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Hugh McKenna

Publications and source records attributed to Hugh McKenna.

At least 19 recordsLinked to original sources
PubMed2006

Consulting the oracle: ten lessons from using the Delphi technique in nursing research.

AIM: The aim of this paper was to provide insight into the Delphi technique by outlining our personal experiences during its use over a 10-year period in a variety of applications. BACKGROUND: As a means of achieving consensus on an issue, the Delphi research method has become widely used in healthcare research generally and nursing research in particular. The literature on this technique is expanding, mainly addressing what it is and how it should be used. However, there is still much confusion and uncertainty surrounding it, particularly about issues such as modifications, consensus, anonymity, definition of experts, how 'experts' are selected and how non-respondents are pursued. DISCUSSION: This issues that arise when planning and carrying out a Delphi study include the definition of consensus; the issue of anonymity vs. quasi-anonymity for participants; how to estimate the time needed to collect the data, analyse each 'round', feed back results to participants, and gain their responses to this feedback; how to define and select the 'experts' who will be asked to participate; how to enhance response rates; and how many 'rounds' to conduct. CONCLUSION: Many challenges and questions are raised when using the Delphi technique, but there is no doubt that it is an important method for achieving consensus on issues where none previously existed. Researchers need to adapt the method to suit their particular study.

Consensus↗
PubMed2006

The introduction of innovative nursing and midwifery roles: the perspective of healthcare managers.

AIM: This paper reports a study exploring issues arising from the introduction of innovative nursing and midwifery roles from the perspective of healthcare managers. BACKGROUND: In recent years, the number of innovative roles in nursing and midwifery has increased dramatically across all areas of health care. A comprehensive literature review has shown that there is a scarcity of empirical studies to inform policy or the organizational context of this rapidly changing situation. METHOD: Semi-structured interviews were conducted with all Directors of Nursing, Chief Nurses and Directors of Primary Care in the Health and Social Services Trusts and Boards in Northern Ireland. This study formed the first phase of a larger exploration of innovative roles. Data were collected from July to October 2004. FINDINGS: The findings confirm that in recent years there has been a considerable increase in the number and type of innovative nursing and midwifery roles. Themes that emerged from the data included professional identity and number of innovative roles; stimuli for role development; service commissioning; infrastructure support; and perceived value for money. CONCLUSION: Analysis of the impact of innovative nursing and midwifery roles on other members of staff, notably healthcare assistants, is needed. The internationally increasing number of innovative roles need to be evaluated further with regard to their effect on care outcomes for patients, their families and communities, their cost-effectiveness and to how best to secure the support and commitment of colleagues. Further study should also be undertaken to determine whether innovative role-holders are pioneers in the development of future nursing, or whether they are responding to the workforce needs of the medical profession or to the requirements of the health service to cut costs.

Administrative Personnel↗
PubMed2006

Nursing the clinic vs. nursing the patient: nurses' experience of a day hospital chemotherapy service.

AIMS AND OBJECTIVES: This study sought to explore the nurses' experience of a day hospital chemotherapy service in an acute general hospital in Northern Ireland and how this compared with their experience of working in an inpatient setting. BACKGROUND: Despite the many changes taking place in cancer care delivery, little research has been conducted on nurses' experience of working in more acute cancer treatment settings. Research conducted to date has tended to focus on the role of nurses in wards, hospices and palliative care settings. DESIGN: This Heideggerian hermeneutic phenomenological study explored nurses' lived experience of day hospital chemotherapy service. METHOD: Face-to-face focused in-depth interviews were conducted with the total population of nurses who worked in the day hospital at the time of data collection (n = 10). Data analysis involved a two-staged approach, the analysis of narratives and narrative analysis, based on the work of Polkinghorne (1995). CONCLUSIONS: The nurses' viewed their experience of the chemotherapy day hospital as having both positive and negative dimensions. The positive dimensions included an increased sense of autonomy and the challenge of developing new skills, while the negative dimension included a perceived decrease in their caring role: (i) The individual characteristics of the nurse were seen to have a key influence on caring experience; (ii) Role changes led to a perceived dichotomy between their actual and aspired role and their caring and clinical role. RELEVANCE TO CLINICAL PRACTICE: There is a need to achieve a balance between delivering a clinical role (administering chemotherapy) while maintaining the centrality of the nurse-patient relationship. This can be likened to achieving a balance between 'nursing the clinic' alongside 'nursing the patient'. These findings have implications for the discourse on caring within other outpatient type clinics and discourse on cancer nursing as therapy and the culture of the cancer clinic.

