Role dimensions of general practice nurses in Ireland.

Introduction: Primary care has the potential to address the challenges associated with the rise of chronic conditions and an aging population; however, General Practitioners are increasingly struggling to meet these demands. Fundamental to the provision of high-quality primary care is the role of the general practice nurse, who typically provides a wide range of services. Examining the current role of general practice nurses must be a first step to determining their educational needs for enhancing their long-term future contribution to primary care.

Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care.

Background: Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus.

Aims And Objectives: Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland.

A national cross-sectional survey of constipation in patients attending cancer centres in Ireland.

The prevalence of constipation in patients with cancer is estimated at 50-90%. It is often associated with pain, anorexia, nausea and vomiting and impacts negatively on quality of life. Despite its common occurrence, it is often poorly recognised and treated by healthcare professionals.

A participatory action research study to inform combined type 2 diabetes and chronic kidney disease care provided in the context of advanced practice nursing.

Aim: To outline the development, implementation and evaluation of an alternative combined type 2 diabetes and chronic kidney disease (CKD) care delivery strategy provided in the context of advanced practice nursing informed by co-created knowledge, between patients and healthcare teams to address identified gaps in care provision.

Design: This study was informed by the theoretical underpinnings of critical theory and operationalized using a participatory action research (PAR) design. This approach enabled alignment between the theoretical underpinnings and research methodology to respond to practice-level problems and address issues related to healthcare delivery.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol.

Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required.

Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland.

Background: Internationally many countries have implemented strategies to enhance primary care, to strengthen their health systems to cope with an aging population, the rise of chronic conditions, and increased costs. Primary care has the potential to address these challenges, however, general practitioners are increasingly struggling to meet patient demand resulting from a growing and aging population. Expanding the role of general practice nurses to advanced nurse practitioner (ANP) level has worked internationally and could equally be a solution to the Irish context.

A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice.

Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel.

Pain assessment and registration in medical oncology clinics: operationalised through the lens of health care professionals and patients.

Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain, due to fear that reporting pain will distract the healthcare professional from their cancer treatment. This study adopted an explanatory sequential mixed-methods design.

Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol.

In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas - acute care, midwifery, children's, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes.

A guidance framework to aid in the selection of nursing and midwifery care process metrics and indicators.

Aim: To describe the development of a guidance framework to assist nurses and midwives in selecting nursing and midwifery care process metrics and indicators for use in practice.

Background: Process metrics are measures of care provision activities by nurses and midwives.

Methods: Phase 1 was a rapid review assessment of the literature conducted to identify an initial framework.

GPs' opinions of discharge summaries generated by advanced nurse practitioners in emergency care settings.

Aim: Clinical handover at the point of discharge is critically important. It generally occurs through a written document, usually in the form of a discharge summary. Hospital discharge summaries contribute to continuity of care for patients who leave hospital and who may require care in the community provided by their GP.

Enablers and challenges to advanced nursing and midwifery practice roles.

Aim: To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland.

Background: Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles.

Method: A descriptive qualitative approach using semi-structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education.

"Heart disease never entered my head": Women's understanding of coronary heart disease risk factors.

Aims And Objectives: This study investigated experiences of women with a primary diagnosis of ACS (NSTEMI & Unstable Angina). The study explored how women interpreted their risk for coronary heart disease (CHD) and how this influenced their treatment-seeking decisions.

Background: Efforts to reduce the incidence of cardiovascular disease, the number one killer of women, require aggressive risk factor modification, risk assessment and evidence-based treatments.

Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers.

Aims And Objectives: To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery.

Background: Expanded practice is a response to population health needs, healthcare costs and practitioners' willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy.

Design: This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis.

An interprofessional learning experience for trainee general practitioners in an academic urban minor injuries unit with advanced nurse practitioners (Emergency).

Background: There is a body of empirical literature indicating that interprofessional education (IPE) not only enriches students' understanding of their own discipline but of other disciplines. However, giving the on-going emphasis on the importance of IPE to healthcare processes and outcomes, on-going attention is needed to advancing the research evidence related to the emergency department setting. The aim of this qualitative descriptive study was to determine the clinical learning experiences of GPs who rotated through an academic urban minor injuries unit as part of their training, led by advanced nurse practitioners (emergency).

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

Aims And Objectives: To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice.

Background: There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system.

An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review.

Objectives: This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services.

Design: A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles.

Data Sources: A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015.

The perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners.

Aim: To explore the perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners.

Background: There is evidence that the contribution of these roles to patient care is poorly understood.

Design: This research took place over 2 months in 2015 and is part of a larger study involving a rapid review to inform policy development on the specialist and advanced nursing and midwifery practice in Ireland.

'Betwixt and between health and illness' - women's narratives following acute coronary syndrome.

Aims And Objectives: This study investigated experiences of women with a primary diagnosis of ACS (NSTEMI and Unstable Angina) in the 6-8 week period following discharge from hospital. The aim was to report the experience of the mediating impact of a newly-diagnosed disease.

Background: Cardiovascular disease is the main cause of mortality in women.

Using rapid reviews: an example from a study conducted to inform policy-making.

Aim: A discussion of the potential use of rapid review approaches in nursing and midwifery research which presents a worked example from a study conducted to inform policy decision-making.

Background: Rapid reviews, which can be defined as outputs of a knowledge synthesis approach that involves modifying or omitting elements of a systematic review process due to limited time or resources, are becoming increasingly popular in health research. This paper provides guidance on how a rapid review can be undertaken and discusses the strengths and challenges of the approach.

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.

Developing 'subject matter experts': an improvement methodology programme for acute postoperative pain with patients post major surgery.

Aims And Objectives: To determine the effectiveness of an improvement methodology initiative, directed at refining the quality of acute pain management of patients in the first 24 hours post major surgery using the Revised American Pain Society Patient Outcome Questionnaire, pre- and post development of a 'subject matter experts' acute pain programme.

Background: Accurately measuring effectiveness of acute pain management post major surgery is intertwined with measuring overall patient satisfaction. A critical element of quality evaluation is obtaining direct feedback from patients about the here-and-now pain experiences post major surgery.

Case report: a patient with dementia presenting with hip fracture in the emergency department -- challenges of acute pain assessment.

The purpose of this case report is to stimulate debate on the practicalities of detecting pain in patients with dementia in the emergency department (ED) - in this case, a patient who sustained a hip fracture subsequent to a fall in a nursing home. Although case reports are low in the hierarchy of evidence, they serve as useful glimpses into future possible detection and management of the pain status of the person with dementia in the ED who present with injuries such as hip fractures. Older patients with dementia, who are unable to provide a self-report of pain post hip fracture in the ED are at risk for under-detection and under-treatment of acute pain.