Leadership in intellectual disability practice: design, development, and evaluation of a programme to support practice.

BACKGROUND: Intellectual disability services have and continue to experience changes in service provision. This has an implication for leadership in practice as the quality of leadership has a direct influence on staff practice and care provided. AIM: To design, deliver, and evaluate a leadership programme for nurse and social care managers in Ireland. DESIGN: An accredited programme was designed based on evidence from literature, practice, and national expertise. A cross-sectional survey was used to collect information on the attitudes and behaviour of participants before commencing and after completing the programme. Data from the questionnaires were analysed using SPSS and open-ended questions were analysed using content analysis. SETTING: Intellectual disability services. PARTICIPANTS: 102 participants completed the programme and survey. METHODS: Pre-post survey and reported using the CROSS guidelines. RESULTS: Participants' expectations were rated highly, and all items scored higher in the post-survey. Qualitative data was overall positive regarding opportunities for more time to work through each aspect of the programme. The key learning was through the forum day where participants shared their group projects. CONCLUSIONS: Overall, the programme was positively evaluated and through engaging with the programme participants' perceptions moved from seeing leadership as mostly task-oriented to realising that qualities such as good communication, person-centredness, advocacy, supporting, role modelling, and empowering are key to leadership.

The palliative care experience in Irish nursing homes during the COVID-19 pandemic: a survey of residents, family, and staff.

BACKGROUND: Nursing homes and other long-term care services account for a disparate share of COVID-19 cases and casualties worldwide. During COVID-19 there is a distinct need to preserve a holistic view of the wellbeing of residents of nursing homes, be mindful of their rights as citizens, and to be aware of protecting residents from infection. The delivery of health and social care throughout a pandemic must remain person-centred and adhere to a human rights-based approach. METHODS: This study aimed to capture nursing home residents, their families and staff's perspective of the nursing homes residents experience, approaches of staff and the nursing home environment. An online survey was distributed via stakeholder networks and online platforms across Ireland. This study was performed and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). RESULTS: 25 residents, 42 family members and 51 staff completed the survey (n = 118). Across the domains measured all but one aspect scored above 50% (residents get up and go to bed when they want 41.5%) with the highest score of 89.1% scored for the nursing home is comfortable and well-kept. Results highlight evidence of positive experiences and endeavours to preserve social connections, residents were in a safe place cared for by staff who did their best in a difficult position and who went above and beyond their duty of care. However, some families reported poor communication, no internet connections, not enough phones or tablets, and that staff were busy and unable at times to assist residents who needed help using phones/tablets. CONCLUSION: This study highlights the importance of human rights and how they ought to inform and shape the advancement of public health advice and policy documents. Overall, nursing home residents, their families and staff reported favourably on the study measures. However, issues pertaining to communication are essential and there is a need to address issues such as the provision of accurate timely information, communication infrastructure and resources, and inconsistencies in communications. Of note is that while healthcare professionals have a duty to uphold the rights of nursing home residents, they themselves have human rights which must also be protected and supported.

The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives.

AIMS: Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision. BACKGROUND: The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities. DESIGN: Qualitative descriptive. METHODS: Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected. RESULTS: Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop. CONCLUSION: Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace. IMPACT: This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care. REPORTING METHOD: The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed. PATIENT OR PUBLIC CONTRIBUTION: Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review.

BACKGROUND: Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD: A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS: The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION: These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.

Parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability: A qualitative descriptive study.

AIM: To describe parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability (ID). BACKGROUND: People with ID are vulnerable in terms of their health needs and marginalized when accessing and utilizing acute healthcare services. Reasonable adjustments are positive measures that can help alleviate health disparities. However, despite significant research advocating their use, evidence of implementation of reasonable adjustments in acute healthcare practice is limited. DESIGN: A qualitative descriptive study. METHODS: Qualitative semi-structured interviews were conducted with six parents of children with ID, who had accessed and used acute healthcare services. The interviews were conducted between January and May 2022, audio-recordings were transcribed and thematically analysed. RESULTS: Parents described limited or no experiences of reasonable adjustments when accessing or utilizing acute healthcare services for their children. The findings are captured in three themes; describing the reality, understanding the impact and signposting the future. The findings highlight a lack of implementation of reasonable adjustments in acute healthcare which negatively impacts the experience of all stakeholders. CONCLUSION: There is a pressing need for reasonable adjustments to be implemented at a strategic level across acute healthcare services, so that people with ID and their families can access person-centred acute healthcare when needed. IMPACT: The research findings will inform researchers interested in reasonable adjustments and implementation research, and those interested in advocating for the rights of people with ID. REPORTING METHOD: This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups. PATIENT OR PUBLIC CONTRIBUTION: A parent of a child with an ID was part of the research team informing the design, data collection, data analysis and write-up of this article.

