Margaret P. Treacy

Elder abuse and neglect in Ireland: results from a national prevalence survey

OBJECTIVE To measure the 12-month prevalence of elder abuse and neglect in community-dwelling older people in Ireland and examine the risk profile of people who experienced mistreatment and that of the perpetrators. DESIGN Cross-sectional general population survey. SETTING Community. PARTICIPANTS People aged 65 years or older living in the community. METHODS Information was collected in face-to-face interviews on abuse types, socioeconomic, health, and social support characteristics of the population. Data were examined using descriptive statistics and logistic regression, odds ratios (OR) and 95% confidence intervals (95% CI) are presented. RESULTS The prevalence of elder abuse and neglect was 2.2% (95% CI: 1.41-2.94) in the previous 12 months. The frequency of mistreatment type was financial 1.3%, psychological 1.2%, physical abuse 0.5%, neglect 0.3%, and sexual abuse 0.05%. In the univariate analysis lower income OR 2.39 (95% CI: 1.01-5.69), impaired physical health OR 3.41 (95% CI: 1.74-6.65), mental health OR 6.33 (95% CI: 3.33-12.0), and poor social support OR 4.91 (95% CI: 2.1-11.5) were associated with a higher risk of mistreatment but only social support and mental health remained independent predictors. Among perpetrators adult children (50%) were most frequently identified. Unemployment (50%) and addiction (20%) were characteristics of this group.

Smoking and peer groups: results from a longitudinal qualitative study of young people in Northern Ireland.

Previous research has indicated that young people are under considerable social pressure to take up smoking. This study has therefore sought to explore and better understand the mechanisms through which peer-related social factors operate to encourage young people to smoke. Individual qualitative interviews were held with adolescent children aged 11-12 years (N = 102) within youth clubs based in economically deprived areas of Northern Ireland, and then followed up on two occasions during the subsequent 3 years (N = 51/39). The data implied that, although peers influence smoking uptake, this seldom happens through direct persuasion, but rather as the result of the young person striving to conform to the normative behaviour of the peer group with which they identify. The findings are consistent with social identity theory and self-categorization theory in that for both smoking and nonsmoking 14-year-olds smoking activity appears to provide a means through which to define social groups, to accentuate similarity within groups and differences between groups. In-group favouritism was expressed in the sharing of cigarettes within the in-group and in the negative stereotyping of out-group members. There was some evidence that group affiliation may be negotiated differently for boys and girls. These findings imply that successful intervention needs to reconsider the normative processes that encourage young people to smoke.

Anxious adults vs. cool children: children's views on smoking and addiction.

Tobacco addiction represents a major public health problem, and most addicted smokers take up the habit during adolescence. We need to know why. With the aim of gaining a better understanding of the meanings smoking and tobacco addiction hold for young people, 85 focused interviews were conducted with adolescent children from economically deprived areas of Northern Ireland. Through adopting a qualitative approach within the community rather than the school context, the adolescent children were given the opportunity to freely express their views in confidence. Children seem to differentiate conceptually between child smoking and adult smoking. Whereas adults smoke to cope with life and are thus perceived by children as lacking control over their consumption, child smoking is motivated by attempts to achieve the status of cool and hard, and to gain group membership. Adults have personal reasons for smoking, while child smoking is profoundly social. Adults are perceived as dependent on nicotine, and addiction is at the core of the childrens understanding of adult smoking. Child smoking, on the other hand, is seen as oriented around social relations so that addiction is less relevant. These ideas leave young people vulnerable to nicotine addiction. It is clearly important that health promotion efforts seek to understand and take into account the actions of children within the context of their own world-view to secure their health.

