Leveraging momentum of 2020-Reflections from an International Conference.

PURPOSE: This Commentary illustrates how innovative clinical and research initiatives highlight the ingenuity and creativity of nursing and midwifery professions thus leveraging the momentum of 2020 that commenced with the Year of the Nurse and Midwife and the Nursing Now Challenge. BACKGROUND: Speakers demonstrated through vision, creativity and policy generation how the world is now in a different place due to COVID-19 and how the global crisis will change and shape the future of health care delivery. EVALUATION: Speakers were invited because of their reputation as international leaders in global health and population. Participants evaluated content and its relevance to research, education and practice in group discussions. KEY ISSUES: The current global crisis determines that the capabilities and capacity of nurses and midwives will become more crucial than ever to the delivery of universal health coverage (UHC) and population health by 2030. CONCLUSIONS: Global leaders and policymakers must seek the knowledge and skills they need to support their work during a global crisis. IMPLICATIONS FOR NURSING MANAGEMENT: Achieving population health and equitable access to health care is dependent on an adequate health workforce.

Collaborative strategic initiative between a university and hospital network group: Advanced nurse/midwife practice forum.

BACKGROUND: The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties worldwide, was established in 1974 by Ms Mary Frances Crowley, for postgraduate nursing education, and is situated within the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences. The RCSI operates through a network group of university hospitals: Beaumont, Connolly, Drogheda, Cavan, Monaghan and the Rotunda. Combined these hospitals have 120 registered and candidate ANP/AMPs and caters for general, psychiatric, children and maternity patients/clients. The drive to establish the forum between the faculty and the six Dublin hospitals was to build capacity among advanced nurse practitioners and advanced midwife practitioners (ANP/AMPs) who are seen as intelligent consumers of evidence-based research and safe practice. The SCAPE report identified research as the single domain that was underdeveloped within the ANP role, in the study exploring the role of ANPs and CNSs. Latterly, the Nursing and Midwifery Board of Ireland highlighted research as a vital component of the ANP/AMP role in its standards for advanced nurse and midwife practice. The faculty acted collaboratively to introduce an ANP/AMP forum to support advanced practitioners working in the university hospital group in their education and professional development, support the expansion of their knowledge base through practice-based enquiry and research and act as a conduit for interactions between ANPs/AMPs by keeping them up to date with practice and research. METHODS: The Initiation phase was undertaken through a survey of needs; Implementation phase by extensive literature review and research-based newsletters sent to individuals by the forum coordinator; and the Evaluation phase through focus groups.

Regulation of advanced nurse practice: its existence and regulatory dimensions from an international perspective.

AIM: To explore the regulation of advanced nurse practice internationally and to identify differences and commonalities. BACKGROUND: Regulation of advanced practice nursing does not occur in many countries. Ireland is currently in the minority in regulating advanced practice at a national level. KEY ISSUES: Lack of regulation poses difficulties for national governments and for society due to uncertainty in advanced practice concept and role. METHODS: A literature review of 510 scholarly nursing papers published in CINAHL, PubMed and MEDLINE between 2002 and 2013 and 30 websites was undertaken. RESULTS: There is a lack of consistency in legislative systems internationally. Nursing organisations have recognised advanced nurse practice by regulation in some countries and by voluntary certification in others. CONCLUSIONS: Research has demonstrated that care delivered by advanced nurse practitioners has enhanced patient outcomes yet regulation of advanced practice is not undertaken in most countries. IMPLICATIONS FOR NURSE MANAGER: Nurse managers need to know that criteria for the regulation of advanced practice are in place and reflect the minimum requirements for safe practice.

Role transition from student nurse to staff nurse: facilitating the transition period.

BACKGROUND: Undergraduate nursing programmes are designed to equip student nurses with the skills and knowledge necessary for their future work as professional nurses. Influences on the role during the transition period from student to staff nurse are unclear. PURPOSE: This paper explores the experience of role transition for newly-qualified nurses from an Irish perspective. METHODS: A Heideggerian Hermeneutic approach was the research method adopted. Ten newly qualified nurses from one of Dublin's Academic Teaching Hospitals were interviewed. Data were analysed using Van Manen's thematic analysis. Influences on the transition period were explored in the context of Chick and Meleis's Transition Concept. FINDINGS: Newly-qualified nurses initially felt excited upon qualification. However, professional responsibility and accountability associated with the new role were overwhelming for participants. They felt frustrated when they didn't receive adequate support during transition. CONCLUSION: Newly-qualified nurses need support while they incorporate their knowledge into clinical practice. Hidden influences should as education levels and scope of practice should be considered before nurse educators begin to develop education programmes for undergraduate nurses.

