Due to advances in the management of patients with Haematological disorders, an increased number of patients are being teated in units which historically dealth with Oncological conditions. There are a significant number of education programmes and Post Graduate Education programmes available for Oncological Nursing, but very limited education is available for nurses dealing with Haematlogical conditions. As a result the concept of a 5 day Haematology Education Programme was formulated. The programme was initally established in August 2002, the aim of the programme was to provide nurses in St. James's Hospital and nurses working in the Haematology setting throughout Ireland with an overview of a wide variety of topics relating to the discipline.

Patients attending our rapid diagnostic breast clinic are aware that they may have a breast cancer. Because of this they are highly anxious in anticipation of their clinic visit.The Tallaght breast unit team wanted to send out an information leaflet with the patient appointment details that would inform patient exactly what to expect. It has been well documented that information giving can significantly reduce anxiety(Coulter 1998)In order to ensure that the written information given was patient friendly, we enlisted the assistance of our former breast cancer patient, who had herself been through the rapid diagnostic clinic expierence. She is also a literacy teacher. As a result of our collaboration we hope that our leaflet is clear and easy to understand for patients who attend our service.

This study evolved over a number of years, during which time the researcher was involved in the setting-up and coordinating of a nurse-led heart failure service at a regional hospital in the west of Ireland. Having joint working arrangments, the researcher was also employed as a Clinical Nurse Specialist in Practice Nursing at the time. Whilst the service proved to be an effective intervention, reflected in reductions in hospital lenght of stay, readmission rates and optimization of medication regimes, the researcher was cognisent of the implications for this population with regard to access to the service.

To invest in the development of Clinical Leaders in Nursing and Midwifery.

This study was carried out because although loneliness is often discussed by people facing end-of-life situations, there is very little research on the topic.

This Pactice Development Strategy has been developed as part of the on going work of the practice development team. It provides practitioners with a framework to support and guide them in their practice developemnt initiatives. It was recognised that in order for practice development to be managed strategically within the region, practice development personnel needed to work together as a team and adopt a collaborative standardised approach to practice development.

There are in excess of 11,000 presentations of deliberate self harm (DSH) to our acute general hospitals each year (National Suicide Research Foundation, 2005). Opportunity lies in the provision of effective evidence-based and standardised care in terms of assessment, treatment and referral of self harm. A significant number of self harm presentations are due to repeat acts and unfortunately some will be fatal. Effective assessment of suicide intent has the potential to prevent future suicidal behaviour as well as instigating appropriate treatment and referral pathways. A proposal to pilot nursing assessment of self harm in Accident and Emergency Departments (A&E) was developed by key stakeholders in nurse education and suicide prevention in the South East and submitted to the National Council for the Professional Development of Nursing and Midwifery in April 2002. The proposal included the introduction of a suicide intent scale. Following an initial training programme, a suicide intent scale was utilised by nursing staff in A&E, Wexford General Hospital and evaluated over a period of nine months. The NSRF undertook independent scientific evaluation of the outcomes of the suicide awareness programme. The study is in line with priorities determined by Reach Out, the National Strategy for Action on Suicide Prevention 2005-2014 (HSE, 2005) through raising nursing staff awareness of the public health issue of suicide/deliberate self harm and by improving the efficiency and quality of nursing services offered to persons who present to acute hospitals with deliberate self harm. The study findings indicate evidence to positively support nursing assessment of DSH using a suicide intent scale in terms of assessing behavioural characteristics of individual clients and their suicide risk. Enhanced confidence levels of nursing personnel in caring for suicidal clients was demonstrated by staff who participated in an education programme related to risk assessment and specifically the use of a suicide intent scale.The Accident and Emergency (A&E) department is an important gateway for treatment of deliberate self harm (DSH) patients. The National Registry of Deliberate Self Harm (National Parasuicide Registry) has established the extent of the problem of deliberate self harm presentations to A&E departments in Ireland (National Suicide Research Foundation, 2004; 2005). The issues of the increasing numbers of self harming patients attending A&E and the quality of care they might be receiving are the focus of this study. Inadequate assessment of deliberate self harm patients will result in failure to diagnose treatable underlying conditions such as depression and alcohol dependence. This will lead to inadequate treatment plans, poor compliance with treatment and increased risk of repeated suicidal behaviour, both fatal and non-fatal.

During the last 15-20 years there has been a plethora of reports, studies and evidence identifying very clearly that people with a learning disability have poorer physical and mental health than the rest of the population, and also access mainstream primary care services (GP) less than the general population. With all of the evidence having been around for a number of years now, the starting point, and initial question asked by the Project Team was, ”Why is it that very little has changed or improved?” An audit of Learning Disability in Northern Ireland (McConkey et al 2004) suggests that a limitation of some of the health screening research in Northern Ireland is that although it reports on the number of unmet needs identified, and referrals made to other services, there is no clear indication of the action that these other services subsequently take, and the outcomes achieved for the person with a disability. Therefore, this project centred around “Actioning Health” rather than simply screening, and it was decided to develop and test out the concepts of Health Facilitation and Health Action Planning as endorsed by Valuing People (DoH 2001) within one of the Trust’s statutory residential units for adults with a learning disability.

Nursing staff within the learning disability hospital voiced their dissatisfaction with the care given to patients while they were receiving treatment in the acute hospital. In late 2003, an audit was carried out by the Northern health and SS Board as part of a monitoring programme, to look at the care given to people with a learning disability and people with mental health problems while they were in the acute hospital. It was felt that a joint working party, involving staff from both the acute sector and Muckamore, would be a useful mechanism to address issues of communication and care and drive any changes required.

“Breathlessness” is a problem commonly encountered in the palliative care of many people with advanced cancer as well as other non-malignant conditions such as Heart Failure and Chronic Obstructive Pulmonary Disease. There was concern that some of our patients especially in the acute sector continue to die with distressing breathlessness. Because of this, a decision was taken to audit current practice, implement process of change so that patients will receive appropriate and effective care across primary and secondary care interface.

An audit of the clinical learning environment is a key recommendation of An Bord Altranais (An Bord Altranais, 2000)

To explore the research culture among nurses in Foyle H& SS Trust To determine the capacity for research among nursing staff To identify the training needs of nursing staff in the Trust

In response to the challenges encountered in providing sufficient nurses and midwives for the Irish healthcare service, the Health Service Executive set up a National Project Steering Group to put into effect the actions required to address and rectify the nursing supply. International Recruitment is viewed as one part of the overall solution. Some of these nurses are required to undergo a period of clinical adaptation and assessment in addition to induction and orientation. The clinical adaptation is essential for some candidates to comply with requirements to Register with An Bord Altranais (Irish Nursing Board). This project aims to explore the length of time this takes and the barriers experienced

This research was conducted for two reasons. Firstly, the author was a facilitator for a community based antenatal education programme. I was aware that antenatal classes were not being taken up by many mothers. Secondly, this research was conducted as partial fulfillment for a Masters in Science (Women's Health).

The assessment of carers’ need has become central to the Government policy on informal carers. Despite the importance placed upon ‘carers’ needs assessment’, a well-defined framework for assessment does not exist and ‘unmet carer need’ is not routinely reported in practice. This suggests that community health care professionals are not working within a recognised framework for assessment. The aim of this study is to evaluate the community health care professionals’ perspective on the assessment of carers’ needs.

During the last decade there has been an increasing awareness of the prevalence and serious impact of domestic violence on adult victims and their children. Recent research has dispelled the myth that domestic violence was less likely to occur during pregnancy and has in fact highlighted that pregnancy can itself be a high risk factor for domestic violence. A survey of 127 women living in refuges in N.Ireland found that 60% of them had reported violence during pregnancy (Casey 1989). Studies in the U.S.A. have shown that 37% of obstetric patients were at risk of abuse and 48% of abused women were assaulted during pregnancy. Two Confidential Enquiry into Maternal Deaths reports, “Why Mothers Die 1994-1996 and 1997-1999” also endorse this ethos. These reports made key recommendations for professionals providing services to pregnant women. Following the 1994 -1996 Enquiry report Newry & Mourne Trust developed inter-agency guidelines for the identification of vulnerable women who are pregnant and the provision of support for them and their families. These guidelines relate to the identification of women during the antenatal stages of pregnancy and therefore encompass the care of the pregnant woman, the unborn child and any other children within the family. This audit was conducted to assess practice against the above interagency guidelines using funding provided by the Regional Multiprofessional Audit Group (RMAG).

Introduction This paper is a report on an action research study undertaken on a general surgical ward. The study focuses on nursing handover report and the process of implementing a change from office based handover to bedside patient handover. It describes the benefits achieved from introducing such a change. Aims: The aim of this study is to introduce a change from office based handover to bedside handover with the intention of achieving a more effective communication process.

This bereavement support midwife post is the first of its kind in Northern Ireland, established in December 2003. The post provides support and counselling to parents who have lost a child through miscarraige, stillbirth, neonatal death or the death of an older child.

The objectives of the Best Practice Initiative were to improve overall compliance with clinical practice standards, promote best practice and facilitate change implementation within the Emergency Department.

Blood pressure is a silent condition. The aim of the iniatitive was to develop an educational tool via the hand-held blood pressure card which empowers patients in their management of hypertension.

To develop a clinical care pathway for patients with CHD and to ensure a joined up service between hospital and community

The family planning service in the trust is provided at 9 clinics perweek across five locations and staffed by 4 part time doctors,2 contracted nurses part time clerical staff and bank nursing staff. This leads to a fragmented service sometimes resulting in inappropriately booked appointments.Current waitng times for 1st appointment are up to 18 weeks. The appointment system is kept manually by different clerical officers and family planning clerical officer has only access to diary for clinic she is working at reslting in delays in arranging further appointments.The service has evolved in a piece meal and ad hoc manner and little consideration has been given to its organisational effectiveness.

