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

By Theresa Lowry Lehnen, IAANMP Editorial Officer
In this edition, we showcase a selection of poster abstracts from IAANMP members, highlighting the exceptional work, research, and innovation led by ANMPs across Ireland. These abstracts reflect the strength, depth, and diversity of advanced practice, demonstrating clinical excellence, research innovation, service development, and leadership in action.

Each submission reflects the ongoing commitment of IAANMP 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.

The introduction of the IBD ANP-led pregnancy clinic

Author: Caroline Lardner IBD cANP, Beaumont Hospital, Dublin

Background/rationale: Inflammatory bowel disease (IBD) activity should be closely monitored throughout pregnancy by a suitably experienced member of the IBD team. The IBD ANP is well placed to do this in an ANP-led pregnancy clinic. The initiative is supported by the gastroenterology consultants. The IBD ANP has established relationships with maternal medicine AMP to adopt a multidisciplinary approach.

Aims/objectives: To provide regular close monitoring for pregnant IBD patients in an ANP-led clinic – allowing for more equitable access to the main outpatient clinic. This allows for early identification of problems, avoiding the need for hospital admission. It also provides integrated, person-centred care and promotes self-management; in keeping with the Slaintecare ethos.

Methodology: Patient-centred care can be achieved with the IBD ANP-led pregnancy clinic. Traditionally pregnant patients with IBD received separate care from IBD and obstetric services, but it has been found that co-ordinated care between the services leads to more streamlined care, so, the IBD ANP will liaise with maternal medicine AMP. Self-management is promoted at the ANP-led clinic, and patients are educated regarding symptoms to observe for and when to initiate contact with the ANP.

Results: The IBD ANP is in an ideal position to facilitate ANP-led follow-up clinics. This relieves the burden on the outpatient clinic service and averts the need for hospital admission. This is particularly applicable to the cohort of pregnant women with IBD. The nature of IBD and its potential effects on pregnancy are wellknown and, therefore, the pregnant IBD patient requires timelier, regular follow-up.

The development of an easily accessible IBD ANP to provide clinic follow-up for particular patient cohorts, such as pregnancy, would ensure that the patient receives the ‘right care, at the right time, in the right place’ and avoids hospital admissions. This ensures equitable access to the general gastroenterology clinics and reduces waiting lists.

Discussion: Pregnant IBD patients require close monitoring, and therefore need increased outpatient clinic appointments. This places a significant burden on an already stretched system and waiting lists. Previous practice was separate obstetric and gastroenterology care. Clinic space may be an issue and negotiation skills are required.

There is currently no IBD ANP-led pregnancy clinic, representing an opportunity to develop this role. The IBD ANP aims to liaise with the local AMP in maternal medicine to allow for a combined multi-disciplinary approach, ensuring person-centred care. The ANP-led clinic will allow greater access for other patients to the outpatient service as the ANP clinic will remove these patients from the main outpatient service.

Conclusions/implications for practice: Improve patient outcomes by providing regular IBD ANP review in the IBD ANP-led pregnancy clinics. Alleviate strain on the main gastroenterology outpatient clinic by removing this cohort of patients. Increase patient satisfaction by providing easy access to the IBD ANP clinic. Encourages patient empowerment by teaching self-management/self-care techniques.

Enhancing critical care: Assessing escalation and response in patients with an INEWS score of seven or above

Authors: Donna McGahern and Shelley Kennedy, ANPs Critical Care Outreach, Cavan General Hospital

Background: The audit performed by the critical care outreach service at Cavan General Hospital was undertaken to evaluate compliance with national guidelines for the escalation and response for patients with an INEWS (Irish National Early Warning System) score of seven or above, to enhance outcomes for deteriorating patients.

Aim/objective:
✽ To assess compliance with national guidelines regarding the escalation and response protocols for patients exhibiting an INEWS score of seven or above at Cavan General Hospital.
✽ To identify opportunities for enhancement in the existing escalation and response protocols to improve patient outcomes.
✽ To offer recommendations derived from audit results to enhance compliance with national criteria and enhance patient care.

Methods/approach: This audit encompassed a random sample of 10 patients who satisfied the requirements of possessing an INEWS score of seven or above. The data was gathered applying KEWS (the digital INEWS system), along with patients’ medical records and nursing documentation. The data were gathered retrospectively.

