The influence of attachment styles, dyadic processes and affective states on health outcomes of women with breast cancer and their identified significant other

Breast cancer is one of the most common diagnosed cancers in Ireland (National Cancer Registry Ireland (NCRI), 2014). In today’s healthcare system women with breast cancer are now more than ever being supported through their disease trajectory by the significant others in their lives. While significant others of women with breast cancer are increasingly being involved in their care, little research has been conducted that explores the relationship between women with breast cancer and their significant other. The rationale for this study was prompted by the current change within the Irish healthcare system whereby a transference of breast cancer services to outpatient settings and day procedures means that now more than ever significant others of women with breast cancer are involved in their care. Exploring this relationship is beneficial to healthcare professionals who care for these women as it can aid in further understanding the care needs of these individuals. This study aimed to examine the influence of attachment style, dyadic processes and affective states on quality of life for women with breast cancer and their identified significant other, using the principles of attachment theory (Bowlby, 1969) and underpinned by a framework devised by Pietromonaco, Uchino and Schetter, (2013). A cross sectional correlational survey design was used. Data were collected using a multi-scale questionnaire devised by the researcher, consisting of validated instruments which were administered to both the woman with breast cancer and her significant other. The questionnaire consisted of: questions assessing socio-demographics, The Relationship Questionnaire (RQ), The Berlin Social Support Scale, The Hospital Anxiety and Depression (HADS) Scale, The Relationship Satisfaction subscale and the Functional Assessment to Cancer Therapy scale (for use with both Breast Cancer and General Populations). Data were analysed using SPSS software 22.0. The Actor-Partner Interdependence Model (APIM) was used in analysing dyadic data. A convenience sample of women with breast cancer (n=147) and significant others (n=127) was recruited from a pre assessment and an outpatient clinic within a breast care centre, at a large urban hospital in the South of Ireland. A significant other was defined as the individual the woman identified as being most significant in their care, at the current time. Data from 114 dyad pairs (i.e. both the woman with breast cancer and her identified significant other) who completed the questionnaire, were extracted to form the dyad sample in the study. It was found that affective states relating to anxiety and depressive symptoms were strongly and negatively correlated with quality of life for both the women with breast cancer and their significant other (p≤0.001). Significant others were found to report poorer quality of life (M=77.3, SD=4.25) than women with breast cancer (M=88.6, SD=10.61). Furthermore, the dyadic data analysis identified that being a significant other of a woman with breast cancer was associated with a lower quality of life (p≤0.05). The study identified that the principles of attachment theory are applicable to the breast cancer context. The framework devised by Pietromonaco et al., (2013) was found to be applicable to this context, although adaptation was required. This research has provided substantial rationale for studying dyads in the breast cancer context as it has highlighted the impact that a breast cancer diagnosis has not only on the woman with breast cancer but on her significant other and their relationship. Thus, clinicians, practitioners and researchers need to be aware of the important role that dyadic relationships play in the care trajectory of the woman with a breast cancer diagnosis and their impact on the woman’s significant other

Is there a Racial Gap in Market Facilitation Program Payments and Total Government Payments?

Master of ScienceDepartment of Agricultural EconomicsNathan P HendricksIn 2017, there was 32,910 Black or African American farms that were primarily located in the southeast and mid-Atlantic and had an average farm size of 125 acres. In comparison, 1,963,286 farms were White and had an average farm size of 431 acres (USDA NASS, 2017). In 2017, Black producers received $59 million (0.7$8.9 billion (99%) of total government payments (USDA NASS, 2019). Black farms received 0.17 percent of the total share of Market Facilitation Program payments compared to White farms who received 99.18 percent of payments (Giri et al., 2022). Some policymakers have raised concerns about this apparent disparity in government payments between Black and White farms. However, no existing analysis explains the source of the racial gap. In this thesis, I conducted two sets of analysis using the micro-level Census of Agriculture data from 2017 to provide new insights on the racial gap. The first analysis examined the amount of payment from the 2018 Market Facilitation Program (MFP) that farms were eligible to receive and provided a decomposition to measure how much of the difference in eligible payments was due to differences in yield, acreage, and the share of crops produced. The second analysis utilized six regressions that estimated the average difference in total government payments in 2017 for Black farms compared to White farms. The regressions showed, on average, how much more or less money Black farms received when some agricultural factors were held constant. Findings from the first analysis concluded that conditional on a particular farm size, the 2018 MFP payment eligibility was larger for Black farms rather than White farms. But, because black farms tend to be smaller on average, the average MFP payment among Black farms was smaller than for White farms. Black farms were eligible for a smaller 2018 MFP payment than White farms mainly due to their farm size compared to their yields and crops they grew. The second analysis found that Black farms received on average about $7,395 less in government payments in 2017 compared to White farms. About twenty percent of this gap can be explained by differences in farm size. Even after controlling for farm size, county, the farm’s location, gender of the farmer, and type of commodities produced, black farms still received on average$4,959 less government payments

Growing Up in Ireland: Growing up and developing as an adult: A review of the literature on selected topics pertaining to cohort ’98 at age 20 years. ESRI Report December 2020.