In 2003 twenty-five units comprising of Community Hospitals and Continuing Care facilities in the counties of Cork and Kerry participated in the introduction of a standardised Patient Assessment and Nursing Care Plan documentation package. In the latter half of 2005 Healthcare Quality Quest working with a local expert group carried out a clinical audit to review its subsequent level of implementation and also collated qualitative data to determine nurses likes and dislikes concerning the document layout. Fifteen per cent of patient’s charts (n=203) were randomly selected and data was analysed to determine the level of compliance with each audit measure. In excess of two hundred qualitative responses were elicited in the nurse survey aspect of the exercise. A final report and a confidential copy of individual results were disseminated to Directors of Nursing and Clinical Nurse Managers. Results indicated some area’s of excellent performance where 90% or more of the records met audit standards. Areas of reasonably good practice were identified where 66% or more of records met audit standards. Findings also indicated that some areas of documentation required improvement to meet agreed standards. Nurse’s survey responses indicated that overall the structure of the document was liked and suggestions were offered regarding future document modifications. Publication of results initiated a focused approach which has resulted in individual teams taking responsibility for actions within their own facility while getting organisational support in relation to other findings. This report is regarded as pivotal in the process of enabling staff to further improve the standard of nursing documentation within individual care settings.

Little research is available in relation to stoma care to support practice that is evidence based. Concerns from nurse specialists within the Northern Ireland Stoma Care Forum led to a collaborative approach to the development of protocols. The aim was to address complex nursing issues and provide guidance for nurses in managing clinical problems relating to stoma care.

The idea for a clinical skills fair grew out of a discussion about the availability of clinical policies and guidelines and the perception that some nurses/midwives may not be using them to access information to guide practice in the clinical area. A sub group of the Clinical Nursing Policy and Procedure Committee was set up to project plan this event.

Acute psychiatric admission setting with potential for high levels of stress. Clinical supervision seen as a means to provide support.

This project came about as result of clients needs. Mr Alan George spoke to a number of service users and health care professionals. After a lot of research the evidence available examining the social/psychological needs of clients was paramount. When asked clients felt they would like to have a meeting place where they could go to talk with other people suffering like them and get support.

The origins of the CMP are in a UK-based pilot child development programme begun in 1980. The Public Health Nurses who implemented the pilot project had many other commitments to existing prevention and treatment activities at large and were not able to continue implementing the home visiting programme. It was therefore decided by the former Eastern Health Board to pilot a community based programme using experienced mothers as non-professionals to visit and support other mothers. It was recognised that all parents and particularly those who live in areas of social stress and disadvantage, need support if they are to promote the health and development of their children, their families and the next generation as a whole.

A joint project was undertaken to identify an instrument that would aid Public Health Nurses (PHNs) to deliver a comprehensive service based on client need within the community. It has long been recognised that the most appropriate way to measure community need is to conduct an area or community profile. The Health Strategy proposed the introduction of an inter-disciplinary team-based approach to primary care provision, stating that health needs assessment is central to effective primary care (DOHC, 2001). The composition and numbers of primary care teams to be established are based on health needs assessment, consistent with a population health approach. All PHNs are educated in and strongly recommended to conduct area profiles but the extent to which this actually happens in reality varies (Hanafin, Heuston & Cowley, 2003). Anecdotal evidence suggests that the reason for this is that PHNs perceive area profiles to be complex and time consuming. This issue served as the main impetus for the project. The project of implementing standardised profiles involved collaboration between the Nursing and Midwifery Planning and Development Unit (NMPDU) and the School of Nursing and Midwifery, University College Cork (UCC). Meetings were held with the Directors of Public Health Nursing (DPHNs) HSE South and a commitment to lead out this project through the Assistant Directors of Public Health Nursing (Asst DPHNs) was sought. Collaboration with Asst DPHNs in the HSE, South was necessary in order to create an awareness of the project and obtain their support. They are best placed through their existing role in supporting front line staff to enable implementation of this pro forma. Effectively a community profile is a care plan for the community and necessary for effective public health nursing.

Nurses require ongoing feedback and support to develop and maintain levels of competence. The Framework of Competencies for Registered Nurses was developed and implemented to demonstrate competence of Registered Nurses and to provide evidence of performance management. Competency assessment gives feedback on levels of competence and allows for modification of performance. The Framework gives Clinical Nurse Managers with evidence that Registered Nurses have been professionally developed and progress is monitored.

Ladies who attended Breast Clinic often went back to GP for results of findings at clinic but GP had not received communication yet. Very often they had a diagnosis of malignancy – GP not aware, it was difficult to support ladies. Opinion was sought from Macmillan GP Facilitator and members of Breast Team and idea of compiling a letter was put forward and agreed.

There have been several recent well publicised health care controversies in Ireland e.g. Leas Cross Report (2007), the Lourdes Inquiry Report (2006) & the Nurse Mulholland Case-Naas (2007). The Nursing Practice Development planned a 2-staged Quality Care Project. The aims of this project are  To deliver education to discuss & learn from past legal cases  To inform clinical nurse managers & registered nurses regarding quality care, accountability & clinical supervision  To review systems of nursing care delivery, thereby enabling quality care, accountability, clinical supervision & quality care

The 2004 Value for Money Audit for Distric Nursing within Newry & Mourne highlighted that 61% of District Nursing caseloads was continence related. There have been no prevalence studies in Northern Ireland of people with continence problems, however studies in the UK would suggest 40 adults per 1000 are regularly incontinent. Good Practice in Continence Services (DOH, 2002) reported that the review of continence services recognised geographical variations in the range and quantities of treatment provided and the time spent waiting. This geographical variation was also noted in the numbers of staff trained and the quality of the education and training given. The aim therefore was to review the services within Newry & Mourne Trust in order to provide a high quality continence service for people with bladder and bowel problems.

This project emerged from an Essence of Care Project where it was recognised that the patient gowns were inappropriate. This was also recognised from results of questionnaires that were issued at Breast Clinic. Anecdotal evidence from use of gowns on regular basis demonstrated this fact further. The Breast Clinic is an anxious time for those attending and to have to experience embarrassment compounds this. It can also be very intimate and sometimes an invasion of privacy.

This project is part of a two year Practice Development Programme run by the Royal College of Nursing, Belfast and University of Ulster, Jordanstown to improve existing practices in both hospital and community services. Reasons for chosing the project were as follows: - There is a lack of information available about the wards and community services; - There is a lack of data available on the illness itself, hence relatives lacking understanding about dementia; - There are no Integrated Care Pathways set up yet in dementia services.

This project emerged when nurses in dementia care services identified a need to improve the exeperience of the person living with dementia in residenial care. The Dementia Care Mapping tool, developed by Kitwood & Bredin (1981) was identified as a method of measuring quality of life from the perspective of the person with dementia. Trained Dementia Care Mappers following a period of observation give individual patients and the unit as a whole, a score (a minus score reflecting ill-being and a plus score reflecting wellbeing). Following feedback to staff a plan is developed to enhance the care of persons with dementia.

Although the evidence reflects that pain assessment and management are judged to be a priority, little research has examined the care older people (65 years or over) receive in the acute surgical setting. With the number of older patients requiring surgery increasing, it is important to address pain management issues that are particular to this group of individuals. However, it is evident, from both practice and research, that the creation and dissemination of guidelines, along with extensive education programmes has not resulted in healthcare professionals integrating evidence into daily practice. Thus we must address the wider complex of influences on pain and pain assessment in terms of culture and context if we are to improve pain management practices.

This study considers practice development and in particular the role of facilitation in enabling organizations, clinical teams and practitioners to deliver high quality, innovative and person centred care. The rationale for this study is underpinned by McCormack (2006), Simmons (2004), and Unsworth (2000) who articulated the need for qualitative study to be undertaken to increase understanding of what practice developers mean when utilizing the term facilitation to describe their activities, to explicate how practice developers facilitate change in practice, and to describe how the recipients of facilitation describe this experience.

Work began on the Respiratory Health and Wellbeing Service Framework (RHWSF) in the spring of 2007. During this time it became clear that the emerging standards would impact the practice and roles of the nursing and midwifery workforce involved with caring for patients and clients with respiratory health and care needs. Assessing nurses’ current skills and competencies against those required to deliver the standards would facilitate appropriate learning and development plans. In June 2007, the Chair of the Northern Ireland Regional Respiratory Forum (NIRRF) asked the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) to facilitate a regional project to produce a learning and development strategy for respiratory care (nursing) to support the implementation of the RHWSF standards.

Identified gap in service in relation to supporting parents with pre-school children with difficult behaviour. Currently no second tier services in the Republic of Ireland, it is proposed that an Advanced Nurse Practitioner in Child Health and Parenting could address this identified health need.

Acute hospitals are associated with an increased risk of falling in older people and falls account for at least 40% of all accidents in hospitals. Falls adversely affect patient outcomes in terms of function and quality of life and present a serious challenge for all healthcare professionals to manage this complex issue. Falls occur in all age groups – among children and adolescents as well in the working population – but they are particularly frequent and damaging among the elderly: each year approximately one third of people over 65 and half of those over 80 experience one or more falls. Successful interventions in hospitals have identified a combination of strategies that are best delivered as part of a multi-component program. Components include falls risk screening, modifying environmental risk factors, staff education, patient and family information and multi-disciplinary assessment and treatment. Delivery of these strategies as a sole intervention is not likely to result in reduction in falls. Identifying those at risk allows targeted assessment and intervention.

The Development Framework project, was established in 2003, with an aim to lead, in partnership with relevant stakeholders, the design of a Framework within which registrants in Northern Ireland could best develop in ways that are safe for the public, responsive to need, ethically sound and professionally stimulating. It sought to support and build on the requirements set out in the NMC Code of Professional Conduct Standards for Conduct, Performance and Ethics (2004), and a set of five guiding principles underpinned its design - Accountability, Person-Centeredness, Continuous Learning, Leadership and Integrity.

