A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems

Aim: To report findings of a systematic review and meta-synthesis of qualitative studies exploring public health nurses’ perceptions and experiences of identifying and managing women with perinatal mental health (PMH) problems. Background: Public health nurses play a key role in supporting women who experience PMH problems and several qualitative studies have explored their role. Design: Systematic review and meta-synthesis. Data sources: A comprehensive search was developed and multiple databases were searched from 2000–2015. Review methods: Studies that employed qualitative methods to explore experiences of public health nurses in identifying and managing women with PMH problems were included. Two reviewers independently assessed the methodological quality of studies. Themes, concepts and interpretations were extracted and synthesized using the process of thematic analysis. Results: Fifteen papers including 14 unique qualitative studies were included. Two overarching themes were identified: ‘conceptualization and detection of PMH problems’ and ‘barriers and facilitators to management’. The former of these comprised several subthemes including the use of formal screening tools vs. clinical intuition and challenges encountered in detection. The latter theme, barriers to management included availability of referral pathways and time. In terms of facilitators, training, public health nursing interventions, support groups and referral pathways were identified as factors that optimize management. Conclusions: Public health nurses use a variety of methods to identify women with PMH problems. However, several support structures are needed to optimize management including access to appropriate referral pathways, support groups and relationship continuity

Promoting mutuality in a family-centred service

peer-reviewedFostering mutual relationships, where the expertise of all parties is valued and promoted, is central to providing a supportive environment in a family-centred service. In this article, the nurse manager of a home support and respite service reflects on her working relationship with families to illustrate an example of the complexity of family-centred care and its application in practice.ACCEPTEDpeer-reviewe

Nurses' perceptions of their role in rehabilitation of the older person

peer-reviewedAim The aim of the study was to explore nurses’ perceptions of their role in rehabilitation of the older person. Method Nine participants were interviewed in two rehabilitation units in Ireland. Data were transcribed and analysed using Colaizzi’s (1978) framework. Findings Three main themes emerged: care delivery, collaboration and autonomy/empowerment. Conclusion Nurses have an important role in the rehabilitation of older people, which is often undervalued and ill-defined. Nurses need to recognise and articulate their contribution and value.ACCEPTEDpeer-reviewe

Survey of midwives' perinatal mental health knowledge, confidence, attitudes and learning needs

BackgroundMidwives have a primary role in facilitating the first stage of perinatal mental health risk reduction through inquiring about perinatal mental health, identifying risk factors and current perinatal mental health problems, providing support or crisis intervention, referring for treatment and decreasing stigmatisation.AimsThe aims of this study were to determine midwives’ (a) knowledge of and confidence to identify and manage perinatal mental health problems, (b) attitudes towards women who experience severe mental illness and (c) perceived learning needs.DesignA cross-sectional survey design.MethodsThe study was conducted between September 2016 and April 2017 in seven Maternity services in the Republic of Ireland with a purposeful non-random convenience sample of midwives (n = 157). Data was anonymously collected utilising the Perinatal Mental Health Questionnaire, the Mental Illness: Clinician’s Attitudes scale and the Perinatal Mental Health Learning Needs questionnaire.FindingsMidwives indicated high levels of knowledge (71.1%) and confidence (72%) in identifying women who experience depression and anxiety however, they reported less confidence in caring (43.9%) for women. Only 17.8% (n = 28) of midwives felt equipped to support women whilst 15.3% (n = 24) reported having access to sufficient information. Midwives desire education on the spectrum of perinatal mental health problems. The mean score for the Mental Illness: Clinician’s Attitudes scale was 36.31 (SD = 7.60), indicating positive attitudes towards women with severe mental illness.ConclusionMidwives require further education on perinatal mental health across cultures with a skill focus and which explores attitudes delivered in a study day format

Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: an integrative review

Background Perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. Aim To synthesise primary research on midwives’ perceived role in Perinatal Mental Health (PMH). Design Integrative review. Methods Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. Findings A total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. Conclusions and implications for practice The findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit

Cultivating support during COVID ‐19 through clinical supervision: A discussion article

