Helen Mulcahy | University College Cork (original) (raw)

Papers by Helen Mulcahy

International breastfeeding journal - Electronic Edition -, May 31, 2024

I declare that while registered for the degree of Doctor of Nursing (DN) I have not been a regist... more I declare that while registered for the degree of Doctor of Nursing (DN) I have not been a registered candidate or enrolled student of any other award at another academic or professional institution Helen Mulcahy 95200207 I declare that the content of this thesis is all my own work. Where the work of others has been used to augment it has been acknowledged and/or referenced accordingly.

Journal of Psychosomatic Research, Nov 1, 2019

Background: Social support facilitates a woman's transition to motherhood. This major development... more Background: Social support facilitates a woman's transition to motherhood. This major developmental transition can be stressful as it includes adaptation of self as well as learning new infant care practice skills. Although a number of instruments have been developed to measure social support, none have been developed or underpinned by theory in the context of perinatal infant care practices. Aim: To develop a reliable and valid instrument to measure social support for new mothers in the perinatal period. Methods: Phase 1 involved the development of instrument structure and content. Constructs to be measured were defined through an analysis of relevant theoretical and empirical literature. Phase 2 established the psychometric properties of the functional domain of the PICSS. Exploratory factor analyses and principal Component Analyses were undertaken with a sample of first-time mothers (n = 371) from postnatal wards of a large maternity hospital. Item reduction and Cronbach's alpha reliability tests were performed. The structural social support domain was not amenable to psychometric testing. Results: Exploratory Factor Analyses and Principal Component Analyses of the functional domain resulted in a logically coherent 19-item, two-factor solution. The first factor 'Supporting Presence' has nine items (Cronbach's alpha = 0.90) and the second factor 'Practical Support' has ten items (Cronbach's alpha = 0.86). Conclusions: The PICSS is a coherent and valid measure of social support for new mothers in the postnatal period in the context of infant care practices.

BMC Pregnancy and Childbirth, Apr 29, 2020

Background: The estimated global premature birth rate for 2014 was 10.6%, equating to an estimate... more Background: The estimated global premature birth rate for 2014 was 10.6%, equating to an estimate of 14.84 million live premature births. The experience of premature birth does not impact solely on the infant and mother as individuals but occurs in the context of a critical point in time when they are developing a relationship with one another. The aim of this study was to investigate the relationships between social support, mother to infant attachment, and depressive symptoms of mothers with preterm infants within the first 12 months' post discharge from the Neonatal Intensive Care Unit (NICU). Methods: A correlational cross-sectional study design was used. Data were collected using a four-part online survey which included the Perinatal Social Support Questionnaire (PICSS), Maternal Postnatal Attachment Scale (MPAS) and the Edinburgh Postnatal Depression Scale (EPDS) with mothers of preterm infants (n = 140). Results: The prevalence of postnatal depression was 37.9% (95% CI: 29.8 to 46.4%). In univariable analyses, history of depression (p = 0.005), aged 35-39 years (p = 0.006), no formal social support (p = 0.040), less informal social supports (p = 0.018), lower overall maternal attachment (p < 0.001) and lower overall functional social support (p < 0.001) were significantly associated with a higher level of depressive symptoms. Lower scores on two of the maternal attachment subscales (quality of attachment and absence of hostility) and all four of the functional social support subscales were significantly associated with a higher level of depressive symptoms (p < 0.001 for all). In the multivariable analysis, prior history of depression (p = 0.028), lower score of maternal attachment (p < 0.001) and lower emotional functional social support (p = 0.030) were significantly associated with a higher level of depressive symptoms. Conclusion: Women who experience a premature birth, have a prior history of depression, poor infant attachment and poor emotional social support have a higher level of depressive symptoms. Results emphasise the need for professionals to encourage mobilisation of maternal formal and informal social supports. It is important to intervene early to address maternal emotional well-being and enhance the developing mother-preterm infant relationship.

Public Health Nursing, Jan 17, 2022

Public health nurses (PHNs) in Ireland provide preventative child health. An evidence‐based Natio... more Public health nurses (PHNs) in Ireland provide preventative child health. An evidence‐based National Healthy Childhood Program (NHCP) has been in development since 2016. The final program implementation, including training all PHNs coincided with the Covid‐19 pandemic.ObjectiveTo describe implementation and evaluation of a blended training program for PHNsDesignThe evaluation used quantitative and qualitative methods underpinned by an implementation science framework to assess the training program. The three‐phase blended training was led by a Training and Resources implementation team. Data from a national cohort of PHNs (n = 1671) who completed training were descriptively analysed.ResultsThe majority of PHNs completed a suite of four online units (phase 1), as well as self‐directed and asynchronous content in phase 2. Results of phase 2 indicated it met participant needs in terms of knowledge but outstanding needs in terms of skills remained. Phase 3 (a modified Face to Face Clinical Skills Review) was completed by 1671 PHNs over a 5‐month period in 2020. Evaluation was very positive in terms of organisation and usefulness for practice.ConclusionsDespite challenges the NHCP training implementation goals were met. A well‐designed blended learning training program met service delivery imperatives and PHN needs.