Adaptation, Psychological↗
PubMed2005

The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation.

The aim of the present study was to explore the experiences of recipients and providers of community care in rural areas in Northern Ireland. Additionally, the authors sought to examine the impact of location, housing and environmental factors on the delivery of community care to older people with complex needs. Individual, semistructured interviews were held with service users (n = 17) and family carers (n = 14). Individual and focus group interviews were conducted with care assistants, health and social care professionals, and senior managers from a large health and social care trust and health and social services board in Northern Ireland. The importance of enabling older people to remain in their own homes and communities was emphasised by all participants. The main challenges associated with care provision in rural areas included: difficulties recruiting care assistants; lack of choice of care assistants; isolation; travel and distance between clients and their care assistants; and poor housing conditions. There was a general consensus among participants that the effectiveness of rural community care was perceived to be reliant upon the goodwill of the community. Additionally, changing demographic trends and the predicted shortfall in the number of formal and informal carers were considered key issues for service planners. A number of creative strategies could be used to address many of the limitations associated with rural isolation. These should involve capitalising on available community networks. However, planners should also acknowledge that additional resources are required to maintain older people in rural communities.

Community Health Services↗
PubMed2005

Nurses', midwives' and patients' perceptions of trained health care assistants.

AIM: This paper reports on part of a larger study and outlines Registered Nurses' and Midwives' perceptions of, and satisfaction with, trained health care assistants in a regional hospital setting in the Republic of Ireland. BACKGROUND: An increased reliance upon health care assistants in the clinical setting has highlighted the need to consider how staff and patients perceive the health care assistant role. FINDINGS: Nurses were satisfied with the work undertaken by trained health care assistants and considered that they contributed positively to patient care and supported nurses/midwives by undertaking non-professional duties. However, maternity clients reported that health care assistants were mostly giving direct care, and their availability was perceived to be better than that of qualified staff. Some nurses/midwives were reluctant to assume responsibility for delegation of direct care duties to health care assistants. CONCLUSION: The employment of health care assistants yields positive outcomes for staff and female clients but consideration must be given to role clarity. Further research into how qualified staff perceive health care assistants is important as such perceptions influence delegation, integration, role development and acceptance of health care assistants.

Attitude of Health Personnel↗
PubMed2005

Relationship between quality of care, staffing levels, skill mix and nurse autonomy: literature review.

AIMS: This paper reports a literature review exploring the relationship between quality of care and selected organizational variables through a consideration of what is meant by perceptions of quality, whose perceptions are accorded prominence, and whether changes in staffing, skill mix and autonomy affect perceptions of quality. BACKGROUND: Three basic ideas underpin this literature review: the growing focus on quality improvement in health care, concerns about the quality of care, and the move towards patient involvement and consultation. Of particular interest is the way in which changes in nurse staffing, skill mix and autonomy may affect the delivery of quality patient care. METHODS: A search was conducted using the CINAHL, Medline and Embase databases. Key words used were quality of health care; quality of nursing care; nurse; patient; skill mix; nurse-patient ratio; outcomes; adverse health care events and autonomy. The objective was to draw together a diverse collection of literature related to the field of health care quality. Papers were included for their relevance to the field of enquiry. The original search was conducted in 2003 and updated in 2004. FINDINGS: Quality of care is a complex, multi-dimensional concept which presents researchers with a challenge when attempting to evaluate it. Traditional nursing assessment tools have fallen out of use, partly because they have failed to provide opportunities to engage with and access the views of patients or nurses. There is also evidence that patient satisfaction as an indicator of quality is compromised on a number of fronts. There is conflicting information on how nurses and patients think about quality. Research looking at the relationship between the selected organizational variables and perceptions of quality also suffers from a number of limitations. We argue that there is a requirement for more patient-centred research exploring perceptions of quality and differences in nurse staffing, skill mix and autonomy.

Attitude of Health Personnel↗
PubMed2005

Health care assistants: the views of managers of health care agencies on training and employment.

