Investigation of the lived experiences and illness perceptions of adults with sudden onset neurological conditions

Purpose: The systematic review summarised the literature on the impact of patient illness perceptions on health outcomes and coping after an acute neurological event, guided by Leventhal’s Self-Regulatory Model (SRM). The empirical study investigated individuals’ lived experiences of emotionalism, a sudden onset neurological disorder characterised by involuntary laughter and crying. A further aim was to develop a questionnaire measuring beliefs about emotionalism based on patients’ perspectives. Method: The review identified seventeen articles through database searches using predefined inclusion criteria. In the empirical paper, eighteen individuals took part in a qualitative study to explore their experiences of emotionalism. Results: Findings provided support for the SRM in acute neurological populations. Negative illness perceptions were associated with a range of poor health outcomes and unhelpful coping behaviours. The empirical paper provided rich individual accounts of the social and personal impact of emotionalism. Four themes were identified and used to develop a questionnaire measuring beliefs about emotionalism. Conclusions: Both chapters emphasise the value of eliciting patient beliefs about their neurological condition and of providing support at the early stages of recovery. The clinical implications and directions for future research were discussed as was the need for further validation of the questionnaire

‘Emigration is a matter of self-preservation. The working conditions . . . are killing us slowly’: qualitative insights into health professional emigration from Ireland

Background Achieving a sustainable health workforce involves training and retaining sufficient staff to deliver health services. The Irish health workforce is characterised by a high level of emigration of Irish-trained staff and a heavy reliance on internationally trained staff. This paper presents qualitative findings from a mixed - method study of doctors, nurses and midwives who have recently emigrated from Ireland. Methods Using Facebook, this study elicited 556 (388 completed) responses to an exploratory mixed-method online survey in July 2014. Respondents provided rich responses to two free-text questions, one on health worker return (N = 343) and another on he alth professional emigration (N = 209) from the source country (Ireland). Results Respondents emigrated because of difficult working conditions in the Irish health system (long working hours, uncertain career progression), which compared poorly with conditions in the destination country. Respondents‘ experiences in the destination country vindicated the decision to emigrate and complicated the decision to return. Their return to Ireland was contingent upon significant reform of the Irish health system and an improvement in working conditions, expressed, for example, as: \u27It’s not about the money, it’s about respect . . . we love working in medicine, but we love our families and health more\u27 (RD283). Conclusions This paper highlights that doctors, nurses and midwives are emigrating from Ireland in search of better working conditions, clear career progression pathways and a better practice environment. The question for the source country is whether it can retain and attract back emigrant doctors, nurses and midwives by matching their expectations

Gone for good? An online survey of emigrant health professionals using Facebook as a recruitment tool

Background Health professionals, particularly doctors, nurses and midwives, are in high demand worldwide. Therefore, it is important to assess the future plans and likelihood of return of emigrating health professionals. Nevertheless, health professionals are, by definition, a difficult population to track/survey. This exploratory study reports on the migration intentions of a sample of doctors, nurses and midwives who had emigrated from Ireland, a high-income country which has experienced particularly high outward and inward migration of health professionals since the year 2000. Methods Health professionals who had emigrated from Ireland were identified via snowball sampling through Facebook and invited to complete a short online survey composed of closed and open response questions. Results A total of 388 health professionals (307 doctors, 73 nurses and 8 midwives) who had previously worked in Ireland completed the survey. While over half had originally intended to spend less than 5 years in their destination country at the time of emigration, these intentions changed over time, with the desire to remain abroad on a permanent basis increasing from 10 to 34 % of doctor respondents. Only a quarter of doctors and a half of nurses and midwives intended to return to practice in Ireland in the future. Conclusions The longer health professionals remain abroad, the less likely they are to return to their home countries. Countries should focus on the implementation of retention strategies if the ‘carousel’ of brain drain is to be interrupted. This would allow source countries to benefit from their investments in training health professionals, rather than relying on international recruitment to meet health system staffing needs. Improved data collection systems are also needed to track the migratory patterns and changing intentions of health professionals. Meanwhile, social networking platforms offer alternative methods of filling this information gap

Applying a typology of health worker migration to non-EU migrant doctors in Ireland

