Paul Slater

Providing Meaningful Care Learning From the Experiences of Suicidal Young Men

Little is known about young suicidal men’s preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men’s initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man’s unique biography.

The Development and Pilot Testing of an Instrument to Measure Nurses’ Working Environment: The Nursing Context Index

BACKGROUND Evidence shows that adopting a person-centered approach to nursing alters the work environment, reduces anxiety levels among nurses in the long term, promotes teamwork among staff, and increases job satisfaction. However, few studies have attempted to quantify the outcomes from the adoption of person-centered nursing. The lack of outcome measurement is in part influenced by the lack of a standardized instrument to measure person-centered nursing. AIMS The aim of this study was to develop an instrument (the Nursing Context Index) to inform the development of person-centered nursing and outcomes arising. METHODS The Nursing Context Index (NCI) was developed through three stages. Stage 1 involved a systematic literature review to identify the key characteristics that needed to be considered in the instrument. Stage 2 involved the identification and selection of items for inclusion in the instrument identified through focus group discussions. A 19-construct instrument was developed. Face validity and content validity were gauged. In Stage 3, a pilot study (n = 23) was conducted to test the instrument. Measures of internal consistency were ensured using Cronbachs alpha. Criterion-related validity of the instrument was ensured through comparison between factors contained in the instrument. RESULTS Findings show that the NCI is an accurate representation of the factors influenced by a clinical settings progression to person-centered nursing. The factors were deemed appropriate to the clinical settings, and possessed face and content validity. Initial statistical findings confirm the validity and usability of the NCI. IMPLICATIONS AND CONCLUSIONS The process used for the development and testing of the instrument was found to be effective. The NCI was deemed to be an effective measure of factors influenced by the implementation of person-centered nursing and would help in redressing a scarcity of quantitative evidence to examine the benefits of nurses working in a person-centered manner.

Providing Meaningful Care

Little is known about young suicidal men’s preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men’s initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man’s unique biography.

Testing of the Factor Structure of the Nursing Work Index-Revised

BACKGROUND Recent research has questioned the reliability and validity of the Nursing Work Index-Revised (NWI-R) instrument, raising the possibility that managers reconfiguring hospitals in line with the factors derived from the NWI-R may be misdirecting resources. AIM To test the factor structure of the NWI-R. APPROACH A population of 864 acute hospital nurses was surveyed using the NWI-R, and a response rate of 449 (52%) was achieved. The statistical factor model was examined using SPSS 11.5 and based on guidelines of successful factor analysis. Measures of internal consistency were calculated for each of the factors to emerge from the data. FINDINGS The findings confirm appropriateness of conducting a factor analysis on the NWI-R. A core three-factor structure emerged from the findings that are generic to all but one of the studies exploring the factor structure of the NWI-R. These factors were adequate staffing and resources, nurse management, and the doctor-nurse relationship. The factors suggested good measures of internal consistency. IMPLICATIONS The composition of the factors shares similarities with the original factors of the NWI-R. The authors recommend that the factors be renamed and the data reinterpreted in light of the new findings. The findings also raise interesting questions about the role a nurses practice environment plays in a nurses work life.

Incontinence: prevalence, management, staff knowledge and professional practice environment in rehabilitation units

Background.  Bladder and bowel incontinence is a major health care problem, which adversely affects the lives of many individuals living at home or in health service facilities. Current approaches to continence care emphasize comfort, safety and reduction of risk, rather than detailed individualized assessment and management. The literature illustrates a gap between evidence and actual practice and emphasizes the context of care as being a key element for successful implementation of evidence based practice. Aims.  To identify prevalence of bowel and bladder incontinence and its management, investigate continence knowledge and describe the professional practice environment within a rehabilitation unit for older people. Method.  An integrated evaluation of continence prevalence, staff knowledge and the work environment was adopted. Results.  Findings revealed a high incidence of incontinence (60% urinary, 3% faecal, 37% mixed) a lack of specific continence assessment and specific rationale for treatment decisions or continuation of care. The focus was on continence containment rather than on proactive management. Staff demonstrated a reasonable knowledge of incontinence causation and treatment as measured by the staff knowledge audit. The evaluation of the work environment indicated a low to moderate perception of control over practice (2.39), autonomy in practice (2.87), nurse doctor relationship (2.67) and organizational support (2.67).

