Royal College of Surgeons in Ireland
Coláiste Ríoga na Máinleá in Éirinn
Faculty of Nursing and Midwifery
29th Annual International
Nursing & Midwifery Conference
Thursday 25th February 2010
TABLE OF CONTENTS
WELCOME TO THE 29th CONFERENCE
President’s Welcome 3
Conference Welcome 3
ABOUT THE FACULTY OF NURSING AND MIDWIFERY
The Faculty 4
The Dean’s Medal 4
Fellowship of the Faculty 4
Faculty Nursing Education Programmes 6
ORGANISERS AND SPONSORS
Conference Committee 7
Social Committee 7
Conference Scientific Committee 7
Conference Sponsors 8
CALL FOR ABSTRACTS & AWARDS
Call for Abstracts 9
St. Luke’s Institute of Cancer Research Awards 10
ChiesiNeonatal Nursing Research Awards 10
INDEX OF SPEAKERS & PRESENTATIONS
Keynote Speaker 11
Plenary Speaker 11
Florence Nightingale Centenary Celebration 11
Closing Plenary 11
Concurrent Speakers 11
Poster Presentations 11
Chairpersons 12
ABSTRACTS & BIOS- PART 1
Keynote Speaker 15
Plenary Speaker 16
Specialist Speaker 17
Closing Plenary Speaker 18
Concurrent Speakers 20-79
ABSTRACTS & BIOS- PART 2
Poster Presentations 80-119
MSc (Year 2) Student Posters 120-122
SPACE FOR NOTES 124-125
*This book contains the final abstracts and biographical details submitted by presenters.
CONFERENCE AIMS:
• To provide a forum for emerging leaders in nursing and midwifery to explore advances in nursing.
It is my great pleasure to welcome you to the 29 Annual International Nursing & Midwifery Research Conference organised by the Faculty of Nursing and Midwifery at the Royal College of Surgeons in Ireland. This is a very special event in the annual College programme and is usually well attended and respected by the nursing community. Without research we do not have new knowledge and without knowledge we do not make progress.
Knowledge generation requires dissemination and exchanges through conferences and journals. The peer review process is a necessary component for the critical evaluation and validation of research results. Validation processes require the collaborative engagement from people of different backgrounds and experiences, a robust exchange of views, with analyses and feedback which is informed by practical experience. The conference mechanism is essential for this type of interaction and for education through academic and social exchanges. It is at conferences that the state of theart is defined, the evidence base for progress is agreed and friendships are made and sustained.
Continued strong support for this meeting reflects not only the importance of the programme content but also the success of previous meetings and the respect and esteem of RCSI Nursing Faculty. It further reflects the important role of nursing, nurse development and teamwork in health care delivery. Continued professional development is needed to meet the challenges in the modern healthcare environment. New methods of investigating and treating disease processes, greater public expectation, accountability and resource scarcity are major stresses but also Drivers of reform. Implementing changes requires the development of human capital and the appropriate use of validated information. At the conference these issues will be explored and debated in specialist sessions and state of the art lectures.
On behalf of the Council of the College I congratulate the Nursing Faculty, the Dean of the Faculty Ms Maeve Dwyer, the Professor of Nursing Professor Seamus Cowman and the organising committee. We extend a warm welcome to all the speakers and delegates and particularly those who have travelled from foreign parts. We hope that your attendance will be rewarded academically, that you will make new friends and that you will be fulfilled through the conference activities and the artistic delights of Dublin.
Professor Frank B.V. Keane, MD, FRCSI
President
On behalf of Ms. Maeve Dwyer, Dean of the Faculty, Board members of the Faculty and staff of the Faculty, I would like to welcome all delegates to the conference. The Faculty of Nursing & Midwifery is now in its 36th year and during that time it has remained at the forefront of developments in Nursing and Midwifery. It is one of the longest serving providers of nursing and midwifery education in Ireland. The Board and Staff of the Faculty continue to look forward to accepting leadership roles and in being innovative and creative in supporting future health service developments in policy formulation, education and research.
This is our 29th annual International conference and it is one of the oldest conferences in Europe and a main event in the Irish nursing calendar and as such, it continues to enjoy outstanding support. It’s now very much an international event and this is a reflection of the standards set that more and more delegates from overseas attend and present their work at our conference.
What is also pleasing is that each year an increasing number of Irish nurses and midwives are presenting papers and posters and this must be viewed positively for the future of the profession in Ireland. The theme of this year’s conference is ‘Integrating Care More Effectively: Unlocking the Potential of Nurses and Midwives
The papers presented at this conference identify the many challenges confronting the professions of nursing and midwifery in the years ahead.
Organising a conference is a major task and in this regards a special word of thanks to the conference committee and in particular Catherine O Neill, Margie Craig, James Hayes and Frances Roseto
May I also take this opportunity to wish overseas delegates a pleasant stay in Ireland.
Seamus Cowman Professor of Nursing Head of Department
THE FACULTY
THE DEAN’S MEDAL
The Faculty of Nursing and Midwifery in the Royal College of Surgeons in Ireland was inaugurated in April 1974 under the leadership of Mary Frances Crowley (First Dean 1974 – 1979). It takes its place alongside the various faculties in the Royal College of Surgeons. It is a post registration / post graduate continuing education Faculty for nurses and midwives based within the Royal College of Surgeons in Ireland, St. Stephens Green, Dublin. Miss Crowley and the founder members were professional nurses with foresight and their work is still of enormous benefit to nurses as evidenced in the Faculty’s role as a major provider of nursing education in Ireland.
The Faculty of Nursing and Midwifery consists of a Dean and twelve board members who constitute the Board of the Faculty. It is bound by the constitution of the Royal College of Surgeons in Ireland and the Council of the College. The membership of the Board is largely representative of the various specialist areas in Nursing and is inclusive of representation from An Bord Altranais. As one of the earliest and longest serving providers of Nurse Education in Ireland, the Faculty of Nursing has ensured wide ranging and relevant programmes of education for nurses from a variety of clinical nursing specialties.
The Faculty provides full time and part-time Nursing Programmes including degrees, post graduate diplomas and masters, approved through the National University of Ireland. Among the Faculty’s existing programmes are part-time BSc degrees in nursing, and nursing management. The Faculty provides 20 post graduate diplomas/MSc programmes run in conjunction with our partnership hospitals and approved through the National University of Ireland. These programmes are inclusive of many nursing/midwifery specialties. A new MSc programme in Nursing Leadership is included in our prospectus this year. There are also a number of independent modules mainly on subjects related to clinical practice. Fellowship in Nursing and Midwifery (FFNMRCSI) is a qualification offered exclusively by the Faculty of Nursing and Midwifery of the Royal College of Surgeons in Ireland.
A Nursing/Midwifery Research Centre has been established within the Faculty where a number of research projects are being undertaken. Post-graduate nursing research supervision is provided at all levels including Masters and PhD level.
The College Badge mounted on a black
background with eight stars to symbolize the
essential qualities of leadership.