AIM: The aim of this study was to obtain the views of managers of health care agencies to assess whether they would employ trained health care assistants (HCAs). BACKGROUND: In 2000/2001, a training programme for HCAs was piloted in the Republic of Ireland. It was important to ascertain if the training programme was capable of producing HCAs that health care agencies would employ. METHODS: A self-administrated postal survey was distributed to health care agencies. RESULTS: Findings included suggestions on how the content of the programme could be made more relevant; most of the managers surveyed would employ a HCA trained on the programme; respondents did not believe that the HCA role encroached on that of the nurse and/or midwife and; most already employed HCAs with some offering informal, in-house training. CONCLUSION: Overall, respondents' views of the training programme were extremely positive with many recommending that it be continued and expanded.

Attitude of Health Personnel↗
PubMed2005

What do midwifery healthcare assistants do? Investigating the role of the trained healthcare assistant.

There has been relatively little discussion in the literature regarding the role of the healthcare assistant (HCA) in midwifery. The study examines and contrasts HCA duties in one maternity department in the Republic of Ireland. Observations of six trained HCAs were undertaken to evaluate if they have the relevant repertoire of skills as taught in a national training programme, and to assess if they are using these skills competently. Findings indicate that HCAs carried out more indirect patient care activities than direct care activities. Findings show that the HCA provided support to qualified staff by assisting them in a range of care activities. This was consistent with the specified job description and with their training programme. This exploratory study helps to further understand the role of the HCA. It identifies the activities that HCAs undertake in support of qualified staff in maternity settings. The findings highlight the need for further investigation to determine the relationship between the role of the trained HCA and the qualified midwife.

Adult↗
PubMed2004

Barriers to evidence based practice in primary care: a review of the literature.

People with health problems deserve a service that is based on best available evidence and is possible within obtainable resources. No credible health professional could deny that sound evidence should be an integral part of clinical decision making. The demand for up to date information to inform care and treatment highlights the crucial role of research and development in the modern health service. However, within primary care, practitioners have not always been able to underpin their actions with robust research findings. In addition, the research activities within primary care are limited to a small number of 'enthusiasts'. This paper aims to analyse the literature surrounding this area, highlighting the significance of United Kingdom (UK) government reports on primary care, primary care research activities and the pursuit of evidence based practice in primary care. It shows that primary care research has been the 'poor relation' in terms of research funding and this has resulted is a dearth of high quality research results to underpin practice.

Attitude of Health Personnel↗
PubMed2004

The role of an outreach oncology nurse practitioner: a case study evaluation.

Nurses have an extensive input into the care of cancer patients both in hospital and in the community and are central to the current movement to improve and streamline cancer services. Internationally there has been a move to employ highly skilled nurse practitioners in cancer care. This paper describes a single case study evaluating the role and work of an Oncology Nurse Practitioner (ONP). Multiple sources of data were used. Stage One involved collecting descriptive information about the post holder, her role and the types of patients cared for. Stage Two used a qualitative approach to explore how the post was established, its key features, its perceived advantages and disadvantages and the factors influencing its success. Findings show that all participants viewed the post positively and that such nurses can provide high-quality services in remote rural areas. The study found that to be successful the post holder needs appropriate personal attributes such as flexibility and communication skills and the ability to work independently as well as part of a team. The limitations of this study and the implications for the further development of nursing roles in oncology are discussed.

Aged↗
PubMed2004

Nurse leadership within primary care: the perceptions of community nurses, GPs, policy makers and members of the public.

AIM: The aim of this section of a wider study was to seek the views of community nurses, general practitioners, members of the public and policy makers on nursing leadership in primary care. The wider study aimed to review the role and function of primary care services and community nursing with reference to developments in practice, education, research and policy. BACKGROUND: Key messages, challenges and opportunities for leaders within nursing have been highlighted in the literature and in turn emphasis placed on the positive effect this would have on improved quality of services [Department of Health and Social Services (1998) Valuing Diversity...A Way Forward. Department of Health and Social Service, Belfast]. In order to grasp these opportunities, nursing has to invest in the development of leaders. METHODS: A two round Delphi technique was employed using a focus group approach in round one and a postal questionnaire in round two. Semi-structured interviews were carried out with senior policy makers. RESULTS: Findings show that there was agreement that strong leadership was needed for the development of community nursing but that at present there is confusion and disagreement over whether it exists currently. Other findings focus on problems inherent in identifying future nurse leaders. CONCLUSION: The traditional subservient culture of community nursing is blamed for the perceived inability to nurture strong leaders. Recommendations are made for the development of nurse leaders.

