Nurses', midwives' and key stakeholders' experiences and perceptions on requirements to demonstrate the maintenance of professional competence.

Aim: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Background: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintenance of professional competence have application to nurses, midwives and regulatory bodies and healthcare employers worldwide. Design: A mixed methods approach was used. This included an online survey of nurses and midwives and focus groups with nurses and midwives and other key stakeholders. The qualitative data are reported in this study. Methods: Focus groups were conducted among a purposive sample of nurses, midwives and key stakeholders from January–May 2015. A total of 13 focus groups with 91 participants contributed to the study. Findings: Four major themes were identified: Definitions and Characteristics of Competence; Continuing Professional Development and Demonstrating Competence; Assessment of Competence; The Nursing and Midwifery Board of Ireland and employers as regulators and enablers of maintaining professional competence. Conclusion: Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse's/midwife's role, organizational needs, patient's needs and the individual nurse's/midwife's learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice.

Clinical autonomy and nurse/physician collaboration in emergency nurses

Aim: To investigate clinical autonomy and Nurse/Physician collaboration among emergency nurses and the relationship between these concepts, personal characteristics and organisational influences. Background: Nurses have been identified as having a significant role in addressing the challenges of providing modern healthcare. Emergency nurses have reported competence in a wide range of emergency care skills. However, there is evidence that Emergency Department (ED) nurses may have lower levels of clinical autonomy than other areas of practice. Levels of clinical autonomy appear to be influenced by levels of collaboration with physicians and the organisations in which nurses work Methods: A descriptive correlational study using a survey design with a purposive convenience sample of 141 ED staff nurses (response 70.9%) from 3 EDs in Ireland. Data were collected using the Dempster Practice Behaviours Scale (DPBS) the Nurse/Physician Collaboration Scale (NPCS) and the newly developed Organisational Influences on Nursing Scale. Demographic information was also sought from participants. Results: Participants were largely female (87%), relatively young (mean age 35.57, SD=7.83) and educated to degree level (48%) or higher (31%) with 40% posessing specialist emergency nursing qualifications. Participants reported moderate levels of clinical autonomy and Nurse/Physician collaboration. No relationships were found between sample characteristics and clinical autonomy and Nurse/Physician collaboration among emergency nurses. Relationships were found between levels of clinical autonomy and Nurse/Physician collaboration (r=-0.395, n=100, p<0.001), and organisational influence on nursing (r=0.455, p<0.001) and also between Nurse/Physician collaboration and organisational influence on nursing (r=-0.413, p<0.001). Discussion: Clinical autonomy of nurses has been linked with quality outcomes in healthcare. The quest for quality in modern healthcare in a challenging environment should acknowledge that strategies need to focus beyond education and skills provision and include essential elements such as Nurse/Physician collaboration and the organisational influence on nursing to ensure the greater involvement of nurses in patient care.

Language legislation in Ireland and the United Kingdom: Exploring the gaps between theory and practice

The central objective in this thesis is to explore the gaps between the normative justifications advanced for language rights and language legislative protection and the effective realisation of those rights and legislative provisions in practice. This objective is achieved by examining the scope and application of language rights and legislative provisions within language legislation in Ireland and the United Kingdom. Drawing on Canadian jurisprudence advocating for language rights to be recognised as “purposeful”, the thesis considers the extent to which Ireland and the United Kingdom have limited the acceptance of positive obligations as they relate to the provision of language services in the public sphere. In arguing that language rights are distinct in nature, the thesis suggests that in order for language rights to be effectively realised, an approach to language rights and language legislation more generally must be underpinned by a substantive vision of equality, otherwise language rights and legislative provisions merely amount to symbolic recognition and vacuous rhetoric as opposed to being substantive and enabling rights and provisions. Having said that, the thesis also recognises and elucidates the practical difficulties that arise in the realisation of language rights and language legislative provisions and in doing so seeks to stimulate further dialogue about the nature and limits of language rights and language legislation.

Self-neglect: a case study and implications for clinical practice

Self-neglect is a worldwide and serious public health issue that can have serious adverse outcomes and is more common in older people. Cases can vary in presentation but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this article is to create a greater understanding of the concept of self-neglect among community nurses.

A study of the situations, features, and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress

Purpose: The purpose of this study was toinvestigate moral distress in Irish psychiatric nurses. Design: A qualitative descriptive methodology was used. Findings: The study confirmed the presence of moral distress and the situations that gave rise to moral distress within psychiatric nurses working in acute care settings. Practice Implications: The findings indicate that while multidisciplinary teams appear to function well on the surface, situations that give rise to moral distress are not always acknowledged or dealt with effectively. Furthermore, unresolved moral conflict impacts upon the quality of clinical decision-making by not allowing open and transparent discussions that allow clinicians the opportunity to address their concerns adequately.

