IAANMP: Showcasing excellence – highlighting ANMP research and innovation across Ireland

By Theresa Lowry Lehnen, IAANMP Editorial Officer

We are delighted to feature the exceptional work, research, and innovation led by IAANMP ANMPs nationwide. These abstracts reflect the breadth, depth, and diversity of advanced practice, showcasing clinical excellence, research leadership, service development, and the transformative impact of ANP/AMP roles nationwide.

Each submission reflects the ongoing commitment of our members to evidence-based practice, professional advancement, and improved patient outcomes. By highlighting this exceptional body of work, we aim not only to recognise the achievements of individual practitioners but also to promote shared learning, collaboration, and the dissemination of best practice throughout the ANP/AMP community.

This platform offers an opportunity to showcase the real impact of advanced practice on healthcare delivery and to inspire continued innovation, scholarship, and excellence in every area of advanced nursing and midwifery.

Bouncing your way to labour and birth using biomechanics and foetal optimal positioning

Author: Roisin Lennon, RAMP, Sligo University Hospital

Introduction: Locally, nationally, and internationally, Caesarean section (CS) and emergency CS (EMCS) births following induction of labour (IOL) are rising. Pregnancy and childbirth are a normal, physiological process, but have become medicalised in the past century. The ethos of the local advanced midwife practitioner (AMP) service is to promote physiological birth. One way to achieve this is through labour hopscotch (LH). This visual tool encourages activity during pregnancy and childbirth. It has been used in the service since 2017, and in Ireland since 2020. Biomechanics for birth (BFB) was added to routine AMP care in 2022.

Aims: To determine if the introduction of BFB resulted in more spontaneous labours (SOL), less IOL, and a higher vaginal birth rate.

Methods: Retrospective audit of all AMP care pregnancy records of the pre-intervention group (LH education) 01/01/2022-30/09/2022 (n=155) and the post intervention group (BFB education) 01/01/2023-30/09/2023 (n=154). Data was collected using a local pre-existing labour and birth audit questionnaire in November 2023 and reported as frequencies and percentages. Ethics approval was not required as per ethics committee.

Results: Age and parity were similar across the groups. Pre BFB, there was a 57 per cent SOL with 33 per cent birthing before 41 weeks with post BFB showing a 72 per cent SOL with 92 per cent birthing
before 41 weeks. IOL rates dropped from 43 to 28 per cent with IOL EMCS rates dropping from 33 to 24 per cent.

Discussion: Using BFB alongside LH offers choice for women, increases SOL rates, optimises physiological birth, and reduces inductions and IOL EMCS. This simple intervention continues to be standard care at the AMP clinic, but should be available to all women attending Sligo University Hospital maternity services.

Conclusion: A simple intervention that should be available for all women attending the audit maternity unit and incorporated nationally into standard antenatal education and labour care giving.

Community rehabilitation inpatient specialist programme (CRISP) – an ANP-led rehabilitation programme for frail older adults

Authors: Mary Doyle, RANP Older Persons; and Jincy Mathews, RANP Older Persons, Age-Related Rehabilitation Services, Peamount Healthcare, Newcastle, Co Dublin

Background: CRISP is a bespoke, RANP-led programme providing access for home-dwelling older adults to short-term (two-weeks) inpatient intensive multidisciplinary rehabilitation based on a comprehensive geriatric assessment. Referrals to CRISP are received from geriatric emergency department services, geriatric/neurology/rehabilitation medicine outpatient clinics, Integrated Care Programme for Older Persons, and local GPs. Admission to an age-related rehabilitation centre occurs within four to eight weeks of referral.

Aims: The aim of the programme is to reduce crisis presentations to acute care by focusing on falls and frailty and promoting community-based health promotion.

Method: This prospective cohort study examines the short to medium-term effects of the CRISP programme. Functional, mobility, and quality of life (QOL) measures were collected on admission and discharge. Data were analysed using Microsoft Excel. Functional outcome and QOL measurements were compared on admission (A), discharge (DC), and four months post discharge.

