A National Evaluation of Undergraduate Nursing and Midwifery Curricula.

AIM: To conduct a comprehensive review of Undergraduate Nursing and Midwifery Curricula leading to registration in Ireland. DESIGN: A mixed methods approach using a curriculum evaluation framework that was underpinned by the philosophy and principles of appreciative inquiry. METHODS: Five separate workstreams completed an evaluation of national policy documents and international curriculum documents, a literature review and two phases of stakeholder engagement including a graduate survey and peer-grouped stakeholder focus groups. The workstreams were emulated for the professions of nursing and midwifery. RESULTS: National policy indicates a significant shift in healthcare delivery to the community environment, with a strong focus on the social determinants of health and a flexible interprofessional workforce. International curricula review revealed that nursing and midwifery education was split equally between academia and clinical practice at bachelor's degree level. Graduates were assessed for clinical competence with a variance of four to seven domains of competence evident for nurses and five principles for midwives. Direct entry midwifery was not widely available. The graduate survey identified that students were satisfied with the academic components of the curriculum; however, significant challenges in clinical placement were reported. Stakeholder focus groups reported a need for a learner-focused approach to the curricula, increased access to education, a deeper understanding and appreciation of the various roles required to educate nurses and midwives and a recognition of midwifery as a separate profession. CONCLUSION: There is a need for a significant revision of the current nursing and midwifery curricula to meet the future healthcare needs of the diverse patient population with a community-focused delivery. REPORTING METHOD: The good reporting of a mixed methods study was used to guide the development of this manuscript. PATIENT OR PUBLIC CONTRIBUTION: An Expert Advisory Group (EAG) was appointed to oversee the conduct of the research project and advise the research team as requested. There were five service user representatives included in the membership of the EAG. This included one representative from each of the divisions of the nursing and midwifery register in Ireland. A separate stakeholder engagement focus group was also conducted for the research upon the request from the service users.

From the ground up: stakeholders' representations of the Irish longitudinal study on ageing (TILDA).

Healthy ageing, which is the target of life' s later developmental stage, can be achieved through building a wise perspective towards life and existence. However, it may not be achievable for older people when the societal sources are limited. The TILDA project aimed to evaluate the associated factors with healthy ageing and to transfer that knowledge into practice. Hence, determining the perspectives of older people support and advocacy organisations on the enablers and facilitators of the healthy ageing strategies of TILDA is essential to gain a better understanding of the project and plan future strategies. This study aimed to investigate how the TILDA project has influenced or impacted upon these organisations from education, policy, or practice perspectives. The participants (n = 15) included in the study's sample were reached through representative organisations acting to support older people in the Republic of Ireland. Semi-structured interviews were conducted online via Zoom. A systematic thematic data analysis procedure was followed, and three themes emerged from the qualitative data, revealing the perceptions of participants about the TILDA project: (1) Limitations of TILDA, (2) Contributions of TILDA, and (3) Future recommendations for TILDA. In conclusion, among the disadvantages of TILDA, the most significant is not being representative and visible enough; it is evident that it is pivotal to develop a more inclusive culture of TILDA with close cooperation and effective marketing strategies. It is also apparent that TILDA has several advantages that include providing insights into ageing and rich data to plan future support for older people.

The perceived effects of COVID-19 while living with a chronic illness.

