Aileen Murphy

Background: Emergency departments are experiencing crowding and delays in care, which are associated with poorer patient outcomes. Nurse staffing is a key determinant of patient throughput and outcomes, but much of the existing research relies on indicators such as average nurse-to-patient ratios that do not account for daily variation in patient acuity. Acuity-adjusted measures of staffing that reflect the balance between available nursing hours and patient care requirements may provide a more accurate understanding of how nurse staffing affects emergency department performance.Objective: To examine the association between nurse staffing, adjusted for daily case-mix acuity, and patient processes and outcomes. Design: Retrospective longitudinal study.Setting: Emergency department of a university hospital. Participants: Administrative data from 67,010 patients corresponding to 115,078 adult visits over 787 consecutive days.Methods: Routinely collected emergency department data from January 2018 to February 2020 were analysed, with each 24-hour period as the unit of analysis. Actual nursing hours were taken from rosters. Required nursing hours were estimated by linking each patient’s Manchester Triage System category to a pre-determined nursing care time. A staffing deficit was defined as actual minus required hours. Process measures were time to triage, and wait to be seen; outcome measures were patient experience time, and leaving without being seen. Models were run unadjusted and adjusted for potential confounders.Results: On average, 85% of visits were triaged as urgent or very urgent. On 88% of days, actual nursing hours were below the estimated requirement. Median times were 21 minutes to triage, 2.1 hours to be seen, and a median of 7.0 hours total patient experience time. Staffing deficits were associated with poorer patient processes and outcomes (p < 0.001). Each 5-hour deficit (versus no deficit) in nurse staffing was associated with a 21% increase in time to triage (RGM 1.21; 95% CI 1.19 to 1.23), a 12% increase in wait to be seen (RGM 1.12; 95% CI 1.09 to 1.14), a 7% increase in patient experience time (RGM 1.07; 95% CI 1.05 to 1.09), and 16% higher odds of a patient leaving without being seen (OR 1.16; 95% CI 1.11 to 1.22). Conclusions: Lower nurse staffing relative to patient acuity was associated with delays across all stages of care and more patients leaving without being seen. An acuity-adjusted staffing metric provides a more accurate relationship between staffing and patient need than simple nurse-to-patient ratios supporting its use in determining safe emergency department staffing.

Objectives Namaste Care, a non-pharmaceutical daily multicomponent palliative care intervention, offers care for people with dementia, aiming to improve quality of life of those living with dementia as well as their family and caregivers. This systematic review explores the Namaste Care intervention and its clinical and economic effects in multiple care settings. The aim of this review is to consolidate existing evidence on Namaste Care’s clinical and economic outcomes and examine the tools used for data collection. Design A systematic literature search was conducted (PubMed, Scopus and Web of Science) to identify peer-reviewed studies on Namaste Care’s impact on quality of life, costs, health, economic outcomes and benefits up to 22 February 2026. Methodological quality was assessed using the Mixed Methods Appraisal Tool, while the completeness of reporting of economic evaluation studies was evaluated according to the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS). Results 31 studies reported the clinical and/or economic outcomes of Namaste Care. The results for quality of life and quality of dying were mixed, while 5 of 11 studies evaluating quality of life reported significant improvements. The various quality-of-life instruments used include the Quality of Life in Late-Stage Dementia (QUALID), EQ-5D-3L and EQ-5D-5L instruments, ICEpop CAPability Measure for Older People (ICECAP-O), ICECAP Supportive Care Measure (ICECAP-SCM), Quality of Life for People with Dementia (QUALIDEM) and Carers-DEMentia Quality of Life (C-DEMQOL). The clinical outcomes considered included pain, behavioural symptoms and quality of end-of-life care. The Medication Quantification Scale and Minimum Data Set indicated reductions in antidepressant and antianxiety medication use. Seven studies reported significant improvements in well-being, and two studies reported reduced stress among family members following Namaste Care sessions. A subset of five studies reported a range of economic outcomes. Conclusion The findings suggest that Namaste Care improves well-being, reduces caregiver stress and lowers the use of antidepressant and antianxiety medications at a moderate cost. The current literature is characterised by small, non-random, heterogeneous studies. Randomised controlled trials, which include economic evaluations, help to improve evidence-based research to support funding and implementation decisions on Namaste Care. PROSPERO registration number CRD42024560056.

