Double jeopardy: The importance of nurturing culturally responsive perinatal mental healthcare

Perinatal mental illness is a common complication of pregnancy, which can result in devastating effects for the mother, infant and family unit. Consequently, perinatal mental health is a growing public health concern and there is a renewed emphasis on early identification of mental illness during pregnancy and within the first year after birth, as a means of ensuring appropriate interventions are provided in a timely manner. Healthcare professionals across healthcare settings and services play a critical role in identifying perinatal mental health concerns and providing appropriate woman and family centred supports and referrals to specialised perinatal mental health services when required. However, healthcare professionals often feel ill prepared and uncertain of their roles and responsibilities when engaging with women experiencing perinatal mental illness. The complexities and difficulties with providing perinatal mental healthcare is further exacerbated when caring for women from diverse cultural, ethnic and linguistic backgrounds. Consequently, there are growing reports of missed opportunities in identifying perinatal mental health concerns and substandard perinatal mental healthcare for culturally and linguistically diverse women (Heslehurst et al., 2018; Pangasa et al., 2019). The persistent and systematic barriers to accessing healthcare for women from diverse cultural, ethnic and linguistic backgrounds warrants urgent attention. The need for easily accessible, equitable and culturally responsive perinatal mental healthcare is now a necessity. In this context, culturally responsible perinatal mental healthcare is defined as the provision of quality and safe healthcare in culturally appropriate and sensitive ways for women experiencing perinatal mental illness. This commentary paper highlights the importance of exploring perinatal mental healthcare through a social justice lens and illustrates how culturally responsive perinatal mental healthcare is a means of achieving social justice principles in practice. </p

Time to re-envisage culturally responsive care: Intersection of participatory health research and implementation science

Aim: In the context of widening societal diversity, culturally and linguistically diverse patients continue to experience inequities in healthcare access and deficiencies in standards of nursing care. Re-framing culturally responsive care as a complex intervention spanning multiple interacting factors at micro, meso and macro levels is an essential prerequisite for addressing knowledge translation gaps into everyday nursing practice. To this end, this paper proposes and explicates the potential of applying synergistic participatory implementation methodologies for developing effective implementation strategies with impact at individual and wider structural levels. Design: Discussion Paper. Data Sources: A co-design case study is presented as an example of combining normalization process theory and participatory learning and action to investigate and support the implementation of culturally responsive care in general practice nursing. Implications for Nursing: Enacting culturally responsive health care is inherently complex in that it is influenced by multiple interacting factors. Viewing culturally responsive care as a complex intervention and incorporating a synergistic participatory implementation science approach offers possibilities for addressing the documented shortcomings in the implementation of culturally responsive nursing care. Conclusion: There is a need to move away from conventional approaches to conceptualizing and generating evidence on culturally responsive care. Incorporating participatory implementation methodologies can provide a new lens to investigate and support whole system implementation strategies. Impact: The combination of participatory and implementation methodologies is both theoretically and empirically informed. Engaging stakeholders in the co-design and co-production of evidence and solutions to long standing problems has the potential to increase the likelihood of influencing iterative and sustainable implementation and changes to clinical practice and systems. Patient or Public Contribution: This work is part of a wider programme of participatory health research on migrant health, partnering with a non-governmental organization that supports migrants</p

Healthcare professional’s promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: a systematic review

Purpose: Human papillomavirus (HPV) vaccination coverage remains suboptimal with a global vaccination rate ranging from 12 to 90%. This review examined the approaches used by healthcare professionals in improving the uptake of HPV vaccine and reducing vaccine misconceptions among adolescents. Methods: A systematic review of literature between 2007 and 2021 was conducted using five databases: CINAHL, MEDLINE, PsycInfo, Scopus and ASSIA. Studies that examined healthcare professional’s promotional strategies in improving the HPV vaccine uptake in adolescents were included. Two researchers independently reviewed study selection, data extraction, and study methodological quality. Results were analysed and synthesised using narrative synthesis. Results: Twelve studies met the inclusion criteria. Studies reported on effective approaches used by healthcare professionals to improve vaccine uptake including the use of multi-settings to target hard-to-reach vulnerable adolescents; consistently recommending the vaccine; and initiating the vaccine before the age of eleven. In addressing vaccine misconceptions, open-communication, motivational approaches, and sexual health education were effective strategies used. Conclusion: This review found that healthcare professionals need to be better informed and educated on HPV vaccine to reduce their own vaccine hesitancy. Uptake of HPV vaccine can be improved by adopting better communication, engagement, supportive information resources, and training for healthcare professionals.</p

