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Biomedical subjects

Brendan McCormack

Publications and source records attributed to Brendan McCormack.

At least 19 recordsLinked to original sources
PubMed2026

Effectiveness and implementation of task-sharing cognitive-behavioral interventions for perinatal mental health: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of cognitive-behavioral interventions (CBIs) delivered by nonspecialist providers (NSPs) on perinatal depressive (PND) and anxiety symptoms, and to narratively synthesize their implementation processes and reported implementation outcomes, including acceptability, feasibility, fidelity, cost, and sustainability. METHODS: We systematically searched eight databases from inception to April 8, 2025. Eligible studies were randomised controlled trials (RCTs) assessing CBIs delivered by NSPs for PND and/or anxiety. Two reviewers independently screened, extracted, and assessed trials. Meta-analyses employed random-effects models, with subgroup, sensitivity, meta-regression, and publication bias analyses conducted in Stata 18.0. Implementation processes and outcomes were reported as frequencies or percentages across trials. RESULTS: A total of 47 trials (11, 357 participants) were included in the systematic review, of which 37 trials (8,709 participants) were included for meta-analyses. CBIs were conducted in 12 countries. Nurses and midwives delivered 45% of CBIs. CBIs were associated with reduced PND post-intervention compared with control conditions (standardized mean difference [SMD] -0.49, 95% CI -0.63 to -0.35; I² = 86.8%). Limited evidence from four trials suggested a small sustained effect at 12 months (SMD -0.14, 95% CI -0.27 to -0.02; I² = 26.4%). Reductions in anxiety symptoms were observed immediately post-intervention (SMD, -0.45, 95% CI -0.65 to -0.25; I²=81%), but evidence for longer-term effects was limited. Subgroup analyses confirmed consistent effects across diverse settings, populations, and intervention characteristics. Reporting of implementation processes (e.g., training, supervision, fidelity) was limited, with only 23.4% of trials assessing fidelity and 10.6% evaluating costs. CONCLUSIONS: NSP-delivered CBIs showed beneficial effects on PND and anxiety, with generally encouraging evidence for acceptability and feasibility. However, evidence for sustained effects beyond the immediate post-intervention period remains limited. Future studies should strengthen long-term follow-up and improve reporting of implementation processes and outcomes, particularly in rural and adolescent perinatal populations, to inform scalable and equitable task-sharing models.

Humans↗
PubMed2006

Development of a framework for person-centred nursing.

UNLABELLED: This paper presents the development and content of a person-centred nursing framework. BACKGROUND AND RATIONALE: Person-centred is a widely used concept in nursing and health care generally, and a range of literature articulates key components of person-centred nursing. This evidence base highlights the links between this approach and previous work on therapeutic caring. METHODS: The framework was developed through an iterative process and involved a series of systematic steps to combine two existing conceptual frameworks derived from empirical studies. The process included the mapping of original conceptual frameworks against the person-centred nursing and caring literature, critical dialogue to develop a combined framework, and focus groups with practitioners and co-researchers in a larger person-centred nursing development and research project to test its face validity. FINDINGS: The person-centred nursing framework comprises four constructs -prerequisites, which focus on the attributes of the nurse; the care environment, which focuses on the context in which care is delivered; person-centred processes, which focus on delivering care through a range of activities; and expected outcomes, which are the results of effective person-centred nursing. The relationship between the constructs suggests that, to deliver person-centred outcomes, account must be taken of the prerequisites and the care environment that are necessary for providing effective care through the care processes. CONCLUSION: The framework described here has been tested in a development and research project in an acute hospital setting. Whilst there is an increasing empirical base for person-centred nursing, as yet little research has been undertaken to determine its outcomes for patients and nurses. The framework developed can be described as a mid-range theory. Further testing of the framework through empirical research is required to establish its utility for nursing practice and research.

Attitude to Health↗
PubMed2006

An evaluation of the role of the clinical education facilitator.

