A study of the health of Irish born people in London: the relevance of social and economic factors, health beliefs and behaviour.

This thesis argues that the health of Irish people in London is influenced by factors arising in both Ireland and Britain. Using different qualitative methods, the perceptions and experiences of Irish born people in London and professionals working with the Irish community were elicited. High levels of social distress, poor health and disability were evident and related to the experience of being Irish in London. Psychosocial factors associated with low income, poor housing and living in deprived localities added to the effects of discrimination and low socio-economic position. The insidiousness and specificity of anti-Irish racism evoked persistent feelings of insecurity, impacted on identity, access to health care and influenced ways of coping. Factors relating to earlier life in Ireland may also account for poor health. Resentment about unfairness which compelled interviewees to leave Ireland, and failure to acknowledge their remittances persisted long after the experience of culture shock and homesickness. Aspects of childhood, schooling and Irish society, abuse in institutions or by family were clearly linked to physical or mental ill-health by interviewees. Factors from both countries influenced health beliefs and behaviour. Smoking and alcohol were culturally acceptable strategies for coping with life's difficulties and although harmful, afforded dignity and control in a hostile environment. Religious or spiritual beliefs and practices, contact with Ireland and a sense of belonging in both countries were associated with better health and greater service uptake. Contrary to expectations there was considerable willingness to discuss painful, emotional issues and engage with culturally sensitive services. The pathways by which negative experiences impact upon health are not totally clear but the data highlight the relevance of psychosocial explanations. The thesis demonstrates a relationship between being Irish in London and ill-health but reveals the relevance of childhood experiences and factors associated with Ireland in understanding the complexity of the Irish health experience

Promoting cultural competence in health care through a research based intervention in the UK.

There is an urgent need to develop cultural competence among nurses and other care workers if they are to meet the needs of the diverse populations they serve, yet there is limited clarity about what this means, or how it can be measured. To date few attempts have been made to measure the effectiveness of education and training programmes which are designed to promote cultural competence. A research project commissioned by mental health service providers was undertaken to deal with the increasing need for cultural competence in a number of mental health care settings. It involved the delivery of a training intervention with an assessment of cultural competence before and after the intervention. The training intervention was negotiated with the participating teams and was based on the Papadopoulos, Tilki & Taylor model (1998). The project included the design and development of a tool for assessing cultural competence (CCATool). The paper discusses the challenges faced by the trainers during this intervention and proposes a set of principles for the development of effective cultural competence programmes

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

Forgotten Irish

The research was commissioned by the Ireland Fund of Great Britain to inform its Forgotten Irish Campaign and decisions about where to deploy funds most effectively. It aimed to identify groups of Irish people who have experienced problems settling in Britain but who, for personal or economic reasons, are reluctant or unable to return to Ireland. They may be isolated and lack support in Britain, especially as they get older, but have little contact with family in Ireland. It is this group which has become the focus of the Forgotten Irish Campaign. The research used a range of evidence – from national statistics, local research reports and key informant interviews – to identify particular groups who suffer disadvantage and specific issues which disproportionately affect the Irish population. Some of these groups – such as single elderly men – are well known to organisations working with the Irish community. The research provides further evidence of the inter-related problems which they face. The research also uncovered evidence of other problems which particularly affect the Irish population in Britain and of groups within the Irish community who face specific difficulties but whose needs are not widely acknowledged either by mainstream service providers or by Irish services

Minimizing complications during retropubic radical prostatectomy - is ureteral stenting necessary?

<p>Abstract</p> <p>Objectives and aims</p> <p>To avoid damage to the ureters during bladder neck preparation in radical prostatectomy for prostate cancer, it may be helpful to insert ureteral stents temporarily or to intravenously administer indigo carmine dye for enhanced visualisation of ureteric orifices. We evaluated our bladder neck preserving technique at radical prostatectomy with regard to ureteric injuries.</p> <p>Patients and methods</p> <p>We analysed 369 consecutive radical prostatectomies operated in our clinic in a bladder neck preserving technique. The following parameters were assessed in this retrospective study: number of prophylactic ureteric stent insertions, application of indigo carmine dye, observed injuries of the ureters by the surgeon, postoperative increase of serum creatinine and postoperative status of kidney ultrasound.</p> <p>Results</p> <p>In 7/369 prostatectomies (1.90%) a ureteric stent insertion was performed, indigo carmine was not applied to any patient at all, yet no intraoperative injury of a ureter was observed by a surgeon. No revision was necessary due to a ureteral injury within the observation period of one year after surgery. In 17 patients with preoperative normal creatinine value a pathological value was observed on the first postoperative day (mean 1.4 mg/dl). In these patients no consecutive postrenal acute renal failure was observed, no hydronephrosis was monitored by ultrasound and no further intervention was necessary.</p> <p>Conclusions</p> <p>Bladder neck preserving operation technique does not implicate the need of prophylactic ureteric stent insertions and has no higher incidence of ureteric injuries.</p