Knowledge
Conciliation
Wisdom
Co-Operation
Responsibility
Availability
Co-Ordination
Prudence
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Applicants must:
1) Be a registered nurse/midwife with a minimum
of five years nursing experience
2) Have a masters level qualification in nursing or
midwifery or other relevant and related Masters
qualification
Assessment will take the form of Portfolio
submission and viva voce.
Guidelines on portfolio presentation are available
from the Faculty.
Examination Fee: €920.00
Applications Details:
An Application form may be obtained from:
Fellowship Applications
Faculty of Nursing & Midwifery
Royal College of Surgeons in Ireland
123 St Stephen’s Green
Dublin 2
Tel: 01 402-2206/2445
Email: [email protected]
Web: www.rcsi.ie
CONFERENCE COMMITTEE CONFERENCE SCIENTIFIC COMMITTEE SOCIAL COMMITTEE
Maeve Dwyer, Dean Aine Colgan, Vice Dean Nicola Clarke, Hon Treasurer Kay Leonard
Josephine Bartley Prof. Seamus Cowman Kay Kinirons Eileen Maher Edna Woolhead CONFERENCE CO-ORDINATORS Catherine O’Neill Margie Craig CONFERENCE ADMINISTRATORS Frances Rosato James Hayes Maeve Dwyer, Dean
Dr. Aine Colgan, Vice Dean Louise Johnston, Hon Secretary Nicola Clarke, Hon Treasurer Kay Leonard
Josephine Bartley Catherine Clune Mulvaney Prof. Seamus Cowman Margie Craig Nora J. Cummins Maureen Duff Noreen Keane Kay Kinirons Eileen Maher Dr. Therese C. Meehan Dr. Zena Moore Catherine O’Neill Mary O’Neill Edna Woolhead
Maeve Dwyer, Dean Dr. Aine Colgan, Vice Dean Louise Johnston, Hon Secretary Nicola Clarke, Hon Treasurer Kay Leonard,
Josephine Bartley Prof. Marie Carney Catherine Clune Mulvaney Prof. Seamus Cowman Margie Craig Nora J. Cummins Dr. Georgina Gethin Deirdre Hyland Noreen Keane Kay Kinirons Stephanie Lawrence Eileen Maher Dr. Therese C. Meehan Dr. Zena Moore Catherine O’Neill Mary O’Neill Chanel Watson Edna Woolhead
CONFERENCE SPONSORS
CALL FOR ABSTRACTS 2011
Royal College of Surgeons in Ireland Faculty of Nursing & Midwifery
30TH ANNUAL INTERNATIONAL NURSING & MIDWIFERY RESEARCH CONFERENCE
2011
Wednesday 23rd and Thursday 24th February 2011
TITLE:
PROMOTING PATIENT CENTRED CARE IN TIMES OF CHANGE – THE CHALLENGE FOR NURSES AND MIDWIVES
Plenary, Concurrent Papers and Poster Presentations
CALL FOR ABSTRACTS
Application forms and further information from
Administration Co-ordinator Faculty of Nursing & Midwifery Royal College of Surgeons in Ireland 123 St. Stephens Green Dublin 2 Tel: +353 (1) 402 2206/ 2445 Fax: +353 (1) 402 2465 Website: www.rcsi.ie/nursingconf e-mail: [email protected] ABSTRACT SUBMISSION
Abstract (max. 200 words) for oral and poster presentations should be submitted, using the abstract template, with completed Presenter Profile and Biographical details by e-mailing to [email protected].
Deadline for submission is 17th September 2010.
Abstract template is available at www.rcsi.ie/nursingconf .
ABSTRACT LAYOUT
• Relevant contextual and background
• Aims/research question
• The research design
• Data analysis with
• Results
• Contribution to nursing practice.
You are requested to indicate which of the following categories best reflects your abstract:-
1. Greatest potential contribution for nursing/midwifery practice
2. Greatest contribution to the body of Nursing & Midwifery knowledge
3. Pushing the boundaries in nursing or midwifery research methodology
4. Innovation in health care
To accommodate as many presenters as possible, the Selection Committee reserves the right to limit each presenter to only one presentation.
CONCURRENT SESSION
Concurrent session papers are allocated 30 minutes including time to set up and five minutes of discussion.
POSTER PRESENTATION
Poster presentations are presented and exhibited throughout the duration of the conference.
For further information please contact
Conference Administrator Faculty of Nursing & Midwifery Royal College of Surgeons in Ireland 123 St. Stephens Green Dublin 2 Tel: +353 (1) 402 2206/ 2445 Fax: +353 (1) 402 2465 Website: www.rcsi.ie/nursingconf e-mail: [email protected]
ST.LUKE’S INSTITUTE OF CANCER RESEARCH AWARDS
The Faculty of Nursing and Midwifery on the occasion of its 29th Annual International Nursing & Midwifery Research Conference is pleased to announce a collaborative venture with St Luke’s Institute of Cancer Research.
Awards will be presented by St Luke’s Institute of Cancer Research to nurses and midwives in recognition of outstanding research and knowledge development that contributes to patient care. There will be six category awards and one for overall presentation.