Journal of Nursing Education and Practice, Mar 26, 2019

Elder abuse (EA) within the population of community dwelling older people living with dementia is... more Elder abuse (EA) within the population of community dwelling older people living with dementia is significantly more prevalent when compared with the population of older adults without cognitive impairment. Public Health Nurses (PHNs) in Ireland are a key professional service provider group in safeguarding vulnerable populations. Interpretative Phenomenological Analysis (IPA) was utilized to explore the experiences of PHNs in identifying and addressing abuse, among community dwelling older adults living with dementia that was perpetrated by informal caregivers. Semi-structured interviews were conducted with PHNs (n = 5) in Ireland that had in the previous 12 months dealt with a case of elder abuse involving an older adult living with dementia. Analysis of the data revealed three super-ordinate themes; identifying hidden abusive relationships; Complexity-'where do I start'; and Isolation. This study provides unique insights from PHNs relevant to safeguarding this particularly vulnerable group. Specific implications for practice and recommendations are presented.

Journal of Psychiatric and Mental Health Nursing, Apr 24, 2022

Accessible SummaryWhat is known on the subject? The delivery of mental health recovery orientated... more Accessible SummaryWhat is known on the subject? The delivery of mental health recovery orientated acre is a requirement of mental health professionals and an acknowledged desired outcome for individuals presenting with mental health issues. Hope has been recognized as one of 5 key processes of mental health recovery, and critically as the key catalyst of recovery. Mental health nurses are required to be competent in cultivating service user hope. What the paper adds to existing knowledge? Novel exploration of how people described and made sense of the lived experience of hope in mental health recovery. Participants described hope as intrinsic to life in the context of its ability to cultivate desire and provide energy for life and living. Participants with experience of attempts to end life had a very clear concept of hope as missing at these times. Participants described the concept of hope as present but hidden to explain their survival through tortuous circumstances. The themes generated contribute to a greater understanding of the dynamic role and process of hope in mental health recovery. What are the implications for mental health nursing practice? Mental health practitioners need to be competent in understanding and cultivating hope as part of a person‐centred approach, embedded in a therapeutic relationship. All stakeholders including service users, mental health nurses and educators need a more accessible reified dialogue of “hope” that harnesses its therapeutic potential. IntroductionMental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro‐process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential.AimTo explore how individuals describe and make sense of their experience of hope in mental health recovery.MethodA qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi‐structured interviews and analysed using an IPA framework.ResultsThree superordinate themes emerged: “Without it we would wither up and die”—Hope as intrinsic to life; “I will be ok”—Having a sense of possibility and “Making it happen”—Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances.DiscussionIndividuals were more familiar with the concept of hopelessness, had a ready‐to‐hand vocabulary of “having no hope” and used this by default to inform what hope meant.Implications for PracticeIt is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential.

Worldviews on Evidence-based Nursing, May 27, 2021

BackgroundImplementation of evidence‐based practice (EBP) is essential for ensuring high‐quality ... more BackgroundImplementation of evidence‐based practice (EBP) is essential for ensuring high‐quality health care at minimum cost. Although all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners (NPs) as clinical leaders have additional responsibilities in leading and collaborating with transdisciplinary teams to implement EBP across patient groups and embed practice change into routine care.AimTo explore the factors affecting the implementation of EBP into routine care by NPs. Specifically, to examine NP beliefs, levels of EBP implementation, and barriers and enablers to EBP implementation into routine care.MethodsA scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework. The electronic databases CINAHL, Medline, and PsycINFO were searched for studies published between 2009 and 2018 along with gray literature and reference lists of included articles. Abstracts and studies were screened using predefined eligibility criteria. Data extraction was undertaken using a standardized framework and data synthesis completed.ResultsSeven studies were included in the review. Findings indicated NPs valued EBP and believed it to be important in standardizing patient care. NPs’ implementation of EBP was found to be relatively low overall. It was not possible to fully determine the extent to which NPs implemented EBP into routine care. NPs experienced similar barriers to EBP implementation as do nurse generalists such as lack of time, lack of EBP competence, lack of support from colleagues and managers, and inadequate resources. In particular, NPs identified collaborative practice issues as factors affecting EBP implementation. Identified barriers included physician‐driven practice and the need to maintain professional and political boundaries. Supportive collaborative relationships and having professional confidence were identified facilitators.Linking Evidence to ActionAn exploration of NPs’ experience of interprofessional collaboration when implementing EBP into routine care is needed to identify requirements for support in this area.

British Journal of Community Nursing, Dec 1, 2013

People with early-onset dementia (EOD) and their family carers remain an overlooked population wi... more People with early-onset dementia (EOD) and their family carers remain an overlooked population within the policy and practice priorities of community health care. No standard provision of care or support currently exists for those with EOD and the family carer. Yet family members provide the majority of the full-time care required for this progressive, irreversible illness. The aim of this research was to explore the impact of care-giving on family members caring for a relative with EOD. The care-giving experiences identified in this study emphasise the need for improvement in the provision of community and specialised services for people with EOD and family carers. The key themes of this qualitative study were diagnostic problems, impact of care-giving, relationship change and lack of resources. These findings provide key directives for improving community practice, services and support for people with EOD and their family carers.