The value and contribution of intellectual disability nurses/nurses caring for people with intellectual disability in intellectual disability settings: A scoping review.

BACKGROUND: People with intellectual disability experience poorer health and healthcare access issues. As a leading role in healthcare provision for people with intellectual disability nurses are key to supporting person-centred care and health outcomes. However, little is known about specialist intellectual disability nursing and their contribution to care provision for people with intellectual disability. METHODS: A systematic scoping review. Searches of seven academic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO, Embase, Scopus and Web of Science were conducted to identify relevant literature. Literature addressing intellectual disability nursing or nursing care for people with intellectual disability in intellectual disability centres/units/care homes were reviewed and reported as per PRISMA-ScR checklist and PRISMA flow diagram. RESULTS: The published literature (n = 68) is extensive and describes the value and contribution of intellectual disability nursing across all domains of professional practice and supports a biopsychosocial-educational approach to addressing the physical, mental and social needs of clients with intellectual disability across the care continuum of health management, health promotion and health education. CONCLUSIONS: Despite the importance of the review question and the large volume of publication evidence detailing wide-ranging professional nursing roles and responsibilities, there remains limited literature on the assessment and intervention strategies employed by intellectual disability nurses that highlight their specialist knowledge and skill. Future research should focus on making the role of the nurse more visible and presenting their unique contributions to client care, service delivery, policy and ultimately to the art and science of nursing.

Exploring factors that influence HRQoL for people living with Parkinson's in one region of Ireland: A cross-sectional study.

BACKGROUND: The diversity of symptoms associated with Parkinson's and their impact on functioning have led to an increased interest in exploring factors that impact Health-Related Quality of Life (HRQoL). Although the experience of Parkinson's is unique, some symptoms have a greater impact than others, e.g. depression. Moreover, as the risk of Parkinson's increases with age, the financial and public health impact of this condition is likely to increase, particularly within the context of a globally ageing population. In Ireland, research is ongoing in the pursuit of causes and effective treatments for Parkinson's; however, its impact on everyday living, functioning, and HRQoL is largely under-examined. This study aims to describe factors that influence HRQoL for people with Parkinson's (PwP) in one region of Ireland. METHODS: A cross-sectional postal survey was conducted among people living with Parkinson's (n = 208) in one area of Ireland. This survey included socio-demographic questions, Nonmotor Symptoms Questionnaire for Parkinson's disease (NMSQuest), the Geriatric Depression Scale (GDS-15), and the Parkinson's disease Questionnaire (PDQ-39). Statistical analysis was conducted using SPSS, IBM version 25 (SPSS Inc., Chicago, II, USA). RESULTS: Participants reflected a predominantly older population who were married, and lived in their own homes (91%). Participants diagnosed the longest reported poorer HRQoL regarding mobility, activities of daily living, emotional well-being, social support, cognition, communication domains and overall HRQoL. Lower HRQoL correlated with higher depression scores p < 0.001 and participants in the lower HRQoL cohort experienced 2.25 times more non-motor symptoms (NMSs) than participants with higher HRQoL. Hierarchical multiple linear regression analysis predicted Geriatric Depression Scale (GDS15) score, NMS burden, and years since diagnosis to negatively impact HRQoL. Principal component analysis (PCA) also indicated that for the population in this study, components measuring 1) independence/dependence 2) stigma 3) emotional well-being, and 4) pain were central to explaining core aspects of participants' HRQoL. CONCLUSIONS: Findings highlighted the negative impact of longer disease duration, NMS burden, depression, mobility impairments, and perceived dependence on HRQoL for PwP. The positive influence of perceived independence, social engagement along with close supportive relationships were also identified as key components determining HRQoL. Findings emphasised the importance of long-term healthcare commitment to sustaining social and community supports and therapeutic, rehabilitative initiatives to augment HRQoL for PwP.