Resigned indifference: the importance of cultural competence education

This paper presents the findings of a PhD study, which explored how nurses' deal with their main concern when caring for patients from diverse cultural and ethnic backgrounds. Utilising theoretical sampling and the principles of a grounded theory approach, focus groups (n-10) and individual face-to-face interviews (n-30) were conducted with student and qualified nurses, in one region of Ireland. As data were collected, it was simultaneously analysed using constant comparative analysis during open, selective and theoretical coding. Uncertainty was the consistent main concern that emerged for participants in this study. Feelings of ambiguity of how to act were further influenced by a lack of knowledge, an awareness of potential ethnocentric beliefs and the culture of the organisation in which participants learn and work in. Resigned indifference explains how participants in this study dealt with their uncertainty when caring for patients from diverse cultures. It explains how participants adopted a range of disengagement strategies. Instead of doing what they sometimes knew to be right, participants adopted a range of disengagement strategies which were underpinned by a resigned indifference. The culture within the organisation allowed the disengagement strategies and indifference to also go un-noticed. As a result culturally insensitive care went unchallenged, often un-noticed and subsequently unchanged. The discomfort associated with providing culturally insensitive care was eased with shifting the blame to professional preparation or organisational constraints. As a consequence culturally insensitive care is sustained and perpetuated. This paper highlights the need for imaginative learning and teaching approaches that will replace uncertainty with curiosity and resilience, apathy with courage and commitment both at individual and organisational levels

Resigned indifference: an explanation of gaps in care for culturally and linguistically diverse patients'

Aims To develop a theory that explains students and registered nurses' behaviours when caring for culturally and linguistically diverse patients'. Background Despite ongoing calls for improvements to the quality of patient care, the continued reports of substandard care to patients from diverse cultural and linguistic backgrounds are concerning. Methods A classic grounded theory methodology incorporating focus groups (n‐10) and individual interviews (n‐30) with students and registered nurses in one region of Ireland. Findings Participants resolved their main concern of uncertainty through disengagement (masking, distancing and fitting in), which was sustained by resigned indifference, resulting in gaps in care. Resigned indifference explains how participants were aware of the consequences of disengagement, but became resigned and accepting of substandard care. Conclusion This study explains how nurses want to provide quality care, but gaps in care to culturally and linguistically diverse patients' are perpetuated through resigned indifference. Implications for Nursing Management Nurse managers need to understand nurses' behaviours as a means of supporting collective ways of addressing gaps in care for culturally and linguistically diverse patients. Strategic leadership in developing culturally responsive structures is essential. Nurturing nursing values such as commitment, compassion and courage through education and leadership is a priority

The experiences of registered intellectual disability nurses caring for the older person with intellectual disability

Aim and objectives. To explore the experiences of registered intellectual disability nurses caring for the older person with intellectual disability. Background. Increased longevity for the older person with intellectual disability is relatively a new phenomenon with social and medical factors having significantly increased the lifespan. The ageing population of people with intellectual disability is growing in Ireland, and they are outliving or expected to outlive their family carers. Design. A qualitative Heideggerigan phenomenological approach allowed the researcher become immersed in the essence of meaning and analyse how registered intellectual disability nurses working with the older person perceive, experience and express their experience of caring. Methods. After ethical approval was granted, data were collected through semi-structured interviews from seven participants and were transcribed and analysed thematically using Burnard’s framework for data analysis. Results. Three key themes were identified: ‘care delivery’, ‘inclusiveness’ and ‘clientfocused care’. The study highlights the need for effective planning, an integrated approach to services and that the registered intellectual disability nurse needs to be integrated into the care delivery system within the health service to support client and family carers in the home environment. Conclusions. Overall, the study shows the importance of teamwork, proactive planning, inclusion, attitudes, individualised care, knowing the person and best practice in providing care for older people with intellectual disability. Relevance to clinical practice. This paper reports on the findings of a study which explored the experiences of caring for the older person with intellectual disability. Teamwork, proactive planning, client-centred approach and supporting clients living at home are important as ageing is inevitable