Parents' constructions of communication with their children about safer sex.

AIMS AND OBJECTIVES: To analyse how a sample of parents reportedly communicated with their adolescent and preadolescent children about safer sex (contraceptive and condom use). BACKGROUND: Among the plethora of existing research available on parent-child communication about sexuality (more broadly), very few studies detail the substance and tenor of what parents actually convey specifically about safer sex. DESIGN: The study adopted a qualitative methodology and involved interviewing 43 parents (32 mothers and 11 fathers). Data were analysed using modified analytical induction. RESULTS: Findings indicated that although the majority of parents professed to being open about sexuality with their children, only a minority reportedly conveyed direct messages about contraception and condom use. Moreover, these direct messages appeared to be imparted at a superficial level. Parents were more likely to communicate such messages in a tacit manner through innuendo and intimation. The complacency that parents displayed about the need to undertake safer sex education with their adolescents arose from an understanding that this was covered adequately at school and the belief that their teenager was not in a romantic relationship. In addition, some parents expressed concern that discussing safer sex with teenagers might actually encourage sexual activity. CONCLUSION: We conclude that some parents may consider themselves to have engaged in sexuality education around safer sex when it appears to be predominantly surface-level education; that what constitutes 'doing' sexuality education is far from clear-cut may cast some light on why there is little consistency in the literature on the impact of parental communication on sexual health outcomes for young people. RELEVANCE TO CLINICAL PRACTICE: For nurses engaged in sexuality health promotion with parents, we caution about presenting unequivocal messages to parents about the impact of parental communication about sexuality on adolescent sexual behaviour without due acknowledgement of the grey areas indicated in the literature.

Parents' constructions of the sexual self-presentation and sexual conduct of adolescents: discourses of gendering and protecting.

In this paper, we explore the discourses on sexuality that a sample of parents drew upon when they talked about teenage sexual self-presentation and conduct. The sample consisted of 43 parents (32 mothers and 11 fathers) of young people aged 10-19 years. Data were gathered using in-depth interviews and were analysed using a strategy known as modified analytical induction. Findings indicated that while an acceptance the traditional heterosexual script permeated participants' accounts, and protective discourses in relation to young women were brought to bear, so, too, were protective discourses invoked in relation to young men. On the whole, young women tended to be cast as sexual subjects who chose to self-sexualise and this was sometimes seen by participants as a threat to young men. We argue that the discourses that parents connoted were multiple and sometimes contradictory, and our analysis problematises the notion that conventional discourses singularly cast women as objects of male sexuality. However, the overall picture indicated that in parents' narratives, young women tended to be more heavily regulated and either viewed as needing protection from male sexual advances or castigated for encouraging them.

Influence of organizational culture on quality healthcare delivery.

PURPOSE: The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery. DESIGN/METHODOLOGY/APPROACH: Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study. FINDINGS: Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery. RESEARCH LIMITATIONS/IMPLICATIONS: Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions. ORIGINALITY/VALUE: Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

AIM: The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. BACKGROUND: Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. EVALUATION: Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. KEY ISSUES: Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. CONCLUSIONS: In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. IMPLICATIONS FOR NURSING MANAGEMENT: As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

The silent treatment: parents' narratives of sexuality education with young people.

This paper is based on research undertaken in Ireland that sought to understand how parents communicate with their children about sexuality. Forty-three parents were interviewed and data were analysed using analytical induction. Data indicated that while parents tended to pride themselves on the culture of openness to sexuality that prevailed in their home, they often described situations where very little dialogue on the subject actually transpired. However, unlike previous research on the topic that identified parent-related factors (such as ignorance or embarrassment) as the main impediments to parent-young person communication about sex, participants in our study identified the central obstacle to be a reticence on the part of the young person to engage in such dialogue. Participants described various blocking techniques apparently used by the young people, including claims to have full prior knowledge on the issue, physically absenting themselves from the situation, becoming irritated or annoyed, or ridiculing parents' educational efforts. In our analysis, we consider our findings in light of the shifting power of children historically and the new cultural aspiration of maintaining harmonious and democratic relations with one's offspring.