INTRODUCTION: A diagnosis of chronic illness posed a serious threat to people during the recent COVID-19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self-care is the process of maintaining health and managing a chronic illness. Nurses working in specialist services provide healthcare education to people with chronic illnesses. Access to these nurses was decreased during periods of the COVID-19 virus escalation due to the reconfiguration of services and redeployment of nurses. The purpose of the research was to learn from the experiences of people with a chronic illnesses in self-care behaviors and accessing altered healthcare services to inform future practices. DESIGN: A population survey design. METHODS: A mixed methods survey was designed, combining validated questionnaires and scales with open-ended questions. A convenience sample was utilized via using social media platforms. Data analysis included descriptive and inferential statistics. Content analysis was used to analyze open-ended responses. RESULTS: There were 147 responses, with approximately half reporting no changes in face-to-face healthcare contact, 41% reporting decreased contacts and 12% increased contacts. Non-face-to-face contacts were reduced by almost 9%, did not change by almost 60%, while 33% indicated an increase. Participants reported mixed perceptions in contact with healthcare providers during restrictions. In the Patient Assessment of Chronic Illness Care and the Self-Care of Chronic Illness scales, participants scored statistically lower scores than in previous studies. Participants indicated that public health restrictions negatively impacted their confidence, created challenges with re-engaging and that access to care was more difficult. CONCLUSION: This research highlights the importance of providing continued support to people with chronic illness irrespective of other challenges to healthcare services. A structured approach to virtual self-care education is required. CLINICAL RELEVANCE: This research concluded that the experience of access to one healthcare professional as opposed to diverse multidisciplinary input was similar for a number of chronic illnesses groups of people during the COVID-19 pandemic. There was an altered dynamic of virtual contacts with healthcare providers and a lack of confidence interpreting what monitoring was required by people with a chronic illnesses due to a lack of preparedness for virtual healthcare delivery.

Evaluation of a nurse practitioner clinical practicum module using a capability education framework: A case study design.

AIMS AND OBJECTIVES: The aim of this research was to evaluate a nurse practitioner's clinical practicum module designed with a capability education framework. The objectives were to determine if the module prepared students adequately for their role and to determine if the Mini-CEX assessment tool was suitable for use with nurse practitioners. BACKGROUND: Capability is a necessary part of expertise, where a capable person takes responsibility to develop their own education, knowledge and skills. The capability learning framework offers nurse practitioners flexible learning pathways between the student, the university and clinical practice. This capability learning framework focuses on the wider complexities of nurse practitioner practice as opposed to a point-in-time assessment. DESIGN: A case study design was used. METHODS: Mixed methods including, document review, focus group and field notes were used in the case study evaluation adhering to the standards for the reporting of organisational case studies. RESULTS: A layered incremental approach to learning and assessments were applied. Students and assessors were satisfied with using the Mini-CEX assessment tool in the module. The Mini-CEX tool was familiar to clinical mentors, who compared students demonstrating competency in a similar manner to medicine. The feedback component of the tool provided deep and meaningful engagement for students. The module provided mentors with insight and understanding of the nurse practitioner role. Students identified the transitioning process from competent to capable practitioners. The module learning and assessments were mapped to regulatory nurse practitioner standards and requirements. CONCLUSIONS: The module provided comprehensive preparation for students to develop their nurse practitioner role. The Mini-CEX assessment tool is a fitting assessment for nurse practitioner students, particularly when supplemented with a corresponding reflective exercise. The assessments and feedback provided the students with opportunities to focus on agreed learning outcomes in their specialist area of practice. RELEVANCE TO CLINICAL PRACTICE: Nurse practitioners are required to practice autonomously and independently at a level of capability in clinical practice. The education preparation of nurse practitioner students must be directed appropriately.

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland.

AIM: The purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland. BACKGROUND: A recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term. METHOD: An electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland. RESULTS: Sixty-six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty-two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants. CONCLUSIONS: This research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized. IMPLICATIONS FOR NURSING MANAGEMENT: Failure to successfully integrate the nurse practitioner role risks the long-term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

A translational research framework for nurse practitioners.

AIMS: This study aims to explore a proposed translational research continuum for nurse practitioners. BACKGROUND: Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence-based practice and evaluation of outcomes of interventions for their patient groups. EVALUATION: This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework. KEY ISSUES: A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals. IMPLICATIONS FOR NURSING MANAGEMENT: The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role.

Nursing and midwifery workforce readiness during a global pandemic: A survey of the experience of one hospital group in the Republic of Ireland.