Within health visiting practice parents were increasingly seeking help and support in managing their childrens' behaviour. Smacking is not an acceptable means of discipline and parents were searching for ideas for alternative strategies to discipline their children. We believe that the rising need may be associated with societal changes also with increasing isolation from extended family, rising divorce and separation and exposure of domestic violence. In addition affluence contributes to behaviour problems as parents want to give their children material goods that they couldn't have in their youth. Only recently Mr Cameron asked that parents "have the courage to say 'no' to their children".- A telling statement that would certainly have seemed alien 40 years ago. Frequently our work with families involves offering parents strategies to take back that control. When children know their boundaries they are more secure and content. This need was coupled with growing waiting lists at the local Child and Family Clinic. There was special interest in this area among a number of health visitors who sought additional training to enhance their work in behaviour therapy and family therapy. This interest was matched by that of the child psychiatrist,Dr Noel Mc Cune, and clinical nurse specialist in the child and adolescent team, Moira Davren, and with their support a number of health visitors set up a behaviour support service in the form of local clinics within the Trust from 1995.

This manual represents the culmination of the first phase of the development of coordinated documents supporting the delivery of evidenced based care for the Public Health Nursing Service, HSE South (Cork & Kerry). The expectation on the delivery of services within care settings is increasing and an impact is the adoption of accreditation processes by health care providers. Accreditation agencies promote standards of care based on evidence-based practice and recommend guideline use to ensure uniformity of practice across the service area. It is perceived as a priority for Public Health Nursing to move towards an accredited service and the application of Policies, Procedures and Guidelines will aid the provision of a high quality service to the older adult in the community, and compare favourably with other health care services. Clinical practice Policies, Procedures and Guidelines are designed to assist practitioners to integrate research findings and expert knowledge within health care settings. Successful Public Health Nursing is dependent on staff knowledge, skills and attitudes, and health-care professionals must accept responsibility for their role if evidence-based practice is to be the norm. Therefore, for Public Health Nursing, a combination of both experience and clinical guidelines will produce the most favorable outcome. The health strategy ‘Quality and Fairness’ sets out a vision of a health system that supports and empowers the individual, the family and the community to achieve their full health potential. The development of these documents is a response to many new developments in the area of care of the older adult in the community including the development of inter-disciplinary Primary Care Teams. In ‘Primary Care – A New Direction’ the scope of primary care provision is not limited to treating illness, but also encompasses support for people to self-care, improve wellness, prevent illness and support those with long-term problems. Common areas of concern identified by nurses working in the Public Health Nursing Services include a lack of standardisation and uniformity of services and the need for support and direction through policy development. Accreditation is seen to encompass these areas within its scope and is therefore a logical project for development. Accreditation for primary health care therefore is seen as a priority for the Public Health Nursing service. It is envisaged that the development of Policies, Procedures and Guidelines for the older adult will provide a framework and support structure to facilitate the delivery of evidence based care to the older adult in the community. This initiative will also support the implementation of accreditation in Primary Care.

This pilot is one of eight commissioned throughout Northern Ireland (for one year) by the D.H.S.S.P.S. to test out the thinking as discussed in Community Nursing: Current Practice and Possible Futures. (Q.U.B. and U.U. 2003). “To develop innovative models of service delivery for community health nursing that are consistent with public health principles.” The ‘Colin’ area of Twinbrook, Lagmore and Poleglass is recognised as an area where many families have high levels of health need and it has been recognised by nurses working in the area that this pilot creates the opportunity to work “family centred” offering a flexible service in a variety of settings challenging the traditional boundaries that exist within various community nurse specialisms. The vision “… to build services around families and not families around services.”

Within the specialist Continence Team an area of unmet need was identified. This area centred upon the early identification of stress urinary incontinence (SUI) in postnatal mothers (12 weeks or greater post delivery). This was a 2 tiered primary prevention and health promotin project relating to stress urinary incontinence in post natal mothers. Tier 1. A pelvic floor clinic was commenced for post natal mothers which was to run for 12 sessions. Each pelvic floor session would: -Cater for a maximum of 12 clients -Offer health education on pelvic floor exercises -Facilitate individual pelvic floor assessment -Devise and support individulised treatment programmes using verbal/written/information or biofeedback if appropriate -Offer modified pilates as a technique for increasing awareness of the pelvic floor -Act as a support mechanism for these mothers -Offer health promotion advice for mothers and babies by inviting speakers on alternate sessions to talk about family planning,healthy food/baby food made easy.relaxation techniques etc. Tier 2 -Education sessions will be provided to all The Community Midwives and Health Visitors to intrroduce a risk assessment tool for post natal mothers in relation to stress urinary incontinence and increase the knowledge and skills to support mothers in undertaking effective pelvic floor programmes which will reduce thw risk of the development of strss urinary incontinence in later life.

To facilitate earlier hospital discharge and enable older people to make informed long term care decisions in community settings. The project also offers older people the opportunity to maximise their independence through individual rehabilitation programmes.

In January 2006, efforts were made by Project Managers in the Nursing/Midwifery Planning and Development Unit (NMPDU) to identify a regional quality assurance initiative. It was decided to use the Essence of Care framework. Our Director of Nursing selected 3 benchmarks for our hospital to implement:privacy and dignity was chosen as the first benchmark to commence working on, as it impacted on all other 8 benchmarks.Volunteers were called for to facilitate the project and I was selected along with two other staff members.

CHSST was invited by the DHSSPSNI in conjunction with NIPEC to take part in the regional Essence of Care Project. As a reault the Trust undertook a six month internal project looking exclusively at the Essence of Care toolkit. The project was supported by a Senior Nurse Management Steering Group and a Project Facilitator to co-ordinate the project within the Trust. Three benchmarks were chosen, Privacy & Dignity, Food and Nutrition and the Safety of Clients with Mental Health Needs. For ease of implementation four teams were established and team leaders appointed who could report back to the Project Facilitator on a monthly basis regarding the benchmarking progress. All teams working on the benchmarks were multi-disciplinary and included service users.

There is a professional requirement to provide high quality care within the Irish healthcare service. The WHO in 1989 defined quality as “the comparison of how the level of care actually provided compares with that which is defined as the wanted level of care”. It is argued that in attaining professional accountability we must provide quality assurance. The quality of care provided is particularly important in continuing care settings where the staff often care for a vulnerable and perhaps disempowered client group. There is a current shift in long-stay care of the older person from custodial care to a more sociologically focused care and with this shift comes the demand for evidence of the quality of the care provided. Providing quality care in long stay care of the older person has many essential ingredients. It involves encouraging the residents to make real decisions about how they lead their lives, encouraging the residents to function at their highest possible level, empowering not disempowering & focusing on rehabilitation. Staff require expertise and education directed at meeting the unique needs of the older adult. Education enables staff to function to capacity. Managers require sufficient staff who are educated and motivated. Managers require the leadership to organise nurses’ work so that they can have time to build relationships with their residents. Teamwork is needed so that staff can work together in providing quality care. This quality care needs to be owned by the stakeholders and should be dynamic, interactive and ongoing. One of the first steps in providing quality care is the establishment of the organisations essence of care. Through development of an essence of care framework, this project aimed to raise the standards of clinical care for older people at the sites of Clifden District Hospital & St. Anne’s Community Nursing Unit, Clifden, Co. Galway. It also aimed to help staff to recognise the value and importance of their contribution to the fundamental and essential aspects of patient/resident care.

Essence of Care is a patient focused benchmarking framework for health care practitioners.

A project commissioned by the DHSSPS & NIPEC in May 2004 was launched across the Province to test the Essence of Care benchmarks within a Northern Ireland context. Staff working within dementia services in Homefirst Community Trust attended and decided to benchmark Privacy & Dignity, Communication and Food & Nutrition within the two assessment wards and the high dependency ward. A steering group led by a senior nurse was establishment and the project was facilitated by the Practice Development Facilitator. Three comparison groups were established and included members from the multi disciplinary team, hotel support services, a carer, the user initiative and the Alzheimer’s Society.

Food is one of the basic needs of each individual, yet it has continued to be a low priority in many areas within the health service. Nutrition in the Health Service continues to be highlighted as an area of concern. the Nation Health Plan (2000)reinforced the importance of ‘getting the basics right’ and of improving the patient’s experience in relation to food. In a study carried out by Picker Institute Europe as part of the National Health Service Inpatient Survey programme, 45% of patient questioned about hospital food rated the food they received in hospitals as either fair or poor. This would indicate that all hospitals, which are involved in the delivery of patients’ meals, should review their practices in order to achieve the best possible quality service for the patients, taking into consideration their needs. As the hospital is situated in North Belfast, an area associated with high deprivation and poor dietary intakes, it is important for the hospital to offer a highly nutritious and well balanced diet to the community, which we serve. With this in mind a multi-disciplinary quality circle group was set up within the Mater Hospital in June 2002, to review our existing food service, and work toward improving the quality of our service.

Previously in the hospital there was EQUATE and individual departmental audits i.e. Standards of Care. In 2003 as part of the hospital's forward planning and development, it was agreed that a new audit tool would be created using information from the original tools and some new material. This was then incorporated to form the new audit tool - Evaluating Quality Care (EQC). It sets out targets to achieve best patient care and facilitates individualised audits for all services, provided to patients with a learning disability.

The literature has identified that future and existing caregivers of stroke survivors receive very little education, support and advice. To address this problem, the Stroke Multidisciplinary Team organised a Stroke Awareness for Carers programme which was adapted from the programme implemented by the team in the National Rehabilitation Hospital in Dun Laoghaire, Dublin. The main objective of this programme is to provide education on stroke, to highlight coping mechanisms that caregivers of stroke survivors can implement and to provide an opportunity for future and existing caregivers to share their experiences.

Research indicated that the current practice of using the upper outer quadrant of the buttock was no longer best practice, due to high incidence of complications.

The aim of the programme is to help patients recover from their cardiac condition by assisting in the maintenance of physical and psychosocial health; as well as by encouraging behaviour and lifestyle changes. Cardiac Rehabilitation has been shown to improve prognosis and function in patients with Coronary Heart Disease. Prior to the project, the cardiac rehabilitation programme was limited to one session per week based in the hospital. By extending the sessions into the local leisure centres it was hoped that access to the programme would be improved and the aim of encouraging lifestyle changes would be better realised.

The aim of the study was to explore the experiences of older people on discharge from hospital following assessment by the public health nurse. A review of the literature revealed that discharge from hospital remains an area of concern as older people had varying degrees of met and unmet need following discharge from acute hospital. The main source of support for the majority of older people continues to be their families.

