The retention of training doctors in the Irish health system.

BACKGROUND: There is limited quantitative evidence on the migration patterns of training doctors in Ireland. The aim of this study is to estimate the number of trainee doctors leaving the Irish health system and the numbers returning. METHODS: This study uses administrative data to track the migration patterns of Irish trained doctors at various career stages. RESULTS: Eighty-four percent of interns who commenced intern training in 2015 subsequently commenced a basic specialist training (BST) or general practice (GP) training programme in subsequent years (2016-2021). Of those who completed BST training in 2017, 75% went on to higher specialist training (HST) in Ireland. In 2021, of the 2016 cohort of doctors awarded Certificates of Satisfactory Completion of Specialist Training (CSCST), 68% are employed in Ireland and 32% are abroad or unknown. Of the 2016 group that are abroad, the UK is the main country of practice. There are variations in the retention rate across disciplines; from the 2016 cohort, 52% of anaesthesiology CSCSTs were working in Ireland in 2021 compared to 88% of psychiatry CSCSTs. CONCLUSION: Previous research has highlighted Irish doctor's intentions to migrate and intentions to return to Ireland. This study documents for the first time the extent to which Irish doctors are leaving and returning to the Irish health system from 2015 to 2021. The paper also gives a picture of variations across medical disciplines and the location of emigration of qualified specialists.

Validity, reliability and utility of the Irish Nursing Minimum Data Set for General Nursing in investigating the effectiveness of nursing interventions in a general nursing setting: A repeated measures design.

BACKGROUND: Internationally, nursing professionals are coming under increasing pressure to highlight the contribution they make to health care and patient outcomes. Despite this, difficulties exist in the provision of quality information aimed at describing nursing work in sufficient detail. The Irish Minimum Data Set for General Nursing is a new nursing data collection system aimed at highlighting the contribution of nursing to patient care. OBJECTIVES: The objectives of this study were to investigate the construct validity and internal reliability of the Irish Nursing Minimum Data Set for General Nursing and to assess its usefulness in measuring the mediating effects of nursing interventions on patient well-being for a group of short stay medical and surgical patients. DESIGN: This was a quantitative study using a repeated measures design. SETTING: Participants sampled came from both general surgery and general medicine wards in 6 hospitals throughout the Republic of Ireland. PARTICIPANTS: Nurses took on the role of data collectors. Nurses participating in the study were qualified, registered nurses engaged in direct patient care. Because the unit of analysis for this study was the patient day, patient numbers were considered in estimations of sample size requirements. A total of 337 usable Nursing Minimum Data Set booklets were collected. METHODS: The construct validity of the tool was established using exploratory factor analysis with a Promax rotation and Maximum Likelihood extraction. Internal reliability was established using the Cronbach's Alpha coefficient. Path analysis was used to assess the mediating effects of nursing interventions on patient well-being. RESULTS: The results of the exploratory factor analysis and path analysis met the criteria for an appropriate model fit. All Cronbach Alpha scores were above .7. CONCLUSION: The overall findings of the study inferred that the Irish Nursing Minimum Data for General Nursing possessed construct validity and internal reliability. The study results also inferred the potential of the tool in the investigation of the impact of nursing on patient well-being. As such, this new tool demonstrated potential to be used in the provision of quality information to inform policy in relation to the organisation of nursing care. More research is needed to further establish its use in the assessment of patient outcomes.

Is the Community Attitudes towards the Mentally Ill scale valid for use in the investigation of European nurses' attitudes towards the mentally ill? A confirmatory factor analytic approach.

AIM: This study aimed to assess the construct validity of the Community Attitudes towards the Mentally Ill scale in the investigation of European nurses' attitudes towards mental illness and mental health patients. BACKGROUND: The harbouring of negative attitudes by nurses towards any patient can have implications for recovery. To gather robust evidence upon which to base information and education aimed at fostering acceptance, support and general positivity towards people with mental health illness, a valid and reliable system of data collection is required. METHOD: A confirmatory factor analysis of both the original Community Attitudes towards the Mentally Ill scale and two modified versions of the scale were carried out during May - June 2007 using a data set representing the responses of 858 European nurses to the scale. Data were subjected to three different confirmatory factor analyses using Maximum Likelihood estimation in the software package, Analysis of Moment Structures 7. A number of absolute, relative and incremental fit statistics were used to assess the fit of the original Community Attitudes towards the Mentally Ill scale and two modified versions to the European nursing data. FINDINGS: A modification of the scale was found to be most suitable for use in the investigation of European nurses' attitudes towards mental illness and people with mental illness. CONCLUSION: Further research is recommended to develop a valid and reliable research tool to specifically measure the attitudes of 'nurses' working across different mental healthcare facilities towards this vulnerable patient group.

Seen as core: a Delphi consensus study of essential elements of mental health nursing care in Ireland.

Continued ambiguity about the scope of mental health nursing is harmful to the discipline's identity and to patients' interests. Using a Delphi survey design, consensus was achieved on a set of 70 items representing core elements of mental health nursing among a sample of 150 mental health nurses working in Ireland. Items achieving consensus in Round 3 of the survey were composed of 28 clinical phenomena (framed as client problems), 18 direct and 12 indirect nursing interventions, and 12 nursing-sensitive outcomes of care. Mental health nurses accepted responsibility across a broad range of outcomes apart from those linked to physical care, the one domain of care rejected by participants. The findings portray mental health nursing as a psychosocial enterprise, encompassing both phenomenological and diagnosis-related elements.

