Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study.

OBJECTIVE: To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme. DESIGN: A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated. SETTING AND PARTICIPANTS: To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study. FINDINGS: Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review.

BACKGROUND: Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD: A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS: The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION: These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.

Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives.

AIMS: To improve the confidence in student Midwives to provide bereavement careto parents following pregnancy loss and perinatal death. BACKGROUND: The one-day interactive Educational Training Workshop in Bereavement Care (ETWBC) was developed for student midwives in their final year of their B.Sc. Midwifery Degree Programme and those completing a Higher Diploma in Midwifery to help improve their confidence to provide bereavement care in clinical practice. DESIGN: A longitudinal sequential mixed-methods design was used to evaluate the outcome and processes of participation in the Workshop. This paper reports on the outcome evaluation. METHODS: Participants completed the study questionnaires at all 3 time points: pre/post workshop and 3 month follow-up. Thirty nine of the 41 student midwives (Higher Diploma and 4th year B.Sc.) participated in the workshop. 97.44% (n = 38) of the participants completed all the questionnaires. RESULTS: Participation in the ETWBC increased student's midwives confidence (measured using knowledge and skills scales); Bereavement support skills [F(2,72) = 21.150, p < .000, partial eta squared = 0.370] and Bereavement support knowledge [F(1.6,60) = 48.460, p < .000, partial eta squared = 0.567]to provide bereavement care. Improvement in Student Midwives' level of self-awareness of the needs of bereaved parents [F(2,72 )= 20.311, p < .000, partial eta squared = 0.361] and of their own personal needs [F (1.7, 61) = 30.387, p < .000, partial eta squared = 0.458] in relation to providing bereavement support were also found. CONCLUSION: Participation in the Education Training Workshop on Bereavement Care helped increase student midwives confidence to provide bereavement care to grieving parents and to increase their self-awareness around their clinical practice in this area. The ETWBC is recommended as a brief effective educational intervention for inclusion in Midwifery curricula which could be modified for use with other relevant professional groups.

A tool to support meaningful person-centred activity for clients with dementia - a Delphi study.

BACKGROUND: This paper reports on a study to validate the concept of the 'Activity Support Tool' that aimed to assist dementia service workers to identify and act upon the support needs of people with dementia living alone, in line with the person-centred ideal. METHODS: The tool was part of a two-stage exploratory qualitative study, which used interview and observational data from seven people with dementia living alone. Findings highlighted that people with dementia use objects and spaces within their homes to maintain or re-enact identities from the past. Thematic results from interviews were translated into a tool, with construct validation using the Delphi technique. Eighteen expert health professionals received round one of the questionnaire and six participants completed round three. The first round directed our focus towards operationalizing the person-centred ideal of dementia care. RESULTS: The tool was considered by almost all advisory panel members to be a potentially valuable resource for helping to address impediments to integrated, effective and person-centred dementia care. Specific strengths identified were simplicity, person-centeredness and applicability across service settings. Issues of concern included practicability, risk management, gender stereotyping and terminology. The results support the findings of previous research into the intuitive and ethical appeal, but problematic applicability, of person-centred dementia services. CONCLUSION: Health professionals with a range of service-related expertise found the concept of person-centred care compelling, but required tangible, enduring structures to translate the ideal into practical action. The tool now requires further research to test its usefulness in practice.

Decision aids for respite service choices by carers of people with dementia: development and pilot RCT.

BACKGROUND: Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care. METHODS: A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later. RESULTS: The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants. CONCLUSIONS: While these results must be interpreted with caution due to the small sample size, all intervention results trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a community health services context. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN32163031.

A qualitative study of professional and client perspectives on information flows and decision aid use.