Improving the nutritional status of older patients in hospitals remains a challenge for all health care professionals. In our own Elderly Care Unit we introduced a nutritional screening tool but found that this made little difference to how patients were cared for on the wards and to nursing practice. Nurses were keen to change how care was delivered but were unsure how to make this happen.

It was recognised that there were no policies or guidelines regarding children visiting our intensive care unit (ICU) and staff were unsure how to deal with a request for children visiting. A focus group was formed comprised of a ward manager, staff nurses and an auxiliary nurse. A questionnaire was devised and given to all staff (nurses, auxiliaries, doctors) regarding this issue and the results analysed. 77% of staff felt children SHOULD be allowed to visit in ICU but it should be facilitated, children should be well prepared beforehand. The focus group set about the task of how best to approach this. In the first instance it was decided a policy would be too rigid and difficult to define however guidelines for staff and relatives were certainly needed and this was the way forward.

The Fermanagh Active Living Project (FALP) is a secondary prevention programme funded by the Big Lottery aimed at preventing Coronary Heart Disease through physical activity in medically vulnerable clients. There are multiple risk factors for Coronary Heart Disease development both medical & lifestyle . Medical risk factors include diabetes, hypertension and obesity. The second major risk factor for Coronary Heart Disease is Physical Inactivity, which also impacts on at least 3 out of the other 4 main factors. By working in partnership the FALP aims to reduce the risk of heart disease by referring medically 'at risk' clients from their GP to a individually tailored, supervised Physical Activity programme in their local Leisure Centre. The clients initially received 6 month free activity & 6 months ½ price activity in order to maintain behavioural change. Uptake, Compliance, medical data , fitness data and individual diaries are collated throughout. The Project has rolled out shorter versions of the project in other District Council areas & where short listed for the last 2 year for the Northern Ireland Health Care Awards.

The directors and assistant directors of nursing of the six acute hospitals in the Mid-West area collaborated to develop this programme. Key areas of fundamental care were identified within each of the six hospitals in the region through consultation with nurses and midwives in clinical practice. Areas of care that are being developed are privacy and dignity, communication, person centred care, documentation, pressure area care, oral and personal hygiene and continence. The aim of the programme is to facilitate a person centred approach to standard development and implementation in these key areas across the network of the six hospitals.

Male catheterisation was identified by staff as an unmet need, initially in older people's services, where male patients were having to attend accident and emergency for catheter change and catheterisation. Staff felt this was unsatisfactory in terms of providing timely care to patients, distress and inconvencience to patients of having to travel to accident and emergency, and inappropriate use of accident and emergency and ambulance resources. From an early stage it became apparent that nurses needed to expand their roles in this area of care. It was recognised that there was a need for guidelines to support and standardise practice across hospital and community services. The guidelines were launched in November 2005.

Hand hygiene is notoriously poorly adhered to by Health Care Workers (HCWs).This has been the finding in numerous studies world wide.The Infection Control Team in Altnagelvin Trust decided to assess our baseline practice in order to plan educational strategies.

This project was carried out following an audit of pressure ulcer management within the Newry and Mourne H&SS Trust community setting. The audit took place in September 2004 and the findings highlighted that 75% of pressure ulceration occurred in patients while in the care of the Community Nursing Service. It also highlighted areas of inconsistency in practice within the basic concepts of assessment and management of pressure ulceration, including documentation and the appropriate use of risk assessment tools.

In 2000-2001 an Outreach Worker, employed by the Southern Education and Library Board (SELB), was delivering programmes to the youth in four housing estates in the Newry area. The material covered a range of issues including drug and alcohol abuse, crime and risk taking behaviour, which included sexual health. An excellent working relationship was developed with community volunteers and the young people in the estates. The young people expressed concerns to the Outreach Worker and the Community Workers that, within the area of sexual health, there was inadequate provision of information and advice to meet their needs. In autumn of 2001, in direct response to the needs identified, a partnership was formed between the Southern Area Health Promotion Department (SAHPD) and SELB in conjunction with the Magnet Young Adult Centre, Newry and Mourne Health and Social Services Trust and local Community Groups. The main aim of this partnership was to develop a project, which could explore approaches to tackling these issues and take appropriate and relevant action.

I observed a need for educating the over 65 population when they attended Day Hospital for a medical clinic. They appeared to be unaware of certain services which were available to them.

It is estimated that one in six people In Northern Ireland suffer from a diagnosed condition such as depression at any point in time. Primary care settings are considered to be the best location for the delivery of care, mainly because they are less stigmatising than specialist mental health services and more accessible to patients. However, depressive symptoms are undetected in about 50% of patients attending general practice. Mental health nurses can provide the dedicated time to assess, follow up and support patients with depression and have been described as the ‘linch- pin’ for managing depression at practice level. However there are a dearth of benchmarks available to guide, support and develop their practice.

The Integrated Care Pathway was first established in Liverpool by the Marie Curie Centre and the Royal Liverpool and Broadgreen University Hospitals in the early 1990's. The aim of this Integrated Care Pathway is to provide an evidence-based framework across the organisation for the care of the dying patient and their families. The documentation is multidisciplinary and can be used in all care settings. It provides a method of co-ordinating and standardising care for all patients in the dying phase of their illness. It can be used for patients with advanced malignant and non-malignant conditions.

Government legislation and professional guidelines containing directives to modernise and improve services to reduce waiting lists. Numerous cited benefits of nurse led care. Extensive knowledge and skills among dermatology nurses.

Between 2004 and 2006 the NCNM and the NMPDU South Eastern area supported a number of personnel to attend the Oxford Centre for Evidence Based Medicine (CEBM) Critical Appraisal Skills Programme (CASP) and Teaching and Learning Evidence Based Medicine Workshops. Those who attended committed to planning, co-ordinating, delivering and evaluating Evidence-Based Practice (EBP) workshops for staff in the south eastern region. In addition, a regional Research Facilitation Group was established to support the initiative.

The National Kidney Foundation/Kidney Disease Outcomes Quality Initiative National Practice Guidelines, updated in July 2006 recommend that greater than 65% of haemodialysis patients have a functioning arteriovenous(AV)fistula. The Wellstone Clinic in Kilkenny is a 12 station conmmunity based satellite dialysis unit. In March of 2007 a review of vascular access revealed we had 75% tunnelled catheters and 25% AVF. This prompted us to look at ways to improve our rates of AV fistula among our patients. Fistula First is an initiative to increase AV fistula use by haemodialysis patients for whom they are appropriate. This initiative recommends 11 key clinical and organisational changes for increasing AV Fistula use and improving haemodialysis patient outcomes. It also highlights the change concepts that nurses working within a dialysis facility should initially focus on.

Challenging behaviour in dementia impacts negatively on the quality of life of the person. It often precipitates a move into hospital or to another care facility and may result in the person being labelled ‘difficult’ (Innes, 1998). A move is disruptive to the individual and also shifts the ‘problem’ without addressing the reasons for its occurrence. This means care home staff have missed a valuable opportunity to learn about why the behaviours were happening. The quality of care provided for people with dementia in nursing homes is the subject of serious concern (DoH, 1999; Ballard et al, 2001). In surveying 17 homes in the north of England, all were rated as ‘requiring major improvement’ or requiring radical improvement.

To provide education to all staff which was easily accsessed To improve quality of care. To encourage practice development in all disiplines To establish and maintain links with other professionals for sharing knowdledge and expertise.

Overall aim: The aim of this study was to ascertain if the raised awareness of the potential for parastomal hernia development, the introduction and teaching of abdominal exercises and the use of support belts from 3 months until 1 year post surgery minimised the development of a parastomal hernia. Parastomal hernia is a common and distressing problem for approximately 10-50% of patients with stomas. Little research into its prevention has been undertaken. Clinician observation and reflective practice of two Stoma Care Nurses in two centres in Northern Ireland revealed an observed finding that those patients with stomas who regularly exercised and possessed strong abdominal muscles were less likely to develop a parastomal hernia. Armed with this knowledge it was decided to investigate the incidence before and after a programme emphasising and teaching the importance of strong abdominal muscles.

The skin is the largest organ in the body, it is the principle determinant of water balance and acts as a barrier against infection. The Extremely Low Birth Weight (EBLW) infant's skin has a thin epidermis, an underdeveloped stratum corneum, a large surface area to weight ratio, resulting in insensible water loss known as Transepidermal Water Loss (TEWL). Full development of the stratum corneum occurs at 34 weeks gestation. Nursing the premature infant in a warmed humidified environment will reduce TEWL, maintain thermoregulation and skin integrity and mimimise fluid and electrolyte imbalance.

A significant number of information leaflets were in circulation in AMNCH with a variation in readability and format. Also the process was not clearly defined from an authorisation perspective. Recommendations from various agencies provide information on information leaflet generation. As part of the AMNCH Six Sigma Strategy the NPDD decided to review the process of information leaflet generation. The process was reviewed using six-sigma methodology.

The project is to find out about the information needs of suicidal individuals and their significant others. We feel that people could have easier access to pertinent information and that this could have a positive impact on the experience of managing suicidal ideas or a suicidal significant other.

Prior to January 2004 all patients requiring haemodialysis within the Southern Health& Social Services Board area were referred by the Consultants to Belfast City Hospital Education Unit for education to enable patients’ make an informed choice regarding the choices for their treatment. There was, however, a poor uptake of this service which meant that patients may not have chosen the home peritoneal dialysis, and underwent haemodialysis within the Renal Unit in Daisy Hill Hospital three times per week. If patients did opt for the home service of peritoneal dialysis they had to travel to BCH Renal Unit daily for approximately 1-2 weeks for peritoneal dialysis training. Following this, these patients had to travel to BCH for insertion of their peritoneal dialysis catheters and the subsequent management of any complications. The Renal Service Review (DHSSPS 2002) recommended that all Sub-regional Renal Units develop a peritoneal dialysis service locally. To date, Daisy Hill Hospital, Newry, is the only hospital to complete this recommendation successfully. Due to the successful development of this service, and networking opportunities, other units are putting proposals to their Health and Social Services Boards for funding for a peritoneal dialysis nurse. Rationale The impetus for the initiation of the home haemodialysis service was the failure of growth in the Southern Board peritoneal dialysis population. This has put an obvious constraint on the haemodialysis capacity. The experience in England and Scotland indicated that home based training programmes with a locally based peritoneal dialysis service, would enable growth. With this in mind Newry and Mourne Trust decided to devolve the peritoneal dialysis programme and set up a home peritoneal dialysis program, lead by a dedicated peritoneal dialysis nurse.