Fourth year intellectual disability student nurses' journey and future work intention: a qualitative study.

BACKGROUND: The aim of this qualitative study is to explore the views and experiences of final year BSc intellectual disability nursing students' journey, future work plans and examine factors influencing their migration intentions following graduation. METHODS: A qualitative component of a mixed methods study where a focus group interview was conducted with final year BSc intellectual disability nursing students (n = 10) from one University in Ireland in June 2019. A topic guide was utilised, and participant's were interviewed about their programme, future work plans and migration intentions. An inductive approach was utilised, and data were analysed using a pre-existing framework for initial coding and thematic development. Duffy's conceptual model of identity transformation provided a structure to analyse the data and map themes onto the conceptual framework. RESULTS: The findings were mapped onto the five stages of Duffy's (2013) conceptual model of identity transformation: Pre-Entry; Reaffirming; Surmounting; Stabilising and Actualising. Findings indicate that further work is required to promote intellectual disability nursing and address professional esteem issues, support for education and professional development, such as providing career guidance opportunities prior to course completion, development of clinical skills within their education programme and support for the professional development of new graduates. Participant's identified uncertainty about career opportunities and saw scope for future professional development opportunities particularly in community-based work. CONCLUSION: This study has identified that final year intellectual disability nursing students are uncertain about career options and opportunities for intellectual disability nurses in other country's. There is an urgent need for the intellectual disability nursing profession to articulate their practice and advocate for their role and contribution to the care of people with intellectual disability. This study identified a clear need for direction and information regarding intellectual disability nursing roles and career opportunities.

Final year undergraduate nursing and midwifery students' perspectives on simulation-based education: a cross-sectional study.

BACKGROUND: Simulation-based education is a teaching and learning approach that can enhance learning experiences for students on healthcare programmes. Within undergraduate nursing and midwifery education, simulation can support students in developing graduate attributes necessary to become practice-ready professionals. This paper reports on the evaluation of a simulation-based education initiative, which was introduced to support final year undergraduate nursing and midwifery students in preparation for their upcoming clinical internship in practice. METHODS: This study aimed to evaluate a simulation-based education initiative from the perspectives of final year undergraduate nursing and midwifery students (N = 95). An online survey, using the validated Simulation Effectiveness Tool - Modified (SET-M), was distributed to final year nursing and midwifery students at one university in Ireland. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). RESULTS: The results of the study highlight final year nursing and midwifery students' perceptions, experiences, and satisfaction with learning in a simulated environment. Students reported their simulation-based learning experiences as worthwhile, motivating, and as important opportunities to build on previous learning, increase confidence and gain experience in preparation for real-life practice. Students reported feeling more confident in their assessment skills, in providing care and interventions in responding to changes in a person's health status. All students reported that the simulation-based learning experiences enabled them to think more critically about the clinical case scenarios and critically question their actions and decision-making processes. Pre-briefing and debriefing sessions were highlighted as important aspects of the simulation which helped to increase student confidence and cultivate meaningful learning. CONCLUSION: Simulation-based education is a valuable teaching and learning modality, particularly for final year students who are transitioning to real-life clinical practice. Student-centred simulation-based learning experiences can cultivate professional development and support learners in their transition from university student to healthcare professional.

Time to re-envisage integrity among nurse leaders.