Results: Admission numbers are increasing each year. A total of 78 patients completed the programme in 2024. Average age: 79.1 years; standard deviation: 6.6 years; frailty index: 5.3 (mild to moderate frailty). There have been significant gains made in performance in activities of daily living (Barthel Index: 77 A vs 82 DC); balance (Berg Balance Scale: 29.6A vs 36.3 DC); and overall mobility (Elderly mobility scale: 15 A vs 16 DC).

Discussion: CRISP also delivers positive long-term benefits. Fall rates, QOL, and carer stress are measured four months after completion of the programme. Reduction in falls rates: 1.8 (in the four months pre-admission) vs 0.3 (in the four months following completion of the programme). There was a sustained improvement in self-reported QOL: EuroQoL-5 Dimensions: 60 A vs 69 at four months following completion of the programme. Among the 49 per cent of carers who reported stress (n-38) before the programme, 79 per cent had reduced stress levels at four months following the programme.

Conclusion/implications for practice: CRISP improves mobility and function resulting in reduced fall rates. CRISP provides early intervention at the lowest level of care complexity, promoting independence and improving QOL for home dwelling older adults.

Evaluation of a RANP-led sleep clinic within a community setting

Author: Felicity McFadden, RANP, Respiratory Integrated Care, Respiratory Community Integrated Care, Cavan/Monaghan

Background: Approximately 10 per cent of the world’s population suffer from chronic insomnia, and more than 15 per cent from obstructive sleep apnoea (OSA). OSA and insomnia are risk factors for cardiovascular, metabolic (type 2 diabetes and obesity), and neurodegenerative disease.

Current sleep support services within the hospital and community settings in Ireland are fragmented. With the appointment of a RANP Respiratory, Community Integrated Care, in one area, an RANP-led sleep clinic was established in December 2024.

Aims and objectives:
✽ To assess patient satisfaction with the newly established RANP-led sleep service
✽ To evaluate perceived accessibility, timeliness, and adequacy of appointments
✽ To explore patients’ perspectives of the service and suggestions for improvements.

Methods: A nine-item patient satisfaction survey with closed and open-ended questions was developed. Patients were informed that participation was voluntary, information collected was anonymous, and confidentiality was assured. The survey was posted to 40 service users who attended the clinic between January 2024 and January 2025. Twenty surveys (50%) were returned. Data were analysed quantitively and open-ended responses were analysed using content analysis.

Results: Satisfaction with the referral process was 100 per cent. All respondents (100%) reported receiving adequate appointments in a timely manner with no difficulty accessing the location in primary care. Respondents reported that overall experience was excellent (65%), very good (25%), and good (10%). Recurring themes identified from qualitative responses were: Having regular access to ANP expertise; receiving in-depth explanations of their condition and treatments available; and the perceived high quality of service.

Discussion: The RANP-led sleep clinic has demonstrated high patient satisfaction and timely delivery of high-quality person-centred care in a community setting. This is in line with the integrated care model, adopting new ways of working in providing more patient-centred care to people as close to home as possible.

Implications for practice: This service can be expanded out to other community settings.

Evaluating the impact of critical care outreach in a Model 3 hospital

Author: Fabienne Kelly, RANP, Critical Care Outreach, Our Lady of Lourdes Hospital, Drogheda, Co Louth

Background: Our Lady of Lourdes Hospital, Drogheda – classified as a Model 3 hospital – introduced a critical care outreach (CCO) service to enhance patient care by identifying and managing clinical deterioration early, avoiding unnecessary intensive care unit (ICU) admissions, and promoting integrated, ethical decision-making across wards. The service responds to growing national awareness of early intervention benefits, staff support needs, and evolving patient complexity within acute hospital settings.

Aims and objectives: The primary aim was to establish a responsive, educational, and evidence-based CCO service that promotes timely intervention for deteriorating patients, supports ward staff, and enhances patient outcomes. A further objective was to expand this initiative to a seven-day service by quarter 4 of 2025.