Constructing ageing and age identities: a case study of newspaper discourses

ABSTRACT Public discourses concerning older people are available in a variety of texts, including popular media, and these discourses position older people with particular age identities. This study examined discursive formations of ageing and age identities in print media in Ireland. Constituting a single media event, newspaper texts concerned with revised welfare provision for older people were subjected to critical discourse analysis and revealed particular ways of naming and referencing older people and distinct constructions of ageing and age identities. The use of nouns and phrases to name and reference older people positioned them as a distinct demographic group and a latent ageism was discernible in texts that deployed collective names like ‘grannies and grandads’ and ‘little old ladies’. Five distinct identity types were available in the texts, variously constructing older people as ‘victims’; ‘frail, infirm and vulnerable’; ‘radicalised citizens’; ‘deserving old’ and ‘undeserving old’. The discourses made available subject positions that collectively produced identities of implied dependency and otherness, thereby placing older people outside mainstream Irish society. The proposition that older people might be healthy, self-reliant and capable of autonomous living was largely absent in the discourses. Newspaper discourses betray taken-for-granted assumptions and reveal dominant social constructions of ageing and age identity that have consequences for older peoples behaviour and for the way that society behaves towards them.

A risk to himself: Attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical–surgical units†

Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a critical incident of a patient for whom they had cared. Two attitudinal orientations were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular associations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in targeted therapeutic communication skills.

Models of initial training and pathways to registration: a selective review of policy in professional regulation.

AIM To provide a synthesis of literature on international policy concerning professional regulation in nursing and midwifery, with reference to routes of entry into training and pathways to licensure. BACKGROUND Internationally, there is evidence of multiple points of entry into initial training, multiple divisions of the professional register and multiple pathways to licensure. EVALUATION Policy documents and commentary articles concerned with models of initial training and pathways to licensure were reviewed. Item selection, quality appraisal and data extraction were undertaken and documentary analysis was performed on all retrieved texts. KEY ISSUES Case studies of five Western countries indicate no single uniform system of routes of entry into initial training and no overall consensus regarding the optimal model of initial training. CONCLUSIONS Multiple regulatory systems, with multiple routes of entry into initial training and multiple pathways to licensure pose challenges, in terms of achieving commonly-agreed understandings of practice competence. IMPLICATIONS FOR NURSING MANAGEMENT The variety of models of initial training present nursing managers with challenges in the recruitment and deployment of personnel trained in many different jurisdictions. Nursing managers need to consider the potential for considerable variation in competency repertoires among nurses trained in generic and specialist initial training models.

Support networks of older people living in the community

Aim.  The aim of the study was to identify the social support networks of older people living in the community in Ireland using Wengers (1994) network typology. Background.  The population of older people in the community is increasing. With increasing age and changes in family circumstances a substantial proportion of older people will require social, psychological and instrumental support. However a lack of adequate social support networks for vulnerable older people can result in poor health, loneliness and isolation. Method.  A national, cross-sectional telephone survey of 683 people aged between 65 and 99 years was undertaken using the Practitioner Assessment of Network Type as the basis for identifying social support networks. Results.  The results demonstrated that the majority of older people were living in stable and supportive social networks and reported high levels of contact with family, friends and neighbours. However, a significant minority of older people were living in vulnerable networks. Older people in these networks are susceptible to loneliness, isolation and poor emotional and physical health. Conclusion.  Through the identification of people in vulnerable networks, nurses working both in the hospital and community setting can ensure that formal support is aimed at providing care to older people who do not have access to informal care networks. Furthermore, the predictive utility of the Practitioner Assessment Network Type (PANT) can enable nurses to identify people at risk of poor social support.

Nurses’ Perceptions of the Practice of Restricting a Child for a Clinical Procedure

Restricting a child for a clinical procedure has been linked to negative physical and psychological sequelae. The practice of restriction remains an implicit and unquestioned aspect of care for children during a clinical procedure. In this study we aimed to describe the practice of restricting a child’s movement for a clinical procedure by conducting focus groups with children’s nurses. Data were analyzed using a thematic network analysis framework. The findings show that nurses are likely to restrict children based on particular characteristics of the child; for example, the child’s age. The findings indicate that there is no consistent approach to the practice of restricting a child for a clinical procedure, suggesting tension between nurses and other health care professionals, and nurses and parents, about this practice. The findings suggest the need for wider exploration of the practice of restriction at the organizational level and a need for children’s nurses to feel more empowered to act as advocates for those in their care.