A judging committee representing a range of Nursing & Midwifery interests will select the winners for the awards in the following categories:
CATEGORY
AWARD FUND
Best Overall Presentation €1,000
Best Oncology / Cancer Care Presentation €500
Greatest Potential Contribution for Nursing & Midwifery Practice €500
Greatest Contribution to the body of Nursing & Midwifery Knowledge €500
Pushing the Boundaries in Nursing & Midwifery Research Methodology €500
Innovation in Healthcare €500
Best Poster Presentation (x2) €500 each
Best Poster MSc (Year 2) Student €250 each
CHIESI NEONATAL NURSING RESEARCH AWARDS
The Faculty of Nursing and Midwifery on the occasion of its 29th Annual International Nursing & Midwifery Research Conference is pleased to include Neonatal Nursing as a Specialist Strand. In recognition of this, awards will be presented by Chiesi
A judging committee representing a range of Nursing & Midwifery interests will select the winners for the awards in the following categories:
CATEGORY
AWARD FUND
OPENING ADDRESS (WEDNESDAY 24th)
FLORENCE NIGHTINGALE CENTENARY
CELEBRATION
Ms. Mary Donohoe
Ms. Mary Spinks17
KEYNOTE SPEAKER
Professor Janet Rankin
15
PLENARY SPEAKER
Ms. Madge E. Buus-Frank
16
CLOSING PLENARY
Dr. Anne-Marie Ryan
18
CONCURRENT SPEAKERS
(IN ALPHABETICAL ORDER)
John Adams 63 Breda Hayes 30 Susan L. Moran 27
June Andrews-Horowitz 41 Josephine Hegarty 36 Christine Nelson-Tuttle 48
Cassandra Bell 22 Ken Hogan 55 Frances Neville 34
Michael Bergin 68 Geralyn Hynes 58 Honor Nicholl 66
Damien Brennan 75 Fionnuala King 65 Máirín O'Mahony 33
Catherine Buckley 44 Helen Kohlen 60 Mary O'Neill 37
Mary Casey 57 Patricia Leahy-Warren 49 Anne O'Sullivan 26
Carol Chamley 51 Helen Ludkin 50 Sinead O'Toole 56
Rita Collins 38 Marie Lynch 64 Sinead Power 32
Dianne Cooney-Miner 52 Gordon MacLaren 67 Gillian Prue 31
Brigitte S. Cypress 74 Laura Markwick 73 Denis Ryan 40
Mary Rose Day 76 Geraldine Mc Carthy 54 Phillippa Ryan-Withero 47
Maureen Duff 70 Cynthina R. McCloskey 79 David Smith 61
Mel Duffy 39 Edie McConaughey 46 Helen Strapp 25
Gerard Fealy 42 Vicki McManus 24 Robyn L Synnott 45
Sandra Fleming 71 Martin S McNamara 43 Una Toland 28
Georgina Gethin 23 Teresa Meeneghan 35 Helen Walsh 29
Peter Goward 53 Diane J. Mick 78 John S.G. Wells 72
Phil Halligan 59 Una Molloy 77 George Wilkie 69
Kristin Halvorsen 62 Zena Moore 21
Poster Presenters
(IN ALPHABETICAL ORDER)
June Andrews-Horowitz 81 Dawn Farrell 93 Deirdre Mills 106
Catherine Buckley 82 Debra J Gates 94 Helen Mulcahy 107
Nicola Clarke 83 Georgina Gethin 95 Margaret M Murphy 108
Vicki Cleary 84 Sinead Greaney 97 Karen Nash Greally 109
Heather Cooke Smith 85 Irene Hartigan 98 Patricia O'Hara 110
Nicola Cornally 86 Louise Kavanagh-McBride 99 Sue Paffrath 112
Loretta Crawley 87 Jacinta Kelly 100 Celine Stenson 113
Carmel Daly 88 Carol B King 101 Ella Walsh 114
Mary Rose Day 89 Patricia Leahy-Warren 102 Debbie Ward 115
Suzanne Denieffe 90 Catherine Lillis 103 Catherine Wedgeworth 116
CHAIRPERSONS
TIME
THURSDAY 25
thFEBRUARY
CHAIR
VENUE
09.00-10.00 Keynote Address: Professor Janet Rankin
Faculty of Nursing, University of Calgary, Alberta, Canada
Ms. Maeve Dwyer, Dean, Faculty of Nursing & Midwifery, RCSI
Cheyne Lecture Theatre
10.15-12.45 Wound Management & Tissue Viability
Ms. Julie Jordan-O’Brien, CNS Wound Management & Tissue Viability,
Beaumont Hospital
Tutorial Room 2
10.15-12.45 Neonatal Care Ms. Patricia O’ Hara , Programme
Co-ordinator - Postgraduate Diploma in Nursing (Neonatal Intensive Care)
Tutorial Room 4
10.15-12.45 Oncology & Palliative Care
Ms. Kay Leonard, Faculty of Nursing &
Midwifery, RCSI Nightingale Lecture
Theatre
10.15-12.45
Integrated Care Dr. Therese Meehan, Faculty of Nursing
& Midwifery, RCSI
Albert Lecture Theatre
10.15-12.45 Leadership Professor Marie Carney, School of
Nursing, RCSI
Cheyne Lecture Theatre
10.15-12.45
Midwifery Practice Dr. Aine Colgan, Vice- Dean, Faculty of
Nursing & Midwifery, RCSI Newman Study
10.15-12.45 Education Ms. Catherine Clune Mulvaney, Faculty of
Nursing & Midwifery, RCSI
Tutorial Room 1
13.45-14.30
Plenary Speaker: Ms. Madge E. Buus-Frank
The Children’s Hospital and Dartmouth Medical School, Haverhill, New Hampshire, USA
Ms. Edna Woolhead, Faculty of Nursing & Midwifery, RCSI
Cheyne Lecture Theatre
14.30-15.00 Florence Nightingale Centenary Celebration
Speaker: Ms. Mary Spinks
Mr. Michael Shannon, Office of the Nursing Services Director, HSE
Cheyne Lecture Theatre
15.00-17.00
Methodological Issues in Research Dr. Zena Moore, Faculty of Nursing &
Midwifery, RCSI Tutorial Room 2
15.00-17.00 Ethical Issues in Practice Ms. Deirdre Hyland, Faculty of Nursing &
Midwifery, RCSI Nightingale Lecture
Theatre 15.00-17.00 Oncology & Palliative Care Ms. Eileen Maher, Faculty of Nursing &
Midwifery, RCSI Tutorial Room 4 15.00-17.00 Nurse Prescribing Ms. Chanel Watson, Faculty of Nursing &
Midwifery, RCSI Albert Lecture
Theatre
15.00-17.00 Psychosocial Aspects of Patient Care Professor Seamus Cowman, Faculty of
Nursing & Midwifery, RCSI Cheyne Lecture
Theatre 15.00-17.00
The Ageing Process
Ms. Noreen Keane, Faculty of Nursing &
29th Annual International
Nursing & Midwifery Conference
Thursday 25th February 2010
Royal College of Surgeons in Ireland
Coláiste Ríoga na Máinleá in Éirinn
The Managerial Turn in Nursing: A Cautionary Note About Contradictory Practices
Professor Janet Rankin PhD, BScN
Faculty of Nursing, University of Calgary, Alberta, Canada
Janet Rankin has been working in nursing since 1975. In 1987 she began working as a nurse educator teaching in an undergraduate programme. Throughout the mid 1990’s Rankin began to question her work with student nurses and new graduates. She recognized that nursing was fundamentally changing. The contradictions between what she was teaching about to how to provide care to patients and what could be reasonably accomplished in a nurses’ shift of duty were becoming increasingly troubling. Even experienced nurses were challenged to attend properly to the important details of each patient’s care.
Dr. Rankin’s programme of research addresses the changes in nurses’ work. Using a research approach known as institutional ethnography her analysis reveals what is really happening to patients and families within health care reform and hospital restructuring. The findings counter dominant knowledge emerging in health services research which examine health outcomes in a strictly scientific way and that organize nurses to pay less time and attention to treating patients as people with needs beyond what is objectively measurable. The research empirically describes serious consequences for patient care and shows that nurses themselves are agents of practices that disrupt how they can know and act. The research builds an alternate body of evidence that develops a ground for nurses to “talk back” to the professional incursions occurring within applications of evidence-based health services research.
In January 2008 Janet Rankin joined the Faculty of Nursing at the University of Calgary where she is continuing to research nurses’ work while at the same time investigating the interface between nursing education and direct practice.
Around the clock and across the globe nurses report to duty where their work is relied upon to coordinate and respond to the inevitably unpredictable needs of patients that arise within the fast-paced demands of contemporary health care institutions. Nurses’ knowledge and skill are relied upon to ensure that the care of hospitalized patients unfolds safely, properly (and efficiently). Many people trust nurses to know what is required, what must be done first and what can wait. Much of nurses’ work, like domestic work, takes place in the background, unaccounted for in the formal understandings of what nurses do. But without this important nursing contribution, knots appear in the smooth rolling out of health care.
