Irish Nursing Students' Experiences And Understanding Of Reflective Practice: A Narrative Inquiry.

This thesis examines nursing students’ experiences and understanding of reflective practice in the Republic of Ireland. The aim of the study was to provide nurse educators with a deeper insight about reflection from a nursing student’s perspective, with the intention of integrating reflective practice into undergraduate nursing education more effectively. A narrative approach was employed using a convenience sample of eight newly graduated general nurses who had completed the nursing undergraduate four-year Bachelor of Science education programme in a Higher Education Institute in the West of Ireland. A narrative approach had not previously been employed to explore this phenomenon within an Irish context heretofore and therefore contributes to the body of knowledge on reflective practice in nursing. Schön’s methodological framework (1983) of reflective practice was employed for the study. Four themes emerged from the narratives: looking back at practice, seeking support, getting through, and ward reality: tensions and conflict. The data revealed that participants had a positive view of reflective practice and understood reflection to mean looking back at an occurrence to inform future practice. Students also identified models of reflective practice as beneficial in providing guidance to students for reflection. Schön’s reflection-on-action was apparent within the participants’ narratives. However, reflection-in-action was not as evident. Nonetheless participants may have engaged in this process in year four without acknowledging it. The findings indicate that participants positively regarded reflective practice as a method of learning within nurse education. Findings identified that support mechanisms had diverse levels of satisfaction. Clinical Placement Coordinators (CPCs) were considered by the participants as essential for reflective practice. Collegial support was also identified as effective. To a lesser extent the lecturing staff were acknowledged for the classroom teaching of reflective practice and for structured protected reflective time in year four of the programme but were not identified as helpful to the students while on clinical placement. Preceptors were not viewed as a significant source of support by the participants. The findings demonstrated significant variations concerning the facilitation of protected reflective time (PRT) during clinical placements which had previously not been explored within an Irish context. The study also found that the ward culture strongly influenced the facilitation of this time. The more experienced the participant became the less likely it was that PRT was offered. Furthermore, the narratives revealed conflict and confusion among qualified staff nurses about reflective practice which were motivated by power struggles between staff nurses and management. This was compounded by a perceived general lack of knowledge or understanding and value of reflective practice among nursing staff

Effects of 5 Different Finger Rest Positions on Arm Muscle Activity During Scaling by Dental Hygiene Students

Purpose. This study was conducted to determine the effects of 5 different finger rest positions: opposite arch, standard intraoral, basic extraoral, cross arch, and finger on finger on the muscle activity of 4 forearm muscles (extensor carpi radialis longus, flexor carpi ulnaris, biceps brachii, and pronator teres) during a simulated periodontal scaling experience. Methods. A convenience sample of 32 consenting senior dental hygiene students who met inclusion criteria participated. Using a 4 x 5 counter-balanced research design, each participant used a Gracey 11/12 curet to scale one cc of artificial calculus from first permanent molar typodont teeth (#3,14,19,30). Five different typodonts were set up for each participant with fulcrums randomly assigned for use on each typodont. While scaling, the participant’s muscle activity was measured by surface electromyography. Two-way analysis of variance with repeated measures was used to determine if significant differences existed in the amount of muscle activity generated with each fulcrum. Results. Results revealed no statistically significant interaction effect between area of the mouth scaled, muscle activity, and fulcrum used. Similar muscle activity was produced throughout the mouth regardless of the fulcrum used. The upper right quadrant produced the most muscle activity (p= 0.0101) and the lower left quadrant produced the least (p=\u3c .0001). When comparing the overall muscle activity generated with each fulcrum, only the cross arch fulcrum when compared to the opposite fulcrum produced statistically significant results (p=0.0110). Conclusions. Based on the results, similar muscle activity is produced when using any of the 5 fulcrums in each quadrant of the mouth. Clinicians appear to experience minimal ergonomic advantage in terms of fulcrums used and area of the mouth scaled during a simulated scaling experience

Role of Lactobacilli in Flavour Development of Cheddar Cheese.

End of Project ReportCheddar cheese is a complex microbial ecosystem. The internal cheese environment, in particular of hard and semi-hard cheeses, is not conducive to the growth of many microorganisms. At the beginning of ripening the dominant microorganisms are the starter bacteria which are present at high levels (~109/g). However, during ripening, non-starter lactic acid bacteria (NSLAB) grow from relatively low levels (<103/g) at the beginning of ripening, to 108/g within 6 - 8 weeks. Other bacteria, e.g. enterococci and staphylococci, may also be present but in much lower numbers. In a previous study of mature and extra mature Cheddar cheeses from different manufacturers (see End of Project Report No. 1), it was found that the NSLAB population was dominated by strains of Lb. paracasei. However, their contribution to cheese flavour and their source(s) are still unclear, nor is it known if the NSLAB flora is unique to each plant. Hence, understanding the growth of this group of organisms in cheese is a key to defining their role in flavour development. The biochemistry of flavour development in cheese is poorly understood. For most cheese varieties, including Cheddar, proteolysis, which results in the accumulation of free amino acids, is of vital importance for flavour development. Increasing evidence suggests that the main contribution of amino acids is as substrates for the development of more complex flavour and aroma compounds. The manner by which such compounds are generated in cheese is currently the focus of much research. Starter bacteria have been shown to contain a range of enzymes capable of facilitating the conversion of amino acids to potential flavour compounds. However, the potential of lactobacilli (NSLAB) to produce similar enzymes has only recently been investigated. Hence, although, it is generally accepted that the cheese starter flora is the primary defining influence on flavour development, the contribution of NSLAB is also considered significant. The objectives of these studies were: - to develop a greater understanding of the behaviour of NSLAB in cheese, and - to identify suitable strains, and other cheese bacteria, to be used as starter adjuncts for flavour improvement.Department of Agriculture, Food and the Marin

