The Support Needs and Current Practices of Public Health Nurses in the Republic of Ireland Who Provide Support to Breastfeeding Mothers: A Cross-Sectional Survey.

BACKGROUND: Breastfeeding continuation rates are low in Ireland. The Breastfeeding Observation and Assessment Tool (BOAT) was developed to assist public health nurses in assessing breastfeeding challenges; however, little is known of its actual usage, the level of training experienced or desired by public health nurses, or their level of confidence in the support they provide to breastfeeding mothers. RESEARCH AIM: To identify the current practices and support needs of public health nurses who provide breastfeeding support in Ireland. METHOD: An online questionnaire was devised to collect respondents' confidence with breastfeeding issues, caseload, and practices. It was distributed to public health nurses with a current child health caseload in one Community Healthcare Organization. Mann Whitney U tests were used to ascertain the relationship between public health nurses' confidence level and those with qualifications in midwifery or as an International Board Certified Lactation Consultant (IBCLC). RESULTS: The survey was completed by 66 public health nurses. Only 14 respondents (21.2%) indicated that they always used the BOAT. The most common reason for not doing so was a lack of education on its use (n = 17, 25.8%). Postholders also certified as IBCLCs were considered by participants to be the most appropriate professionals to resolve certain breastfeeding issues. Confidence levels to manage breastfeeding issues were highest among public health nurses with IBCLC credentialing (U = 12.5, p = .001) while no difference was seen when comparing those with a midwifery degree to those without (U = 184.0, p = .92). Face-to-face workshops and blended-learning approaches were ranked as the preferred formats for breastfeeding education (Median rank = 2). CONCLUSIONS: Breastfeeding education incorporating a face-to-face component is needed to support public health nurses who work with breastfeeding mothers, as is prioritization of recruitment in the community of public health nurses with IBCLC credentials.

"I'm not being serviced; I'm being cared for": A mixed methods study of patients' and nurses' perceptions of community oncology nursing delivered by a Community Intervention Team.

PURPOSE: Many patients do not have access to community oncology nursing care in a primary setting and are completely reliant on tertiary hospital care. The aim of this study is to gain an understanding of oncology patients' and nurses' perceptions of community oncology nursing, delivered by an urban Community Intervention Team (CIT) in Ireland. METHODS: A descriptive, concurrent mixed methods approach was used which included semi-structured interviews with 14 oncology patients and an online survey of 27 hospital and community nurses. Thematic analysis and descriptive statistics were used to analyse the data. RESULTS: Six broad themes captured patients' views. Right care related to patients' satisfaction with the range of care available. Right place reflected positive views of the physical setting and the option for homecare for those that needed it. Right time represented patients' comments about the increased appointment efficiency, flexibility, and availability of the service out-of-hours, compared to hospital-based care. Right people was based on patients' portrayals of community cancer nurses as professional, confident, friendly, reassuring and relatable. Integration and communication reflected the communication between the services and patients' impressions of how the services were integrated together. The last theme was improvements to the CIT service. Hospital nurses reported satisfaction with the CIT service while CIT nurses responses suggest the need for better communication with hospital partners. CONCLUSION: Patients had positive perceptions of the service provided by the CIT. Both hospital and community cancer nurses were satisfied with the service and reported that they would like to see an expansion of community oncology nursing services delivered by the CIT.

Tune out pain: Agency and active engagement predict decreases in pain intensity after music listening.

Music is increasingly being recognised as an adjuvant treatment for pain management. Music can help to decrease the experience of both chronic and experimental pain. Cognitive agency has been identified as a specific mechanism that may mediate the analgesic benefits of music engagement however, it is unclear if this specific mechanism translates to acute pain. Previous attempts to understand the cognitive mechanisms that underpin music analgesia have been predominantly lab-based, limiting the extent to which observed effects may apply to participants' everyday lives. Addressing these gaps, in naturalistic settings, the present study examined the degree to which cognitive agency (i.e., perceived choice in music), music features (i.e., complexity), and individual levels of musical sophistication were related to perceived pain. In an online global experiment, using a randomised between groups experimental design with two levels for choice (no choice and perceived choice) and two levels for music (high and low complexity), a sample of 286 adults experiencing acute pain reported their pain intensity and pain unpleasantness pre- and post-music listening. A bespoke piece of music was co-created with a commercial artist to enable the manipulation of music complexity while controlling for familiarity, while facilitating an authentic music listening experience. Overall, findings demonstrated that increased perceived control over music is associated with analgesic benefits, and that perceived choice is more important than music complexity. Highlighting the importance of listener engagement, people who reported higher levels of active engagement experienced greater decreases of pain intensity in the perceived choice condition, than those who reported lower levels of active engagement. These findings have implications for both research and practice, emphasising the importance of facilitating freedom of choice, and sustained engagement with music throughout music listening interventions.

How do people with chronic pain choose their music for pain management? Examining the external validity of the cognitive vitality model.