The Irish Nursing Minimum Data Set for mental health--a valid and reliable tool for the collection of standardised nursing data.

AIMS AND OBJECTIVES: To test the validity and reliability of the newly developed Irish Nursing Minimum Data Set for mental health (I-NMDS (MH)) to ensure its clinical usability. BACKGROUND: Internationally, difficulties exist in defining the contribution mental health nursing makes to patient care. Structured information systems, like the Nursing Minimum Data Set, have been developed internationally to gather standardised information to increase the visibility of nursing in the health care system. DESIGN: This study employed a quantitative, longitudinal research design. METHOD: A convenience sample of mental health nurses (n = 184) collected data on the nursing care of patients (n = 367) from care settings attached to 11 hospitals across Ireland. Exploratory factor analysis (EFA), ridit analysis and Cronbach's alpha coefficient were used to establish the construct and discriminative validity and scale score reliability of the I-NMDS (MH). RESULTS: Goodness of Fit scores indicated that the I-NMDS (MH) possesses good construct validity. Alpha coefficients for each factor were above the recommended 0.7 level. Ridit analysis inferred that the I-NMDS (MH) discriminated between elements of nursing care across acute inpatient and community based care settings. CONCLUSIONS: The I-NMDS (MH) possesses a sound theoretical base, has scale score reliability and possesses good discriminative validity. The valid and reliable I-NMDS (MH) is the first NMDS to be developed specifically for mental health. RELEVANCE TO CLINICAL PRACTICE: Data collected using the I-NMDS (MH) will increase the visibility of the contribution mental health nurses make to healthcare delivery. In addition, it will support evidence based practice in mental health to improve further the effectiveness of nursing care in the future.

Ambiguities and conflicting results: the limitations of the kappa statistic in establishing the interrater reliability of the Irish nursing minimum data set for mental health: a discussion paper.

BACKGROUND: In a study to establish the interrater reliability of the Irish Nursing Minimum Data Set (I-NMDS) for mental health difficulties relating to the choice of reliability test statistic were encountered. OBJECTIVES: The objective of this paper is to highlight the difficulties associated with testing interrater reliability for an ordinal scale using a relatively homogenous sample and the recommended kw statistic. METHOD: One pair of mental health nurses completed the I-NMDS for mental health for a total of 30 clients attending a mental health day centre over a two-week period. Data was analysed using the kw and percentage agreement statistics. RESULTS: A total of 34 of the 38 I-NMDS for mental health variables with lower than acceptable levels of kw reliability scores achieved acceptable levels of reliability according to their percentage agreement scores. CONCLUSION: The study findings implied that, due to the homogeneity of the sample, low variability within the data resulted in the 'base rate problem' associated with the use of kw statistic. Conclusions point to the interpretation of kw in tandem with percentage agreement scores. Suggestions that kw scores were low due to chance agreement and that one should strive to use a study sample with known variability are queried.

Reconsidering the conceptualization of nursing workload: literature review.

AIM: This paper reports a literature review that aimed to analyse the way in which nursing intensity and patient dependency have been considered to be conceptually similar to nursing workload, and to propose a model to show how these concepts actually differ in both theoretical and practical terms. BACKGROUND: The literature on nursing workload considers the concepts of patient 'dependency' and nursing 'intensity' in the realm of nursing workload. These concepts differ by definition but are used to measure the same phenomenon, i.e. nursing workload. METHOD: The literature search was undertaken in 2004 using electronic databases, reference lists and other available literature. Papers were sourced from the Medline, Psychlit, CINAHL and Cochrane databases and through the general search engine Google. The keywords focussed on nursing workload, nursing intensity and patient dependency. FINDINGS: Nursing work and workload concepts and labels are defined and measured in different and often contradictory ways. It is vitally important to understand these differences when using such conceptualizations to measure nursing workload. A preliminary model is put forward to clarify the relationships between nursing workload concepts. CONCLUSION: In presenting a preliminary model of nursing workload, it is hoped that nursing workload might be better understood so that it becomes more visible and recognizable. Increasing the visibility of nursing workload should have a positive impact on nursing workload management and on the provision of patient care.

Developing a data dictionary for the irish nursing minimum dataset.

One of the challenges in health care in Ireland is the relatively slow acceptance of standardised clinical information systems. Yet the national Irish health reform programme indicates that an Electronic Health Care Record (EHCR) will be implemented on a phased basis. [3-5]. While nursing has a key role in ensuring the quality and comparability of health information, the so- called 'invisibility' of some nursing activities makes this a challenging aim to achieve [3-5]. Any integrated health care system requires the adoption of uniform standards for electronic data exchange [1-2]. One of the pre-requisites for uniform standards is the composition of a data dictionary. Inadequate definition of data elements in a particular dataset hinders the development of an integrated data depository or electronic health care record (EHCR). This paper outlines how work on the data dictionary for the Irish Nursing Minimum Dataset (INMDS) has addressed this issue. Data set elements were devised on the basis of a large scale empirical research programme. ISO 18104, the reference terminology for nursing [6], was used to cross-map the data set elements with semantic domains, categories and links and data set items were dissected.