature on health and social inequalities, the consequences of this broadly positive ageing discourse can, somewhat perversely, frame older adults in unintended negative ways, including homogenising them and attributing to them capacities for ageing well that they may not possess. Discursively constructing older adults as a social and economic resource can also impose unrealistic expectations on them and may legitimise exploitation and demonstrate how normative ideologies of ageism and ableism are conveyed through legitimising language. Despite these potentially unintended consequences, the available media resources associated with TILDA may represent one of the most important contributions of the study, in terms of informing positive public attitudes towards ageing.

Stress levels and coping strategies among undergraduate nursing students in Greece during economic recession: a cross-sectional study.

AIM: To identify factors contributing to Greek nursing students' stress and the coping strategies used. BACKGROUND: Stress experienced by nursing students in the context of ongoing economic recession is as yet unexplored. DESIGN: A cross-sectional study . METHODOLOGY: Undergraduate nursing students (n = 424) completed the Student Nurse Stress Index (short version) and the Brief COPE questionnaires during the year 2017. RESULTS: Most of the participants stated that their current financial status (81.7%) contributed towards their experience of stress, and they had higher scores on the interface worries subscale (p < 0.001). Female gender (p < 0.001) seniority (p = 0.005) and stress of transportation from home to university (p = 0.019) significantly increased the SNSI total score as well as most of the stress subscales scores. As far as coping subscales were concerned, higher means were shown in active/positive coping (mean 2.95), seeking support (mean 2.84), expression of negative feelings (mean 2.71) and avoidance (2.47). However, the use of higher maladaptive coping strategies was noted in cases presenting higher SNSI Total score, interface worries and personal problems. CONCLUSION: The introduction of stress management training and conflict management skills ought to be considered. Fund raising initiatives should be considered to provide financial assistance to those in need.

The WeanCare nutritional intervention in institutionalized dysphagic older people and its impact on nursing workload and costs: A quasi-experimental study.

AIM: The aim of this study is to explore how a nutritional intervention that improves the biochemical and functional profile of dysphagic older people impacts on nursing workload and costs for nursing homes. BACKGROUND: Dysphagic institutionalized older people particularly at risk of malnutrition require more intensive support from nursing staff and higher costs for nursing homes. METHOD: This is an open pre-post longitudinal multicentre quasi-experimental study without a control group. RESULTS: There is a significant reduction in the number of enemas (from 3.51 to 1.11 enemas), with an average nursing workload reduction from 52 to 16 min per patient every month. Each nurse also spent 20 h less per patient every month spoon-feeding. This resulted in nursing staff cost savings. CONCLUSIONS: The nutritional intervention led to a significantly better quality of life for the patients manifested through increased independence and social engagement. This reduced workload for nursing staff and costs for nursing home administrators. IMPLICATIONS FOR NURSING MANAGEMENT: Sensitive, targeted nutritional interventions have the potential to improve nursing home residents' quality of life and enable a more efficient use of resources. This study revealed reduced workload and cost savings due to less time spent administering enemas and spoon-feeding, in addition to reduced malnutritional consequences.

Ethical dimensions of paediatric nursing: A rapid evidence assessment.

BACKGROUND: Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, 'What are the most common ethical dimensions and competences related to paediatric nursing?' RESEARCH DESIGN: A rapid evidence assessment. METHOD: According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. FINDINGS: Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. CONCLUSION: Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses' perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

An evaluation of the effectiveness of a dedicated health and well being course on nursing students' health.

BACKGROUND: Many studies have shown that the transition to college can have a negative effect on students' life style choices resulting in weight gain, increasing inactivity and stress. Additionally while this issue is well recognised there have been only limited attempts at targeted interventions aimed at the university student population. The establishment of poor behavioural choices at this stage in the student's life can lead to consistency of unhealthy lifestyle practices, ultimately placing students at risk of heart disease and other lifestyle related health issues. This is more problematic for nursing students who are identified within the public domain as health promoters and as such ought to model, or at least not grossly contradict, healthy lifestyle choices. The current intervention is proposed as a possible mechanism to interrupt this process and establish healthy lifestyle choices at this crucial time in students' life in the hope that this will have lifelong health benefits. AIM: This is an innovative study aimed at evaluating the effectiveness of a health and well being module on nursing students' health. METHODS: Teaching on Health and Well-Being, a new course in the University, was provided to all first year undergraduate students at one university site in the Republic of Ireland (ROI) (n=110). Approximately half the sample (Nursing students) underwent an intervention while the other half served as a comparison group, health behaviours of both groups were compared using pre and post-test measures. FINDINGS: The most important finding from the study was a statistically significant increase in psychological well-being in the intervention group with a corresponding decrease in psychological well-being in the comparison group. Findings also indicated an initial significant increase in physical activity in the intervention group although this was not maintained over time. DISCUSSION: Targeted health behavioural interventions that include stress management skills ought to be provided as mandatory to nursing students to ensure the health of our future professionals. Only in this way they can role model the behaviours required of clients in their care.

