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The aim of this study was to explore the COVID-19 pandemic as it was experienced by people on the front line in residential care settings for older people in the Republic of Ireland (ROI).The COVID-19 pandemic had a disproportionate effect in residential care settings for older people in Ireland.A two-phased mixed methods study was conducted, consisting of an online survey administered shortly after the first wave of the virus to staff, residents and family members and one-to-one interviews with family members shortly after wave 2 of the virus.Isolation, loss of connectedness as well as a reduction in the level/quality of care provision led to significant adverse impacts for both residents and their families. Staff reported high levels of stress, trauma and burnout. Family input to care was suspended, with adverse consequences.The pandemic had an extremely adverse impact on residents, family members and staff in care settings for older people.Strategies to ensure that residents' physical, emotional and social needs and staffs' professional and personal needs are appropriately supported during future waves of the pandemic should now be implemented.

Background The COVID-19 pandemic had a disproportionate effect among residents, family members and staff in residential care settings for older people in Ireland relative to other health care settings, particularly in wave one of the virus. The purpose of this study was to explore the COVID-19 pandemic as it was experienced by people on the front line of the virus - residents, family members and staff in residential care settings for older people in the Republic of Ireland (ROI). Method A 2-phased mixed methods cross-sectional study was conducted. This consisted of a survey administered anonymously online shortly after the 1st wave of the virus (June - August 2020), via our nursing and health care networks, advocacy organisations for older people and on social media targeting - staff, residents and family members. Family members who took part in the survey were invited to take part in phase 2 - qualitative one-to-one interviews which were conducted shortly after wave 2 of the virus (November - December 2020). ResultsSeventy-six staff members completed the survey as well as 28 family members and 2 residents. Eleven family members took part in the qualitative interviews. Good infection control protocols, good governance/management structures, being prepared and agile responses were important factors in determining better outcomes. Isolation, loss of connectedness (to family, staff members and other residents) as well as a reduction in the level/quality of care provision led to significant adverse impacts for both residents and their families. Staff reported high levels of stress, trauma and burnout. A strong theme emerging from the qualitative element was the important role that family members typically have in supplementing care provision which suddenly and completely ceased during the pandemic. This caused huge distress amongst family members and physical decline and mental anguish amongst residents. ConclusionsThis is the first research study to explore the experiences of residents, family members and staff who were at the front line of the pandemic in residential care settings in ROI when the pandemic struck. This study provides valuable insights which could be used by staff in residential care settings, policy makers/implementers in further waves of the pandemic or in future communicable disease outbreaks. The rights and needs of residents must be carefully balanced with infection control and prevention measures. Strategies to ensure that residents and staff are appropriately supported during future waves of the pandemic should now be implemented.

WHAT IS KNOWN ON THE SUBJECT?: Mental health support workers (MHSWs) are frequently employed in mental health services in order to augment and diversify the workforce and to promote recovery centred care Research shows that while MHSWs positively support service user mental health recovery, these roles are often unclear or not well understood by MHSWs and other mental health practitioners WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Through arts-based research methods, three MHSWs communicated their personal vulnerabilities and anxieties in supporting others with mental health issues; these insights are rarely presented in mental health research. MHSW experiences of not having recovery-oriented expertise recognized or valued by healthcare team were powerfully conveyed through arts narrative. These findings promote recognition of the strengths and contributions of MHSWs to mental health practice. Arts-based inquiry is a means of providing additional depth to what is already known and contributes novel insights regarding the occupational experiences and perceptions of MHSWs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses and healthcare teams need to engage fully with recovery-oriented principles acknowledging the vulnerabilities of all practitioners and establishing adequate supervision and support. There needs to be greater clarity concerning roles/scope of practice for MHSWs to enable productive working partnerships in mental health teams. This can be achieved through open communication, education and planning among the wider mental healthcare team. ABSTRACT: Introduction Mental health support workers (MHSWs) make positive contributions to mental health recovery practice yet their roles and support needs are often unclear. This research explored the occupational lived experiences of three MHSWs working in Irish mental healthcare services. Aim The study examined the experiences and perceptions of MHSWs regarding their mental health recovery work. Method A narrative design was used incorporating participatory art-based inquiry as a collaborative means of engaging participants. This innovative methodology enabled exploration and evocative expression of participants' occupational experiences and stories. Results Participants revealed feelings of vulnerability and anxiety regarding personal mental health and supporting the mental health of others; a finding not commonly explored in previous research. MHSW skills and knowledge were evident; however, this expertise and recovery focus was not valued in mental health services. Discussion The strengths and challenges of MHSW engagement in service provision are discussed. Interdisciplinary team integration is explored in terms of contrasting recovery philosophies, practitioner vulnerability and professional demands and imperatives. Implications for practice Mental health teams need to engage with recovery principles, acknowledging strengths and vulnerabilities of all practitioners and establishing adequate supervision and support. Greater clarity and education is required concerning roles/scope of practice for MHSWs to enable productive interdisciplinary partnerships.