Methodology/approach: The project commenced with a phased roll-out in December 2022, reaching full launch in June 2023. The team, composed of two RANPs and two candidate ANPs (cANPs), now provides Monday-Friday coverage from 08:00 to 19:00 across 20 ward areas in a 320-bed hospital with a 10-bed ICU/high dependency unit. Their scope includes direct referrals, comprehensive patient reviews, post-ICU monitoring, and support with Do Not Attempt Resuscitation (DNAR) forms, staff training, and structured data collection.

Interventions and changes implemented: The CCO service introduced several key interventions:
✽ Establishment of a direct phone referral line
✽ Post-ICU follow-ups and early warning score (EWS) surveillance
✽ DNAR form revision and initiation processes
✽ Safety huddles and cardiac arrest response participation
✽ A digital tracheostomy and central venous catheterisation education initiative including QR-accessible training tools
✽ Daily tracheostomy reviews and documentation enhancements.

These changes aimed to improve the identification and timely escalation of deteriorating patients while also empowering ward staff through education and hands-on support.

Evaluation: Robust data collection and outcome measurement tools were integral to the evaluation. Metrics included EWS trends, ICU admissions/avoidances, tracheostomy care outcomes, DNAR initiations, and cardiac arrest incidence. Qualitative feedback from multidisciplinary staff further informed evaluation, and national benchmarks such as the NOCA (National Office of Clinical Audit) average ICU length of stay (LOS) were used for comparative analysis.

Results: Quantitative outcomes demonstrated the significant value of the CCO service:
✽ 202 new patient referrals recorded
✽ 161 ICU admissions avoided
✽ 6.7-day average ICU LOS (per NOCA, 2024)
✽ Estimated savings of €1.09million based on €1,000/day ICU costing
✽ Reduction in average EWS from eight-10 pre, to a score of six  post interventions
✽ Notable decreases in ICU admissions (35%), sepsis-related ICU admissions (21%), and patient falls (74%).

Impact on patients/staff/service: Patients benefited from timely, compassionate, and coordinated care that reduced unnecessary escalation while ensuring safety. Staff reported increased confidence, skill retention, and enhanced situational awareness. The service strengthened ward culture, communication, and collaboration between ICU and general ward teams. Feedback highlighted the CCO team’s indispensable role, particularly in supporting new graduates and facilitating ethical, patient-centred care planning.

Sustainability and future plans: Continued focus on simulation training, digital education tools, national dataset contributions, and interdepartmental collaboration will underpin the model’s sustainability. Ongoing data monitoring, patient feedback, and staff engagement will guide service evolution.

The role of an ANP in meeting national standards in sepsis management in a standalone paediatric specialist neurorehabilitation unit

Author: Adele Buckley, RANP, Paediatric Neurorehabilitation, National Rehabilitation Hospital.

Background: As a small paediatric unit in a standalone adult specialist hospital, we face challenges in the management of deteriorating paediatric patients lacking specialist cover over the 24 hours. In addition, we try to de-medicalise the environment – providing a different atmosphere to acute services to meet the unique needs of our patients. A peer review audit completed by Ireland East Hospital Group on sepsis management highlighted areas for improvement.

Aims: To improve practice and develop a suite of documentation to guide staff practice and support the decision-making process for deteriorating paediatric patients.

Methods/approach: All areas of the deteriorating child were examined, and it became evident there was a lack of knowledge and confidence in managing a deteriorating paediatric patient. It highlighted the need for guidance documents to specifically meet the needs of our unique patient cohort.

Results/outcomes: Documentation was developed by the ANP to support non-paediatric staff who may be called to care for a deteriorating child, which guides practice, supports decision-making, and ensures we adhere to national guidelines.
✽ Paediatric early warning score/sepsis policy
✽ Policy for the transfer of a deteriorating paediatric patient
✽ Intravenous escalation pathway
✽ Guidance document on sepsis management specific to our environment
✽ Procedure for the transfer of a patient to acute services
✽ ISBAR (identify, situation, background, assessment, and recommendation) communication prompt for calling an ambulance.

Discussion: This new documentation is supported by monthly ANP-led scenario training and workshops to put principles to practice and ensure new documentation is embedded into practice.

Conclusions/implications for practice: This quality improvement initiative aims to increase patient safety and improve outcomes in the child with sepsis.