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

AIMS: To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary. BACKGROUND: Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role. METHODS: A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100. RESULTS: Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident. CONCLUSION: The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.

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

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

Public health nurses perception of clinical leadership in Ireland: narrative descriptions.

AIM: The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery. BACKGROUND: Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles. METHOD: Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery. RESULTS: Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective. CONCLUSIONS: Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor. RELEVANCE TO NURSE MANAGERS: Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.

Public Health Nurses and the delivery of quality nursing care in the community.

AIM: The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. BACKGROUND: Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. METHOD: A qualitative method using semi-structured interviews were conducted. Interviews were taped and content analysed. FINDINGS: Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence-based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. CONCLUSION: Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. RELEVANCE TO CLINICAL PRACTICE: This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence-based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment.

How commitment and involvement influence the development of strategic consensus in health care organizations: the multidisciplinary approach.

AIM: The aim of this study was to describe how clinician and non-clinician managers achieved consensus of strategy in hospitals. This was the first empirical study undertaken that investigated the impact of organizational commitment on the strategic involvement-strategic consensus relationship. BACKGROUND: Clinicians and non-clinician managers hold a pivotal role in health care management from the strategic perspective. The importance of multidisciplinary collaboration is recognized, yet how strategic consensus is achieved amongst health service managers, has not been previously researched. KEY ISSUES: The focus of the professional is often on local concerns rather on the broader organizational strategy. This orientation has led to the charge by health service management that clinicians are not interested in, or do not seek to be involved in strategy development. As half of the clinician group in this study were registered nurses and midwives it is important, for multidisciplinary and interdisciplinary collaboration and for strategic development that this group has an awareness of the importance of strategic involvement and organizational commitment in the attainment of strategic consensus. CONCLUSION: A descriptive study was undertaken and quantitative data were generated through the survey method. The aims of the study were articulated through hypotheses. Almost 400 middle manager heads of department, working in acute care not-for-profit health service organizations, in the Republic of Ireland, responded. Findings indicated that a stronger relationship existed between consensus and commitment than between involvement and commitment. In addition, when present in the organization, involvement and commitment together were better predictors of consensus than each of those factors on its own, but significantly commitment had a greater impact in predicting consensus than involvement had.

Positive and negative outcomes from values and beliefs held by healthcare clinician and non-clinician managers.

AIM: The aim of this paper is to present the values and beliefs of clinicians and non-clinicians working in not-for-profit healthcare organizations, and the positive and negative outcomes of holding such values. BACKGROUND: Ethical values are part of the essence of healthcare management and delivery. Although studies have identified what some of those values are, few studies have been undertaken to identify if the values and beliefs held are ethical, and what the outcomes, positive and negative, to holding such values are. METHODS: This study was undertaken in 60 of the 65 acute care hospitals in the Republic of Ireland, and in eight regional health boards during 2001. The study population included all accessible professional clinician and non-clinician department heads. The sample size was 862 and the valid response rate was 42%. Research findings from questions requiring qualitative responses are presented and are part of a wider study. Responses were subjected to content analysis. RESULTS: Eleven key values identified are excellence in care delivery, positive value system, managerial receptiveness and non-receptiveness, organizational dependability and lack of dependability, peer cohesion and lack of peer cohesion, equity in care delivery, personal contribution to the organization and personal importance. Findings also demonstrated positive and negative outcomes for the organization, patients and staff as a result of the values held. CONCLUSIONS: Findings show that healthcare clinicians and non-clinicians demonstrated a range of values in the delivery of health care, some of which have not been identified before. Should professionals now reconsider the values required in the delivery of health care? The most widely perceived values held by both groups were similar, although clinicians perceived that non-clinicians did not hold the same ethical values and beliefs as they did, and vice-versa, demonstrating a lack of trust in each other's moral and ethical value system.

Understanding organizational culture: the key to successful middle manager strategic involvement in health care delivery?

AIM: The aim of this study was to explore the extent to which organizational culture influenced strategic involvement. BACKGROUND: It is crucial for the strategic management of health care that the cultural dimensions affecting health service organizations are identified and understood. How culture influences middle manager strategic involvement has not been established and therefore an understanding of the power of organizational culture is important to middle managers working in not-for-profit health care organizations. CONCLUSION: It was demonstrated that strong organizational culture predicted strategic involvement, and supported the importance of middle managers remaining strategically involved in the development of new organizational strategic initiatives. Findings have implications for strategic management in health service organizations.