The development and testing of the Person-centred Practice Inventory – Staff (PCPI-S)

Objective The aim of the study was to develop and test an instrument, underpinned by a recognized theoretical framework, that examines how staff perceive person-centred practice, using proven methods of instrument design and psychometric analysis. Design The study used a mixed method multiphase research design involving: two Delphi studies to agree definitions and items to measure the constructs aligned to the person-centred practice theoretical framework (Phase 1); and a large-scale quantitative cross-sectional survey (Phase 2). Setting Phase 1 was an international study involving representatives from seven countries across Europe and Australia, with Phase 2 conducted in one country across five organizations. Participants Two international panels of experts (n = 33) in person-centred practice took part in the Delphi study and a randomly selected sample of registered nurses (n = 703, 23.8%) drawn from across a wide range of clinical settings completed the Person-centred Practice Inventory - Staff (PCPI-S). Main Outcome Measures The main outcome is to establish a measure of staff perceptions of person-centred Practice. Results Broad consensus on definitions relating to 17 constructs drawn from a person-centred practice framework was achieved after two rounds; likewise with the generation of 108 items to measure the constructs; a final instrument comprising 59 items with proven psychometric properties was achieved. Conclusions The PCPI-S is psychometrically acceptable instrument validated by an international expert panel that maps specifically to a theoretical framework for person-centred practice and provides a generic measure of person-centredness.

Predictors of Coping Strategies Employed by Iraqi Refugees in Jordan.

The purpose of this study was to examine coping strategies used by Iraqi refugees in Jordan based on their demographic details. A cross-sectional design was used. A representative sample of 333 refugees living in Jordan participated in the study. The Cope inventory and the demographic details were compiled to produce and collate the relevant data. Being older, female, educated, single, and living with more than three family members was associated with greater use of the problem solving coping strategy. Being female, educated, and unemployed was associated with greater use of the active emotional coping strategy. In addition, being older, male, illiterate, unemployed, and living with less than three family members was associated with greater use of the avoidant emotional coping strategy. This study recommends a multidisciplinary approach intervention as being the best method of addressing and fulfilling the health and socioeconomic needs of older, male, illiterate, unemployed people.

The Relationship of Workplace Culture With Nursing-Sensitive Organizational Factors.

OBJECTIVE: The aim of this study is to explore the relations of workplace culture on nursing-sensitive organizational factors. BACKGROUND: The need for standardized and valid measures for nursing-sensitive organizational outcomes has already been recognized in the literature. METHODS: A cross-sectional questionnaire survey of 21 inpatient acute care units in 9 organizations at the municipal primary healthcare level was conducted. Participants included licensed practical nurses, registered nurses, and nurse managers. RESULTS: Workplace culture, especially the overarching factor of stress, correlated with the use of supplemental nursing staff and patients’ length of stay. CONCLUSION: It is essential to find and test workplace-sensitive indicators so that managers will have a wider range of methods to plan and evaluate nursing outcomes.

Developing nursing and midwifery research priorities: a Health Service Executive (HSE) North West study

AIM The primary purpose of this study was to identify research priorities for nurses and midwives across the Health Service Executive (HSE) North West region. The rationale for the study was underlined during meetings of HSE North West Directors of Nursing and Midwifery in January 2011. It was agreed that a more strategic approach to generating synergy among nursing and midwifery research, evaluation, and evidence-based practice should be developed through the Nursing and Midwifery Planning and Development Unit. METHODS The research design was founded upon collaborative processes for consensus building that included the Delphi technique and nominal group technique. The study sample included a panel of experts. Data were collected between March 2011 and December 2011. FINDINGS Findings from this study validate the efficacy of the research methodology in enabling the effective identification of priority areas for research. These include: (a) an evaluation of the impact of postgraduate nursing and midwifery education programs focusing upon patient, professional, and organizational outcomes; (b) development and evaluation of an effective culture of nurse- and midwife-led audit across all services within a Regional Health Trust in Ireland; (c) an examination of the efficacy of approaches to clinical supervision within the context of the Irish health system; (d) an evaluation of the impact of an Advanced Nurse Practitioner role in supporting the effective management of long-term conditions within the context of Regional Health Trust primary care settings in Ireland; and (e) Supporting and developing an ethical framework for nursing and midwifery research within a Regional Health Trust in Ireland. LINKING EVIDENCE TO ACTION It is anticipated that future work, outlined within this paper, will lead to important improvements in patient care and outcomes. Furthermore, this study provides evidence that a strong nursing and midwifery research agenda can be established upon genuine collaborations and partnerships across varying levels of research knowledge and skills, but with a shared purpose and shared values.

Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: A systematic review of the literature:

Background: Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management. Aim: To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting. Design: This is a systematic review. Data sources: MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction, and undertook a thematic analysis. Results: In total, 13 studies were included in the review comprising randomised trials (n = 3), observational (n = 4) and descriptive studies (n = 6). Most research was conducted in specialist palliative care units, targeting either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation, raising questions on the existence and comparability of baseline prevalence figures, the physical and psychological impact on patients, resource impact on staff and service, the subjective and objective methods of assessing constipation, and key aspects of constipation management, including a lack of focus on non-pharmacological management in this setting. Conclusion: The results of this review are being used to inform the development of an educational intervention targeting healthcare professionals. Gaps in the evidence base include lack of consistent definition of constipation, constipation prevention, non-pharmacological management, and the consideration of the management of constipation for the dying patient.