AIMS AND OBJECTIVES: The objective of the study was to identify whether clinical education facilitators made a difference to the learning experiences of nurses in a large teaching hospital. BACKGROUND: Strategies for enabling continuous professional development are well established in health care organizations as key components of approaches to lifelong learning. The benefits of continuous professional development include the maintenance of high standards of care, the improvement and development of services, ensuring the competency of all nursing staff and guaranteeing the accountability of nurses for their actions. The role of clinical education facilitator is relatively new and little evaluation of this role has been undertaken. CONCLUSIONS: This study highlights important issues to be considered in developing a 'learning culture' in a hospital organization, through the adoption of such roles as clinical education facilitators. Whilst the roles have had an important function in the active coordination of learning activities in the hospital, there is little evidence of the role directly impacting on the learning culture of clinical settings. Learning mechanisms have been identified. The results of this evaluation can be subjected to further testing through ongoing evaluation of the outcomes arising from the learning mechanisms in place. Given the emphasis on work-based learning and continuing professional development in health care, then this ongoing evaluation can yield important information about future directions for nurse education. RELEVANCE TO CLINICAL PRACTICE: The study highlights the importance of supported learning in the workplace. However, more importantly, it identifies the need for a culture of professional practice to be developed in order to sustain learning in practice. Classroom-based learning alone, cannot create a culture of development in nursing and there is thus a need for models of work-based learning to be integrated into practice environments.

Attitude of Health Personnel↗
PubMed2006

Determining factors that have an impact upon effective evidence-based pain management with older people, following colorectal surgery: an ethnographic study.

AIM: The aim of this project was to examine pain management practices with older people admitted to the colorectal unit of an acute hospital trust. BACKGROUND: Although pain assessment and management are judged to be a priority, little research has examined the care older people receive in the acute surgical setting. Thus, pain in older people (65 years and over) can be under recognized and unrelieved. With the number of older people requiring surgery increasing, it is important to identify factors in the practice context that enhance or inhibit effective pain management. DESIGN: The project drew upon an in-depth ethnographic approach. METHOD: Sixty-two hours of around the clock, non-participant observation of nursing practice was completed. Thirty-nine (78%) nurses and forty-six (42%) patients were observed. Seven (6%) additional patients participated in pre- and postoperative interviews and 35 (90%) nurses completed the Nursing Work Index--Revised Questionnaire. FINDINGS: Holistic pain assessment for older people was found to be deficient in the acute surgical setting. Nurses appeared unaware of the importance of addressing the particular pain needs of older patients. Inflexible analgesic prescriptions provided the mainstay treatment of pain, with minimal consideration given to non-pharmacological strategies. Older people wanted to be active participants in their care. However, existing pain management practices disempowered older patients, making them reluctant or unable to discuss their pain with ward staff. CONCLUSION: Comprehensive pain assessment, improved documentation and proficient communication, inclusive of older patients, are necessary to improve pain management practices. It is imperative that patients, nurses, doctors and Acute Pain Service work in collaboration to challenge pain management practices and implement change. RELEVANCE TO CLINICAL PRACTICE: The project demonstrated some of the multiple and complex factors that affect the older persons' pain experience and identified three action research cycles for further development work.

Aged↗
PubMed2006

Critical realism as emancipatory action: the case for realistic evaluation in practice development.

To provide rigour when preparing a research design, the researcher needs to carefully consider not only the methodology but also the philosophical intent of the study. This, however, is often absent from reported research and provides the reader with little evidence by which to judge the merits of the chosen methodology and its influence on the study. The purpose of this paper is to set out the case for critical realism as a framework to guide appropriate action in practice development and realistic evaluation for understanding the consequences of those actions. It is evident that critical realism and critical social science share common ground. Emancipatory practice development (ePD) is based on the philosophy of critical social science and therefore by virtue is linked to the tenets of critical realism. Until now, the evaluation of ePD programme has been well served by 4th-generation evaluation. However, this paper outlines the need for a different approach to evaluation, one that is based on critical realism, that is concerned with emancipation, and that can be used in the ever-changing environment of clinical practice. Realistic evaluation not only links strongly to ePD programmes, but also serves as the basis for effective research questions that will test the outcomes of the research and inform the transferability of ePD mechanisms into differing contexts.

