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

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.

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

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

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

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.

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 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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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

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.

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 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.

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 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.

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

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.

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.

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).

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.

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.

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.

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.

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 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.

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

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.

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 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.

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.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.