Increasing health care costs have raised the demands for improved efficiency and cost effectiveness in hospital bed use and occupancy. Coupled with this, the best available evidence on breast cancer services, (NICE Guidelines 2004) advocates the need to improve information and services available. The literature also supports the view that earlier discharge is facilitated through the provision of appropriate information and education to patients (Leadbeater, 2001; Lauri and Sainio 1998). Dietrick-Gallagher & Hyzinski (1989) found that teaching patients to care for their drains not only resulted in decreased length of stay and potential cost savings, but also allows patients to recuperate at home with their families. Early discharge was not associated with any specific complications and proved popular with patients (Boman et al (1993; Holcombe et al, 1995). Earlier discharge for patients undergoing mastectomy has been accepted normal practice in America. Average hospital stay can be shortened by 5 days per patient if patients were discharged with drains, and a service developed to deal with seroma complications following discharge for patients who require treatment. With this in mind, a nurse led service was developed in the Female Surgical/Gynaecological Ward of Daisy Hill Hospital Newry, to support earlier discharge of mastectomy patients with a drain insitu. This project has ‘broke new ground’ in that it has allowed the first nurses within Northern Ireland to be trained to undertake seroma drainage. Prior to this project, the length of stay for patients who had breast surgery was approximately 7-10 days. In the event of post-operative complications, such as seroma formation (a collection of fluid), patients’ would have to contact their GP or district nurse, who would refer them either to the Outpatient clinic or to Accident and Emergency Department to have the seroma drained by a doctor, often encountering a long wait to be seen. The project has thus reduced the average length of stay for patients following mastectomy, reduced anxiety levels and time delays for patients who develop complications, and promotes continuity of care.

Delivering the Future 1999 recommended obstetric drills were undertaken in every maternity setting. Black and Brocklehurst (2003) noted that research to assess effectiveness was required; confidential enquiries noted problems with teamwork. This formed the background for my PhD studies.

At the Adelaide and Meath Hospital incorporating the National Children’s Hospital (AMNCH) we strive to promote best practice, recognising the Scope of Practice Framework (An Bord Altranais, 2000). We facilitate nursing students and staff in the provision of evidence based care to patients. Continuous quality improvement is central to care delivery in AMNCH. Concerns were raised from the clinical area to the Clinical Placement Co-ordinators regarding difficulties with the interpretation of our intravenous medication policy. The variance in interpretation resulted in ambiguity for staff and rostered nursing students.

Modern healthcare systems require health professionals to demonstrate the cost effectiveness of their interventions: nurses and midwives are therefore challenged to articulate what it is they do and its benefits to patients and clients in a way that is meaningful not only to themselves, but to their multidisciplinary healthcare, social care and health service administrative colleagues. At present this is not being achieved and there have been repeated concerns regarding nursing documentation. An increase in the complexity of patient health problems, nursing and midwifery workload, the increase in the amount of data available and patients participation in the decision making can present challenges to nursing and midwifery care and to the accuracy of its documentation. The current system of documentation has been identified as a risk from individual nurses, clinical nurse managers, clinical nurse specialists, risk advisors, patient complaints officer and management.

The haemodialysis unit had grown from a 6 to a 24 station unit. With this expansion communication difficulties had arisen and practice was not standardised. It was difficult to implement change in practice within the Unit, to evaluate and audit adherence to protocols and to ensure that staff were being trained in a consistent way.

We embarked on the poject because people who were diagnosed with Alzheimer’s disease and commenced on treatment, then referred to the Specialist Dementia team, were placed on awaiting list for a keyworker. In April 2005, the maximum waiting time for allocation of a keyworker was nine months. Generally those people who were receiving anti-Alzheimer’s drugs waited the longest, as patient’s with more urgent social needs were often prioritised. Currently patient’s who are prescribed anti-Alzheimer’s medication are reviewed by the Consultant. At these appointments monitoring and titration of drug therapy is undertaken. Generally Consultant appointments are short, and it can be difficult for both patients and carers to take in the information given, therefore opportunities for the Specialist Dementia Team to provide timely and appropriate information to this group of patient’s and carers was being lost. The team recognised the significance of this given the identified need by patients and carers for information, at the time of diagnosis. The premises used for Dementia Services, was unsuitable, for people with memory difficulties and their carers. There were not sufficient consulting rooms, meaning a carer could not speak to the Consultant privately without worrying about their relative. Access was difficult, there was insufficient parking close to the premises, and on-site facilities do not lend themselves to patient comfort. In addition the team were aware that research in America, evaluating nurse prescribing showed that, o Quality of care and patient satisfaction can increase when nurses prescribe o The nature of the therapeutic alliance between nurse and service user can improve adherence with medication plans o The quality of user education can be better when nurses prescribe. The team has a qualified Independent and Supplementary Prescriber (ISP), whose skills were not being used. With these in mind the team embarked on a Service Improvement Project, Keep In Mind (K.I.M), to establish a nurse-led review clinic for people prescribed anti-Alzheimer’s treatment.

A small research study was conducted as part of a Quality and Research Initative within Specialist Practice in conjunction with a role development programme associated with the Macmillan National Institute of Education at Glasgow University. The rationale behind initiating this project was to identify what the learning needs of palliative care nurses were within a Trust area and how their effectiveness impacted upon service delivery. (It is worth noting that although a palliative link nurse system had already been established six months prior to the study no evidence-based research had been conducted into these learning needs and there was no systematic approach to this style of learning.)

The aim of this project is to 'get to know' and understand the individual person. Providing the older person's Life Story can illustrate the uniqueness of each individual (Janzen, 2001) and assist staff to see the person behind the patient, thus gaining a greater understanding and knowledge of them as an individual (Davies, 2003). The sharing of Life Stories in clinical practice can help health care professionals to form closer relationships with residents and their families (Mcgilton, 2002; Clarke, 2003) and supports the provision of quality, person centered care (Day, 2007). In some situations certain aspects of the residents lives only become known to the staff when they pass away.

Approximately 20 – 25% of patients who undergo treatment for breast cancer will develop lymphoedema at some stage following treatment. This is a chronic incurable condition, characterised by protein rich swelling within the tissues. Tissue infections requiring hospitalisation are not uncommon. In rare occasions a lymphaemgioscarcoma can develop. The condition can be debilitating and lead to social withdrawal, financial hardship if employment is affected, body image issues. Although the condition may occur there are some measures which may reduce the likelihood of it developing. Patients are advised prior to axillary surgery of the possibility of the condition occurring, preventative measures and what to do should they notice any swelling.

Intravenous (IV) therapy is a common and essential invasive procedure (Kiernan, 2003). Such breaches in skin can act as a portal for micro-organisms resulting in infection (Gould, 2004). At least 90% of all hospitalised patients require some IV therapy (Hanchett, 2004) and in recent years there has been an increasing nursing contribution to IV therapy and care. Cannulation, venepuncture and IV administration are now seen as subsumed into the core skills of registered nurses (Masterson and Humphries, 2000) and the Nursing and Midwifery Council Code of Professional Conduct (2004) identifies that nurses have a responsibility to deliver evidence based care. Therefore through this initiative safe and appropriate IV therapy could be addressed.

Recent results of many outcome studies support combined psychosocial and pharmacological strategies in improving function of those suffering a disabling severe mental illness (SMI) including schizophrenia (Wykes et al, l998; Goodwin, l998). Non-compliance of medication is one of the major preventable causes of relapse and morbidity (Kemp et al, l998) and rates of poor compliance from l0% to 80% have been cited in various reviews of patients with psychotic disorders (Kemp et al, 1996, 1998; Eckman et al, 1992). Repeated studies implicate poor compliance as a crucial factor associated with relapse and rehospitalisation, length of readmissions and eventual outcome (Kemp et al, l998). Hence the need for effective Medication Management (MM) strategies.

Aim of the study was to ascertain if current nurse education provision equips nurses for the purpose and practice of independent and supplementary nurse prescribing and to identify how they are applying their acquired knowledge and skills to their practice

Within each of the Northern Ireland regional maternity services there is an identified midwife responsible for quality issues. Each of these midwives was working independently from the others. In 2000 as a practice development midwife at the Ulster Hospital I contacted all other maternity units in the region and asked if they would be interested in working together collaboratively. Aim: to try to benchmark our own services and help each other progress women centred care issues. Every unit allocated at least one and in many cases two midwives to meet and share work. We have progressed 6 benchmarks to date and are discussing incorporating guidelines into our remit

The aim of the initiative was to set up a process for developing and implementing Trust wide nurse led discharge (NDL) for patients with simple non-complex discharge requirements. Simple discharges are reported to be 80% of overall discharges (DoH,2004). The objectives of the study were to ensure that patients and their carers were involved in their discharge; to ensure that where possible patients were discharged earlier in the day; to promote seven day a week discharge; to ensure that all band 5( with 18 months experience) and above staff nurses were competent in nurse led discharge and to ensure a standardised approach and documentation was used across the Trust.The Department of Health and Social Services (DHSSPS) has identified timely discharge as a key priority for improvement for all Northern Ireland Hospitals. An analysis of admission / discharge trends by days of the week and times of day revealed variation in discharges by day of the week, few week end discharges and late in the day discharges. Some patients were discharged into the evening. This pattern of activity impacted on patient waiting time in the Accident and Emergency Department (A&E). The backlog of patients waiting in A&E was most evident on Monday mornings and from 4pm onwards each day. On occasions A & E reported diminished floor space for treating patients. Direction was taken from recent government report “Achieving Simple Timely Discharge from Hospital “(DoH,2004) and DHSSPS compulsory actions on discharge that include discharging patients by 2pm, setting an expected date of discharge (EDD) for all patients and putting in place facilities for seven day a week discharge. Nurse led discharge has been acknowledged as an evidenced based method of enabling the achievement of these targets.

