Papers by Martin McNamara
Interdisciplinary Journal of Partnership Studies, 2015
Partnering in research across disciplines and across countries can be challenging due to differin... more Partnering in research across disciplines and across countries can be challenging due to differing contexts of practice and culture. This study sought to demonstrate how central constructs that have application across disciplines and countries can be studied while concurrently considering context. Groups of nurses from Botswana, Ireland, Israel, New Zealand, and Spain partnered to identify how to measure the constructs of caring for self, burnout, and compassion fatigue, replicating a study by Johnson (2012), who found that caring for self had a moderately strong negative relationship with both compassion fatigue and burnout. While these constructs were of interest to all five groups, the conversation of contextual influences varied. All five groups used the same instruments to measure the central constructs. Levels of burnout and compassion fatigue varied by country but were moderated by caring for self. Partnering across countries made it possible to understand that caring for sel...
Journal of Advanced Nursing, 2019
Results 68 papers were included. There exists empirical support for six key domains which require... more Results 68 papers were included. There exists empirical support for six key domains which require to be addressed in the policymaking and analysis process: 1) Context 2) Process 3) Content 4) Stakeholder Consultation 5) Implementation 6) Evaluation. Failure to contextualise and integrate these six domains in problem identification, policy analysis, strategy and policy development, policy enactment and policy implementation is problematic. Conclusion There is a need to test and refine the constructs linked to the policymaking cycle taking cognisance of the context where these are developed, implemented and evaluated. Impact This review makes a novel contribution to the synthesis of evidence to inform the policymaking and analysis process. Findings illuminate the complexity of policymaking, the competing pressures involved and the importance of the local, national and international context. These findings have international relevance and provide empirical support for key criteria to guide those involved in context specific policymaking and/or the analysis of existing policy.
Journal of Nursing Management, 2019
Aim: To develop a tool for the analysis of nursing, midwifery and health-related policy and profe... more Aim: To develop a tool for the analysis of nursing, midwifery and health-related policy and professional guidance documents. Background: Analysis tools can aid both policy evaluation and policy development. However, no framework for analysing the content of professional regulation and guidance documents among healthcare professionals currently exists. Method: This study used an action research, cooperative inquiry design. Data were generated from two integrative literature reviews and discussions held during the cooperative inquiry meetings. Results: A set of key themes to be considered in the development or evaluation of health policy or professional regulation and guidance documents were identified. These themes formed the basis of the six domains considered by the Health-related Policy Analysis Tool (HrPAT): Context, Process, Content, Stakeholder Consultation, Implementation, and Evaluation. Conclusion: Use of the HrPAT can assist in policy development, evaluation and implementation, as well as providing some retrospective analytical insights into existing health policies. Implication for Nursing Management: Professional regulation documents, guidelines and policy reports should be capable of being scrutinised for their content, quality, and developmental process. The HrPAT can assist relevant stakeholders in the development , analysis and evaluation of such documents, including local, servicelevel policies and guidelines.
6.3.2 Evolving roles of nurses and midwives and negotiating role boundaries 6.3.3 Impacts on care... more 6.3.2 Evolving roles of nurses and midwives and negotiating role boundaries 6.3.3 Impacts on care delivery 6.4 Theme 2: Scope of practice, understanding and use 6.4.1 Understanding my scope of practice 6.4.2 Use of scope of practice Framework 6.4.3 Aspects of scope 6.5 Theme 3: Expanding scope of practice 6.5.1 Expanded scope 6.5.2 Barriers to expanded scope 6.5.3 Enablers of expanded scope 6.6 Theme 4: Professional competence 6.6.1 What is competence? 6.6.2 Gaining and maintaining competence 6.6.3 Competence and the practitioner 6.7 Theme 5: Practice setting and context 6.7.1 Legislation, policies, guidelines and regulation 6.7.2 Practice concerns 6.8 Theme 6: Reflections on the current Framework 6.8.1 General thoughts on the current Framework 6.8.2 Comments on individual sections of the Framework 6.9 Summary of findings 6.10 Case examples of expanded practice 6.10.1 Case example of midwifery practice 6.10.2 Case example of advanced practice: Reflective tool 7 DISCUSSION 7.1 Introduction 7.2 Self-reported scope of practice 7.3 Expanding practice: Enablers and barriers 7.4 Scope of practice and role boundaries 7.5 Perspectives on the Framework 7.6 Strengths and limitations of the study design 8 CONCLUSIONS AND RECOMMENDATIONS
HRB Open Research, 2020
Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed ... more Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing t...
International Journal of Environmental Research and Public Health
The eighteen papers in this Special Issue, ‘Whole-Systems Approaches to Process Improvement in He... more The eighteen papers in this Special Issue, ‘Whole-Systems Approaches to Process Improvement in Health Systems’, address an enduring challenge in healthcare: to improve efficiency with existing or reduced resources, while maintaining safe and effective care [...]