Individuals with neurodisabilities require comprehensive support to improve outcomes in multiple areas related to their primary condition, such as continen

Retinal disease is one of the leading causes of blindness and vision impairment worldwide, including Europe. With the advent of gene therapy, the treatment

This qualitative study explores the economic impacts of bereavement from the perspectives of bereaved individuals and professionals supporting them in Ireland. Data from interviews with bereaved individuals and focus groups with professionals supporting them are analysed using inductive thematic content analysis. Results show there are identifiable groups, with pre-existing vulnerabilities, who are most likely to be severely economically impacted by bereavements. The economic hardship may be owing to direct loss of income arising from the deceased no longer financially contributing to the household, increased expenses associated with the funeral, and indirectly arising from the adverse impacts of grief. This hardship can reduce household incomes and create a complex and challenging financial situation, with long-term implications for workforce participation. While some support is available, it is often insufficient, which in turn contributes to household debt and financial strain. Future policies must mitigate the impacts and minimize inequalities.

Falls and fall-related injuries in older people are common, with negative effects on functional independence, social engagement and quality of life. The estimated cost of falls related injuries in Ireland, including primary, acute and social care costs, is projected to exceed €2 billion by 2030. The COVID-19 pandemic led to an increase in frailty and falls. Falls Management Exercise Programme (FaME) is a 24-week community-based group and home exercise programme led by qualified Postural Stability Instructors. It has been shown to reduce falls, and improve physical activity levels, physical function and wellbeing. FaME was first introduced in Ireland in 2021, and there are 120 specialist instructors trained to deliver FaME. We want to find the best way to get FaME implemented cost effectively in Ireland. How can we best establish FaME, ensuring we reach everyone who may fall, deliver FaME effectively and appropriately, and support people to keep living their best life after the programme? Although much has been learned regarding implementation of FaME in the UK, it is important to consider the implementation of FaME in an Irish context, where systems and cultures are different. By learning from and working with the specialist instructors at the early adopter sites, using mapping, observation, gap analysis, surveys, interviews, focus groups and workshops throughout, aligning our evaluation to the AFFINITY Project logic model and the Health Services Executive Change Guide we will ‘Define, (co-)Design, Deliver and Disseminate’ our findings based on equity and reach, efficiency, appropriateness and sustainability, suitable physical activity options after the programme, and cost analysis for different scenarios of delivery. Working closely with PPI, Knowledge Users and an International Expert Group, we will deliver a FaME Community of Practice with a fit for purpose FaME Toolkit, synthesising the learning for future implementation across Ireland.

Background Virtual reality (VR) is potentially effective in raising awareness of testicular diseases, promoting self-examination and early help-seeking among men. This paper presents an early economic evaluation exploring the potential cost-effectiveness of Enhancing Men’s Awareness of Testicular diseases (E-MAT)_VR, a VR interactive experience compared with E-MAT_E, electronic information, among male athletes Results from this economic evaluation will inform and support the design of a future randomized controlled trial (RCT). Methods Results from an Irish feasibility trial (ClinicalTrials.gov identifier: NCT05146466) with 74 participants conducted in 2022 were employed. Benefits were measured in monetary units whereby the contingent valuation method was used to elicit participants’ preferences through willingness-to-pay measures. A micro-cost analysis estimated the costs of the intervention and comparator and subsequent resource use. The costs and benefits of E-MAT_VR and E-MAT_E were compared to determine the net benefit. Sensitivity analyses were also conducted. Results Base case analysis suggests participants were willing to pay €21.88 for E-MAT_VR and €11.16 for E-MAT_E. The total cost of E-MAT_VR was €104.09 and of E-MAT_E was €22.75 per participant. These estimates include capital and delivery costs, of which delivery costs were €25.02 and €22.40 for E-MAT_VR and E-MAT_E, respectively. A negative net benefit indicates E-MAT_VR was not cost-beneficial as delivered in the feasibility trial. Scenario analyses demonstrated reducing costs via delivery modifications increased the probability of E-MAT_VR being considered cost-effective. The cost–benefit analysis was feasible, response rates were acceptable, and willingness-to-pay estimates were stable. Conclusions Economic evaluations alongside feasibility trials enable early economic evaluations, informing the design and conduct of a future RCT. E-MAT_VR had higher expected benefits (WTP) and costs than E-MAT_E, yielding a negative net benefit. Given the high cost of digital health interventions, investigating their cost-effectiveness early is important to inform and optimize resource allocation decisions. We present a series of scenarios to demonstrate how delivery modifications to reduce costs could improve the likelihood of E-MAT_VR being considered cost-effective.