Attitude of Health Personnel↗
PubMed2006

Re-defining nursing expertise in the United kingdom.

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.

Attitude of Health Personnel↗
PubMed2005

A literature review to explore integrated care for older people.

PURPOSE: This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. METHODS: The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and 'grey' literature, i.e. material which had not been reviewed for publication. RESULTS: The study found that thinking has moved on from a focus on the problems of accessing services to exploring ways in which they may function in an integrated way. CONCLUSIONS: The study shows how thinking on integrated care for older people has developed, and knowledge of micro, mezzo and macro strategies is now more available.

Journal Article↗
PubMed2005

Determining older people's needs for care by Registered Nurses: the Nursing Needs Assessment Tool.

AIMS: This paper reports a study to determine an appropriate framework for assessing older people's needs for nursing within the policy of 'free nursing', and to attempt to identify valid, reliable and usable assessment tool for determining this eligibility. BACKGROUND: In 2001, the United Kingdom government introduced 'free nursing care' legislation, eligibility for which was subject to a nursing needs assessment. This paper outlines the search for and subsequent development of an appropriate tool for assessing older people's eligibility for free nursing care in Northern Ireland. METHODS: Following a systematic search of the literature, existing tools used in ascertaining older people's nursing needs were identified. Each tool was systematically assessed in accordance with criteria of validity, reliability, usability, comprehensiveness of assessment and ability to quantify nursing care needs. From the findings, an assessment instrument, Nursing Needs Assessment Tool was subsequently developed and tested. Paired assessments of older people were undertaken independently by assessor dyads and evaluated statistically. Assessors' opinions on the usability of the instrument were sought through a focus group. RESULTS: One hundred and ten paired assessments were returned (63%). Overall there was 65% agreement between assessors. Kappa scores indicated good levels of inter-rater reliability. Correlation co-efficient measures reinforced these results. Findings from the focus group confirmed the validity, usability and comprehensiveness of the tool. CONCLUSIONS: The Nursing Needs Assessment Tool is a reliable, valid and usable instrument. This has major implications for the standardization of assessment for older people.

Aged↗
PubMed2005

Developing postoperative pain management: utilising the promoting action on research implementation in health services (PARIHS) framework.

BACKGROUND: The development of acute pain services (APS), education programmes, and protocols assumed an expectation that health care professionals would integrate evidence into everyday practice. However, research evidence into pain management would suggest that this is not the case. APPROACH: Through a review of the literature, the authors aim to (1) explore the factors that have a significant influence on getting evidence into practice (using the PARIHS model as a guide) and (2) examine the relevance of these factors to postoperative pain practices. FINDINGS: The need to assist clinicians with developing a greater awareness of the competing and complex influences that surround pain management practices is outlined. RECOMMENDATIONS: There is a necessity to adopt a systematic, rigorous, and multidimensional approach to pain management issues, utilising the PARIHS framework as a guide, to improve pain practices.

Culture↗
PubMed2004

What counts as evidence in evidence-based practice?

BACKGROUND: Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. AIM: This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. DISCUSSION: Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. CONCLUSION: Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced.

Decision Making↗
PubMed2004

Person-centredness in gerontological nursing: an overview of the literature.

Person-centred practice is a recurring theme in gerontological nursing literature. While there are many descriptive accounts of attempts at developing person-centred practice, in reality, there are few studies that identify the benefits of this way of working. Thus far, systematic research into person-centred nursing practice is poorly developed. This paper aims to explore the concept of person-centredness and person-centred practice in order to add clarity to discussions about the term in the context of gerontological nursing. This literature-based exploration discusses the meaning of the word 'person' and the way this word is translated into person-centred practice. It is argued that there are four concepts underpinning person-centred nursing: (i). being in relation; (ii). being in a social world; (iii). being in place and (iv). being with self. The articulation of these concepts through existing models of person-centred practice in nursing raises the recurring themes of knowing the person, the centrality of values, biography, relationships, seeing beyond the immediate needs and authenticity. There is a need for further research and development work in gerontological nursing to distinguish between person-centred practice and good quality care for older people.

