Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research.

OBJECTIVES: To capture the extent and nature of intellectual disability nursing publications in Ireland. DESIGN: Scoping review using Arksey and O'Malley approach. DATA SOURCES: Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020. ELIGIBILITY CRITERIA: Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education. DATA EXTRACTION AND SYNTHESIS: Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken. RESULTS: The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring. CONCLUSIONS: This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.

An integrative review to identify how nurses practicing in inpatient specialist palliative care units uphold the values of nursing.

BACKGROUND: Caring for individuals and their families with a life-limiting, symptomatic illness and those who are dying has long been an integral role of palliative care nurses. Yet, over the last two decades, the specialty of palliative care has undergone significant changes in technology and medical treatments which have altered both the disease trajectory and the delivery of palliative care. To date, there is little evidence as to the impact of these medical and nursing advancements on the role of nurses working in palliative care and how in clinical practice these nurses continue to uphold their nursing values and the philosophy of palliative care. METHODS: An integrative review was conducted searching seven academic databases from the time period of January 2010 - December 2019 for studies identifying research relating to the role of the palliative care nurse working in specialist palliative care units and hospices. Research articles identified were screened against the inclusion criteria. Data extraction was completed on all included studies and the Crowe Critical Appraisal Tool was utilized to appraise the methodological quality and thematic analysis was performed guided by Braun and Clarke's framework. The review was conducted and reported in lines with PRISMA guidelines. RESULTS: The search yielded 22,828 articles of which 7 were included for appraisal and review. Four themes were identified: (1) enhancing patient-centred care (2) being there (3) exposure to suffering and death (4) nursing values seen but not heard. The findings highlight that while palliative care nurses do not articulate their nurse values, their actions and behaviors evident within the literature demonstrate care, compassion, and commitment. CONCLUSION: These findings suggest that there is a need for nurses working in specialist palliative care units to articulate, document, and audit how they incorporate the values of nursing into their practice. This is pivotal not only for the future of palliative nursing within hospice and specialist palliative care units but also to the future of palliative care itself. To make visible the values of nursing further practice-based education and research is required.

Interventions in pain management for persons with an intellectual disability.

Pain is a multidimensional and subjective experience, and an ideal pain management regime needs to be comprehensive, integrative and involve all relevant persons. Multimodal interventions may include pharmacological, physical, social, psychological and spiritual approaches in order to address pain management at a molecular, functional, behavioural, cognitive and affective levels. Pain management interventions will vary according to pain aetiology, patient characteristics and preferences. In keeping with best practice guidelines for effective pain management, a structured approach incorporating an effective assessment of pain by the healthcare professional, identification of the source and type of pain and accurate documentation is essential. This article focuses on pharmacological and non-pharmacological pain management for individuals with intellectual disability.

Understanding pain physiology and its application to person with intellectual disability.

The issue of pain warrants attention as, by virtue of having an intellectual disability, a person may have associated medical or physical conditions and associated factors increasing their risk of pain disorders. People with intellectual disability experiencing pain need to be provided with the best possible care. The focus of this article is on the exploration of pain: physiology and types; manifestations and responses in the context of intellectual disability in order to promote effective, knowledgeable assessment and management of pain for this client group. Pain is a subjective, complex, physiological and psychological phenomenon that can be acute or chronic and may be classified according to its cause. Within the experience of pain, the concept of total pain describes the physical, psychological, social and spiritual factors that influence the experience of pain.

Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative.

AIM: This paper reports on a quality-improvement project to develop nursing documentation that reflects holistic care within a specialist palliative centre. BACKGROUND: The World Health Organization definition of palliative care includes impeccable assessment and management of pain and other symptoms. However, existing nursing documentation focuses mainly on the management of physical symptoms, with other aspects of nursing less frequently documented. METHODS: Supported by a project team and expert panel, cycles of review, action and reflection were used to develop a new palliative nursing documentation. The project was divided into three phases: audits of existing nursing documentation, development of a new palliative nursing care document and audit tool, and pilot implementation and audit of the new nursing documentation. RESULTS: The new palliative nursing care document demonstrated a higher level of compliance in relation to nursing assessments and a more concise, accurate and comprehensive approach to documenting holistic nursing care and recording of patients' perspective. CONCLUSIONS: This project has enabled the consistent documentation of holistic nursing care and patients' perspectives; however, continuous education is necessary in order to sustain positive results and ensure that documentation does not become a 'tick box' exercise. Organisational support is required in order to improve documentation systems.

Detection of precancerous lesions in the oral cavity using oblique polarized reflectance spectroscopy: a clinical feasibility study.