As health care is reformed, nurses are expected to continue the smooth rolling out of care as usual. Or do they? It is this issue that will be the focus of this key-note address. Nurses on the ground of their practice understand that there is a great deal of care that is going seriously wrong; and that gaps appearing in patient care are going unnoticed in the official ‘evidence-based’ methods being used to audit and account for health care improvements. Using data dating from the 1970’s I describe a ‘managerial turn’ in nursing. I outline how computerized managerial technologies that promise to solve some of the tensions in nursing care ricochet back into nursing practice in troubling ways. I describe how this happens “off the radar”; outside of the common explanations that nurses develop about our work. My argument goes against the grain of a good deal of contemporary belief about how to solve the serious issues facing health care and nursing. It uses careful ethnographic descriptions of what is actually happening to nurses and their patients and empirically links what is happening into the textualized and computerized systems that integrate and standardize care.
The analysis being reported focuses on the intersection of different kinds of knowledge – of nurses’ own knowing about how their work unfolds and how this knowledge is brought together with other, externally derived and explicitly organized systems of information that are being used to reform how hospital care is produced. It develops a strong case about what nurses know about patient care being seriously undermined.
PLENARY SPEAKER: THURSDAY 25TH FEBRUARY: 13.45
Survive & Thrive: Unlocking the Potential of Nurses and Midwives
Madge E. Buus-Frank RNC, MS, APRN-BC
The Children’s Hospital and Dartmouth Medical School, Haverhill, New Hampshire, USA
Madge Buus-Frank is a neonatal nurse practitioner who has been caring for infants and families for over 30 years. She is an honours gradate from Boston College and is currently clinically active in the newborn intensive care unit (NICU) at The Children’s Hospital at Dartmouth. Madge is an Instructor in Paediatrics at Dartmouth Medical School. Additionally, Madge is the principal consultant and co-founder of Dynamic Neonatal Solutions, a consulting firm that provides education and innovative programmatic and clinical solutions to newborn intensive care units, health systems and hospitals across the US.
In addition to her clinical, academic and consulting activities Madge was the Founding Editor-in-Chief for Advances in Neonatal Nursing: The Official Journal of the National Association of Neonatal Nurses, a peer reviewed publication dedicated to advancing the art and science of neonatal care, serving for 5 years in this capacity.
Madge is a dynamic and motivating speaker. She is able to share a wealth of knowledge based on her extensive clinical experience balanced by thoughtful programmatic insights. Participants are challenged to improve their critical thinking and assessment skills, and integrate a parent-centred, team-oriented, evidence-based philosophy of care for infants and families in the hospital, community and the home. This presentation will provide an overview of the current top
three global trends converging on the future of nursing in Ireland and beyond. Relevant economic, social and population, and technology trends will be summarized with an emphasis on the potential impact on human health, healthcare systems and the future nurses and midwives.
Strengths, weaknesses, opportunities and threats relative to these trends will be discussed. Specifically the opportunity for expanding the role advanced practice nurses to improve patient outcomes will be highlighted Relevant lessons from the evolution of nurse practitioner roles in the U.S., specifically the example of the emergence of neonatal nurse practitioner role, will be provided as a benchmark for Ireland’s progress. Finally, the presentation will end with a whirlwind tour of rapidly emerging healthcare technologies including sophisticated hand-held diagnostics, advanced imaging, tools to map and repair genes, and more. A glimpse at birthing in the future, and integrated technologies in a futuristic hospital room will be provided in an effort to spur thinking about the education, knowledge, and skills that the nurse of the future will need to survive and thrive.
The Legacy of Florence Nightingale Mary Spinks
Visiting Professor at the University of Ulster and Director of the Florence Nightingale Foundation, London
The Florence Nightingale Foundation is a charitable organisation granting and funding scholarships for nurses and midwives to research and study; the outcome of which is to change and improve the planning and delivery of health care. Mary has held this post for ten years and during this time has greatly increased the number of applications and secured more funding from sponsors to enable even more scholarships to be awarded.
She is also responsible, and has successfully run, the Annual Florence Nightingale Commemoration Service in Westminster Abbey for the last ten years. In 2005, she introduced a new initiative of Leadership Development Scholarships for senior nurses who aspire to the top posts in the nursing profession.
Mary was formerly Director of Nursing and Consumer Affairs at the North East Thames Regional Health Authority, an Executive position on the Board. Previous to that, she was Chief Nursing Officer and Director of Consumer Affairs for Brighton Health Authority. Her career in the NHS spanned a period of 44 years during which time she specialised in Operating Theatre Nursing and Management and held honorary appointments as the Nurse Member of Maidstone Health Authority, a member of the NHS Training Authority and a member of the English National Board for Nursing, Midwifery and Health Visiting.
During her career, she has had and continues to have many publications in the nursing and health care press. She was an Arena columnist for the Nursing Times during 1995.
In August 2007, she was appointed a Visiting Professor at the University of Ulster.
“For us who nurse, our nursing is a thing,
which, unless we are making progress every
year, every month, every week, take my word
for it, we are going back” FN
CLOSING PLENARY: 17.00
Managing the Continued and Evolving Professionalisation of Nursing
Dr. Anne-Marie Ryan
PhD, RGN, RNT, BNS, MSc, FFNMRCSI
Chief Education Officer, An Bord Altranais, Ireland
Anne-Marie is employed as Chief Education Officer in the nurse regulatory body in Ireland, An Bord Altranais, overseeing the development, setting and maintenance of educational standards for nurse/midwife education and guidance to the professions. Anne-Marie has led and represented An Bord Altranais on many national committees to develop policy and implement regulatory structures to support the developing role of the nurse and midwife. Anne-Marie currently chairs the working group on education, training and competencies of nurses for FEPI, the European Council of Nurse Regulators. Anne-Marie completed her doctoral studies in education from Dublin City University examining the regulatory approach to general nurse education in Ireland. Anne-Marie’s previous experience as a nurse educator was in Trinity College Dublin, and University College Dublin and she was also the Principal Nurse Tutor in Beaumont Hospital School of Nursing. Anne-Marie’s clinical nursing experience was in medical and surgical nursing and she specialised in oncological nursing.
The role of the Nurse is changing to meet ever more complex healthcare needs in modern society.
Societal pressures form the basis of what we do and ultimately who we are professionally. Knowing what it is that informs this picture, and how we capture our science of knowing nursing, creates a space for our debates. The pressure to expand roles and maintain and develop new competencies for a new understanding of the potential of nursing practice is captured in the wide ranging research papers presented in the conference. Re-claiming the essence of nursing as patient focussed quality care is as important to understanding the professional roles adapted for current practice as it was in the time of Florence Nightingale. The patient-nurse relationship must remain at the heart of professional nursing practice.
The tensions of managing this changing landscape are explored in light of the research papers presented at today’s Conference.