AIM: This paper highlights integrity as a central tenet in the journey of ethical leadership among nurse leaders and dialogue as a way of working within integrity. BACKGROUND: Nurse leaders play a critical role in ensuring ethically sound, safe patient care by supporting staff and fostering positive working environments. Although there is an abundance of literature on leadership, no universally accepted leadership theory exists. Hence, it can be difficult to apply leadership theory and principals to real-life clinical practice. EVALUATION: From the literature, it is evident that integrity is a crucial aspect of leadership. This paper proposes suggestions for nurturing integrity and fostering open and honest dialogue. KEY ISSUES: Globally, public health care is complex and evolving and effective nursing leadership is paramount to meet public health needs and support health care systems. CONCLUSION: This paper explores integrity with leadership, re-envisaging personal and professional integrity as a portal to authentic leadership, which has human relationships and dialogue at its core. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders need support in guiding the nursing profession and promoting ethically sound patient care. The true nature of leadership is dialogue, and nurturing a culture of listening and openness at different levels within an organisation is crucial.

Ghanaian Erasmus+ students' experiences of a semester abroad during the COVID-19 pandemic.

This article describes two Ghanaian students' experiences of connecting with learning, faculty, family and friends during an Erasmus+ semester abroad in Ireland during the COVID-19 pandemic. University faculty members' experiences are also explored. The students describe their experiences of adjusting to new ways of learning online and living through lockdown in a country far from home. These reflections highlight the students' positive learning experiences during a journey of both personal and professional development while also highlighting the challenges of converting to an online learning environment. These experiences illustrate the students' unexpected opportunities and challenges, demonstrating how support from the university faculty, Erasmus+ team and friends, both virtually and physically, helped them through this unprecedented time. This article presents an account of the students' and staff's learning experiences during a semester that was affected by the pandemic.

COVID-19 healthcare policies in Ireland: A rapid review of the initial pandemic response.

AIMS: Healthcare systems urgently required policies to guide the response to the COVID-19 pandemic. The aim of this review was to document the healthcare policies developed during the initial wave of widespread COVID-19 transmission in Ireland. We further sought to determine the key focus and impact of these policies. METHODS: We conducted a rapid review of COVID-19 healthcare policies published from 28 January to 31 May 2020. Key information including the focus of the policy, target population and impact on service delivery was extracted from included policies. During analysis, data was grouped under descriptive categories and narrative summaries were developed for each category. RESULTS: We identified 61 healthcare policies relating to COVID-19. We developed six category headings to describe the focus and impact of these policies: infection prevention and control (n = 19), residential care settings (n = 12), maintaining non-COVID-19 healthcare services and supports (n = 12), testing and contact tracing (n = 7), guidance for healthcare workers concerning COVID-19 (n = 6), and treating COVID-19 (n = 5). CONCLUSIONS: This review has identified lessons for policy development and implementation to help prepare for future healthcare emergencies. Factors to consider include support of vulnerable groups during and in the aftermath of the pandemic, providing psychological supports for healthcare workers and investment in public healthcare services such as contact tracing for future emergencies. While pandemic conditions necessitate the speedy development of policies, effective communication and adequate resourcing is required to ensure policy implementation.

An integrative review to identify how nurses practicing in inpatient specialist palliative care units uphold the values of nursing.

BACKGROUND: Caring for individuals and their families with a life-limiting, symptomatic illness and those who are dying has long been an integral role of palliative care nurses. Yet, over the last two decades, the specialty of palliative care has undergone significant changes in technology and medical treatments which have altered both the disease trajectory and the delivery of palliative care. To date, there is little evidence as to the impact of these medical and nursing advancements on the role of nurses working in palliative care and how in clinical practice these nurses continue to uphold their nursing values and the philosophy of palliative care. METHODS: An integrative review was conducted searching seven academic databases from the time period of January 2010 - December 2019 for studies identifying research relating to the role of the palliative care nurse working in specialist palliative care units and hospices. Research articles identified were screened against the inclusion criteria. Data extraction was completed on all included studies and the Crowe Critical Appraisal Tool was utilized to appraise the methodological quality and thematic analysis was performed guided by Braun and Clarke's framework. The review was conducted and reported in lines with PRISMA guidelines. RESULTS: The search yielded 22,828 articles of which 7 were included for appraisal and review. Four themes were identified: (1) enhancing patient-centred care (2) being there (3) exposure to suffering and death (4) nursing values seen but not heard. The findings highlight that while palliative care nurses do not articulate their nurse values, their actions and behaviors evident within the literature demonstrate care, compassion, and commitment. CONCLUSION: These findings suggest that there is a need for nurses working in specialist palliative care units to articulate, document, and audit how they incorporate the values of nursing into their practice. This is pivotal not only for the future of palliative nursing within hospice and specialist palliative care units but also to the future of palliative care itself. To make visible the values of nursing further practice-based education and research is required.