Perceived barriers to the professional development of modern nursing in Italy - A discussion paper.

The aim of this paper is to discuss the development of modern nursing in Italy. Specifically, the paper aims to draw attention to the fact that while nursing in Italy has mirrored developments in Europe, in many respects the advancement of the profession is much less accelerated. The paper considers the reasons for this and the contributing factors and explores possible solutions.

How to maintain equity and objectivity in assessing the communication skills in a large group of student nurses during a long examination session, using the Objective Structured Clinical Examination (OSCE).

BACKGROUND: While development, testing, and innovation of the Objective Structured Clinical Examination (OSCE) are common in the international literature, studies from the United States of America (USA), Australia, and the United Kingdom (UK) predominate. There is little known about OSCE use in European countries, such as Italy, where other than cost analysis, there is little reporting of OSCE use or validation. OBJECTIVES: This paper reports on one Italian initiative, which evaluated the equity and objectivity of the OSCE method of assessing communication skills. DESIGN: An OSCE method was used to assess the communication skills of first-year students of the Degree Course in Nursing. A method of simulation was implemented through role-playing with standardized patients. An observational method was used to collect data. PARTICIPANTS AND SETTINGS: Four hundred and twenty-one first-year undergraduate nursing students at one university site in Italy took part. METHODS: Ten examination sessions were carried out. The students' performances were assessed by two examiners who used a structured observation grid and conducted their assessment separately. A situation simulated by four nurses with experience as actors was used as the topic for the students' examination. RESULTS: Calculation of the daily rate of students who passed the examination revealed a random distribution over time. The nonparametric correlation indexes referring to the assessments and to the scores assigned by the two examiners proved statistically significant (P≤0.001). CONCLUSIONS: The study confirmed the validity of the OSCE method in ensuring equity and objectivity of communication skills assessment in a large population of nursing students for the purpose of certification throughout the duration of the examination. This has important implications for nurse education and practice as the extent to which OSCE approaches, while deemed objective, are culturally sensitive or valid and reliable across cultures is not clear. This is something that requires further research and examination in this field.

A case study approach to the examination of a telephone-based health coaching intervention in facilitating behaviour change for adults with Type 2 diabetes.

AIMS AND OBJECTIVES: This study aims to examine the effectiveness of the use of telephone empowerment-based health coaching as a cost-effective alternative to changing health behaviours of adults with Type 2 diabetes. BACKGROUND: Guidelines regarding lifestyle management to reduce the risk of complications in diabetes include changing patterns of eating, physical activity and smoking cessation. Traditional education/behavioural methods of support for behaviour change reveal mixed and mainly short-term effects. DESIGN: A mixed method case study approach was used (n = 10). METHODS: Data were collected by means of physiological measurements survey and focus group interview both before and after telephone a coaching intervention. RESULTS: Participants took greater responsibility for health and revealed high self-efficacy scores. Short-term benefits were seen in physiological variables at three months but these deteriorated with the cessation of the intervention indicating the need for continuous support. CONCLUSION: Telephone coaching is a cost-effective approach to supporting health behaviour change for those with diabetes. It embraces the principles of empowerment and warrants further evaluation in supporting long-term behavioural changes. As such coaching emerges as a suitable proposition for this cohort. RELEVANCE TO CLINICAL PRACTICE: Health coaching has a positive impact on health behaviours for those with diabetes. Health coaching facilitates an increase in personal control of health and builds confidence in self-managing diabetes. Patients feel really supported and become motivated towards self-care.

Nursing students' attitudes to health promotion to: implications for teaching practice.