Community Health Nursing↗
PubMed2004

Community nursing: health professional and public perceptions.

BACKGROUND: Almost 10 years ago senior United Kingdom nurses met at Heathrow Airport to discuss the challenges and opportunities facing nursing. One aspect of this 'Heathrow Debate' was to encourage nurses to work closer with members of the public. The resulting report stated that nurses have not been effective in working outside their professional area and, in particular, they have not been adept at working in partnership with the public. AIM: The aim of this paper is to report a study to obtain the views of general practitioners (GPs), community nurses and members of the public on how the public perceive community nursing. A further aim was to explore the perceptions of senior health care managers and policymakers about public involvement in primary care. METHODS: A two-stage Delphi investigation was undertaken with community nurses (n = 38), GPs (n = 14) and members of the public (n = 8). In addition, one-to-one interviews were carried out with 34 senior health service managers and policymakers. FINDINGS: There was agreement on the following issues: community nurses must work more closely with members of the public; there is a lack of public understanding on the roles of community nurses and specialist nurses; there is public support for nurse prescribing; there is a preference for seeing the community nurse as opposed to the GP; and people prefer one nurse to care for them rather than a variety of nurses. Comments from managers and senior policymakers showed agreement on the public being involved in primary care, but an acknowledgement that this was problematic. A number of recommendations are outlined.

Community Health Nursing↗
PubMed2003

The role of stress, peer influence and education levels on the smoking behaviour of nurses.

Smoking kills yet a substantial number of qualified nurses continue to smoke. Stress, peer influence and education levels have been cited as influencing prevalence levels among nurses. A self-completed questionnaire was used to survey qualified nurses' perceptions of smoking prevalence, attitudes, and reasons for smoking. The respondents were composed of a random sample (n=1074) of qualified nurses employed in Northern Ireland. Results show that 25.8% of the sample smoked. Factors influencing smoking behaviour and reasons for continuing smoking are explored. This paper discusses the implications of these findings for nursing and nurses' health promotion activities.

Attitude of Health Personnel↗
PubMed2003

Exploring the patient's experience of a day hospital chemotherapy service: preliminary fieldwork.

This paper describes some preliminary findings from a Heideggerian hermeneutic phenomenological study exploring patients' experiences of a day hospital chemotherapy service. Phenomenology has been described as both a philosophical perspective and a research method. Following a review of the literature, it was apparent that there is a paucity of qualitative studies regarding the experience of chemotherapy treatment. The aim of the study was to explore patients' experiences of receiving treatment within a day hospital setting and to compare this with previously having received treatment as an inpatient. Purposeful sampling and face-to-face interviews were conducted. Preliminary data analysis from the pilot study has identified themes for patients relating to the need to maintain hope associated with treatment; feelings of adjustment; incorporating treatment as 'part of life'; need for closure following treatment; thoughts of comradeship and sharing the experience.

Ambulatory Care Facilities↗
PubMed2003

Generic and specialist nursing roles in the community: an investigation of professional and lay views.

In the UK, a number of policy documents have sought to outline and clarify the role of the community nurse in the past 10 years. Furthermore, the increasing specialisation of community nursing has been the topic of much debate in the UK and Ireland. The present study aimed to investigate the perceptions of community nurses, general practitioners (GPs), members of the public, and senior strategists and policy-makers in relation to specialist and generalist nursing roles within community nursing in Northern Ireland and the Republic of Ireland. Focus groups were undertaken with community nurses (n = 38), GPs (n = 14) and public representatives (n = 8). This was followed by a two-stage Delphi investigation using self-report questionnaires with the same samples. In addition, data were collected from 34 senior policy-makers using a semi-structured interview schedule. The results uncovered a mix of views. While there was much negativity about specialisation, the participants felt that the move away from generalism was unavoidable. There was concern that specialisation, whilst welcome in some areas, would lead to role conflict, role overlap and role confusion. Findings from this study have the potential to inform the specialisation-generalism debate within and outside the UK and Ireland. Recommendations are suggested for future policy and practice.

Attitude of Health Personnel↗