We developed a multifiber optical probe for oblique polarized reflectance spectroscopy (OPRS) in vivo and evaluated its performance in detection of dysplasia in the oral cavity. The probe design allows the implementation of a number of methods to enable depth resolved spectroscopic measurements including polarization gating, source­detector separation, and differential spectroscopy; this combination was evaluated in carrying out binary classification tasks between four major diagnostic categories: normal, benign, mild dysplasia (MD), and severe dysplasia (SD). Multifiber OPRS showed excellent performance in the discrimination of normal from benign, MD, SD, and MD plus SD yielding sensitivity/specificity values of 100%/93%, 96%/95%, 100%/98%, and 100%/100%, respectively. The classification of benign versus dysplastic lesions was more challenging with sensitivity and specificity values of 80%/93%, 71%/93%, and 74%/80% in discriminating benign from SD, MD, and SD plus MD categories, respectively; this challenge is most likely associated with a strong and highly variable scattering from a keratin layer that was found in these sites. Classification based on multiple fibers was significantly better than that based on any single detection pair for tasks dealing with benign versus dysplastic sites. This result indicates that the multifiber probe can perform better in the detection of dysplasia in keratinized tissues.

Psychomotor Ability and Short-term Memory, and Reading and Mathematics Achievement in Children.

OBJECTIVE: The aim of our study was to examine whether the findings from previous research, indicating the role of short-term memory as a mediator of the relationship between motor coordination and academic achievement in adolescents, is also evident in a younger child population. METHOD: The study utilized a quantative cross-sectional design involving 133 children aged 8-12. The McCarron Assessment of Neuromuscular Development (MAND) provided four indicators of psychomotor ability (Finger Nose, Walking, Balancing, and Jumping). The Woodcock-Johnson Cognitive battery and the Automated Working Memory Assessment (AWMA) provided two measures of short-term memory (Numbers Reversed and Digit Recall) and the WJIII Achievement battery provided two measures of reading achievement (Letter-word Identification and Passage Comprehension) and two measures of mathematics achievement (Applied Problems and Calculation). Structural equation modeling was used, controlling for age, processing speed, crystallized, and fluid intelligence where appropriate. RESULTS: The results found support for the hypothesis that short-term memory fully mediates the relationship between psychomotor ability and reading and mathematics achievement. CONCLUSION: These findings indicate the significant affect of psychomotor ability on learning outcomes and consequently the need to assess these in considering learning difficulties, and as such these findings also advance understanding of developmental neural mechanisms underpinning the relationships.

Depth-resolved measurements with elliptically polarized reflectance spectroscopy.

The ability of elliptical polarized reflectance spectroscopy (EPRS) to detect spectroscopic alterations in tissue mimicking phantoms and in biological tissue in situ is demonstrated. It is shown that there is a linear relationship between light penetration depth and ellipticity. This dependence is used to demonstrate the feasibility of a depth-resolved spectroscopic imaging using EPRS. The advantages and drawbacks of EPRS in evaluation of biological tissue are analyzed and discussed.

Setting a research question, aim and objective.

AIM: To describe the development of a research question, aim and objective. BACKGROUND: The first steps of any study are developing the research question, aim and objective. Subsequent steps develop from these and they govern the researchers' choice of population, setting, data to be collected and time period for the study. Clear, succinctly posed research questions, aims and objectives are essential if studies are to be successful. DISCUSSION: Researchers developing their research questions, aims and objectives generally experience difficulties. They are often overwhelmed trying to convert what they see as a relevant issue from practice into research. This necessitates engaging with the relevant published literature and knowledgeable people. CONCLUSION: This paper identifies the issues to be considered when developing a research question, aim and objective. Understanding these considerations will enable researchers to effectively present their research question, aim and objective. IMPLICATIONS FOR PRACTICE: To conduct successful studies, researchers should develop clear research questions, aims and objectives.

The development of clinical nurse specialist roles in Ireland.

While the term specialist in nursing can be traced to the turn of the 20th Century, it is only since 2001 that a framework was developed for a clinical career pathway in Ireland. This framework has promoted the development and expansion of the clinical nurse/midwife specialist (CNS/CMS) throughout Ireland over the past 10 years guided by the National Council for the Professional Development of Nursing and Midwifery (NCNM). To build upon the achievements of the NCNM and advance nursing practice, it is imperative that CNS/CMSs adopt and fulfil the components of their role. Since CNS/CMS practice is relatively new to Ireland, there is the opportunity to learn from experiences of other countries. This article outlines the development and challenges of the CNS role in Ireland.

Caring for children and families in the community: experiences of Irish palliative care clinical nurse specialists.