Co-designing patient-centred care using participatory action research (PAR) - the epilepsy partnership in care (EPIC) Project

The abstract is included in the test

ApoE elevation is associated with the persistence of psychotic experiences from age 12 to age 18: Evidence from the ALSPAC birth cohort

Apolipoproteins, which play important roles in lipid metabolism, innate immunity and synaptic signalling, have been implicated in first episode psychosis and schizophrenia. This is the first study to investigate plasma apolipoprotein expression in children with psychotic experiences that persist into adulthood. Here, using semi-targeted proteomic analysis we compared plasma apolipoprotein expression levels in age 12 subjects who reported psychotic experiences at both age 12 and age 18 (n = 37) with age-matched subjects who only experienced psychotic experiences (PEs) at age 12 (n = 38). Participants were recruited from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who participated in psychiatric assessment interviews at ages 12 and 18. We identified apoE, a protein with significant regulatory activity on cholesterol metabolism in the brain, to be significantly up regulated (p < 0.003) in those with persistent psychotic experiences. We confirmed this finding in these samples using ELISA. Our findings indicate elevated plasma apoE in age 12 children who experience PEs is associated with persistence psychotic experiences

Igniting intersectoral collaboration in chronic disease management: a participatory action research study on epilepsy care in Ireland

Models of care developed to improve the lives of people with chronic diseases highlight integrated care as essential to meeting their needs and achieving person (patient)-centered care (PCC). Nevertheless, barriers to collaborative practice and siloed work environments persist. To set in motion some groundwork for intersectoral collaboration this study brought two expert groups of epilepsy care practitioners together to engage in participatory action research (PAR). The expert practitioner groups were hospital-based epilepsy specialist nurses (ESNs) and community-based resource officers (CROs). The PAR highlighted, that while the participants share a mutual interest in caring for people with epilepsy, underdeveloped CRO-ESN relationships, arising from unconscious bias and ambiguity can result in missed opportunities for optimal care coordination with consequent potential for unnecessary replication and waste of finite resources. However, through dialogue and critical self-reflection, a growing emotional connection between the disciplines evolved over the course of the PAR. This allowed for buds of collaboration to develop with CROs and ESNs working together to tackle some of the key barriers to their collaboration

The rhetoric and reality of integrated patient-centered care for healthcare providers: An ethnographic exploration of epilepsy care in Ireland

In line with healthcare reform across the world, the National Clinical Programme for Epilepsy (NCPE) in Ireland describes a model that aims to achieve holistic integrated person (patient)-centered care (PCC). While generally welcomed by stakeholders, the steps required to realize the NCPE ambition and the preparedness of those involved to make the journey are not clear. This study explored the perceptions of healthcare providers in the Irish epilepsy care ecosystem to understand their level of readiness to realize the benefits of an integrated PCC model. Ethnographic fieldwork including observations of different clinical settings across three regions in Ireland and one-to-one interviews with consultant epileptologists (n = 3), epilepsy specialist nurses (n = 5), general practitioners (n = 4), and senior healthcare managers (n = 3) were conducted. While there is a person-centered ambiance and a disposition toward advancing integrated PCC, there are limits to the readiness of the epilepsy care environment to fully meet the aspirations of healthcare reform. These are the following: underdeveloped healthcare partnerships;, poor care coordination;, unintended consequences of innovation;, and tension between pace and productivity. In the journey from policy to practice, the following multiple tensions collide: policy aims to improve services for all patients while simultaneously individualizing care; demands for productivity limit the time and space required to engage in incremental and iterative improvement initiatives. Understanding these tensions is an essential first step on the pathway to integrated PCC implementation

Trusting relationships between patients with non-curative cancer and healthcare professionals create ethical obstacles for informed consent in clinical trials: a grounded theory study

Background: Clinical trial participation for patients with non-curative cancer is unlikely to present personal clinical benefit, which raises the bar for informed consent. Previous work demonstrates that decisions by patients in this setting are made within a ‘trusting relationship’ with healthcare professionals. The current study aimed to further illuminate the nuances of this relationship from both the patients’ and healthcare professionals’ perspectives. Methods: Face-to-face interviews using a grounded theory approach were conducted at a regional Cancer Centre in the United Kingdom. Interviews were performed with 34 participants (patients with non-curative cancer, number (n) = 16; healthcare professionals involved in the consent process, n = 18). Data analysis was performed after each interview using open, selective, and theoretical coding. Results: The ‘Trusting relationship’ with healthcare professionals underpinned patient motivation to participate, with many patients ‘feeling lucky’ and articulating an unrealistic hope that a clinical trial could provide a cure. Patients adopted the attitude of ‘What the doctor thinks is best’ and placed significant trust in healthcare professionals, focusing on mainly positive aspects of the information provided. Healthcare professionals recognised that trial information was not received neutrally by patients, with some expressing concerns that patients would consent to ‘please’ them. This raises the question: Within the trusting relationship between patients and healthcare professionals, ‘Is it possible to provide balanced information?’. The theoretical model identified in this study is central to understanding how the trusting professional-patient relationship influences the decision-making process. Conclusion: The significant trust placed on healthcare professionals by patients presented an obstacle to delivering balanced trial information, with patients sometimes participating to please the ‘experts’. In this high-stakes scenario, it may be pertinent to consider strategies, such as separation of the clinician-researcher roles and enabling patients to articulate their care priorities and preferences within the informed consent process. Further research is needed to expand on these ethical conundrums and ensure patient choice and autonomy in trial participation are prioritised, particularly when the patient’s life is limited