The initiative to develop the first nurse-led community based Benign Prostatic Hyperplasia (BPH) clinic in Northern Ireland was launched as a project on 1 January 2003. During the development of Foyle Continence Advisory Service, the Continence Manager became increasingly aware that, within the Primary Care setting, the needs of men with bladder problems were not being addressed to the same extent as those of women. The traditional pathway for men presenting with symptoms of BPH in the Western Health Board area was through GP referral to the Consultant Urologist. However, waiting times for prostate assessment and general urology consultation were becoming increasingly lengthy. Greater emphasis on Primary Care and shared care strategies also provided the context in which the need for a Community based BPH clinic arose. The project was designed to help GPs manage patients with suspected benign prostatic disease more efficiently in the community.

The aim of this project was to develop a standard form of nursing documentation which is patient centered and user friendly. This project was undertaken because there are three stand alone units within the service and each one was using different nursing documentation.

With an increased emphasis on legal issues in nursing, record keeping and documentation were highlighted in the Community Care Unit as areas requiring improvement. In keeping with best practice it was decided to conduct an audit of nursing documentation.

The need for change in nursing documentation in CUH was clearly identified in 2003 during the self-assessment process of accreditation with the Irish Health Services accreditation board. A change from the ‘Kardex’ system was considered essential in order to keep in line with An Bord Altranais standards. Nursing services anticipated that the introduction of a standardised nursing documentation format throughout the hospital would improve the quality and accuracy of records within the context of professional and legal obligations. It was also envisaged that a new patient focused documentation system would contribute to the improved assessment, planning, implementation and evaluation of nursing care.

A review of a critical incident showed that we as Trust needed to review the way that we gave nursing handovers. I was asked to chair this group.

This project entails the development of a palliative care practice development programme to be piloted within the Trust area, to promote person-centred practice in the delivery of palliative care. In the Down Lisburn Trust area there are approximately 980 nursing home places, the majority of which are used by older people, most of whom will end their lives there, many requiring palliative care and symptom management. Training needs analyses show that in the private sector, fewer than 17% of nurses have received additional training in palliative care, and that as few as 5% of care assistants in the Eastern Board area have NVQ training. Research has shown the importance of creating an environment supportive to change, and the need to adopt a practice development approach in the provision of training.

As part of the regional launch of the Essence of Care this hospital choose the Nutrition Benchmark to examine current practice.

A regional Paediatric Steering Group was established and this group identified that a Clinical Facilitator was needed to support staff in the development of evidence based guidelines and policies. The Paediatric/Neonatal Clinical Facilitator commenced in September 2004 and worked collaboratively with Paediatric and Neonatal nurses at all levels in Mayo General Hospital, Portiuncula Hospital and University College Hospital Galway. Through this process priority areas were identified and from the priority areas evidenced based guidelines and procedures were developed and implemented.

To explore district nurses' experience of providing palliative care for patients with cancer & their families. There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experience in palliative care.

Following the publication of the Draft Quality Standards for Residential Care Settings (DoHC), management at St. Brendan's Community Nursing Unit prioritized implementing a Continence Care programme. The primary aim of the programme is to preserve continence of residents and when this is no longer achievable to ensure access to individualised continence care, which respects the dignity, privacy and comfort of each resident.

The idea began when working on renewing the careplans within the Renal Unit. On discussion it was felt that especially within chronic illness goals are only achieved if working in parnership with patients. In order to see life more from a patient centred approach we needed them to tell us about life from their perspective. We also wanted them to become an active participant in establishing care which met their needs. Assessment schedules are normally filled in by the nurse, to answer the questions the nurse requires. To challenge this, the assessment took the form of a circle in the middle of the page, with the patients name in it. (Patient Centred!!). From this circle came four guiding spokes (of the wheel). Guidance notes on the top of the page were used to prompt the individual to answer 4 questions. They were advised that they could add extra spokes if necessary and even get family members to contribute if they wanted. The 4 guiding questions were: What is important to you? What do you value in life? What areas do you need our help or assistance with? What concerns do you have regarding kidney failure and the treatment?

Perinatal mental health refers to the emotional well being of a mother, her partner and their infant, during pregnancy and the postnatal period. Most people successfully negotiate major transitional life stages and the experiences they gain in these transitions enhance their coping capacities. Transitional life stages also represent times of increased vulnerability, and a degree of anxiety and a labile mood can be expected at these times. However, they are also associated with increased vulnerability to more severe mental health disturbance. The perinatal period is a time when women are especially vulnerable mental illness and the structure of maternity care represents a unique opportunity for early detection and treatment. During this time, women may experience difficulties ranging from mild, transient anxiety or depression to more severe psychiatric illness. common during the perinatal period. Perinatal mental health problems have consequences. Without treatment 30% of depressed mothers are still depressed one year post partum. This is more common than for example anaesthetic death and death from eclampsia. There are known potential effects on the infant and its subsequent development. Breakdown in parenting may affect a child’s emotional development leading to conduct and other psychiatric disorders and increased need for later care. Postpartum (‘Puerperal’) psychosis carries a greatly increased morbidity and risk of harm to both mother and infant. Suicide and other ‘psychiatric deaths accounts for 10% of all maternal deaths in the UK. There is good evidence that these mental disorders though severe, are responsive to treatment. The Perinatal Liaison Mental Health Service is a nurse-led service and forms part of the Liaison Mental Health Service in Cork University Hospital (CUH). Following referral to the service, a comprehensive mental health and psychosocial assessment of need is completed (using a purpose designed assessment form) which forms the basis for any future intervention. The perinatal liaison mental health nurse also offers: · Advice to maternity, public health nurses and mental health staff about perinatal mental health issues. · Training for maternity staff and public health nurses in mental health issues. The perinatal life stage offers unique opportunities for enhancing mental health through prevention and early intervention strategies. Women come into frequent contact with health professionals during this critical period, and the enhancement of their emotional well-being can promote their own, their infant’s and their partner’s health.

Background Quality and Fairness: A Health System for You (2001) identified the need for healthcare organisations to measure patient satisfaction as a means of contributing to the achievement of client centred care. As a result, the Health Board Executive (2003) published Best Practice Guidelines for measuring levels of patient satisfaction. These guidelines state that feedback from patients can influence the quality improvement agenda and provide an opportunity for organisational learning and development. Therefore, in 2006, the multidisciplinary team in the Stroke Unit conducted patient satisfaction surveys to evaluate the care and therapy they provided for patients within the unit and to identify areas for improvement. Sample The target population for the survey was all patients who had been discharged from the Stroke Unit from October 2006 to March 2007. All patients that were discharged home, transferred to the general rehabilitation unit or to another continuing care service were included in the population. Patients that became ill and were transferred to an acute hospital were excluded from the population. Permission to send out these surveys was granted from the Director of Nursing and the patients consultants. Response rate: The identified sample for inclusion was sixteen. The response rate was 75% (12). The section on Services after Discharge (Q14-16) were not completed by the three patients discharged from the Stroke Unit and admitted as in-patients to the General Rehabilitation Unit as the questions were not applicable.

To improve patient care by ensuring that 'the basic human right of having a drink of water will be possible when needed'(Hung 1992). That unnecessary and prolonged pre-operatively fasting will cease to exist unless medically required. To ensure uniform practice which is evidence based.

Challenging behaviour in dementia impacts negatively on the quality of life of the person. It often precipitates a move into hospital or to another care facility and may result in the person being labelled ‘difficult’ (Innes, 1998). A move is disruptive to the individual and also shifts the ‘problem’ without addressing the reasons for its occurrence. This means care home staff have missed a valuable opportunity to learn about why the behaviours were happening. The quality of care provided for people with dementia in nursing homes is the subject of serious concern (DoH, 1999; Ballard et al, 2001). In surveying 17 homes in the north of England, all were rated as requiring major improvement’ or ‘requiring radical improvement.

Identified a need for nurses in older person residential services both public & private, to network in relation to developing evidence based practice.

Preoperative assessment is a process to ensure that the patient is fit for surgery and anaesthetic, aiming to improve outcome and reduce periopertaive morbidity and mortality. It provides an opportunity to provide the patient with information related to their care and admission for surgery, whether that be as a day case or as an inpatient for major surgery.It ensures the patient is informed and has an opportunity to ask questions about their planned surgical procedure. From an organsisation perspective preoperative assessment reduces the risk of late cancellation, provides the opportunity to ensure availability of essential resources and facilitates discharge planning. Prior to the establishment of the Preassessment Working Group in 2004 preassessment was solely undertaken by the anaesthetic staff. It was recognised that this was an area in which nurses could impact positively on the patient experience as they progress on the surgical pathway and also it was an opportunity to develop expanded roles and develop a closer liaison with the surgical and anaesthetic teams. It is recommended that all patients undergoing operations should attend pre-operative assessment. This allows patients who are suitable for day surgery to be selected promptly and placed on the correct waiting list. It also ensures that patients with medical conditions requiring further investigations or treatment are identified early and appropriate actions taken.

Since the inception of the degree programme there has been unprecedented change in the role of the registered nurse in the education of undergraduate nursing students. Registered nurses now assume a heavy responsibility for being preceptors to nursing students with over 300 general and integrated students allocated to Cork University Hospital (CUH) alone. There are also additional students that require clinical placement in CUH and if they are to achieve the desired clinical outcomes or develop competencies preceptors need to be well supported in order to continue effectively in their role.

The Erne Hospital Mobile Coronary Care Unit is a 24/7 service serving a population of 58,000 people across counties Fermanagh and South Tyrone, and has been in operation since 1983. The introduction of the EWTD for Junior Doctors' Hours, threatened to deprive the local population of this pre-hospital service from 5.00pm weekdays, all weekends and public holidays. The implications of this meant that the local population could be denied essential thrombolyis therapy in the event of a myocardial infarction, within the timescale recommended in the National Service Framework guidelines. The cardiac unit team agreed to maintain the current level of service by developing a nurse-led mobile coronary care service. The nurse-led service would be desiged to cover the following times; - 5.00pm - 9.00am Monday- Friday - 24 hours all weekends and public holidays

Response to child protection case management review that recommended improvements are made in relation to the assessment of attachment between children and their primary carers - particularly where neglect is an issue. A number of health visitors had expressed the view that their role within families, including those where there are child protection concerns needed to maintain a preventative focus. To promote infant mental health through development of strong attachment to primary care giver and to secure the long term individual, family and community benefits of this. This is in keeping with Bamford Review recommendations.