Mental health nurses experience of the introduction and practice of the Safewards model: a qualitative descriptive study.

BACKGROUND: A lack of safety experienced by patients and staff in acute psychiatric units is a major concern and containment methods used to manage conflict have the potential to cause harm and upset to both staff and patients. To ensure safety for all, it is highly desirable to reduce levels of conflict and containment and the Safewards model is an evidence-based model aimed at reducing conflict and containment rates by improving nurse-patient relationships and safety. METHODS: The aim of this study was to explore mental health nurses' experience of the introduction and practice of three Safewards interventions; reassurance, soft words and discharge messages. A qualitative descriptive research design utilising a purposive sample (n = 21) of registered psychiatric nurses (n = 16) and managers (n = 5) in an acute psychiatric unit in Ireland. Following a 12-week implementation of Safewards, three focus groups were conducted, two with nursing staff and one with nurse managers. Data were analysed using Braun and Clarke thematic analysis framework which supported the identification of four themes: introducing Safewards, challenges of Safewards, impact of Safewards and working towards success. RESULTS: The findings indicate that the process of implementation was inadequate in the training and education of staff, and that poor support from management led to poor staff adherence and acceptance of the Safewards interventions. The reported impact of Safewards on nursing practice and patient experience were mixed. Overall, engagement and implementation under the right conditions are essential for success and while some participants perceived that the interventions already existed in practice, participants agreed Safewards enhanced their communication skills and relationships with patients. CONCLUSION: The implementation of Safewards requires effective leadership and support from management, mandatory training for all staff, and the involvement of staff and patients during implementation. Future research should focus on the training and education required for successful implementation of Safewards and explore the impact of Safewards on nursing practice and patient experience.

The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review.

CONTEXT: Globally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. OBJECTIVES: To identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. METHODS: A scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions. RESULTS: COVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection. IMPLICATIONS: The importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources. ACCESSIBLE SUMMARY.

Cultivating ethical leadership in the recovery of COVID-19.

AIM: To propose the necessity of fostering ethical leadership in the recovery of COVID-19. BACKGROUND: Supporting physically and emotionally exhausted nurses, whilst ensuring quality standards of care delivery in the recovery phase of COVID-19, requires careful, considerate and proactive planning. EVALUATION: Drawing on literature and utilizing Lawton and Paez Gabriunas' (2015) integrated ethical leadership framework (purpose, practices, virtues), possible practical suggestions for the operationalization of ethical leadership are proposed. DISCUSSION: Nurse managers must maintain ethical vigilance in order to nurture value-driven behaviour, demonstrating empathy and compassion for nurses experiencing physical and emotional exhaustion because of COVID-19. It is important that open dialogue, active listening and self-care interventions exist. Nurse managers have an essential role in inspiring and empowering nurses, and building morale and a collective commitment to safe and quality care. CONCLUSION: Nurse managers need to consider ways of empowering, supporting and enabling nurses to apply ethical standards in everyday practice. IMPLICATIONS FOR NURSING MANAGEMENT: Fostering ethical nurse leadership requires careful and sensitive planning, as well as charismatic, compassionate and inspirational leaders. Supporting staff through respect, empathy, role modelling and genuine conscientiousness is essential for increasing job performance and sustaining an ethical work environment.

Effective workforce planning: Understanding final-year nursing and midwifery students' intentions to migrate after graduation.