Music interventions for pain are more successful when patients choose the music themselves. But little is known about the attentional strategies used by chronic pain patients when choosing or using music for pain management, and the degree to which these attentional strategies align with the cognitive mechanisms outlines in the cognitive vitality model (CVM, a recently developed theoretical framework that outlines five cognitive mechanisms that mediate the analgesic effects of music for pain management). To investigate this question, we used a sequential explanatory mixed method approach, which included a survey, online music listening experiment, and qualitative data collection, with chronic pain patients (n=70). First, we asked chronic pain patients to name a piece of music that they would use to manage their chronic pain, and answer 19 questions about why they chose that particular piece of music using a questionnaire based on the CVM. Next, we asked chronic pain patients to listen to high energy and low energy pieces of music, to understand aesthetic music preferences and emotional responses at the group level. Finally, participants were asked to qualitatively tell us how they used music to manage their pain. Factor Analysis was completed on the survey data, and identified a five-factor structure in participant responses that was consistent with five mechanisms identified in the CVM. Regression analysis indicated that chronic pain patients choose music for pain management if they think it will facilitate Musical Integration and Cognitive Agency. Musical Integration refers to the degree to which the music can provide an immersive and absorbing experience. Cognitive Agency refers to having an increased feeling of control. At the group level, participants reported a preference for low energy music, and reported that they found high energy music more irritating. However, is it important to note that individual people had different music preferences. Thematic synthesis of patient responses highlighted how these processes mediate the analgesic benefits of music listening from the perspective of chronic pain patients, and highlighted the wide range of music used by participants for chronic pain management including electronic dance music, heavy metal and Beethoven. These findings demonstrate that chronic pain patients use specific attentional strategies when using music for pain management, and these strategies align with the cognitive vitality model.

Community nurses' attitudes, knowledge and educational needs in relation to urinary continence, continence assessment and management: A systematic review.

AIMS AND OBJECTIVES: To identify, appraise and summarise the available evidence relating to community nurses' attitudes, knowledge and educational needs in relation to urinary continence. BACKGROUND: Community nurses play a pivotal role in identifying and supporting individuals who experience urinary continence issues. Gaps in nurses' continence-related education and knowledge may contribute to sub-optimal assessment and management across the continuum of care. DESIGN: A systematic review. METHODS: MEDLINE, CINAHL Complete and EMBASE were searched from inception to November 2020; keywords used included community nurses, urinary continence, incontinence, knowledge, attitude and education needs. Given the degree of heterogeneity between included studies, a meta-analysis was not feasible. Included studies were critically evaluated; key study characteristics and findings pertinent to the review purpose were summarised. The review adhered to the PRISMA 2020 checklist. RESULTS: Four studies reported in six papers were included. Community nurses lacked knowledge in certain areas of urinary continence and incontinence. Nurses reported they were adequately prepared but without sufficient knowledge to effectively care for those with urinary incontinence. Community nurses' attitudes to urinary incontinence were generally positive, but they demonstrated misconceptions that urinary incontinence was inevitable and less distressing for older people. CONCLUSIONS: There is limited research exploring community nurses' knowledge, attitudes and education needs in relation to urinary continence and incontinence care. Community nurses may have knowledge gaps and less favourable attitudes to some aspects of urinary continence care.

Cognitive agency in music interventions: Increased perceived control of music predicts increased pain tolerance.

BACKGROUND: Self-selected music is consistently found to be the strongest predictor for successful music listening interventions in pain management contexts, but the specific cognitive mechanisms that mediate these effects are currently unknown. OBJECTIVES: The aim of this study was to isolate the role of cognitive agency on pain tolerance in music listening interventions, independently from parallel effects related to enjoyment. Additionally, the study examines the role of intramusical features and individual attributes related to musical engagement. METHODS: Fifty-two participants completed a repeated measures experiment, which involved listening to six different pieces of music while completing the cold pressor task. Cognitive agency was operationalized by giving participants different degrees of perceived control over the music selection, when in fact it was pre-determined by the experimenter. RESULTS: A generalized linear mixed model was used to analyse the impact of perceived choice and intramusical features on pain tolerance measured in terms of duration on the cold pressor task, pain intensity and pain unpleasantness. Increased levels of perceived choice predicted increases in pain tolerance when enjoyment was accounted for. Individual levels of trait empathy and sophisticated emotional engagement with music also contributed to the effects. Intramusical features did not predict increases in pain tolerance. CONCLUSIONS: This study demonstrates that the reason self-selected music is particularly effective in reducing pain is related to the act of making a choice over the music itself. This study provides support for the cognitive vitality model and emphasizes the importance of giving people as much control as possible in music interventions. SIGNIFICANCE: This study identifies that the act of selecting music contributes to increases in pain tolerance in parallel with the independent factor of enjoyment. This provides support for the role of cognitive agency in mediating the analgesic effects of music interventions, which suggests that people should be given as much control as possible in music interventions. Additionally, this study identifies specific individual attributes related to emotional engagement and empathy that amplify the effect of cognitive agency.

The Cognitive Mechanisms in Music Listening Interventions for Pain: A Scoping Review.

Music interventions have been introduced in a range of pain management contexts, yet considerable inconsistencies have been identified across evaluation studies. These inconsistencies have been attributed to a lack of clarity around the prospective cognitive mechanisms of action underlying such interventions. The current systematic scoping review was conducted to examine the theoretical rationales provided in the literature for introducing music listening interventions (MLIs) in pain contexts. 3 search terms (music, listening, and pain) were used in four electronic databases, and 75 articles were included for analysis. Content analysis was used to identify that more intensive listening schedules were associated with chronic and cancer pain compared with procedural pain. The degree to which patients had a choice over the music selection could be categorized into 1 of 5 levels. Thematic synthesis was then applied to develop 5 themes that describe the cognitive mechanisms involved in MLIs for pain. These mechanisms were brought together to build the Cognitive Vitality Model, which emphasizes the role of individual agency in mediating the beneficial effects of music listening through the processes of Meaning-Making, Enjoyment, and Musical Integration. Finally, content analysis was used to demonstrate that only a small proportion of studies were explicitly designed to examine the cognitive mechanisms underlying MLIs and we have suggested ways to improve future practice and empirical research. We call on researchers to design and evaluate MLIs in line with the Cognitive Vitality Model of music listening interventions for pain.