Journal of Psychiatric and Mental Health Nursing

IntroductionSelf‐care is essential for nurses' wellbeing, with stress posing a major barrier.... more IntroductionSelf‐care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self‐care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self‐care practices is essential. There is currently a paucity of literature on this topic.AimTo explore mental health nurses' views about what influences their ability to self‐care in relation to workplace stress and the impact on their practice and work environment.MethodsAn Interpretative Phenomenological Analysis approach was utilized. In‐depth interviews explored how nurses perceived the influence of environment and relationships on self‐care practices in the workplace.ResultsParticipants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes—the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling ...

BMC Pregnancy and Childbirth, Oct 1, 2021

Cork Open Research Archive, 2021

International Journal of Older People Nursing, Dec 8, 2022

BackgroundTransitions to long‐term care are challenging for individuals and often associated with... more BackgroundTransitions to long‐term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person‐centred way which are respectful of the person's human rights. One approach which facilitates self‐determination during a transitional period is shared decision‐making, but there is a lack of clarity on the nature and extent of research evidence in this area.ObjectiveThe purpose of this scoping review is to identify and document research related to shared decision‐making and transitioning to long‐term care.MethodsA comprehensive search in CINAHL, Medline and Psych‐info identified papers which included evidence of shared decision‐making during transitions to a long‐term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice.ResultsEighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision‐making during transitions to long‐term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved.ConclusionsThe evidence identified the complexity of such decision‐making with efforts to engage in shared decision‐making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person‐centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision‐making.

British Journal of Community Nursing, Jan 2, 2016

Background: The extent of self-neglect on public health nurses' (PHNs) caseloads in Ireland i... more Background: The extent of self-neglect on public health nurses' (PHNs) caseloads in Ireland is unknown. People who self-neglect may be vulnerable or hidden and, as a consequence, difficult to profile. PHNs in Ireland profile their areas to identify the nursing needs of their population. Aim: This paper aims to: collate caseloads on self-neglect on the basis of a review of community profile and health need assessments (CPHNA) and identify the geographical and demographic factors within which self-neglect cases were found. Method: A retrospective review of the CPHNA of student PHNs (n=88) was undertaken from 2010 to 2014 in a university in Ireland. In all, 88 community profiles were manually reviewed. Results: A total of 374 self-neglect cases were identified—79 cases were aged between 18–64 years and 295 were over 65 years. The range of self-neglect cases per profiled area was between 0 to 25. The geographic and demographic factors linked to self-neglect across profiles were higher rates of older people, deprivation, disadvantage, and cultural factors. Conclusion: This retrospective review illustrates that self-neglect is a prominent feature in PHN caseloads, which has not been identified previously. Early identification is important to promote the mental health and wellbeing of self-neglecting clients.

British Journal of Community Nursing, Mar 2, 2015

Self-neglect is a worldwide and serious public health issue that can have serious adverse outcome... more Self-neglect is a worldwide and serious public health issue that can have serious adverse outcome and is more common in older people. Cases can vary in presentation but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this paper is to create a greater understanding of the concept of self-neglect among community nurses.

Women and Birth, Apr 1, 2017

Background: Breastfeeding rates in Ireland are among the lowest in Europe. Breastfeeding groups c... more Background: Breastfeeding rates in Ireland are among the lowest in Europe. Breastfeeding groups can provide support, information, and friendship for women. However, there is little research exploring community breastfeeding groups led by Public Health Nurses providing universal maternal and child care to all postnatal mothers in the community in Ireland. Aim: The aim of this study was to explore breastfeeding women's experiences of a Public Health Nurse led support group. Methods: A qualitative descriptive design to explore women's experiences of a community breastfeeding support group was conducted. Data were collected using one to one interviews with breastfeeding women (n = 7) in a primary healthcare setting. Transcripts were analysed using Burnard's thematic content analysis. Results: The overall theme identified was 'normalising breastfeeding' which emerged from the subthemes 'socialising and sharing', 'information and support seeking', 'building confidence', 'overcoming embarrassment', 'negative perceptions of others', and 'promoting breastfeeding to others'. Discussion: Women who attended the PHN led breastfeeding support group found it to be a cocoon of 'normality', whereas breastfeeding was considered almost something to be ashamed of in other circumstances. Many women attributed their success with breastfeeding to the support group. Conclusion: Facilitating a sense of normalcy for breastfeeding women at individual, community and societal levels was essential in promoting breastfeeding. The community support group was influential in normalising breastfeeding for a sample of women, by minimising the potential for embarrassment, promoting social interaction and sharing, building confidence and knowledge. This buffered the effects of negative attitudes of others and personal feelings of shame.