International Journal for Quality in Health Care, 2019
This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme t... more This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme that has enabled the delivery of over 90 quality improvement projects led by its graduates across 50 healthcare organizations in Ireland. A key success factor in embedding and sustaining LSS in these organizations was the accreditation by a major, national, research-intensive university of the LSS education programme from which the students graduated. To ensure the programme’s approval by the university it was necessary to contextualize LSS within established conceptual frameworks. This helped counter misconceptions that what was proposed was technical training in tools and techniques to provide quick fixes for routine healthcare process issues. Two related conceptual frameworks were selected to frame the curriculum: Senge’s Fifth Discipline and Deming’s System of Profound Knowledge. This paper focuses on how a central element of both frameworks, systems thinking or appreciation for a sys...
International Journal of Environmental Research and Public Health
Quality measurement initiatives promote quality improvement in healthcare but can be challenging ... more Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theor...
International Journal of Environmental Research and Public Health, 2022
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care... more The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated ...
International Journal of Environmental Research and Public Health, 2022
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligam... more Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient’s length of stay. This study contributes to ...
This article reports the findings of a structural analysis of the field of academic nursing in Ir... more This article reports the findings of a structural analysis of the field of academic nursing in Ireland and considers the implications of the field's current structure for its present status and future trajectory in the academy. Six years after preregistration nursing education transferred to the higher education sector, tensions continue to exist concerning the status and legitimacy of academic nursing and of those who profess to profess it. The languages of legitimation of senior nursing academics and national nursing leaders (n = 16) were elicited and subjected to a critical discourse analysis. Respondents' languages were analyzed in terms of the settings of four underlying structuring legitimation principles: autonomy, density, specialization, and temporality. Academic nursing in Ireland was found to be structured by low autonomy, high density, and weak specialization. I conclude that academic and professional leaders in Irish nursing need to urgently consider how academi...
International Journal of Environmental Research and Public Health, 2021
Clinical documentation is a key safety and quality risk, particularly at transitions of care wher... more Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between the surgical operating team and other colleagues, which should be completed immediately following surgery. Incomplete operating surgeon documentation of the ON, in a legible and timely manner, impacts the quality of information available to nurses to deliver post-operative care. In the project site, a private hospital in Dublin, Ireland, the accuracy of completion of the ON across all surgical specialties was 20%. This project sought to improve the accuracy, legibility, and completeness of the ON in the Operating Room. A multidisciplinary team of staff utilised the Lean Six Sigma (LSS) methodology, specifically the Define/Measure/Analyse/Design/Verify (DMADV) framework, to design a new digital process appli...
International Journal of Environmental Research and Public Health, 2021
Healthcare systems internationally are working under increasing demand to use finite resources wi... more Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ...
International Journal of Environmental Research and Public Health, 2021
The Health Service Executive Ireland model of care for elective surgery supports the delivery of ... more The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days ...
Journal of Nursing Management, 2021
Ethical approval not required as this is a discursive article that did not involve primary resear... more Ethical approval not required as this is a discursive article that did not involve primary research or the involvement of research participants, and does not present data.
Journal of Clinical Nursing, 2018
Nurse education today, 2017
This paper presents the results of a systematic rapid review and narrative synthesis of the liter... more This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services. A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles. A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015. The study also included primary data collection on the perceived impact of specialist and advanced practice nursing and midwifery roles and enablers and barriers to these roles using semi-structured interviews. These are not included in this paper. To facilitate a systematic approach to searching the literature, the PICO framework, was adapted. The database search yielded 437 a...
European Journal of Engineering Education, 2012
Critical thinking is a graduate attribute that many courses, including engineering courses, claim... more Critical thinking is a graduate attribute that many courses, including engineering courses, claim to produce in students. As a graduate attribute it is seen by academics as a particularly desirable outcome of student learning and is said by researchers to be a defining characteristic of university education. However, how critical thinking is understood and defined varies quite significantly between disciplines. The paper describes a series of in-depth, semi-structured interviews with academics involved in teaching and learning in a number of disciplines, including engineering. The objective of these interviews is to look at how different disciplines define critical thinking and how they teach critical thinking in their courses. The paper also describes how an analysis of student work and module descriptors has led to the development of a model of critical thinking that can be used across disciplines.
International Journal of Environmental Research and Public Health, 2021
Healthcare staff are required to undertake mandatory training programs to ensure they maintain ke... more Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre- and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual ...
International Journal of Environmental Research and Public Health, 2021
The aim of this study was to redesign an emergency department [ED] data management system to impr... more The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the voice of the customer, Gemba, and 5S to identify areas for improvement in ED data management processes and to inform solutions for improved ED patient flow processes. A multidisciplinary ED team includes medical consultants and registrars, nurses, patient service staff, radiology staff, as well as information technology and hospital management staff. Lean Six Sigma [LSS] diagnostic tools identified areas for improvement in the current process for data availability and access. A set of improvements were implemented to redesign the pathway for data collection in the ED to improve data availability and access. We achieved a reduction in the time taken to access ED patient flow data from a mean of 9 min per patient pre-inte...
Uploads
Papers by Martin McNamara