The Irish nursing minimum data set for mental health – a valid and reliable tool for the collection of standardised nursing data

AIMS AND OBJECTIVES To test the validity and reliability of the newly developed Irish Nursing Minimum Data Set for mental health (I-NMDS (MH)) to ensure its clinical usability. BACKGROUND Internationally, difficulties exist in defining the contribution mental health nursing makes to patient care. Structured information systems, like the Nursing Minimum Data Set, have been developed internationally to gather standardised information to increase the visibility of nursing in the health care system. DESIGN This study employed a quantitative, longitudinal research design. METHOD A convenience sample of mental health nurses (n = 184) collected data on the nursing care of patients (n = 367) from care settings attached to 11 hospitals across Ireland. Exploratory factor analysis (EFA), ridit analysis and Cronbachs alpha coefficient were used to establish the construct and discriminative validity and scale score reliability of the I-NMDS (MH). RESULTS Goodness of Fit scores indicated that the I-NMDS (MH) possesses good construct validity. Alpha coefficients for each factor were above the recommended 0.7 level. Ridit analysis inferred that the I-NMDS (MH) discriminated between elements of nursing care across acute inpatient and community based care settings. CONCLUSIONS The I-NMDS (MH) possesses a sound theoretical base, has scale score reliability and possesses good discriminative validity. The valid and reliable I-NMDS (MH) is the first NMDS to be developed specifically for mental health. RELEVANCE TO CLINICAL PRACTICE Data collected using the I-NMDS (MH) will increase the visibility of the contribution mental health nurses make to healthcare delivery. In addition, it will support evidence based practice in mental health to improve further the effectiveness of nursing care in the future.

Motivations for adolescent self‐harm and the implications for mental health nurses

Accessible summary What is known on the subject?Self‐harm is a relatively common occurrence in adolescents; however, there remains a lack of understanding about the motivations behind adolescent self‐harm, and this poor understanding can have a negative impact on how mental health professionals respond to young people who self‐harm. &NA; What does this paper add to existing knowledge?This paper identifies the reasons for self‐harm in a community sample of young people and finds that the functions of self‐harm differ for different people and that there may be multiple reasons for self‐harm.Findings provide support for the affect‐regulation model of self‐harm which states that young people self‐harm to regulate how they are feeling, but provides little support for the interpersonal influence model which proposes that self‐harm is an attempt to influence how other people respond to them. &NA; What are the implications for practice?Self‐harm for most young people serves at least one specific function and is an indication of distress.There is a requirement for a non‐pathologizing response towards young people who self‐harm; self‐harm should be understood as a meaningful behaviour rather than a symptom of an illness.Mental health nurses need to understand the multiple functions of self‐harm. A better understanding of the individualized meaning behind self‐harm can positively impact on attitudes towards young people who self‐harm and provide for improved mental health service provision. Introduction: Although self‐harm is a relatively common occurrence in adolescents, there is a lack of understanding about the motivations behind it. A poor understanding of self‐harm contributes to negative perceptions about those who self‐harm and a poor healthcare experience. Aim & Methods: This study identifies motivations behind self‐harm in school‐based adolescents using a cross‐sectional survey. Motivations behind self‐harm were elicited using a scale and open‐ended responses. Results: Of the 856 adolescents who completed the survey across 11 postprimary schools, 103 reported a history of self‐harm. The most commonly endorsed reason for self‐harm was to ‘get relief from a terrible state of mind’ (79%). Open‐ended responses were consistent with scale responses with most reporting that they self‐harmed to relieve distressing emotions. Discussion: Findings provide support for the affect‐regulation model of self‐harm with support also demonstrated for the self‐punishment and antidissociation models. There was little support for the interpersonal influence model suggesting that the commonly held belief that self‐harm is attention‐seeking is one attributed by others to young people, and not widely reported by young people themselves. Implications for practice: Mental health services need to be responsive to the needs of young people who self‐harm which requires eliciting and understanding the individual and multiple meanings behind self‐harm to best inform treatment options.