The effectiveness of interventions to improve the seasonal influenza vaccination uptake among nurses: A systematic review.

Background: Seasonal influenza is a significant cause of mortality and morbidity worldwide. Despite annual recommendations, influenza vaccination uptake rates are disproportionately lower among nurses compared to other health care professionals, especially when compared to physicians. Nurses have an additional risk of exposure to influenza infection due to the nature of their work. Aim: To determine the effectiveness of interventions in increasing seasonal influenza vaccination uptake among nurses. Methods: Evidence on the effectiveness of interventions to improve seasonal influenza vaccination uptake among nurses was systematically reviewed. A comprehensive search of six electronic databases and grey literature was undertaken. A minimum of two reviewers completed study selection, data extraction and risk of bias assessment independently. Results: One hundred and thirty-four studies were identified of which one cluster randomised trial met the inclusion criteria. The results of the included study found the implementation of an intervention with multiple components increased nurses' seasonal influenza vaccination rates during a single influenza season in geriatric healthcare settings in France. As the evidence in this review was very limited, it was not possible to make recommendations regarding which interventions were effective at increasing the seasonal influenza vaccination rate for nurses. Conclusion: This systematic review highlights a lack of high-quality studies that assessed interventions to improve the seasonal influenza vaccination of nurses. In view of the likelihood of influenza and the coronavirus (COVID-19) pandemic occurring together, it is imperative to have evidence on effective interventions for the nursing workforce and for policy decision makers.

Student nurses' experiences of remote learning during Covid-19 pandemic: A qualitative evidence synthesis.

AIM: To systematically synthesize undergraduate student nurses' experience of online, blended or distance learning during Covid-19 pandemic. DESIGN: A qualitative evidence synthesis (QES). REVIEW METHODS: A QES. Themes were organized using the 'best fit' framework approach. Methodological limitations and confidence in the review findings were informed by GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). DATA SOURCES: Qualitative literature from five databases including CINAHL, PubMed, Medline, Education Full Text (H.W. Wilson) and ERIC were searched from March 2020 to November 2021. RESULTS: Nine qualitative and two mixed method studies were included in this 'best fit' framework using Chickering and Gamson's Seven Principles for Good Practice in Undergraduate Education. Importance of the social presence of the teacher through effective communication and interpersonal relationships is highlighted. Clinical placement and in-person practical skills training are needed for effective nursing education. CONCLUSIONS: This review highlighted that online content can be developed into efficient and high-quality learner-centred education within blended undergraduate nursing programmes incorporating essential face-to-face and practical components. Various supporting measures are required for both students and faculty. We suggest an adaptation of a 'Blending with Purpose: The Multimodal Model' with key considerations for undergraduate nursing programmes where pedagogical objectives and activities drive the approaches to achieve intended learning outcomes and student satisfaction. IMPLICATIONS FOR THE PROFESSION: Well-designed online programmes using digital tools that support interaction and teamwork are required for undergraduate nursing education. IMPACT: Blended learning approaches offer more flexibility than online learning alone which leads to improved student engagement. Clinical placement and in-person practical skills training are needed for effective nursing education. REPORTING METHOD: 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) for QES. NO PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

The 'inbetweeners': living on a watch and wait approach for chronic lymphocytic leukaemia - a qualitative study.

BACKGROUND: Chronic lymphocytic leukaemia (CLL) is an incurable disease; many people with the condition do not require active treatment and are monitored using a watch and wait approach. AIM: The aim of this study was to explore the experiences of people living with a diagnosis of CLL and on watch and wait. METHODS: Using a descriptive qualitative approach, seven participants on the watch and wait approach were interviewed. Data analysis was guided by systematic text condensation. FINDINGS: Participants reported anxiety, referring to 'wait and worry'. Their information needs were not met, and they resorted to seeking information on possible future treatments themselves. They also experienced feeling like an imposter because they were not receiving active treatment like other patients with cancer. CONCLUSIONS: A greater understanding of how information provision affects levels of anxiety and worry among people living with CLL on watch and wait is needed. In addition, clinical nurse specialists could deliver education on the watch and wait approach, supplemented by video-based educational materials developed by the haematology team.