Aim: To examine burnout levels, nurse perceptions of the work environment, job satisfaction, intention to stay and quality of care for nurses working in emergency departments before and following a planned change to nurse staffing levels. Design: A pre‐post observational design. Methods: A systematic approach (Nursing Hours per Patient Presentation) was introduced to determine nurse staffing levels based on patient presentations resulting in adjustments to nurse staffing. Data on burnout, the work environment, intention to stay, job satisfaction and quality of care were collected from three emergency departments prior to and following the adjustments to nurse staffing. Results: An adjustment to nurse staffing levels was made to all three emergency departments. Mean emotional exhaustion scores were significantly lower, and quality of work environment scores and levels of job satisfaction were significantly higher for nurses following staffing adjustments. There was an increase to the proportion of nurses who perceived an improvement in quality of care delivered. In general, the results indicated improvements in outcomes following adjustments to nurse staffing levels. Conclusion: A more holistic organisational approach is required to address staffing in emergency departments. Initiatives that involve frontline nurses in resource planning facilitating a bottom‐up approach to allow for improved work environments would be beneficial. Impact: This study addressed a planned change to nurse staffing levels in emergency departments and staff outcomes pre and post changes to staffing levels. This study highlighted that staffing an emergency department, based on nursing hours per patient presentation, was associated with improvements in staff outcomes. The research will impact on nurses working in emergency departments as outcomes from this research were used to develop a Framework for Safe Nurse Staffing and Skill Mix in Emergency Care Settings. Reporting Method: STROBE and SQUIRE checklist. Patient or Public Contribution: No Patient or Public Contribution.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Introduction: Job satisfaction and intention to leave have been consistently linked to the working environment. However, there are few studies of interventions for improving the environment or staff outcomes. Aim: To determine the impact of implementing a framework for safe nurse staffing on the environment and staff outcomes. This involved an assessment of required nursing hours per patient day, supernumerary nurse in charge and minimum 80:20 skill‐mix, with intentional changes in staffing if required. Design: A pre‐post observational design. Methods: This was a prospective observational study in six medical and/or surgical wards across three acute hospitals in Ireland. The outcomes were measured pre‐ and post‐implementation, and included the environment, using the Practice Environment Scale of the Nursing Work Index; and job satisfaction and intention to leave using a dichotomised 4‐point scale. Outcomes: Changes in staffing levels, adjustments to skill‐mix and the supervisory role of the ward leader were seen following the implementation. A multilevel model found significant increases over time on three of the five Nursing Work Index subscales: Staffing and Resource Adequacy, Collegial Nurse‐Physician Relations, and Nurse Participation in Hospital Affairs. Job satisfaction increased and intention to leave decreased, although the differences were not statistically significant. Increased job satisfaction was significantly associated with Staffing and Resource Adequacy, Collegial Nurse Physician Relations and Nurse Manager, Leadership and Support. A decreased odds of intention to leave was associated with increased job satisfaction. Conclusion: There were significant improvements in the environment following the implementation of the Framework. Three of the practice environment subscales were significantly associated with job satisfaction, while job satisfaction is a predictor of intention to stay. This study indicates that intentional changes to staffing can result in improvements to working environments which may in turn have an impact on job satisfaction and furthermore, on intention to stay. Impact: This study investigated intentional changes to nurse staffing in medical and surgical wards, examining the impact pre‐ and post‐implementation. This study underlined that when staffing is based on a systematic approach, based on a Framework for Safe Nurse Staffing, a subsequent improvement can be seen in staff's perceptions of the work environment, along with improvements in staff outcomes. This research will impact on staff working in acute settings as a means of determining staffing and improving outcomes using a Framework for Safe Nurse Staffing. Reporting Method: STROBE checklist. Patient or Public Contribution: No patient or public contribution.