Objective Chronic Kidney Disease (CKD) is a complex disease that requires lifelong treatment. Transplantation is the goal standard treatment, however; it is not without its challenges. While previous research has demonstrated that transplantation increases survival rates and enhances young people’s quality of life, little is known about the impact of kidney transplantation on adolescents’ self-identity development. This presentation will discuss the struggles that adolescent transplant recipients experience as they endeavour to incorporate a new kidney into their embodied self. These findings were identified as a predominant theme from a narrative inquiry of embodiment experiences among young people living with CKD in Ireland. Methods This study employed a narrative inquiry research design. Using an ethnographic approach data were gathered through multi-media approaches including: visual body maps (i.e. life-size human body images), oral informal conversations and observational field notes. Five adolescents (10–17 years) participated in the study, which took place over a period of 18 months as adolescents experienced living with CKD in both hospital and home settings. Results A nuanced finding identified from this study was a disrupted sense of self and identity arising from adolescents’ encounters with a foreign body part (i.e. kidney). Adolescent participants experienced a tension between their body, self and identity as a consequence of transplant surgery. They struggled to adjust to the presence of a foreign organ from a deceased donor and they were concerned about developing personality characteristics of the donor As one participant described, the kidney was not viewed as her own but was conceptualized as ‘a dead persons kidney’. Another participant described the prospective of acquiring the personal qualities or characteristics of the donor as ‘disgusting’. Findings also revealed that adolescents engaged in different individualised ways to cope with the transplanted organ. Discussion The findings from this study provide an understanding of the struggles adolescents endure as they attempt to incorporate a foreign organ within their bodies and the potential impact on their self-identity. Clinicians need to be aware that substituting kidneys with donor organs is much more than a complex technical procedure; it requires an amalgamation of ‘other’ and ‘self’. From a clinical perspective, a multifaceted and holistic person-centred care approach is needed to equip adolescents with the individual skills required to adapt to a new kidney.

Aim The aim of this paper is to present and discuss three popular narrative research approaches which have been successfully used by the authors in nursing research. Examples of each approach are offered to illustrate potential application in healthcare contexts. Background The creation, function and interpretation of narratives are of increasing interest to nurse researchers worldwide. Currently a variety of narrative research approaches are used to explore how people make sense of experience. While this diversity adds to the richness and scope of the methodology, practitioners new to narrative research may struggle in determining which approach best suits their research purposes and contexts. Design This discussion paper presents the philosophical basis, methodology, strengths and challenges of the following three commonly used narrative approaches: Murray's Narrative Framework, the Biographical Narrative Interpretive Method and Arts-Based Narrative Methods. Data sources Data sources dating from 1934–2014 were used. These included seminal texts and articles from nursing and social science journals on narrative and narrative research found in the CINAHL, Medline and PsycInfo databases. Implications for nursing This discussion offers clarity and guidance to nurse researchers who are considering/ using narrative research methods to enquire into the storied nature of human experience and sense making processes. Conclusions Employing a specific narrative research approach requires close attention to the ‘fit’ of the research question/context with the particular method under consideration. While sharing some narrative commonalities, each of these three methods enables the emergence of unique analytic and interpretive perspectives about stories relevant to nursing practice.