Breast cancer genetic mutation: Synthesis of women's experience.

AIMS AND OBJECTIVES: To systematically identify and synthesise the experiences reported by women with a breast cancer mutation who do not have cancer as reported in qualitative research published between 2013 and 2020. BACKGROUND: Women carrying a BReast CAncer (BRC) genetic mutation have an increased risk for breast and ovarian cancer. They must engage in emotional decision-making regarding risk management strategies to prevent cancer, including risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy. DESIGN AND METHODS: The ENTREQ statement guided this review. Eight databases were systematically searched (CINAHL, Pubmed, Embase, Psychinfo [Ovid], Web of Science, Scopus, Proquest and Lenus). Synthesis was guided by "best fit" framework. The Critical Appraisal Skills Programme guided assessment of methodological limitations and confidence in the review findings was informed by GRADE-CERQual. RESULTS: Twenty studies met the inclusion criteria for synthesis. Six themes were synthesised from the included studies (anxiety; family planning; it's a family affair; empowerment; actions; pragmatic adjustments). CONCLUSIONS: The multidimensional experiences of women living with a BRCA1/2 mutation require an individualised response based on women's needs at their life stages. A decision coaching model adopted during consultations could support women to guide decision-making regarding cancer risk-reducing strategies.

Collaborative identification and prioritisation of mental health nursing care process metrics and indicators: a Delphi consensus study.

BACKGROUND: The Irish Office of Nursing & Midwifery Services Director (ONMSD) commissioned the development an updated suite of mental health nursing metrics and indicators for implementation in Irish mental health clinical settings. While measuring care processes does offer the potential to improve care quality, the choice of which mental health nursing metrics to measure presents a significant challenge, both in Ireland and internationally. The provision of safe and high-quality mental health nursing care stems from nurses' expertise, skills and overall capacity to provide recovery focused care across a range of health care settings. Accordingly, efforts to measure what mental health nurses do depends on the identification of those care processes that contribute to mental health nursing practice. This paper reports on the identification, development and prioritisation of a national suite of Quality Care Metrics (QCM), along with their associated indicators, for mental health nursing care processes in Ireland. METHODS: The study was undertaken over four phases; i) a systematic literature review to identify mental health care process metrics and their associated indicators of measurement; ii) a two-round, online Delphi survey of mental health nurses to develop consensus on the suit of mental health nursing care process metrics; iii) a two-round online Delphi survey of mental health nurses to develop consensus on the indicators to be used to measure the agreed metrics; and iv) a face-to-face consensus meeting with mental health nurses and service user representatives to develop consensus on the final suite of metrics and indicators. RESULTS: Following these four phases 9 metrics and their 71 associated indicators were agreed for inclusion in the final suite of Mental Health Nursing QCM. These metrics are applicable across the life span and the range of mental health nursing health care settings. CONCLUSION: The development of this suite of Mental Health Nursing QCM and their indicators represents an opportunity for the measurement of safe and high-quality mental health nursing care for application in Ireland and internationally. This initial development of metrics and indicators should be followed by a rigorous baseline review of QCM uptake and implementation amongst mental health nurses as part of an ongoing evaluation.

Identification of quality indicators of public health nursing practice: "modified Delphi" approach.

OBJECTIVE: Identify process indicators to measure public health nursing practice during first postnatal visits in Ireland. DESIGN: Using a RAND/UCLA appropriateness- "modified Delphi" method, a two-round rating and ranking process was completed in 2016. Fifty-nine statements were reviewed for consensus and priority ranking. SAMPLE: The sample comprised a panel of 21 national and international experts. RESULTS: Fifty-nine indicators were identified and subsequently reduced across two rounds of consensus testing. Fifty-six indicators achieved consensus and priority ranking identified 13 indicators to measure care for mothers and 15 indicators to measure care for newborns resulting in 28 process indicators to enable Public Health Nurses (PHNs) to measure care during the first postnatal visit. CONCLUSIONS: Measurement of care using quality indicators plays an integral role in quality improvement. Developing quality indicators is important in improving care outcomes. This two round "modified Delphi" study combined with literature and previous qualitative findings identified process indicators to measure public health nursing practice at first postnatal visits and enables benchmarking. Developing quality indicators for public health nursing practice using a "modified Delphi" technique has enabled a platform to provide consensus amongst a panel of experts and identified key processes of care by PHNs and mothers.