BACKGROUND: This paper explores the meanings given by a diverse range of stakeholders to a decision aid aimed at helping carers of people in early to moderate stages of dementia (PWD) to select community based respite services. Decision aids aim to empower clients to share decision making with health professionals. However, the match between health professionals' perspectives on decision support needs and their clients' perspective is an important and often unstudied aspect of decision aid use. METHODS: A secondary analysis was undertaken of qualitative data collected as part of a larger study. The data included twelve interviews with carers of people with dementia, three interviews with expert advisors, and three focus groups with health professionals. A theoretical analysis was conducted, drawing on theories of 'positioning' and professional identity. RESULTS: Health professionals are seen to hold varying attitudes and beliefs about carers' decision support needs, and these appeared to be grounded in the professional identity of each group. These attitudes and beliefs shaped their attitudes towards decision aids, the information they believed should be offered to dementia carers, and the timing of its offering. Some groups understood carers as needing to be protected from realistic information and consequently saw a need to filter information to carer clients. CONCLUSION: Health professionals' beliefs may cause them to restrict information flows, which can limit carers' ability to make decisions, and limit health services' ability to improve partnering and shared decision making. In an era where information is freely available to those with the resources to access it, we question whether health professionals should filter information.

Ambiguous gain: uncertain benefits of service use for dementia carers.

Community services for carers of people with dementia can assist in relieving caregiver burden and delay the institutionalisation of the person with dementia. Under some conditions, however, engagement with dementia services may produce unintended negative consequences, resulting in increased confusion and a reduction of agency for carers. Drawing on an analysis of three salient aspects of caregiver identities, this paper examines specific instances and consequences of 'ambiguous gain', defined as 'a putative or demonstrated benefit that, as an unintended outcome, results in increased uncertainty and a consequent reduction of agency or wellbeing at the level of individual or collective identity'. The paper concludes with a discussion of implications for policy and practice.

Capacity for colorectal cancer screening by colonoscopy, Montana, 2008.

BACKGROUND: Colorectal cancer is largely preventable by screening, but screening participation is low in Montana. Colonoscopy is often considered the most accurate screening test and has the potential to prevent colon cancer by pre-emptive removal of polyps. However, colonoscopy may not be equally available to all residents of rural states. The Montana Department of Public Health and Human Services (DPHHS) has assigned high priority to colorectal cancer prevention, but before beginning a campaign to increase screening, DPHHS conducted a survey to determine existing colonoscopy screening capacity. METHODS: An eight-question survey was sent by DPHHS to all hospitals and ambulatory surgical centers that perform colonoscopy in Montana, assessing their current and projected capacity to perform screening colonoscopies. Data were collected from March to May 2008, and analysis was performed in June 2008. RESULTS: Responses were received from 43 of 44 hospitals and ambulatory surgical centers performing colonoscopies in Montana. The number of screening colonoscopies performed was estimated to be 19,444 per year. Unused colonoscopy screening capacity was estimated to be 23,096 procedures per year. Although similar total capacity existed in urban and rural areas, more unused capacity existed in rural areas. CONCLUSIONS: Montana has statewide capacity to meet moderately increased demand for screening colonoscopy but would be able to meet only 17% of demand in 2009 if all eligible adults chose colonoscopy as their primary form of screening. It is feasible to develop campaigns to increase screening colonoscopy participation now, but a systematic combination of colonoscopy and other screening modalities may be better able to meet Montana's long-term needs.

The continuing care guidelines and primary and community health services.

The confirmation of NHS responsibilities for continuing health care has important implications for primary and community health services. In early 1996, during the period of consultation on draft local policies and eligibility criteria, exploratory interviews were carried out with general practitioners (GPs), community nursing managers, primary care development officers and social services purchasers in three health authority areas. The interviews indicated that few GPs had responded to local consultation and were only slowly becoming aware of the implications for the provision and purchasing of primary and community health services. Moreover, local continuing care policies had apparently not addressed two issues which GPs and community nursing staff indicated were currently highly problematic: their responsibilities in relation to independent sector residential and nursing home patients; and the consequences for primary health and community nursing services of hospital discharge decisions. The need for purchasers and commissioners of health services, whether health authorities or GPs, to begin collecting information on patients' potential needs for continuing care services was widely recognised as an urgent priority.

Impresiones de la enfermera / Nursing impresions

Publicado en ingles en el Nursing Outlook, mayo 1955