AIM: To explore the mobilization of nurses/midwives in a designated hospital group in Ireland during a global pandemic. BACKGROUND: The recent global pandemic has resulted in the large-scale worldwide mobilization of registered nurses and midwives working in the acute care sector. There is a dearth of literature reporting the mobilization of this professional workforce. METHOD: Mixed-methods design using an electronic survey and facilitated discussion across one Irish hospital group. RESULTS: Eight of 11 hospitals responded to the survey. There was a 2% vacancy rate prior to the pandemic. Mobilization included reconfiguration of clinical areas and redeployment of 9% of the nursing/midwifery workforce within 2 weeks of the pandemic. A total of 11% (n = 343) of nurses/midwives were redeployed in 3 months. Nurses/midwives required re-skilling in infection prevention control, enhancement of critical care skills and documentation. CONCLUSIONS: Three key areas were identified to enable the nursing workforce readiness. These are referred to as the three 'R's': Reconfiguration of specific resources, Redeployment of nurses to dedicated specialist areas and Re-skilling of nurses to safely care for the patients during the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: A centralized approach to reconfiguration of clinical areas. Redeployment is enabled by closing non-essential departments. Hands-on re-skilling and reorientating staff are essential.

Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study.

BACKGROUND: Special palliative care is provided in a range of settings including a patient's home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. METHODS: This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). RESULTS: Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. CONCLUSIONS: This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes.

AIMS: This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. BACKGROUND: Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery. DESIGN: This study used a systematic integrative review by using Torraco's approach. DATA SOURCES: Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019. REVIEW METHODS: A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. RESULTS: Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes. CONCLUSION: The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

Stakeholder perceptions of curriculum design, development and delivery for continuing e-learning for nurses.

BACKGROUND: This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. AIM: The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. METHOD: This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. FINDINGS: Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. CONCLUSION: Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops.

An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective.

AIMS AND OBJECTIVES: To explore the ways in which Irish and Australian Nurse Practitioners (NPs) implement leadership and research in their roles and whether there is a difference in how leadership and research are demonstrated between NPs in Ireland and Australia. BACKGROUND: The original concept of the NP role was to expand nursing practice in order to provide high-quality, accessible health care to patients. This placed NPs at the crux of changes to healthcare delivery. Implementing these changes requires leadership. Research demonstrates the effects of these changes to healthcare delivery and contributes to healthcare knowledge from the nursing profession. DESIGN: In the qualitative phase of a mixed methods study, an interpretative descriptive approach was used to draw on participant experiences. METHODS: Thirty-eight respondents agreed to be interviewed following an online survey. Ten interviews were recorded and transcribed verbatim. Data were analysed using Braun and Clarke thematic analysis method. The research complied with the consolidated criteria for reporting qualitative research, COREQ. RESULTS: Ten participants, five NPs from Ireland and five from Australia were interviewed. Four themes emerged from the analysis: (a) Innovative leadership, which included the categories of leadership activities, the work of NPs and trailblazers; (b) Optimism, incorporating pride in achievements, the future outlook for the role and continued innovation of NPs over time; (c) Research, which included the NP research role, research challenges, support and research leadership; and (d) Resilience, which included overcoming resistance, isolation and seeking positive support systems. CONCLUSION: Nurse Practitioners are clinical leaders focused on improving healthcare delivery for patient populations. There is a lack of understanding of the NP role. Nurse Practitioners lack confidence to be independently research active. Research by NPs requires support from nurses in academia. There is no difference in the role in Ireland and Australia. RELEVANCE TO CLINICAL PRACTICE: Nurse Practitioners are engaged in healthcare transformation. Nurse Practitioners require support from research experts in academia to make a significant contribution to nursing knowledge in healthcare delivery.

Fit for purpose? Evaluation of CPD courses for nurses in an Irish university teaching hospital.