Work environment challenging Irish public health nurses' care quality: First postnatal visit.

OBJECTIVES: Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. DESIGN: An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. SAMPLE: Nineteen public health nurses from four health service regions in Ireland participated. RESULTS: Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. CONCLUSIONS: Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.

Identifying the role of public health nurses during first postnatal visits: Experiences of mothers and public health nurses in Ireland.

Aim and Objective: Explore the views and experiences of quality of care provided during a first postnatal visit from the perspectives of mothers and public health nurses. Background: Quality of nursing care is high on the policy agenda internationally, especially in the year of Nurse and Midwife. Public health nurses are acknowledged nationally and globally as essential health professionals supporting infants and parents. The first postnatal visit provided by the public health nurse is a complex intervention for mothers incorporating physical, social, educational and emotional support, and we know little about the quality of care provided. International evidence suggests a lack of consensus in setting priorities for this crucial visit. Design: Exploratory, qualitative design, utilising focus groups and interviews and analysed using thematic analysis. Setting/Participants: Nineteen public health nurses from all four health service regions and five mothers from one health service region were interviewed to explore the quality of care provided during first postnatal visits. Methods: Adopting qualitative data collection methods for the study; five individual semi-structured interviews with mothers ascertained their experiences of care. Further, four focus groups with public health nurses explored their understanding of the quality of care provided to mothers. The data collection period was August 2015 to January 2016. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Mothers and public health nurses identified that public health nurses were crucial for providing support during the first postnatal visit as mothers required care and advice around physical, psychological and social wellbeing for themselves and their new infant. Discordant experiences of quality care and lack of standardisation of care practices emerged. Nurses identified relationship building, empowerment and health promotion as pivotal to the public health nurses' role. Mothers acknowledged the supportive and practical aspects of the care provided. Conclusion: This is the first Irish study combining nurses and mothers experiences, identifying care provided at the first postnatal visit, presenting the quality of care experienced. This visit is vital for relationship-building and empowering mothers' child-care and self-care abilities. The findings provide an insight into how quality of care is perceived by public health nurses and mothers. Experiences facilitate reflection and the development of quality improvements to ensure mothers and infants are adequately supported during the first postnatal visit.

Evaluating the impact of a quality care-metric on public health nursing practice: protocol for a mixed methods study.

AIM: To establish, implement and evaluate the impact of a quality care-metric developed to measure public health nursing practice. BACKGROUND: Measurement of care practices plays an integral role in quality improvement and promotes positive change in healthcare delivery. Quality care-metrics has been identified as a means of effectively measuring public health nursing practice. Public health nurses in Ireland are 'all-purpose' generalist community-based nurses caring for people across the lifespan, in defined geographical areas, employed by the Health Service Executive. In the public health nurse's child and maternal health role, the 'primary visit' (postnatal visit) has been identified as the most important contact a public health nurse has with a mother and her new baby. DESIGN: Mixed methods using a sequential multiphase design. METHODS: This study involves three phases. The first phase will include focus group and individual interviews with key healthcare professionals and new mothers, using purposively chosen sampling. Thematic analysis of data will identify key components for the development of a quality care-metric. Phase two will be a RAND appropriateness survey with a panel of experts, to develop and validate the quality care-metric. The third phase will involve implementation and evaluation of the quality care-metric. Descriptive and inferential statistics will be completed using SPSS version 21. Funding for this research study was approved in December 2013. CONCLUSION: This study will evaluate the impact of introducing a quality care-metric into public health nursing practice. Results will illuminate the quality of public health nursing practice in relation to the primary visit.