Royal College of Surgeons in Ireland
Coláiste Ríoga na Máinleá in Éirinn
Faculty of Nursing and Midwifery
29th Annual International
Nursing & Midwifery Conference
Thursday 25th February 2010
Repositioning for Prevention of Pressure Ulcers- An Economic Analysis
Dr. Zena Moore
PhD, MSc, FFNMRCSI, PG Dip, Dip Management, RGN Royal College of Surgeons, Dublin in Ireland
I am a registered nurse, from Dublin, currently employed as a lecturer at the Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, where I coordinate the Post Graduate Diploma/MSc in Wound Management & Tissue Viability & Infection Control programmes. I worked in the area of wound management and tissue viability for 11 years prior to taking up this post.
I am president of the European Wound Management Association; in addition I chair the education committee. I also sit on the scientific committee, the patient outcomes group, the editorial committee and the industrial liaison committee of EWMA. I am a member of the World Health Organisation’s Global Initiative in Wound and Lymphoedema Care and I am a member of the EUCOMED advanced wound care sector.
Professor Seamus Cowman
PhD, MSc, FFNMRCSI, PG Cert (Adults), Dip N (London), RNT, RGN, RPN
Professor & Head of Nursing, Royal College of Surgeons
Seamus is the first Professor of Nursing at the Royal College of Surgeons in Ireland and Head of Department at the Faculty of Nursing and Midwifery.
Background
International best practice advocates the use of repositioning for the prevention of pressure ulcers, however, one must have cognisance of the economic implications of interventions used within the clinical setting, therefore, as one component of a larger RCT, economic analysis was conducted to explore the cost implications of repositioning.
Aims and Objectives
To compare the cost implications of repositioning individuals using 2 different repositioning regimes - the experimental group (n=99) were repositioned 3 hourly at night, using the 30 degree tilt; the control group (n=114) received standard care (6 hourly turning using the 90 degree lateral rotation).
Methods
Ethical approval was received. The cost analysis focused on the cost difference between the two study groups (in terms of the number of nurses needed per turn, the time per turn, the cost of a nurse per minute and the cost of Dressing treatments and nurse time for Dressing changes for pressure ulcers that developed during the study period). Data were collected for a 4 week period.
Analysis and Results
The mean time per turn was 3.01 minutes (experimental), and 5.93 minutes (control). The mean number of nurses needed for each turn was 1.51 (experimental), and 2.02 nurses (control). The mean daily nurse time was 18.5 minutes (experimental) and 24.5 minutes (control) (p<0.001). The daily mean difference between the groups was -6.00 minutes (95% CI -3.71 to -8.48). The cost per patient was €207.4 (experimental) and €274.3 (control) (p<0.001). The mean difference between the groups is -€66.90 (95% CI –€24.68 to –€81.03). In the experimental group 96.6% of participants remained free of pressure ulcers, 88.1% of patients remained pressure ulcer free in the control group (p=0.030). The incremental cost effectiveness ratio is -€787 thus, the intervention is a dominant option (costs are lower for better outcomes). For the total study period, the cost of repositioning was €19,958.40 (experimental) and €31,270.20 (control). Three pressure ulcers developed in the experimental group whereas 13 developed in the control group (all pressure
Total costs were €19,962.27 (experimental) and €31,370.56 (control). The cost difference was -€11,408.29. Projected annual costs of repositioning were estimated for those who would require repositioning of all individuals who where hospitalised across the study sites, using the 30 degree tilt compared to repositioning using standard care. Of these individuals, 53.5% would require repositioning based on Braden mobility scores. Costs for use of the 30 degree tilt were estimated as €258,402.48, these costs were estimated as €509,078.64 for standard care. The annual cost difference is -€250,676.16.
Recommendation
Repositioning using the 30 degree tilt is less time consuming, requires less manpower and is more cost effective when compared standard care.
Acknowledgements
ORAL PRESENTATION: WOUND MANAGEMENT & TISSUE VIABILITY: 10:45
Pain at Wound Dressing Change: Nurses Knowledge and Perceived Competency
Cassandra Bell
Dip, BSc, MSc (Nursing Studies) Cork University Hospital, Ireland
I began my Nursing Studies in the University of Limerick where I received a Diploma in Nursing Studies. Following this I completed a Degree in Nursing Studies also in the University of Limerick. I then travelled to Australia where I worked as a staff nurse and got a deep insight into a different way of nursing compared to Ireland. Currently I am working in a general Ward in Cork University Hospital where I have been for the last three years and have been working as a Clinical Nurse Manager 1 for the last 9 months. I have just completed a 2 year Masters in Clinical Nursing Studies in University College Cork. My thesis focused mainly on nurses knowledge in relation to Dressing change and wound pain as this is an area I have great interest in. Dressing change and wound pain was discussed under a number of themes including pain, assessment of pain, factors contributing to pain, strategies to overcome pain, choice of Dressing at Dressing change and ability to choose Dressings based on perceived competency level. On completion of my research a number of interesting findings were yielded and I feel that presenting at this conference provides me with a great opportunity to convey these findings to others.
Background
The literature confirms that pain is a major issue for many patients who suffer from both acute and chronic wounds. Despite the fact that pain is one of the most frequent reasons for seeking hospital admission, pain management appears to be under treated by healthcare professionals. Research also indicates that nurse’s knowledge of wound pain is insufficient due to their lack of knowledge about the properties of wound Dressings and their inability to select Dressings based on evidence.
Aims and Objectives
To investigate nurse’s knowledge and perceived competence in relation to wound management with particular emphasizes on Dressing change and wound pain.
Methods
A descriptive quantitative design was employed. A convenience sample of 94 nurses were recruited and data were collected via a researcher-designed questionnaire.
Analysis and Results
Findings indicate that nurse’s knowledge of pain assessment and the strategies used to overcome pain at Dressing change are limited. However, participants demonstrated a good knowledge of the factors that contribute to pain with Dried out Dressings being rated as the most common factor contributing to pain at Dressing change. Surprisingly, the majority of respondents rated themselves as competent in their ability to choose Dressings based on knowledge. However, most importantly, the results show that statistically significant correlations were established between both variables ‘age’ and ‘length of time worked in the clinical setting’ to nurses use of a pain assessment tool both before and after Dressing change.
Recommendations
Findings emphasise the need for researchers and clinicians to update their knowledge in relation to wound pain, its assessment and management so that Dressing change and wound pain are dealt with sufficiently. In addition there is an urgent need to continuously educate nurses about the properties of wound Dressings and the appropriate use of them so that decisions are made based on evidence and research.
Identifying the Research and Education Priorities in Wound Management and Tissue Repair – An International edelphi Study
Dr. Georgina Gethin
RGN, PhD, HE Dip (Wound Care), Dip (Anatomy), Dip (Applied Physiology)
Research Centre, Faculty of Nursing and Midwifery, RCSI
I qualified with honours from Sligo General Hospital in 1984. Since then I have worked in the USA and Ireland and my primary area of practice was surgical and intensive care units. My role as acting clinical tutor in the early 1990s heralded my interest in broadening my theoretical knowledge in the delivery of nursing practice. I completed a diploma in Anatomy and Applied Physiology and through my primary interest in wound healing I completed a Higher Diploma in wound care from Thames Valley University. From this I went on to become Clinical Nurse Specialist in Tissue Viability and was awarded a research fellowship from the HRB to complete my PhD on the use of Manuka honey in wound healing. I was awarded my PhD from RCSI in 2007. In 2008, I became a fellow of the Faculty of Nursing and Midwifery in RCSI. I have studied clinical trials management and statistics in clinical trials in the University of York. Currently I am engaged in research development and management of 8 research projects in RCSI. I also lecture in research methodologies and wound healing and assist in programme co-ordination. I am President of the Wound Management Association of Ireland, Board member of the European Wound Management Association, member of the Cochrane wounds group and other organisations. I also peer-review for five journals and on the editorial board of others.