Prostate cancer is currently the most commonly diagnosed male cancer in the UK with 31,923 men diagnosed each year. A worrying aspect of this disease is that the incidence is showing a clear upward trend. Despite this fact, prostate cancer services have been given a low priority in health care. In 2006, the Governement were urged to improve prostate cancer services across the NHS. This project aimed to address two major issues in relation to prostate cancer. Firstly, PSA is a blood test that may be used in the diagnosis of prostate cancer. However, screening for prostate cancer using the PSA test is not national policy. An informed choice programme is advocated by NHS Cancer Screening Programmes. Despite this, it was felt that many men had PSA test conducted in practice, without making an informed choice. This project aimed to address this deficit in care and influence relevant health care professionals knowledge, attitudes and practice regarding this. Secondly, it is well-documented that patients diagnosed with cancer require adequate information regarding their disease and treatment to help them cope in a more positive manner. This is of particular significance in relation to prostate cancer, as there is often little consensus of the best treatment option for patients. Patients are often presented with various options and they must make an informed choice rgarding their treatment. Therefore, they need adequate information so they can participate in shared decision making and make such a choice. This project aimed to develop a Prostate cancer Information and Counselling Centre, that could be attended by men or significant others at any point on their prostate cancer journey so that they could receive individualised inforamtion regarding their care

The aim of the project is to develop an evidence based model of practice for clients with serious mental illness in an in-patient rehabilitation setting. The objectives were firstly to enable nurse participants to develop in-depth critical understanding of theories, concepts and research findings that inform evidence based interventions for individuals with enduring mental health problems. Secondly, to develop individual and team PSI skills that can be tailored to the individual needs of clients on St. Teresa’s Rehab unit. Thirdly, to develop a practice framework on St. Teresa’s that demonstrates the provision of evidence based care. And fourthly, to equip participants with therapeutic skills necessary to deliver safe and effective evidence based interventions. Since we are taking a team approach, it is envisaged that the Psycho-social Intervention (PSI) model will therefore be fully integrated into the philosophy of nursing care provided in the unit. In the short-term, a trained cohort of staff will become capable of educating their colleagues and mentoring them in the use of the model. In this way it will be possible to completely introduce the principles of PSI in its entirety in the “live” situation. In the long term, it is planned that trainer/s would be trained in order to extend the use of the model to other units/situations.

While our health generally is improving, there are increasing demands made on the NHS due to population changes, lifestyle choices and a widening gap across socio-economic groups. Government policy aims to not only reduce inequalities but to actively promote health. This project is about integrating a public health approach into nursing practice – public health should be a starting point for all nurses. All nurses have a part to play regardless of whether they work in the acute, community or private sectors. Community nurses are active in Health promotion, nurses working in the acute sector also have a critical role in improving health. The project aim is to test out the proposal to mainstream public health activity across all programmes of care, settings and disciplines in nursing in keeping with the DHSSPS nursing strategy by :  Creating an awareness of the public health agenda  Developing capacity across programmes of care  Ensuring capability in public health activity

As part of the Post Graduate Diploma in Nursing (Gerontology)at NUIG the students are required to design, plan, implement & evaluate a quality inititive at their place of work.

As part of the Post Graduate Diploma in Gerontology at NUIG - the students are required to design, plan, implement & evaluate a quality initiative in their place of work.

In 2005 the recorded infection rates of MRSA had risen within our ward to an unacceptable level. It was clear that in order to reduce infection, a collaborative approach would need to be used to first study the possible causes of infection and then improve practice to prevent infection.

Acute inpatient care has had some criticism internationally. In Ireland user groups have expressed dissatisfaction with an over reliance on the medical model and lack of information on diagnosis and treatment(IAN,2001). Staff in acute Psychiatry, especially nursing staff, face high demands and low levels of job control. Nursing in acute psychiatry is seen as one of the toughest roles in mental health care. Acute psychiatry is beginning to re-establish itself as a specialist area of practice and service users are demanding a greater input into the way services are provided. Pioneered by the staff in Kerry and Cork, the Refocusing Model changes service delivery, professional practice, promotes nurse leadership, achieves in-patient wards that are more purposeful and values based. Refocusing not only places a greater emphasis on high levels of staff and patient engagement, we also seek to achieve closer collaboration between staff and service users in the managing of care and service delivery. The acute units in Cork and Kerry (KGH, Mercy, CUH) aim to be at the forefront of developing best practice in acute psychiatry, providing a service in which service users are regarded not just as recipients of services but partners in the organisation and development of services.

Ladies who were returning for results of investigations were being seen in the middle of a very busy Assessment Clinic. Neither group was being given due care and attention. Time spent was rushed and quality care was compromised. Discussion took place with patients, staff and Finance and the subject of a separate clinic was discussed at length. The facility was not difficult because accommodation was available at Breast Clinic.

Despite over 10 years of work in this area, and a wide range of publications, there is evidence to suggest that clinical supervision systems are often ineffective, undervalued and may make little difference in terms of developing the quality and safety of care. Given recent public inquiries that have recognised poor supervision systems as a possible contributing factor, the DHSSPS asked NIPEC to review clinical supervision across the HPSS in Northern Ireland.

OREM Model of Nursing deemed unsuitable. Project committee established and sub-groups formed - Training & Audit

The project began in January 2006 to implement standards for practice following the DHSSPSNI launch of the document 'Tackling Violence at Home' in October 2005. The project was led by a child protection nurse specialist and invloved nurse managers, health visitors, midwives and colleagues from the Women's Aid Federation and refuge staff. A policy for domestic violence was developed with 7 accompanying standards for routine enquiry. A best practice guide and flow chart were also developed to assist midwifery and health visiting staff in their practice when asking women about domestic abuse. A subgroup of the steering group then developed a training programme and timetable for implementation into practice by June 2006. A total of 75 midwifery and 48 health visiting staff plus two physiotherapy colleagues who work with women after child birth, were trained in the policy and process of routine enquiry . The training sessions were co facilitated with Woman's Aid refuge staff and also there was input from PSNI domestic violence officer and social services. These training sessions prepared professions to undertake a risk assessment of domestic violence and develop skills to manage a client's disclosure of domestic abuse. Down and Lisburn HSST began to consider routine enquiry of pregnant women to promote disclosure of incidences of domestic violence following the publication and launch of the DHSSPSNI paper 'Tackling Violence at Home' in October 2005. It was decided that the disciplines of midwifery and health visiting would be involved initially as these two nursing professional groups come in contact with women during pregnancy and in the post natal period. Involving both disciplines also ensured that all service sites in both urban and rural areas of the Trust would be covered by the policy. Support and services were also sought from Women's Aid during the planning, introduction and training stages demonstrating a commitment to interagency collaboration in both policy development and service provision.

to be supplied

The Essence of Care document was used to guide the process for the Safety of patients and clients in the mental health setting benchmark. The comparison group held their first meeting on 5th November 2004. The group was multi-professional from the beginning including clerical staff, domestic services, medical, nursing, occupational therapy, psychology and also included a former patient. Each department and each discipline within the Directorate were invited to send a respresentative to the first meeting. The invitation emphasized the importance and necessity of Essence of Care. The first meeting was well attended with everyone represented except for medical staff however they were represented at subsquent meetings. Having identified areas of practice that could be improved and possible barrriers to improving care, our challenge was to devise an action plan that would put into effect the improvements identified as needed. It was then that our commitment to achieving best practice would be tested. We were under no illusion that change within such a large and complex organisation would create many difficulties. However, all the ingredients for successful change were present within the group including a shared understanding of what needed to be done, commitment to the project and to providing the best possible care to our users.

The aim of this project is to provide a more person centred approach to medication management, by allowing clients to take responsibility for their own medication. The project was undertaken because it was noted that a number of our respite clients are self medicating at home, however when they come into our service their medications are taken from them. They have to adapt to the timing of our "drug rounds" which may vary from their own routines.

Foyle Health and Social Services Trust provide a Social Work service in Altnagelvin Health and Social Services Trust. Social Work staff in the hospital regularly receive requests for information, advice and assistance in relation to a plethora of increasingly complex social security benefits. Social work staff have responded to emerging need with a number of initiatives. Links were established over a number of years since 1995 with two community based Welfare Rights groups, Hillcrest House and Galliagh Integrated Advice Service. The development of a specialist welfare rights hospital based service has resulted in significant outcomes in terms of social security benefits and grants obtained at a micro level (patient) in the context of poverty and social exclusion at a macro (institution) level. Literature suggests that appropriate benefit levels assist with safe and effective discharge from hospital and may assist in unnecessary readmission to hospital. The Noble Report (2001), Measures of Deprivation in Northern Ireland, www.nisra.gov.uk/whatsnew/dep/index.html has addressed domains of deprivation which are unique within the Foyle Health and Social Services Trust catchment area. The correlation between poverty and ill health is well established. Hillyard et al (2003) published the results of a large scale study of poverty and social exclusion: Bare Necessities – Poverty and Social Exclusion in Northern Ireland. It is estimated that 156,000 children and 350,000 adults are living in poverty in Northern Ireland. The physical manifestation of an illness and its psychological impact may inevitably lead to a reduction in quality of life for individual patients and contribute to social exclusion. The rationale for the development of the service was therefore primarily to meet emerging need from a variety of patients through a service that is responsive, creative and which promotes patient involvement in reducing inequalities. In the context of human rights and equality legislation, patients and carers ought to have access to appropriately trained welfare rights staff in order to claim relevant social security benefits.