Aim: This article aims to discuss how clinical supervision is an important approach in supporting frontline nurses and students during and post COVID‐19 through the lens of the nursing metaparadigms. Design: Discussion article. Methods: Discourse of the literature considering the importance of working collaboratively with healthcare and educational organisations in operationalising clinical supervision. Results: The evidence base supporting clinical supervision as an effective support strategy for nurses exists, however, its implementation and practice has become sporadic. A resurgence is required to support student's and nurse's during this pandemic. It is timely for nurse educators to creatively engage with clinical partners in supporting clinical supervision to enhance both nurses and students pandemic practice experiences. Clinical supervision is proposed as one strategy to support and guide both nurses and students to develop, strengthen and challenge the effectiveness of their care during COVID‐19

Pathways for nutrient loss to water with emphasis on phosphorus

Teagasc wishes to acknowledge the support of the Environmental Research Technological Development and Innovation (ERTDI) Programme under the Productive Sector Operational Programme which was financed by the Irish Government under the National Development Plan 2000-2006.End of project reportThe main objective of this project was to study phosphorus (P) loss from agricultural land under a range of conditions in Ireland, to quantify the main factors influencing losses and make recommendations on ways to reduce these losses. This report is a synthesis of the main conclusions and recommendations from the results of the studies. The final reports from the individual sub-projects in this project are available from the EPA (www.epa.ie).Environmental Protection Agenc

TLR-mediated activation of Waldenström macroglobulinemia B cells reveals an uncoupling from plasma cell differentiation

Waldenstr¨om macroglobulinemia (WM) is a rare malignancy in which clonal B cells infiltrate the bone marrow and give rise to a smaller compartment of neoplastic plasma cells that secrete monoclonal immunoglobulin M paraprotein. Recent studies into underlying mutations in WM have enabled a much greater insight into the pathogenesis of this lymphoma. However, there is considerably less characterization of the way in which WM B cells differentiate and how they respond to immune stimuli. In this study, we assess WM B-cell differentiation using an established in vitro model system. Using T-cell–dependent conditions, we obtained CD1381 plasma cells from WM samples with a frequency similar to experiments performed with B cells from normal donors. Unexpectedly, a proportion of the WM B cells failed to upregulate CD38, a surface marker that is normally associated with plasmablast transition and maintained as the cells proceed with differentiation. In normal B cells, concomitant Toll-like receptor 7 (TLR7) activation and B-cell receptor cross-linking drives proliferation, followed by differentiation at similar efficiency to CD40-mediated stimulation. In contrast, we found that, upon stimulation with TLR7 agonist R848, WM B cells failed to execute the appropriate changes in transcriptional regulators, identifying an uncoupling of TLR signaling from the plasma cell differentiation program. Provision of CD40L was sufficient to overcome this defect. Thus, the limited clonotypic WM plasma cell differentiation observed in vivo may result from a strict requirement for integrated activation

Evaluating scenarios to reduce phosphorus transport in surface waters from slurry applications in temperate grasslands

Publication history: Accepted - 7 April 2022; Published online - 30 May 2022.This study evaluates a range of scenarios to reduce soluble reactive phosphorus (SRP) losses using the surface runoff phosphorus transport model (Surphos) to simulate the application of liquid manure (slurry) to grassland catchments. Surphos was applied using data from two contrasting sites in the Republic of Ireland and Northern Ireland. It explored scenarios that investigated changes to the timing of slurry applications, based both on policy (i.e. a “closed” period where regulations prohibit any slurry spreading) and on climate-based restrictions, where soil moisture and antecedent rainfall were important factors. The observed data showed a considerable spatial variability in runoff at both sites, which resulted in a corresponding variable range of SRP losses predicted by the model. However, at both sites the model results showed that maintaining a closed period led to a greater reduction in SRP losses than opening this period up to slurry applications under climate-based restrictions.This work was supported in part by the Department of Agriculture, Environment and Rural Affairs (DAERA) under an Evidence and Innovation Grant [Award No. 17-4-08]