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

The forgotten guidelines: cross-sectional analysis of participation in muscle strengthening and balance & co-ordination activities by adults and older adults in Scotland.

BACKGROUND: In 2011, the UK physical activity guidelines were updated to include recommendations for muscle strengthening and balance & coordination (at least two sessions of relevant activities per week). However, monitoring and policy efforts remain focussed on aerobic activity. This study aimed to assess differences by gender and age in the a) prevalence of muscle strengthening and balance & co-ordination guidelines, and b) participation in guideline-specific activities. METHODS: The sample for the muscle strengthening analyses was 10,488 adult (16-64 years) and 3857 older adult (≥65 years) 2012-2014 Scottish Health Survey respondents. The balance & co-ordination analyses used only the older adult responses. Differences by gender and (where possible) age in guideline prevalence and activity participation were assessed using logistic regression and t-tests. RESULTS: Thirty-one percent of men and 24 % of women met the muscle strengthening guideline, approximately half that of published figures for aerobic physical activity. Nineteen percent of older men and 12 % of older women met the balance & co-ordination guidelines. The oldest age groups were less likely to meet both guidelines compared to the youngest age groups. Differences by gender were only evident for muscle strengthening: more men met the guidelines than women in all age groups, with the largest difference amongst 16-24 year olds (55 % men compared with 40 % women). Participation in relevant activities differed by gender for both guidelines. 'Workout at gym' was the most popular activity to improve muscle strength for men (18 % participated), while swimming was for women (15 % participated). Golf was the most popular activity to improve balance & co-ordination for older men (11 % participated) and aerobics was for older women (6 % participated). Participation decreased in most muscle strengthening activities for both men and women. One exception was golf, where participation levels were as high amongst older men as in younger age groups, although overall levels were low (3 % of all men). CONCLUSIONS: Physical activity policy should aim to increase prevalence of these 'forgotten' guidelines, particularly amongst young women (for muscle strengthening) and older age groups (both guidelines). Gender and age participation differences should be considered when designing population-level interventions

Age-related comparisons by sex in the domains of aerobic physical activity for adults in Scotland.

OBJECTIVE: To investigate the age-related differences in the contributions of the domains of physical activity (PA) for men and women in Scotland who met the current PA guidelines or who were insufficiently active. METHODS: We analysed data from the 2013 Scottish Health Survey (4885 adults (≥ 16 years)). Average weekly minutes of moderate or vigorous PA (MVPA) and the relative contributions to total MVPA were calculated for the domains of: walking, cycling, domestic, leisure, occupational, outdoor, non-team sport, team sport, and exercise & fitness. We performed linear regression analyses to assess differences by 10-year age group, stratified by sex and activity status (1-149 or ≥ 150 min of MVPA per week). These were repeated excluding occupational activity due to concerns with its measurement. RESULTS: For the 64.3% of the sample that met the guidelines, occupational activity was the most prevalent domain accounting for 18-26% of all MVPA for those under 65 years. When excluded, there was no age-related decline in total MVPA (p > 0.05). For the 18.6% of the sample that reported 1-149 min of MVPA per week, domestic activity was the most prevalent domain. Across both sexes and activity statuses, exercise & fitness declined with age and walking was most prevalent in the oldest age group. CONCLUSION: The domains in which adults in Scotland undertake MVPA vary by age group. Policies designed to increase PA should take this into account. Our findings challenge current thinking on age-related changes in activity, with the exclusion of occupational activity mitigating any age-related decline in MVPA.University of Edinburgh College Research Awar