An increasing number of children require care at home owing to life-limiting illness. In addition, there is growing recognition of the specific care needs of such children and their families, and it is anticipated that recent developments in children's palliative care will result in more people accessing these services. In the Republic of Ireland (ROI), community palliative care clinical nurse specialists (CNSs), who are not registered children's nurses, contribute significantly to the support of these children and families. This study aimed to obtain a picture of the current nursing service that would help to determine whether the needs of these patients are being met. Seven community palliative care CNSs from across one health region in the ROI participated in a focus group. Four key themes emerged: gaining access to the child and family, role complexities, pressures of caring, and support strategies. Provision of community children's palliative care by the CNS is complex. The participants demonstrated their commitment to consult, coordinate, negotiate, and ultimately deliver the care required by children and families, but against a background of issues relating to accessing the patient and family, the complexity of the CNS role, and the pressures that such work incurs.

Student nurses' experiences of using a learning contract as a method of assessment.

The purpose of this study was to describe final year undergraduate nurses' experiences of assessment through the use of a learning contract. Using a qualitative descriptive design, data was collected from a purposive sample of final (fourth) year undergraduate student nurses. Two approaches were taken for data collection, anonymous evaluative questionnaires and interviews. The study was approved by the local university research and ethics committee. Data was thematically analysed. This article presents and discusses the findings from the interviews. Findings suggest that students' approach to the assessment strategy influenced engagement with the learning contract. Three themes were identified: skills, perceptions, and actions. Within these themes three types of learner were identified: happy, pragmatic and fearful. Factors found to influence successful completion of the learning contract were: support, relevant skills, prior experiential learning and required theoretical knowledge. Recommendations include the need for educators to consider module assessments that recognise the learning needs and preferences of the student within a supportive environment.

Creating a spiritual tapestry: nurses' experiences of delivering spiritual care to patients in an Irish hospice.

This study aims to describe nurses' experiences of delivering spiritual support in a palliative care setting in the Republic of Ireland. The authors conducted semi-structured interviews with 22 nurses working in the area of specialist palliative care. A content analysis of the transcriptions revealed five sub-themes: understanding spirituality; the art of nursing in spiritual care; education and learning; the challenge of spiritual caring; and the dimensions of time. The resulting creation of a spiritual tapestry provided an overall theme. Nurses in this study were spiritually self-aware and placed a high value on the spiritual element of their caring role. Nurses described their individual understanding of spirituality and discussed how they recognized and addressed a patient's spiritual needs. Time was described as essential to the provision of spiritual support and appeared to be a significant resource challenge to the provision of spiritual care. The challenges of assessing spiritual needs and measuring outcomes of care were also reported. Participants in this study described the creation of a spiritual tapestry that 'weaves' together care and compassion with skills and knowledge in their nursing practice.

Introducing guided group reflective practice in an Irish palliative care unit.

This paper describes the processes involved over one year in introducing, facilitating and evaluating a project of guided reflective practice for a group of eight palliative care nurses in Milford Care Centre, Republic of Ireland. While literature has tended to concentrate on critical discussion relating to reflection, less attention has been directed towards the organisation and facilitation of reflective processes in practice. In addressing this deficit, a detailed account of the collaborative processes and challenges involved in this project are presented. Group evaluation of the project is discussed under the following themes: understanding the process of reflective practice; the value of keeping a reflective diary; guided group reflection and moving forward. The introduction of guided reflection for palliative care nurses has afforded both the facilitators and the participants an opportunity to meet away from the clinical environment, and to work together, finding fresh insights to inform practice. The valuing and promotion of reflective processes by an organisation arguably provides a fundamental strategy to support nurses in a quality palliative care setting.

The association of depression and sense of belonging with suicidal ideation among older adults: applicability of resiliency models.

Suicide among older people, especially men, is a significant problem. In this study the applicability of the compensatory, the risk-protective, the challenge, and the protective-protective models of resiliency for the prediction of suicidal ideation from depression (the risk factor) and sense of belonging to the community (the protective factor) was investigated. A total of 351 retired Australians (130 males and 221 females), with a mean age of 71.31 years (SD = 7.99), completed the Zung Depression Scale, the suicide subscale of the General Health Questionnaire, and the Sense of Belonging Instrument. When sense of belonging (psychological) was the protective factor, results indicated support for the risk-protective model for men and women, and for the compensatory model for women only. In contrast, when sense of belonging (antecedents) was the protective factor, support was evident for the compensatory model for men and women, and for the challenge model for women only. Results indicate that interventions should be developed to enhance sense of belonging among aging adults.