Nurses’ perceptions of nursing presence and the relationship between nursing presence and moral sensitivity in nurses working with people with dementia in residential care

Aim: The aim of this study was to measure nursing presence among nurses caring for people with dementia in residential care settings, and to investigate the relationship between nursing presence and moral sensitivity. Background: Nursing presence is a core relational skill in nursing and holds many benefits for nurses and their patients. Moral sensitivity is defined as how one recognises the moral elements of a situation, and how one’s moral or ethical decision making may impact on an individual. Methods: A descriptive, cross sectional quantitative methodology was used with a sample of 150 registered nurses. The Presence of Nursing Scale for Registered Nurses was used to investigate nursing presence, and the Moral Sensitivity Questionnaire for moral sensitivity. Results: Findings from the study demonstrated that participants agreed with the majority of elements of nursing presence, (mean 76.97, SD= 7.51). A mean score of 36.22 was evidence of a well developed level of moral sensitivity in participants. Nurses who perceived themselves to be highly present to their patients also scored highest on certain elements of moral sensitivity such as moral strength. Nursing presence was also found to be more developed in those participants that rated themselves as having higher levels of expertise based on Benner’s (1984) definitions. Older nurses also scored higher on nursing presence. There was a high level of agreement that factors such as lack of time (n=133), and heavy workload influenced nursing presence. Nurses, who were older and had longer clinical experience, were shown to have greater moral strength. There were differences in elements of moral sensitivity between groups of nurses who ranked themselves according to Benner’s (1984) competence framework with higher scores evident in the more expert groups. Conclusion: Overall, this study showed that participants had a well developed level of nursing presence, and certain elements of moral sensitivity are positively related to nursing presence. Nursing presence appears to be linked to the level of expertise of the nurse but factors such as time and workload do influence nursing presence.

Caring and anxiety among registered nurses in an acute hospital setting

Background: Even though caring remains the essence of nursing it is still an ambiguous concept as the lens through which each nurse perceives caring differs. The differences are due to multiple factors including the setting in which the nurse works. Nurses experience high levels of anxiety when caring for patients in acute settings. Despite an abundance of published studies on caring there is a dearth of research available that focuses on the relationship between caring and anxiety. Aim: The aim of this research study was to investigate caring and anxiety in a sample of registered nurses working in an acute hospital and to determine the relationship between these and other variables. Method: A quantitative descriptive study using a correlational design was employed, with a sample of 280 registered nurses. The Caring Behaviours Inventory-24 was used to measure caring and the State Trait Anxiety Inventory to measure Anxiety. The study was guided by the Theory of Human Caring (Watson 2008). Findings: Nurses reported high levels of caring and low levels of anxiety. A statistical significant relationship was found between caring and anxiety and between caring and supportive work environment and job satisfaction. A statistical significant relationship was found between anxiety and work environment, job satisfaction gender, age, relationship status and education. Conclusion: This is the first study to investigate the relationship between caring and anxiety in an acute hospital setting. This research contributes to advancing nursing knowledge by providing evidence of the relationship between caring and anxiety among nurses in an acute hospital setting. Despite nurses reporting high levels of caring and low levels of anxiety, it is important to further enhance caring and reduce anxiety levels among all nurses. Thus, educators and managers need to explore strategies for the alleviation of anxiety among nurses, practising in acute care settings.

Irish and Jordanian general student nurses’ attitudes towards people with mental illness (PWMI) and their relationship to cultural and religious beliefs

Background Attitudes held and cultural and religious beliefs of general nursing students towards individuals with mental health problems are key factors that contribute to the quality of care provided. Negative attitudes towards mental illness and to individuals with mental health problems are held by the general public as well as health professionals. Negative attitudes towards people with mental illness have been reported to be associated with low quality of care, poor access to health care services and feelings of exclusion. Furthermore, culture has been reported to play a significant role in shaping people’s attitudes, values, beliefs, and behaviours, but has been poorly investigated. Research has also found that religious beliefs and practices are associated with better recovery for individuals with mental illness and enhanced coping strategies and provide more meaning and purpose to thinking and actions. The literature indicated that both Ireland and Jordan lack baseline data of general nurses’ and general nursing students’ attitudes towards mental illness and associated cultural and religious beliefs. Aims: To measure general nursing students’ attitudes towards individuals with mental illness and their relationships to socio-demographic variables and cultural and religious beliefs. Method: A quantitative descriptive study was conducted (n=470). 185 students in Jordan and 285 students in Ireland participated, with a response rate of 86% and 73%, respectively. Data were collected using the Community Attitudes towards the Mentally Ill instrument and a Cultural and Religious Beliefs Scale to People with Mental Illness constructed by the author. Results: Irish students reported more positive attitudes yet did not have strong cultural and religious beliefs compared to students from Jordan. Country of origin, considering a career in mental health nursing, knowing somebody with mental illness and cultural and religious beliefs were the most significant variables associated with students’ attitudes towards people with mental illness. In addition, students living in urban areas reported more positive attitudes to people with mental illness compared to those living in rural areas.

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.