This study is being submitted by G. Gethin on behalf of the wounds research group in RCSI. Members of the group include:
Prof. S. Cowman, PhD, MSc, FFNMRCSI, PG Cert Ed (Adults), Dip N (London), RNT, RGN, RPN
Head of Department, Faculty of Nursing and Midwifery, RCSI
Dr. Z. Moore, RCSI
Mr. E. Clarke, RCSI
Ms. G. Craig, Our Lady of Lourdes Hospital, Drogheda
Ms. J. Jordan-O’Brien, Beaumont Hospital,
Ms. H. Strapp, AMNCH Tallaght
Ms. N. McLain, Community Care, Leinster
Background
Wounds have a significant impact on the individual, society and the health system. Interest in their management is evidenced by the increasing number of wound care organizations, journals, conference and policy and guidelines. While advances in management have been made, there is no consensus on what are the priority issues in research and education. Therefore, this study set out to answer the following research question: What are the current priority issues in research and education in wound management?
Methods
A three round international eDelphi methodology was employed and aimed to gain consensus from a diverse range of professionals across the globe. Invitations to participate in a web based questionnaire were issued via email to wound care organisations and to known wound care contacts. All correspondence was electronic with direct email invitations sent to consenting participants during rounds 2 and 3. Ethical approval was granted by RCSI. The survey was conducted in English and Spanish. Round one required free text response to the research questions. Results were content analyzed by the research team to identify recurring themes. Descriptive statistical analysis was also conducted. A list of priorities was Drafted based on the most frequently occurring priorities and resent to the respondents. In round two, participants rank ordered the level of priority for each issue. Results were analyzed using descriptive statistics. The mean score for each priority was returned to participants in round 3 and they were invited to adjust the score if they wished. Descriptive statistical analysis was once again conducted.
Results
360 people from 27 countries participated. Almost 2000 priorities were listed. The most frequently recurring theme across both domains was the need to understand optimal use of Dressings and topical agents in wound management. Full results of the highest priority issues will be presented at the conference.
Implications of this Study
This is the first study to identify research and education priorities and the findings will be of importance to academic institutions, grant and funding agencies, industry
ORAL PRESENTATION: WOUND MANAGEMENT & TISSUE VIABILITY: 11:45
Self-Monitoring in Diabetes Care- Conceptual & Theoretical Perspectives: An Exploration of the Conceptual Literature
Vicki McManus
PGDTLHE, MSc (Med), BA (Psych), RGN, RCN School of Nursing & Midwifery, University College Cork
Vicki McManus is a Lecturer in the School of Nursing and Midwifery, UCC, Cork. She has worked both as a paediatric nurse and a general nurse. Since leaving clinical practice she has completed a degree in Psychology and worked in disability research for 8 years. Her research interests Drew her to disability research in cerebral palsy which culminated in a master’s degree. Vicki is now teaching across a variety of subjects; disability, child development, research issues and nursing topics. In recent years research interests have developed in Insulin Dependant Diabetes Mellitus in young people. Vicki’s’ PhD is in diabetes, specifically self-monitoring for glycaemic control. She is widely published.
Additional Author;
E. Savage
PhD MEd,BNS, RGN RCN Associate Professor
School of Nursing & Midwifery, Brookfield Health Sciences Building, University College Cork
Background
Self-monitoring of glycaemic control is the cornerstone of managing DMT1 in young adults on intensive insulin therapy. However, little is known about what this concept means in terms of its critical dimensions that could inform practice and guide future research. Also, little is known about what theories could best underpin research on young adults’ practices of self-monitoring.
Aim and Objectives
This review aimed to explore conceptual and theoretical underpinnings of self-monitoring with application to glycaemic control in young adults with DMT1.
Methods
Electronic health databases were searched for relevant conceptual and theoretical papers.
Analysis and Results
Empirical papers were identified for application. These were analysed to glean attributes, predisposing factors and consequences of self monitoring. Four attributes of self monitoring were found: measurement, awareness of bodily symptoms, interpretation of signs and symptoms; and responses to changes in measurement, bodily awareness and interpretation of signs and symptoms. The preconditions for self-monitoring are knowledge of the disease process and symptoms, social support, technical (e.g. measuring), cognitive (e.g. problem solving, goal setting) skills . A range of potential consequences (health outcomes) of self monitoring were identified and when applied to DMT1, glycaemic control is a priority to prevent immediate and long-term complications. To self-monitor, young adults must have confidence and competence. Bandura’s self efficacy theory was identified are relevant because it is applicable to the target group (young adults). It offers clear causal and testable relationships between behavioural determinants, and behaviour, has strength of evidence about its predictive ability, and clear guidelines for measurement exist.
Recommendations
Self-monitoring is a complex phenomena that, to date, remains poorly understood. Reviewing conceptual and theoretical literature is important to clarifying the key components and process of self-monitoring which in turn has implications for informing practice and future research.
Lymphoedema Prevalence in Ireland: A Hospital Outpatient Clinic Based Pilot Study
Helen Strapp
RSCN, RGN, PG Dip (Wound Management and Tissue Repair), MSc (Nursing)
AMNCH, Tallaght, Dublin, Ireland
Helen started in nursing in Our Lady’s Hospital for Sick Children, Crumlin. After working there for a total of three years she then went on to do a Post Graduate course in General Nursing in the Meath Hospital. After being there for four years, she then moved nearer home to work in St. Vincent’s Hospital, Elm Park. She worked there for a total of 12 years of which the last five years was as a Clinical Nurse Manager on a vascular thoracic ward with a four bedded HDU unit. She also had a high interest in wound management and after completing a Post Graduate programme in Wound Healing and Tissue Repair in the University of Wales College of Medicine, Cardiff, she became involved in wound care and education. She did an MSc in the RCSI. Her research explored nurses knowledge of pressure ulcer prevention and management.
At present, Helen is working in The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital as Tissue Viability Clinical Nurse Specialist.
Background:
While lympoedema is not a very common condition, it is associated with significant morbidity and disability among those who are moderately or severely affected. Services are usually linked to oncology services but many patients with troublesome symptoms have primary lymphodema. A rational development of services and ensuring appropriate access to effective therapy that may improve quality of life depends on accurate epidemiological data. Studies from the UK and elsewhere suggest that the prevalence of lymphoedema is approximately 2/1000 but to date there is no reliable data for the Irish population.