Aged↗
PubMed2004

An exploration of the factors that influence the implementation of evidence into practice.

BACKGROUND: The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry. AIMS AND OBJECTIVES: The aim of the study was to address the following questions: * What factors do practitioners identify as the most important in enabling implementation of evidence into practice? * What are the factors practitioners identify that mediate the implementation of evidence into practice? * Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice? DESIGN AND METHODS: The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n = 17). RESULTS: A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources. CONCLUSIONS: The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence-based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves. RELEVANCE TO CLINICAL PRACTICE: Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.

Diffusion of Innovation↗
PubMed2004

Opening doors of perception. Creativity, learning and developing practice.

The notion of'intelligence and humane choice' is addressed in this article. The only way nursing can be influential in the world of healthcare is questioned by looking at a commitment to learning, development and research. The article aims to challenge issues about nurse education and explore ways in which the nursing profession can move debates about the values underpinning the preparation of undergraduate nurses.

Attitude of Health Personnel↗
PubMed2003

Supernumerary status: definition, operationalisation and its effect in practice.

This paper presents an evaluation of the implementation of supernumerary status in intensive care units in the Greater Belfast area. The evaluation focused on three questions, what did staff understand by the term supernumerary status. How was supernumerary status implemented in the Trusts? What effect did supernumerary status have on the staff/Trusts involved? The results of the evaluation are presented here and issues for further development identified. The study was qualitative in nature and used semi-structured interviews and focus group interviews to collect data. Participants were purposefully selected by virtue of their experience of supernumerary status. Interviews and focus groups were audiotaped and transcribed verbatim. These transcripts were then analysed line-by-line and coded. Data analysis described 10 common themes. In general, the concept of supernumerary status was well received and was supported by all involved who believed that its goal of producing adequately trained and skilled practitioners in an intensive care environment was a worthwhile exercise that benefited both staff and patients. Overall, exploring the operationalisation of a supernumerary status programme helps us to explore the challenges of supporting neophyte nurses in all areas of practice and challenges service providers to consider creative approaches to providing such support. However, whilst making a positive contribution to the recruitment and development of nurses new to the intensive care environment, further study is required to gauge the long-term effect of this programme on retention of staff.

Education, Nursing, Continuing↗
PubMed2003

The meaning of practice development: evidence from the field.

This paper sets out to explore the meaning of practice development. The data from which this exploration is derived is largely drawn from an empirical research project that set out to explore practice development through concept analysis. The paper argues for a model of practice development that is focused on achieving increased effectiveness in patient-centred care. It argues that one-off changes in practice are not the same as a sustained systematic development of practice that focuses on achieving cultural changes in practice settings, ie the context of practice. It will be argued that facilitation is a key concept underpinning practice development work, but that in itself, facilitation is a misunderstood and abused concept. Finally, the consequences of practice development activity will be outlined and the need for further research in this area highlighted.

Australia↗
PubMed2003

The characteristics, qualities and skills of practice developers.

There is a growing interest in practice development as a systematic process for the development of quality patient care. Whilst there is a range of accounts of practice development in the literature, little work has been undertaken to develop an understanding of the systems and processes involved and there is even less on the roles involved in practice development. This paper explores in particular the characteristics, qualities and skills of practice developers, i.e. professionals who have formal responsibility for developing practice in organizations. The paper represents part of a larger study exploring the conceptual basis of the term 'practice development'. Data for this part of the project were collected through literature analysis, seven focus groups involving 60 practice developers and telephone interviews with 25 practising nurses with experience of working with practice developers. The data were analysed using cognitive mapping processes. Four role functions are presented in the paper, as well as qualities and skills needed to operationalize the identified role functions. A clear picture of the skills and qualities required by practice developers emerges from the data.

Communication↗