The provision of effective terminal care in hospital has been compounded by a number of demographic and health related trends. An increase in the older population, advancements in medical and pharmaceutical technology, socio-economic changes and the dispersing disintegrating family along with a higher percentage of chronic diseases have contributed to an increased proportion of elderly dying in hospital (Institute of Public Health In Ireland, 2001). Given the increasing older population and a growing recognition that non – malignant diseases require periods of palliation, it is envisioned there will be rising numbers of patients in hospital wards in need of palliative care. Mc Donnell et al, (2002) claim nurses are the healthcare professionals dying patients have the most contact with. However, a number of studies conducted outside of Ireland reveal there are a number of challenges facing nurses when caring for dying patients in hospital that consequently contribute to an insufficient level of care being provided. There have been no research studies conducted within the Irish HSE that can support or rebuke the above statement. This prompted the need for this research to be undertaken.

This study grew out of a long standing interest in preceptor role commitment. There is a broad consensus that preceptors are fundamental figures in the forefront of clinical education. Preceptorship is a balancing act between valuing both the integrity and the individuality of the student while making certain that they are adequately challenged in their practice experience. One way to ensure the future of nursing is to create preceptorships between preceptors and students.Hospitals have a responsibility to provide preceptors with the knowledge and skills required to provide bedside instruction and evaluation of students. The continuation of a preceptor programme requires expenditure and dedication from nursing, the hospital, educational providers, and the work environment. Dibert and Goldenberg (1995) claim that such an investment may be lost if administrators fail to support preceptors after they are in the role. There is a danger of burnout if these highly qualified staff are required to assume extra obligations without rewards and supports. Research indicates continued commitment to the role is dependent on preceptors, perceived support, benefits and rewards. This study investigated these factors.

The National Association of Theatre Nurses(2003)issued recommendations to assist perioperative practitioners performing swab,instrument and needle counts. The principle being that all swabs,instruments and sharps are accounted for at all times during a surgical procedure, to prevent the retention of a foreign body or injury to the patient. The count must be carried out by two members of staff,one of whom must be qualified.

Following wide consultation with clinical staff, managers and service users, variations in continence management practices and service provision were highlighted including: A need to develop & standardise continence assessment practice The need to develop Clinical guidelines The need for education for all staff, clients/patients, families and carers The need for a database to manage clinical information and other data The need to link the provision of products to the outcome of clinical assessment Need for a home-delivery services for disposable incontinence management products and to establish a protocol for "client/patient specific" products for people in continuing care facilities. Need for a framework to supported audit Need for users input into service developments

Telehealth is a home monitoring system used to record clinical observations and carry out question and answer sessions. Telehealth medicine may offer an alternative strategy to management of patients with COPD over the traditional hospital based model of health care delivery. Telehealth medicine is currently high on the health agenda and has been allocated substantial funds to promote its use.

The Developing Practice Network (DPN) formed in 2002 is a national network for healthcare practitioners, that exists to promote, support and enable the development of practice in health care settings. It provides formal and informal opportunities for practitioners to share knowledge and learning about a wide range of practice development and change activities. This project was an innovative and practical response to a number of members from England, Wales and Northern Ireland questioning the possibility of accessing clinical supervision through the DPN. Clinical supervision might be described as a formal method of supporting practitioners and enhancing clinical practice through a process of action orientated reflection on practice whether as a group, or individually, but more often than not as a ‘face to face’ activity. The latter did not appear feasible due to the geographical distance and it was therefore agreed to explore an alternative method for group clinical supervision.

Wraparound is a project about partnership. The vision of Wraparound is to make a difference to the lives of disabled children (aged 0-18 years) and their families and develop new ways of multidisciplinary/interagency working across the Southern Health and Social Services Board (SHSSB), Northern Ireland. The culture of Wraparound acknowledges parents’ own expertise about their child and family, seeks to empower parents and young people and partnership is the preferred approach to assessing and meeting the needs of the child and family.

Project Aim - To ascertain best practice in relation to the assessment, service delivery and evaluation of the health needs of looked after children. Terms of reference To visit sites within the UK where there are established models for the provision of health care to looked after children. To ascertain the roles and responsibilities of the designated Doctor and designated Nurse for looked after children. To ascertain the multidisciplinary co-ordination of the health care needs process. To ascertain the involvement/empowerment of the looked after children, their family and carers in the process. To explore how health care plans are incorporated in the overall Social Services care plan and education plan. To review documentation used in the health care plan. To review how the health care plan is communicated and contributed to by other agencies. To ascertain the audit process in relation to the effectiveness of the health care plan. To understand the relevant legislative and procedural guidance in relation to looked after children. To ascertain the future objectives and plans for the multidisciplinary team with responsibility for the health needs of the looked after children. Many children and young people, for numerous and varied reasons, are unable to remain in the care of their families. These children are known as "Looked After Children" (LAC) and either voluntarily, or as a result of a legal order are in the care of local Health and Social Service authorities. The Department of Health (2002) states that these children are amongst the most socially excluded groups in society. They have profoundly increased health needs, which often remain unmet resulting in poor health, educational and social outcomes. Across the UK specific health services for this vulnerable group are funded and delivered in a variety of diverse ways. A successful application to the Florence Nightingale Foundation Travel Scholarship provided the opportunity to visit sites within Scotland, England and Wales to gain direct experience and knowledge of innovations in multidisciplinary practice with a strong nurse-led component. Rich, copious information was gained and recommendations for local implementation were suggested.

In the years 2004 to 2006 a research group consisting of nurses from the Nursing Midwifery Planning and Development Unit (HSE Midlands) and researchers from the University of Ulster (Professor Brendan Mc Cormack and Jan Dewing) carried out a collaborative practice development project exploring the processes involved in establishing person-centred care, outcome measurement and evaluation processes in care of the older person. The project was based in two older person settings in the Republic of Ireland ( Birr, County Offaly and Mullingar, County Westmeath). Findings from this work were positive and recommendations informed the research design of this national Practice Development Programme.

The aim of the project is to introduce a period of preceptorship for all newly qualified nurses coming to work in Causeway Hospital. It is essential to the enhancement of practice through reducing role transition problems and provision of support and guidance.

To highlight awareness of the specific problem areas that the older person encounters upon a diagnosis of Established Renal Failure. This educational need arose from students who were completing a short course in renal nursing and who recognised the dramatic increase of elderly patients within this specialised arena. This reflects the current demographic trend within renal nursing throughout the United Kingdom.

The National Clinical Guidelines for Stroke (2004) recommend that the documentation in stroke units must be evaluated for the purpose of clinical governance and quality improvement. Regular auditing is considered to be an integral part of maintaining quality healthcare records as it improves the standard of record keeping (An Bord Altranais, 2002). Furthermore, auditing healthcare records forms an essential element of the Quality Assurance process as the quality of the records maintained by the multidisciplinary team is a reflection of the quality of the care provided to patients. The hospitals self-assessment on the Standards of Accreditation recognised that the development of integrated care plans was a necessary area for improvement in order to enhance the integration of care in the hospital and reduce duplication. This sentiment has also been echoed by the Joint Commission for Accreditation of Healthcare Organisations who emphasised the increased need for integrated care delivery by multidisciplinary teams. Brunt and Glifford (1999) and Edwards (2003) consider integrated documentation to be essential in the co-ordination of care, as individual disciplines making entries in their own forms in their own work areas and rarely referring to one another’s documentation results in poor co-ordination of care. Integrated documentation is considered by Atwal and Caldwell (2002) to be a key strategy for achieving integrated care and reducing the isolation of professionals. Nolan and Nolan (1998) state that team working seems to improve when there is detailed care planning or shared documentation. An Bord Altranais (2001) recommend that all healthcare staff should be encouraged to read each others entries in the record as this facilitates good communication between healthcare staff. Integrated documentation is also considered to be more patient focused as their progress is evident, there is reduced duplication and it is time and cost efficient (Krause et al, 1996). Other benefits of integrated documentation are improved working relations between departments and the elimination of the need to repeatedly ask the same questions of patients, this in turn increases patient and staff satisfaction (Oxtoby, 2004). There are however some limitations of using integrated documentation. Long term complex patients tend to develop very bulky charts leading to a difficulty in perusing pertinent information. Having to rely on other disciplines to collect information about a patient was also recognised as a potential problem for team members (Brunt and Glifford, 1999). Warlow et al (2001) acknowledged that difficulties arose when several team members wished to use the patient record at the same time. A further disadvantage was that different departments did not have access to patient records when away from the unit. Prior to the introduction of multidisciplinary documentation in The Stroke Unit, patient records were kept in numerous places within the hospital. This resulted in documentation by each discipline being very costly, cumbersome and time consuming with very little information sharing. To address this problem, the team in the Stroke Unit introduced multidisciplinary documentation in October 2004. The disciplines involved were Physiotherapy, Speech and Language Therapy, Occupational Therapy, Social Work, Nursing and Clinical Psychology. The medical records were not incorporated due to several logistical reasons at the time of implementation. The teams overall goal was to develop an effective, efficient, user-friendly documentation system that reflected a patient focused and collaborative process of care. In order to assess whether or not this goal was achieved, an audit on the integrated documentation was conducted.

Identified need for group to support parents,carers of twins and triplets.

To evaluate the views and experiences of all representatives on the curriculum development steering group.

To assist nurses and midwives to communicate, share and disseminate information. To enhance meetings and collaboration between nurses and midwives

Urodynamic studies are an important preoperative requisite for many women who present with urinary incontinence, particularly those who have mixed stress and urge urinary incontinence, those with recurrent incontinence following previous surgery and those with evidence of neurological symptoms (Chapple and MacDiarmid, 2000). Although generally well tolerated some patients regard urodynamic studies as an unpleasant and painful procedure (Ku, 2004). The investigation is however, potentially distressing and embarrassing for the patient. Although urodynamic studies have widespread use as an investigative procedure to identify the factors contributing to urinary incontinence, there is an absence of descriptive data on women’s experiences of urodynamic studies. In comparison with American and British sources, there appears to be a dearth of information from Irish sources in medical, nursing or midwifery literature on the topic of women’s experience of urodynamic studies. This has been the motivation for this research study into women’s experiences of urodynamic studies as the role of the researcher is a professional with a specialised clinic and patient case load.