Abstract Background: Research on health worker migration in the Irish context has categorized migrant health workers by country or region of training (for example, non-EU nurses or doctors) or recruitment mechanism (for example, actively recruited nurses). This paper applies a new typology of health worker migrants – livelihood, career-oriented, backpacker, commuter, undocumented and returner migrants (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014) – to the experiences of non-EU migrant doctors in Ireland and tests its utility for understanding health worker migration internationally. Methods: The paper draws on quantitative survey (N = 366) and qualitative interview (N = 37) data collected from non-EU migrant doctors in Ireland between 2011 and 2013. Results: Categorizing non-EU migrant doctors in Ireland according to the typology (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014) offers insight into their differing motivations, particularly on arrival. Findings suggest that the career-oriented migrant is the most common type of doctor among non-EU migrant doctor respondents, accounting for 60 % (N = 220) of quantitative and 54 % (N = 20) of qualitative respondents. The authors propose a modification to the typology via the addition of two additional categories – the family migrant and the safety and security migrant. Conclusions: Employing a typology of health worker migration can facilitate a more comprehensive understanding of the migrant medical workforce, a necessary prerequisite for the development of useful policy tools (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014). The findings indicate that there is some fluidity between categories, as health worker motivations change over time. This indicates the potential for policy levers to influence migrant health worker decision-making, if they are sufficiently “tuned in” to migrant health worker motivation. Keywords: Doctor migration, Migration typology, Medical workforce planning, Health workforce planning, Health human resources for healt

A cycle of brain gain, waste and drain - a qualitative study of non-EU migrant doctors in Ireland.

BACKGROUND: Ireland is heavily reliant on non-EU migrant health workers to staff its health system. Shortages of locally trained health workers and policies which facilitate health worker migration have contributed to this trend. This paper provides insight into the experiences of non-EU migrant doctors in the Irish health workforce. METHOD: In-depth interviews were conducted with 37 non-EU migrant doctors in Ireland in 2011/2012. RESULTS: Respondents believed they had been recruited to fill junior hospital doctor 'service' posts. These posts are unpopular with locally trained doctors due to the limited career progression they provide. Respondents felt that their hopes for career progression and postgraduate training in Ireland had gone unrealised and that they were becoming de-skilled. As a result, most respondents were actively considering onward migration from Ireland. DISCUSSION & CONCLUSIONS: Failure to align the expectations of non-EU migrant doctors with the requirements of the health system has resulted in considerable frustration and a cycle of brain gain, waste and drain. The underlying reasons for high mobility into and out of the Irish medical workforce must be addressed if this cycle is to be broken. The heavy reliance on non-EU migrant doctors to staff the medical workforce has distracted from the underlying workforce challenges facing the Irish medical workforce

The consequences of Ireland’s culture of medical migration

Abstract Background In recent years, Ireland has experienced a large-scale, outward migration of doctors. This presents a challenge for national policy makers and workforce planners seeking to build a self-sufficient medical workforce that trains and retains enough doctors to meet demand. Although, traditionally, medical migration has been considered beneficial to the Irish health system, austerity has brought a greater level of uncertainty to the health system and, with it, a need to reappraise the professional culture of migration and its impact on the Irish health system. Methods This paper illustrates how a culture of migration informs career and migration plans. It draws on quantitative data—registration and migration data from source and destination countries—and qualitative data—in-depth interviews with 50 doctors who had undertaken postgraduate medical training in Ireland. Results Of 50 respondents, 42 highlighted the importance of migration. The culture of medical migration rests on two assumptions—that international training/experience is beneficial to all doctors and that those who emigrate will return to Ireland with additional skills and experience. This assumption of return is challenged by a new generation of doctors whose professional lives have been shaped by globalisation and by austerity. Global comparisons reveal the comparatively poor working conditions, training and career opportunities in Ireland and the relative attractiveness of a permanent career abroad. Conclusion In light of these changes, there is a need to critically appraise the culture of medical migration to determine if and in what circumstances migration is appropriate to the needs of the Irish health system. The paper considers the need to reappraise the culture of medical migration and the widespread emigration that it promotes

Non-EU migrant doctors in Ireland: applying a typology of health worker migration

Research on health worker migration in the Irish context has previously sought to categorize migrant health workers by country or region of training (e.g. non-EU nurses or doctors), by migration channel or mechanism (e.g. actively recruited nurses). This paper applies a recently developed typology of health worker migration, to the experiences of non-EU migrant doctors in Ireland and considers the value of a typology of health worker migration to human resource management internationally