The goal of this report is to provide research information on selected potential research questions using data collected in interviews with 20-year-olds and their parents. At the time of writing, fieldwork was under way, so the topics of the survey were known but not the outcome of the interviews. The research questions address the central outcomes of the Growing Up in Ireland study that contribute to building developmental trajectories from childhood to adulthood: socio-emotional well-being; educational and cognitive development; physical health and growth. Three potential research questions are outlined under each outcome and provide a short supporting review of the national and international literature, followed by a description of the measures in Growing Up in Ireland useful in exploring the topic. While there is a wide array of possible research questions with a dataset such as this, the selected topics are those that offer new potential given the measures at this particular wave and/or are particularly salient to this phase of the life-course

The association between nurse staffing and quality of care in emergency departments: A systematic review

Background: The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak. Methods: We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach. Results: We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department. Conclusion: Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings. Tweetable abstract: Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest

Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives

Aim: The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA). Background: Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care. Methods: A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n = 103 items). Results: Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management. Conclusion: The identified factors are reflective of an ever-changing health care environment. Implications for Nursing Management: Potentially, after further testing, this instrument could be used by nursing management and educators to measure clinical leadership needs, inform the design of clinical leadership training programmes and provide valuable information about health care leadership development

Evaluation of the pilot implementation of the Framework for Safe Nurse Staffing and Skill-Mix in Emergency Care Settings - Report 2

Arising from efforts to introduce a systematic approach to the determination of safe and appropriate nurse staffing levels in the Irish healthcare system, where historical need and legacy issues were often key determinants in staffing decisions, the Department of Health published a policy document titled: A Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland (Department of Health 2018) (henceforth referred to as the Framework). Based on the research undertaken by a research team from University College Cork, the University of Southampton, University of Technology Sydney, and National University of Ireland Galway (Drennan at al. 2018), this report outlined a number of recommendations to ensure staffing levels in medical and surgical wards in acute hospitals were safe and effective in the delivery of care. In a continuation of this evidence-based approach, the Department of Health made the decision to extend the model to develop a framework for emergency care settings; this resulted in the publication of a draft document titled: A Pilot to Implement the Framework for Safe Nurse Staffing and Skill Mix in Emergency Care Settings (Department of Health, 2018). This document outlined a number of recommendations to ensure the safe staffing of emergency care settings. Central among these recommendations was the introduction of a systematic approach to the determination of staffing levels, the adjustment of skill mix to ensure that care was delivered by 85% RN and 15% HCA, and to ensure that the CNM 2 role was 100% supervisory. The research in this report provides data on the implementation of the recommendations of the Draft Framework in three emergency departments (EDs) and one injury unit (IU). Exploring the extent to which changes in staffing within the selected departments have had an impact on patientsâ experience within the emergency care setting, as well as on the experience of the nursing and healthcare assistant workforce and on organisational factors, this report outlines the methods and results of the programme of research examining the impact of introducing a pilot safe staffing framework to emergency care settings

Factors associated with crisis pregnancies in Ireland: Findings from three nationally representative sexual health surveys

Background: Findings on the demographic and sexual health characteristics associated with the experience of a crisis pregnancy is important to inform the public health policy of a country, including Ireland. Findings from other jurisdictions have suggested that certain demographic groups are at risk for unintended pregnancies and the disparity between the groups have been growing in recent years. Ireland is a country which experienced much economic and societal change in the first decade of the 21st century, changes which are likely to have affected demographic variables pertaining to sexual health. The current study had two aims: to investigate changes in the socioeconomic characteristics associated with crisis pregnancies over a seven year period [2003 to 2010], and to investigate the recent [2010] socioeconomic risk factors associated with crisis pregnancies in Ireland. Methods: The study compared the results from 18-45 year old women using data from three broadly similar nationally representative Irish sexual health surveys carried out in 2003, 2004-2006 and 2010. Chi square analysis compared of the socioeconomic characteristics across the seven year period and found that a higher proportion of women with two or more children and women for whom religion was not important reported a crisis pregnancy in 2010 compared with earlier years. A logistic regression then investigated the sexual health history and socioeconomic factors associated with the experience of a recent crisis pregnancy using the most recent 2010 data. Results: Receipt of sex education and contraception use at first sex significantly predicted the experiencing of a recent crisis pregnancy. Younger women and those with a lower level of education were more likely to report having experienced a recent crisis pregnancy. Conclusion: Similar demographic groups are at risk for experiencing a crisis pregnancy in Ireland compared with international research, yet the disparities between demographic groups who have experienced a crisis pregnancy appear to be decreasing rather than increasing over a seven year period. Recommendations are made with regard to the provision of continued sex education throughout the lifespan, particularly for those women who are at an increased risk of experiencing a crisis pregnancy

Explaining the Source of Racial Disparities in Market Facilitation Program (MFP) Payments

This paper aims to analyze the distribution of Market Facilitation Program payments and explain the sources of disparity of those payments by farm operator race. In this paper, we use farm-level data from the Census of Agriculture to estimate the payments each farm was eligible to receive from the 2018 and 2019 Market Facilitation Program. We find that farms with a White operator were eligible to receive significantly larger payments than farms with a non-White operator. Most of the disparity forfarms with a Black operator is due to differences in average farm size, since there are few large farms with a Black operator. The disparities for farms with an operator of other races were roughly half due to farm size and half due to the location of these farms and the types of commodities they tend to produce

Perceived importance and performance of clinical leadership in practice: a cross-sectional study of nurses and midwives of all grades

Aim To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice. Background Clinical leadership is central to the provision of person‐centred care. However, little is known about how nurses and midwives perceive this in practice. Methods Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross‐sectional study design (n = 324). The clinical leadership needs analysis instrument was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager. Results Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p < .01) and Financial & Service Management (p = .02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p < .01]. Conclusion There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff. Implications for Nursing Management Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice

The book of dissertations by third year students of SAUL University of Limerick 2009-2010

The book of dissertations by third year students of SAUL University of Limerick 2009-201