INTRODUCTION: acute tertiary hospitals require knowledgeable, skilled registered nurses to care for patients in specialist areas. It is also a professional responsibility that nurses maintain skills and competence. This article reports on stage 1 of an action research study to evaluate the delivery of continuing professional development (CPD) courses for registered nurses in an acute hospital in Ireland. METHODS: an audit and qualitative self-reporting questionnaire was used to obtain data. The questionnaire focused on the areas of teaching learning and outcomes. Overall, five CPD courses, each of 26 weeks' duration, were evaluated. RESULTS: teaching delivery was all didactic and was delivered primarily by clinical staff with expert knowledge and skills, but the teaching approaches varied. The curriculum content was identified as excessive and at a high level for an introductory course, with a large volume of classroom-based theoretical delivery. Participant learning was reported as excellent in the clinical areas; however, this was counterbalanced by heavy workloads and staffing shortages. Participant motivation was also found to influence learning. From an outcome perspective the development of new knowledge and skills was reported in participants who had undertaken the courses, and participants reported that the CPD courses assisted in recruitment and retention. CONCLUSION: although many positive aspects of the CPD courses were identified, it is clear that some changes were required with particular reference to theoretical delivery and curriculum content.

Changing the delivery of continuing professional education: An action research approach.

AIM: A participatory action research project was used to change the design and delivery of continuing professional education in a large Irish academic teaching hospital. BACKGROUND: Participation in continuing professional education, designed as a short course, is often a method to maintain competence for many nurses. Structured short education courses are often used to orientate and upskill new staff to specialist clinical areas. Traditionally many courses relied on face-to-face delivery over a period of weeks which is challenging for one clinical area to release staff to attend theoretical days in person. DESIGN: A six-stage participatory action research cycle over a 3-year period in a large Irish academic teaching hospital. METHODS: Multiple methods were used in the cyclical process of participatory action research. Constructive alignment theory and instructional design principles were used to redesign the educational framework. Data collection included audits of courses, questionnaires and focus groups with key participants. RESULTS: Analysis of the focus group themes included 1) underestimated time 2) the process of change 3) teaching and learning styles and 4) acceptance and integration. 20 learners completed the evaluation and reported a positive synergy between e-learning and clinical workshops. E-learning was reported as time-consuming. 75 % of learners reported they were motivated to learn. 90 % of the learners reported they gained new knowledge and skills, 84 % reported the clinical area benefited from the education and 80 % identified a direct improvement in their clinical skills in the specialist area. CONCLUSIONS: Participatory action research supports organisational change in continuing professional education. Constructive alignment theory supports the value of outcomes-based learning. In this context it resulted in successfully blending theory and clinical skills for nurses working in specialist areas. The redesigned continuing professional education framework was positively evaluated across nurses in the organisation.

The development of nursing-sensitive indicators: A critical discussion.

Discussion arguments: In a science-based profession, nurses must continuously monitor and evaluate the effectiveness of their care. However, data on what constitutes nursing care in practice and the delivery process is lacking. Insufficient evidence on how nurses contribute to patient care hampers the evaluation of nursing practice.We discuss nursing-sensitive indicators, their origins, current applications, and challenges related to their use in evaluating the quality of nursing care. We analyse nursing-sensitive indicators in the context of criticisms levelled at the profession related to the lack of evidence to support their value in the larger healthcare environment. Conclusions: We have a disjointed approach to evaluating nursing care. Current systems designed to monitor nursing care, such as metrics and data sets, are not adequate or effective for comprehensively evaluating nursing care, considering the fundamentals and values of the nursing profession.

Exploring heart failure nurse practitioner outcome measures: a scoping review.

AIMS: Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure. METHODS AND RESULTS: A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements. CONCLUSION: This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team.

'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.

Consideration of Symptom Management in Advanced Heart Failure.

This work provides an opinion on palliative care for people with heart disease. The work focuses on the management of key symptoms associated with both end stage heart disease, applying a palliative approach and suggesting treatment options. The work also indicates the potential for greater collaboration of specialist teams including specialist palliative care in the assessment and management of patients with complex needs as they progress through their disease trajectory. The practical application of evidence-based guidelines and recommendations is key to the successful individualised management of complex symptoms.