Health of ageing people with intellectual disability and the role of the nurse in Ireland

The number of people with intellectual disability living into old age continues to increase. As one ages, generally, functional ability decreases and health issues increase, with recognising and responding to the health needs of the person with intellectual disability of great importance and the responsibility of the intellectual disability nurse. The nurse must review and adjust the way they deliver care to ageing people with intellectual disability, not only in terms of responding to their health needs but also through collaborative working within teams and other services. As Ireland has specifically trained nurses in intellectual disability, it has a prime opportunity to address the health needs and concerns of people with intdisability and actively advocate for how services develop and responds to the changing health needs of ageing people with intellectual disability

Guiding nurse managers in supporting nurses in dealing with the ethical challenge of caring

Aim(s): This study aims to present the theory of resigning in supporting nurse managers in dealing with nurses’ ethical challenge of caring. Background: In a COVID-19 era, nurses continue to be ethically challenged in maintaining safe patient care. Nurse managers play a critical role supporting staff in responding to the complexities of working in, under resourced environments. Evaluation: Literature suggests care delivery is compromised in times of staff shortages, lack of resources and increased demands on nurses. Examining caring behaviours through the theoretical lens of the theory of resigning enables nurse managers to understand nurses’ behaviours, cultivating supportive working environments. Key issue(s): Nurses strive to provide quality, safe care but are sometimes unable to give the level or type of care they wish, due to the presence of constraints. Conclusion(s): This paper provides suggestions for nurse managers in dealing with nurses’ daily moral distress arising from working within constraints while still trying to provide safe care.  Implications for Nursing Management: Nurse managers need to develop greater insights into the ethical dilemmas nurses experience and support them to temporarily realign beliefs and values, while continuing to work within constraints. Understanding ethical dilemmas of prioritizing care is required to address and manage this concern. </p

Future need of ageing people with an intellectual disability in the Republic of Ireland: lessons learned from the literature

People with an intellectual disability are living longer, and the numbers continue to rise. Ireland has and is seeing a dramatic change in the age profile of clients and the support services they require. While Ireland had specifically trained nurses in intellectual disability, they predominately work in residential settings. This can be seen as been at odds with the philosophy of supporting people with intellectual disability live at home with their family and the primary care system. As the ageing population is rising, intellectual disability services need to proactively develop and respond to this changing age profile by reviewing and adjusting the way in which they deliver services, not only in terms of how services develop and respond to a changing age profile but also in terms of collaborative working across all health services

Integrative literature review examining factors affecting patient safety with robotic‐assisted and laparoscopic surgeries

Purpose: The purpose of this integrative literature review is to examine the evidence on factors affecting patient safety during robotic assisted and laparoscopic surgeries. Design: Systematic review of papers published between 2011 and 2016 that identified factors affecting safety during robotic assisted and laparoscopic surgeries, in the areas of in colorectal, general, urology and gynaecological surgeries. Methods: A systematic literature search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Medline databases were performed. Twelve studies met the inclusion criteria outlining factors affecting safety in robotic assisted and laparoscopic surgeries. All 12 studies selected were quality appraised using the Critical Appraisal Skills Programme. Findings: Using thematic analysis, the outcomes from the 12 studies were categorised into three thematic categories. Intraoperative communication, teamwork and disruptions are the key factors affecting patient safety during robotic assisted and laparoscopic surgeries. Conclusion: This integrative literature review identifies a dearth of evidence examining factors affecting patient safety during robotic assisted and laparoscopic surgeries. It draws attention to the complexities with teamwork, intraoperative communication and disruptions during robotic assisted and laparoscopic surgeries. Although robotic assisted surgery is generally seen as safe and effective, this review highlights the need for education and training that focuses on non-technical skills development, disruption prevention and alertness in anticipating and minimising risk. Clinical relevance: The evidence from this review identifies the different demands and diverse challenges in maintaining safety during robotic assisted and laparoscopic surgery. Although specific technical knowledge and skills are essential, this review highlights the importance of developing new ways of thinking with regards to; assessment and management of disruptions, developing different teamwork patterns and communication skills, in overcoming challenges introduced during technology advanced surgeries. Nurses in the perioperative setting have an increased responsibility to continue professional development and remain vigilant to factors affecting patient safety. Early identification and management of factors leading to disruptions is imperative in the provision of safe perioperative care