Methods:
We designed a study to determine the prevalence of lymphoedema among a patient population presenting to selected outpatient clinics in a university teaching hospital over a four week period to provide pilot data for an Irish population prevalence study. All patients attending the vascular surgery and wound management outpatient clinics during a four week period (July- August 2009) were surveyed and all those with leg swelling were assisted in completing a proforma questionnaire. The study had ethical approval from the Ethics Committee of the Adelaide & Meath Hospital and informed consent was obtained from all those completing the questionnaire.
Results:
There were 542 attendances at the clinic during the period. Of these, there were 418 unique patients of which 66% were male. Twenty patients ( 4%) had leg swelling but 3 of these were of short duration and due to recent onset cardiac failure. Of the 17 with chronic (>3 months) leg swelling, 11 fulfilled pre-determined criteria for lymphoedema yielding a prevalence of 2.63% in this population (67% were male). The average age was 65 years. None of these 11 had been previously diagnosed with, or treated for, lymphoedema despite an average duration of lower limb swelling in these patients of 2.9 years
Conclusions:
Lymphoedema occurs quite commonly among patients attending vascular and wound management clinics and is not usually recognised in the community. The prevalence of lymphoedema among non-cancer patients in Ireland warrants further characterisation. Lymphoedema is frequently unrecognised and awareness of the condition
ORAL PRESENTATION: NEONATAL CARE: 10:15
Sweeten, Soother And Swaddle For Retinopaty Of Prematurity Anne O’ Sullivan
ANP (Neonatology), RGN, RGM, BSc (Nursing
Management), BSc (Neonatal Studies), MSc (Advanced Clinical Practice)
Coombe Women and Infants University Hospital, Dublin
Anne O’ Sullivan is a Registered Nurse and Midwife. She has received Bachelor of Science degrees in Nursing Management and Neonatal Studies and a Master’s of Science degree in Advanced Clinical Practice. Anne has completed the Advanced Nurse Practitioner’s Programme from the University of Southampton and is currently working as an Advanced Nurse Practitioner in the Neonatal Department. Anne has many years experience in Neonatal nursing having previously been a Clinical Manager and Neonatal Nurse.
Background
Retinopathy of Prematurity (ROP) can occur when the normal retinal vascular development is interrupted by premature birth. ROP screening is one of many potentially painful diagnostic and therapeutic procedures performed routinely on preterm infants. Numerous studies demonstrate that repeated pain can have direct and long term consequences on the neurological and behavioural development of neonatal infants. Therefore strategies for stress reduction and pain management are essential to promote growth and development.
Aim and Objectives
To assess the efficacy of oral sucrose combined with non nutritive suck and swaddling for retinopathy of prematurity screening.
Methods
A prospective double blind randomised controlled trial. Infants were randomised to either sucrose or placebo (sterile water). The study was carried out on the first screening examination for each infant. Eye examinations were carried out using indirect ophthalmoscopy utilising speculum and scleral indentation. Both solutions were clear and colourless. The ophthalmologist, nurse recording data and personnel scoring the N-PASS (Neonatal Pain Agitation and Sedation Scale) were unaware of group assignment. Examinations were video recorded and physiological data recorded.
Results and Analysis
40 infants were included in the study. There was no difference in mean gestational age at birth, mean birth weight and corrected gestational age between both groups. The sucrose group had a significantly lower median N-PASS score during ROP screening, following insertion of the speculum (6.5 vs 5, p value 0.002) and during scleral indentation (9.5 vs 7.5, p value 0.003). There were fewer episodes of desaturations or bradycardia in the intervention group (4 vs.1, p value 0.18).
Conclusions and Recommendation
ROP screening is associated with an increase in pain scores using a validated pain scoring system. The administration of sucrose in conjunction with swaddling and nonnutritive suck is associated with a reduction in pain score and improves overall physiological stability during the procedure.
Hypoxic – Ischemic Encephalopathy in Term Infants: A Meta-Analytic Summary of Cooling Methods and Neonatal Outcomes.
Susan L. Moran MS, RN, NNP-BC
The Children’s Hospital, Erie, Colorado, USA
Susan L.. Moran is a neonatal nurse practitioner for The Children’s Hospital as well as a frequent lecturer for the Regis University’s undergraduate and graduate nursing programs in Denver, Colorado.
Susan’s educational and professional qualifications include a Bachelor of Science degree, Master of Science degree and a Neonatal Nurse Practitioner certificate from the Pennsylvania State University. Currently, she is pursuing a Certification in Nursing Education through the University of Northern Colorado.
Susan’s research interests include quality in healthcare delivery, NNP services outreach, community hospital NNP start-up, education, and billing for services. To date, she has presented her work at local and state conferences and enjoys her memberships with The National Association of Neonatal Nurse Practitioners and the Academy of Neonatal Nursing.
Today’s oral presentation will include an overview of hypoxic-ischemic encephalopathy pathology in the newborn. In addition, issues for practice relating to the prevalence and risk for neurodevelopmental deficits as well as strategies to assess the severity and reduction of infant morbidity and mortality will be reviewed.
Background
Neonatal hypoxic-ischemic encephalopathy (HIE) occurs in 1 to 6/1000 term births (Gunn, 2000). The ensuing encephalopathic state is characterized by a need for resuscitation at delivery, neurologic depression, seizures and electroencephalographic abnormalities. Of the newborns affected, 20-60% will die in the postnatal period. Survivors are likely to sustain permanent neurodevelopmental deficits. Recent studies (see, for example Gluckman et al., 2005 and Shankaran et al., 2005) have reported that hypothermia has become a promising therapy for neonatal neuroprotection.
Aim & Objectives
Following this presentation, the participant will:
• Correctly summarize the pathophysiology and clinical presentation of an infant with HIE,
• Critically evaluate the evidence supporting amplitude-integrated electroencephalographs (aEEG) as a quantitative predictor of neurodevelopmental outcome,
• Correctly identify findings of an aEEG tracing for a newborn with this condition, and
• Identify the empirical evidence comparing different cooling strategies.
Methods
Electronic searches were conducted in several biomedical databases using a combination of key terms. Four independent systematic reviews regarding cooling strategies met criteria for inclusion. A similar search assessed the efficacy of aEEG in neonatal HIE and yielded one meta-analysis for review.
Results
The four systematic reviews concerning cooling methods for infants with HIE concluded a relative risk of 0.74 (CI 95%) in favour of the treatment group with death or moderately severe disability outcomes compared. Furthermore, findings demonstrated that there was an overall sensitivity of 91% (95% CI 87-95) for aEEG to accurately predict poor outcome.
Recommendations
The aEEG is a valuable bedside tool for predicting neurodevelopmental outcome in term infants with HIE. Furthermore, there does not appear to be a significant difference when comparing brain and whole body cooling as both strategies result in the reduction of death and disability. However, further study is necessary to determine neurodevelopmental outcomes in school-age children
ORAL PRESENTATION: NEONATAL CARE: 11:15
The Neonatal Dashboard: An Essential Communication Tool Una Toland
RGN, BSc (Health and Social Care) NP (Neonatology) Craigavon Area Hospital, Northern Ireland
Qualified as Registered general nurse 1985 and undertook midwifery training 1987. Since qualifying as a midwife I have worked in Neonatology and have completed ENB 405 course , Enhanced Neonatal Nurse Practitioners course and achieved a Degree in Health and Social Care studies through the Open University . I am currently working in the Neonatal Unit in Craigavon Northern Ireland as a Lead Neonatal Nurse.