For several decades now the World Health Organization has indicated the need for a reorientation of the health services away from focusing solely on illness and disease to one that considers both disease prevention and health promotion. Successive publications that guide public health policy both nationally and internationally reiterate the need for health promotion and the principles of health for all to become integral to the fabric of health care delivery. The role of the nurse as health promoters is well recognized. However despite acknowledgement by professional nursing bodies and nurse educators that health promotion forms a central tenet of undergraduate nurse education curricula, there are varied approaches to teaching and learning and little formal evaluation of the consequences of approaches taken. The aims of this study are to identify current health promotion curricular content within the Irish undergraduate nursing programme context; to measure nursing students' attitudes towards health promotion and to examine nursing students' reported lifestyle behaviours.

An evaluation of a collaborative approach to the assessment of competence among nursing students of three universities in Ireland.

This paper describes a collaborative project conducted by the three principal universities in Dublin to implement and evaluate a competence assessment tool for use by nursing students and their assessors while on clinical placements. In the greater Dublin area, students from three universities are required to share clinical placement sites in specialist practice areas. Accordingly, a liaison group was established among the three universities, in order to develop a common competence-based assessment tool and related protocols for its use. The newly developed competence assessment tool was implemented in 2004, and in 2006, an evaluation of its use was conducted by means of a survey among a non-probability sample of students and their preceptors. Results from the survey data indicate generally positive attitudes to the structure of the tool and positive experiences of its operation in practice. However, respondents indicated dissatisfaction with the amount of time spent completing the assessment tool and the amount of preparation needed to carry out the assessment process. Recommendations for practice include the need to consider placement length in the design process and the need to focus on user preparation. This study also points to the benefits of inter-institutional collaboration in competence assessment and the possible implications for future work in this area.

Spiritual assessment in intensive and cardiac care nursing.

AIM: The aim of this paper is to explore various approaches to spiritual assessments in contemporary intensive and cardiac care (ICU/CCU) environments. BACKGROUND: Despite the increasing recognition that spiritual care is essential for quality patient care, an agreed spiritual assessment approach and tool for use in ICU/CCU settings remains elusive. METHOD: An overview of spiritual assessment and spiritual assessment tools. CONCLUSION: It is suggested that the staff in ICU/CCU nursing settings choose or develop a formal assessment tool that most closely matches their considered collective definition of spirituality, which has been considered in light of their mission statement and philosophy of care. RELEVANCE TO CLINICAL PRACTICE: Spiritual assessment is essential to formulate a care plan as spiritual care provides a powerful inner resource to critically ill patients in acute clinical environments.

Cardiac nurses' views of continuing professional education.

BACKGROUND: There is little information available on cardiovascular nurses' attitudes to continuing professional education. Anecdotally many nurses profess that they require additional study days to keep updated in practice; however these are not always available at local level. This survey aimed to capture the views of cardiovascular nurses with regard to their continuing education needs. AIMS: This research aimed to identify cardiovascular nurses' views on continuing professional education. METHODS: A 26-item questionnaire collected data from 195 cardiovascular nurses in the Republic of Ireland. Response rate was 52% (n=102). RESULTS: Most nurses had attended an educational event in the last 3-6 months and national conferences and local initiatives provided most of these latter services. Most respondents received both funding and study leave to attend. Nurses preferred method of keeping up-to-date was by means of conference and study days, journal use was also frequent. A high level of access to electronic resources was reported. Midweek was the preferred time for continuing education to occur. CONCLUSIONS: The findings reveal a positive attitude to continuing professional education. They also support the endeavours of national professional organisations, such as INCA and highlight the important role that these organisations play in the provision of ongoing education to cardiovascular nurses.

An exploratory study identifying the programme related stressors amongst qualified nurses completing part-time degree courses.

The aim of this paper is to explore the leading programmatic stressors and associated age related stressors experienced by two cohorts of students (n=132) completing part time degree programmes in nursing in two third level institutions in the Republic of Ireland. To date the literature has exclusively focused on the day to day stressors that undergraduate nursing student's experience. The design chosen was descriptive utilising a questionnaire as the mode of data collection. 'Preparing assignments for submission', 'trying to balance work commitments and the required study', 'doing the course assignments', 'the demands of writing an assignment to the necessary level', the prospect of the final examination' and 'preparing for the course examination' were all ranked as the leading stressors. The younger participants in this study were more likely to register higher degrees of stress as a result of the process stressors of their studies owing to the negative correlation with age. Process stressors were associated with the academic workload and time management difficulties. The findings have wider implications for educationalists in relation to course development and ongoing student support. Educationalists need to be cognizant in particular of the age related stressors associated with completing part time degree programmes.