Results/outcomes: Principal findings indicate that, while adherence to the criteria is considerable, specific areas require improvement to provide optimal patient outcomes. Key characteristics assessed include the duration required to escalate treatment, the efficacy of the interventions, and the outcomes attained by the patients.

Implications for practice: The proposals encompassed educating nursing and medical personnel on the care of deteriorating patients through the implementation of simulated training study days.

These training sessions will improve the skills and knowledge necessary for prompt and effective escalation and response by promoting collaboration among various healthcare areas to create a unified approach to patient care and escalation protocols.

Falling through the gaps: Early evaluation of ANP-led falls assessment in older people in rehabilitation

Authors: Byrne L, The Royal Hospital Donnybrook, Dublin and Trinity College Dublin; Diaz J, Manahan A, Pauziene D, Tatel E, De Silva L, Betamor M, Pongol M, Flores R, Mathew J Omboa S, Leitao L, Eisherif T, Tiernan C, and Cogan L, The Royal Hospital Donnybrook, Dublin
Submitted by Lisa Byrne, candidate ANP for Older People, The Royal Hospital Donnybrook, Dublin

Background/objectives: Population ageing poses a global health challenge, with falls the second leading cause of unintentional injury-related death. In response, Ireland’s National Framework for Integrated Care for Older People has funded ANP roles to facilitate early discharge, reduce readmission, and enhance patient experience.

This audit evaluates the initial impact of introducing a candidate ANP to assess falls in a specialist rehabilitation hospital during the first month of implementation.

Methods/approach: During the first month of a candidate ANP-led specialist falls review, all 30 patients admitted to an inpatient rehabilitation ward were included in this service evaluation. Of these, 66 per cent (n=20) met criteria for review due to low or fluctuating blood pressure.

Most were admitted post-hip fracture, all were over 70 years old, with 75 per cent over 80. The intervention group comprised three times more women than men, reflecting typical demographic trends.

Key results/findings: All patients in the intervention group received both verbal and written education on conservative strategies for managing low or fluctuating blood pressure, including guidance on bolus hydration. Medication review led to de-prescribing of fall risk increasing drugs (FRIDs) in 60 per cent (n=12) of cases. In 15 per cent (n=3), pharmacological intervention with fludrocortisone and/or midodrine was initiated alongside de-prescribing.

Two patients were provided with non-pharmacological support using abdominal compression garments to support upright blood pressure. Notably only four patients were not prescribed FRIDs at the time of review, highlighting the prevalence of medication-related falls risk.

Emergency nurses’ knowledge and attitudes toward pain management in an Irish ED

Authors: Laura McCarthy, RANP, Emergency Department, University Hospital Kerry; Dr Patrick Cotter, Lecturer, University College Cork

Background and objectives: Effective pain management in the emergency department (ED) is a fundamental care issue. The published literature suggests that there may be concerns regarding emergency nurses’ knowledge and attitudes towards pain management and its impact on care delivery. This study aimed to assess emergency nurses’ knowledge and attitudes towards pain management in ED.

Methods: A survey design was employed to collect data from nurses working in a single ED in the south of Ireland. Data were collected electronically using a modified version of the KARSP scale for knowledge and attitudes towards pain management via Qualtrix. Demographic data were also collected from participants to enable the identification of potential influences on knowledge and attitudes.

Ethical approval was granted to conduct the study by Cork Teaching Hospitals Research Ethics Committee. The survey link was sent to n=85 nurses working in the ED with n=63 responses, of which n=38 (45%) provided usable data.

Findings/results: Knowledge and attitude scores ranged from 42.9 per cent to 88.1 per cent, with a mean score of 67.4 per cent. Only 10.5 per cent of respondents scored ≥80 per cent, indicating nearly nine in 10 participants had suboptimal knowledge and attitudes towards pain.

Key gaps identified included misconceptions about opioids and dosage, pain assessment and perceptions of patient behaviour – for example, only 45 per cent of nurses correctly identified that patients may sleep despite severe pain. Specialist emergency nursing education improved performance, with 30 per cent scoring ≥80 per cent versus 0 per cent among those without. Two thirds (66%) reported no formal pain management training.

Conclusion: Despite recognising pain management’s importance, emergency nurses showed notable knowledge and attitude gaps, particularly regarding pain assessment and the use of opioid medication. Specialist training improved performance. Comprehensive, ongoing pain management education is essential to enhance emergency nursing practice.