AIMS: To examine the factors influencing final-year nursing/midwifery students' intentions to migrate following graduation. BACKGROUND: With expanding global staff shortages, effective recruitment and retention strategies targeted at new nursing/midwifery graduates are necessary. Understanding factors that influence graduates' decisions to migrate or remain in the health care organisation that supported their education is essential but under-researched. METHODS: A cross-sectional electronic survey was distributed to graduating nursing/midwifery students across nine higher education institutions in Ireland with a 36% (N = 407) response rate. RESULTS: 85% of Irish (n = 376) nursing/midwifery graduating students reported an intention to migrate overseas and 70% intend to return within 5 years. Pay, working conditions and career were ranked as influencing intentions to migrate. Multivariable analysis illustrated that educational opportunities and friends predict migration, while family and obligation were protective factors. CONCLUSION: Nursing and midwifery leaders and policymakers must reconsider recruitment and retention strategies and embrace innovative and responsive approaches to address migration intentions and trends. IMPLICATIONS FOR NURSING/MIDWIFERY MANAGEMENT: Strategic leadership is required to develop effective structures that support personal, professional and career opportunities for new graduates. Targeted recruitment innovations to entice graduates back into the health service are recommended.

Clinical supervision: A panacea for missed care.

AIM: Clinical supervision is proposed as a solution-focused approach that supports nurses in busy health care environments, helping address the mounting incidents of missed care. BACKGROUND: The pervasive nature of missed nursing care is concerning. The growing body of evidence on missed care predominantly focuses on types and causes. However, the effectiveness of solution-focused interventions used to reduce incidents of missed care has received less attention. METHODS: Drawing on the literature, it is proposed that clinical supervision supports personal and professional development, positive working environments and quality patient care outcomes, and therefore reduces missed care incidents. RESULTS: Clinical supervision fosters a supportive working environment where opportunities to critically reflect on caring values are provided, commitment to improving standards of care is nurtured, and courage to challenge care standards is encouraged. CONCLUSION: In an era of reports highlighting declining standards of nursing care and a wealth of evidence highlighting the benefits of clinical supervision, it remains underused in many areas of nursing. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to recognize the value of clinical supervision in improving standards of nursing care and assume leadership in its successful implementation.

Missed nursing care and nurses' intention to leave: An integrative review.

AIM: To identify the factors that are associated with missed nursing care and the nurses' intention to leave. BACKGROUND: Errors and mistakes are an inevitable part of work, but there is increased evidence that missed care is a concerning issue affecting nurses' ability to effectively coordinate, provide and evaluate care interventions delivered to patients globally. EVALUATION: An integrative review of qualitative and quantitative studies examining the consequences of missed nursing care, including intention to leave. KEY ISSUES: Eight papers met the inclusion criteria. Thematic analysis generated three themes: Prevalence of missed nursing care, Factors associated with missed nursing care, Factors that impact on missed care and influence the intention to leave. CONCLUSION: The outcomes of this review demonstrate the need for critical interventions to address the factors that can impact the provision of high-quality nursing care. IMPLICATIONS FOR PRACTICE: Missed nursing care is not only a patient safety issue but may also contribute to the inadequate staffing levels. And, better understanding of the factors that affect the intention to leave by nurse managers can stimulate the development of appropriate leadership styles in combination with adjustment of workplace to prevent intention to leave.

Development of nursing quality care process metrics and indicators for intellectual disability services: a literature review and modified Delphi consensus study.

BACKGROUND: Nursing process quality care metrics and indicators are quantifiable measures of the nursing care delivered to clients. They can be used to identify and support nurses' contribution to high quality, safe, client care and are lacking in specialist intellectual disability nursing. In a national Nursing Quality Care-Metrics project for Irish intellectual disability services, a set of nursing quality care process metrics and associated indicators were established for intellectual disability services. METHODS: A two-stage design approach was undertaken; a broad scoping review of the literature and a modified Delphi consensus process. The Delphi included a four round e-Delphi survey and a consensus meeting. Four hundred one intellectual disability nurses working in Ireland were recruited for the surveys and 20 stakeholders attended the consensus meeting. RESULTS: From the review, 20 existing and 16 potential intellectual disability nursing metrics were identified for nurses to prioritise in the e-surveys. After the four survey rounds, 12 intellectual disability nursing metrics and 84 associated indicators were identified. Following the consensus meeting, these were reduced to 12 metrics and 79 indicators. CONCLUSIONS: This first set of intellectual disability nursing process metrics and associated indicators has been identified for implementation in practice. These metrics while developed in Ireland have international relevance and their application and appropriateness in practice needs to be evaluated.