Background
To demonstrate that the concepts of Governance can be integrated into Neonatal Practice using a tool which acts as an early warning system and as a means of identifying patient safety issues.
Aim and Objective
To use the Dashboard as a graphic tool to demonstrate monitoring of a units performance against local and national standards to provide real time information on clinical activity and unit achievement of educational targets and compliance with cleanliness and infection control targets to present the information in an easily understood format with high visual impact which is then openly displayed for both staff and users. To benchmark against standards that are important to both staff and users to utilise the data to influence service commissioners
Method
Using Qualitative and quantitative data, the units performance is mapped against selected standards and displayed in traffic light coloured graphic formats. Green indicating standard achieved: Amber –standard breached and immediate action required to prevent entering the red. Red—standard breached and immediate action from the highest level needed to maintain patient safety.
Analysis and Results
The Dashboard has been a live visible way of identifying dips and trends in performance over a period of time. The tool demonstrates the importance of risk management and incident reporting as a proactive way of escalating emerging safety issues and breaches in standards to senior management level and to ultimately influence service commissioners. There is a need to strike a balance between the burden of data collection and the need to ensure that standards and goals are realistic and achievable. Issues need to be addressed as they emerge otherwise staff may become cynical and can view this as yet another paper exercise
Establishment of a Neonatal Palliative Care Protocol Helen Walsh
MSc, BSc, FFNMRCSI, RNP, RGN
Advanced Nurse Practitioner (Neonatology) National Maternity Hospital, Dublin
I completed my RGN training in 1990 and following this began working in Neonatal Intensive Care. I completed the ENB 405 (Neonatal Intensive Care of the Newborn) at the Royal London Hospital in 1991. I worked as a Sister (Ward Manager) in two tertiary neonatal referral centers in London and Essex. During this time I undertook advanced neonatal and research modules with City University in London. In 1999, I returned to work in Ireland and continued my professional education by obtaining a BSc (Neonatal Studies) with the University of Southampton and an MSc in Clinical Nursing with University College Dublin. Following accreditation with the National Council for the Professional Development of Nursing & Midwifery (NCNM), I was appointed as ANP (Neonatology) in the National Maternity Hospital in July 2008. Last year, I became a Fellow of the Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland and I also became a Nurse Prescriber.
Background
In keeping with the principles of family-centred care a neonatal palliative care protocol was established to provide guidance on the care and management of an infant for whom intensive care is no longer beneficial. However neonatal intensive care units (NICUs) are challenged to provide palliative care for newborns with life-limiting conditions, specifically in relation to pain management. The majority of neonatal deaths take place in NICU as a result of preterm birth, extreme low birth weight, sepsis, congenital anomalies, cardiac defects or complications of pregnancy. At present in Ireland there are no national standards for neonatal palliative care. The provision of standardised guidelines within NICUs can enable staff to provide best possible quality of care, prevent pain and suffering and support families.
Aim and Objectives
The aim of this ongoing research is to assist in implementing a nicu-based team approach in the provision of end-of-life care in the neonatal setting. In addition to evaluate the palliative care services provided within NICUs in Ireland which will provide insight into the service needs of infants and their families. This information can be utilised to review care provided for this vulnerable population and generate data that will contribute to the development of a specific neonatal palliative care service.
Action/Intervention
For the purpose of identifying current services provided a questionnaire was sent out to all NICUs in Ireland via e-mail and post. The questionnaire examined general demographics, palliative care services currently provided, pain management and future service needs.
Discussion
Neonatal palliative care focuses on care of the infant and support for the family before, during and after the infant’s passing. Development of a formal palliative care protocol should have a multi-disciplinary team approach incorporating prenatal discussion, family considerations, pain management, preparation and process of withdrawal of care including post-mortem procedure, memory taking, family follow-up and additional support networks.
ORAL PRESENTATION: NEONATAL CARE: 12.15
Decisional Conflict for Antenatal Women Regarding Mode of Birth After a Previous Caesarian Section in the Irish Healthcare Setting
Breda Hayes
MSc, BMS (Hons), Dip Midwifery, RGN Cork University Maternity Hospital, Ireland
Breda Hayes is a Clinical Placement Coordinator for Midwifery in Cork University Maternity Hospital where she has a daily responsibility for midwifery students learning in the clinical environment. She is a member of the hospital practice development team and is involved in various educational initiatives involving the practice development team, the Hospital and UCC. Prior to this Breda worked in the Birthing Suite as a staff midwife. She has held various positions in Midwifery and Nursing in Dublin, London and Australia. Breda has a keen interest in midwifery education, woman centred and midwifery led care. This research on Decisional Conflict for Antenatal Women regarding Mode of Birth after a previous Caesarean Birth was completed for an MSc Nursing & Midwifery (UCC), which was completed in 2008.
Background
Caesarean section (CS) rates are increasing globally, without benefit to childbearing women and with increased costs to the healthcare organisation. It is thus imperative to investigate the factors which contribute to decisional conflict for antenatal women regarding mode of birth after a previous CS.
Aims
This study aimed to investigate the factors which have contributed to decisional conflict for antenatal women regarding mode of birth after one previous CS.
Methods
A quantitative, descriptive correlational design was utilised. Data were collected using a demographic questionnaire and a validated questionnaire, the decisional conflict scale, and analysed using SPSS.
Participants
A quota sample of 109 antenatal women of more than 36 weeks gestation, from both public (70%) and private (30%) antenatal clinics participated in the study.
Results
Despite being within four weeks of their expected date of delivery 16% of participants were unsure about which choice to make. While 12% had high decisional conflict scores which are associated with anxiety laden and delayed decision making. Findings showed that 15% were unaware of the risks and side effects and 18% did not agree that they had made an informed choice. A number of participants (13%) were not satisfied with their decision, and over 18% were unsure whether they would stick with their chosen decision. Relational testing of the study variables showed results of statistical significance.
Conclusions
This study will improve understanding on the aspects of decision making in this area. It will help to decrease the physiological, psychological and economic implications of increased CS.
Exploring and Comparing the Experience and Coping Behaviour of Men and Women with Colorectal Cancer: A Qualitative
Longitudinal Study
Dr. Gillian Prue PhD
University of Ulster, Belfast , Northern Ireland
Gillian Prue is currently working as a Research Associate at the University of Ulster. Her main research interest is supportive care in cancer and is currently working on a ‘men and cancer’ project. Gillian completed her PhD in ‘cancer-related fatigue’ in 2008.
Background
Men have higher incidence and mortality rates for nearly all forms of cancer. They are less likely than women to utilise cancer information services and other social support services. A qualitative study was conducted to examine the influence of gender on the experience of colorectal cancer (CRC). There is evidence to suggest that men and women cope differently with CRC, however studies are limited and present conflicting findings. The area also lacks qualitative methods of inquiry.
Aim and Objectives
The aim of this study was to explore and compare the experience and coping behaviour of men and women with CRC ove
