Nursing care left undone in psychiatric hospitals and its association with nurse staffing: A cross-sectional multi-centre study in Switzerland.

INTRODUCTION: Nursing care left undone occurs when nurses omit activities because of resource shortfalls. Higher levels of nursing care left undone are associated with worse nurse staffing and organizational factors. Plentiful evidence from acute, long-term and community care supports such associations; however, mental healthcare settings are under-studied. AIM: The aim of the study was to describe nursing care left undone's frequency in mental health inpatient settings and explore its association with nurse staffing levels. METHOD: As part of the multi-centre cross-sectional MatchRN Psychiatry study, data were collected by questionnaire from 114 units in 13 Swiss psychiatric hospitals. Nursing care left undone was analysed describing frequencies descriptively and used linear mixed models to assess its association with staffing. RESULTS: Data from 994 nurses were analysed. The most commonly omitted activities were evaluating nursing processes (30.5%), formulating nursing diagnoses (27.4%) and defining care objectives (22.7%). Nursing care left undone was higher in units with low staffing levels. DISCUSSION: As in somatic care settings, in psychiatric hospitals, 'indirect' care activities are most commonly omitted. IMPLICATIONS FOR PRACTICE: This study highlights factors affecting the frequency of nursing care left undone, including staffing levels and perceived leadership. The findings emphasize the importance of nurse managers taking action to improve work environment factors.

Waste management developments in the last five decades: Asian perspective.

Solid waste management was explored in Asia's last five decades, and the issues and challenges were identified. Waste generation has increased in all nations in the previous 50 years, although more recently, a declining trend has been observed in Japan and Korea. The composition has been predominantly organic, with 45-50% being kitchen waste. Material extraction and productivity to sustain the most populous part of the globe are explained. Waste management technologies have evolved, with more nations slowly transitioning from landfills to using waste-to-energy options. However, landfilling and open dumps are still the major disposal choice in most developing countries in Asia. Thus, the issues of concern include dumpsites management, the informal sector, waste collection, open burning and food waste. Changes (increasing trends) in the recycling technologies and quantum are evident, as seen in several country reports from India, Indonesia, Japan, Malaysia, Singapore, South Korea, Thailand and Vietnam. There are several issues and challenges for recycling, which are explored in the text. Lastly, the drivers that propel the whole scenario of waste management in Asia and the evolution of these drivers over time are discussed. Several recommendations are included to achieve sustainable waste management in Asia.

Circular economy strategies for waste management in Sri Lanka: A focus on demolitions and repurpose and material recovery and production stages.

In Sri Lanka, the management of Construction & Demolition (C&D) waste poses a major problem, leading to environmental degradation and depletion of resources. This study aims to tackle these issues by examining the implementation of Circular Economy (CE) strategies within the construction industry of Sri Lanka. The focus is on reducing waste generation and maximizing resource utilization during the demolitions and repurpose, as well as material recovery and production stages of the building project life cycle. These stages are crucial in terms of waste generation and resource consumption. A qualitative approach was employed in this research, utilizing the Delphi technique to gather insights through a series of three rounds of expert interviews. In the first round, 17 experts were involved, followed by 15 in the second round, and 12 in the final round. The data collected from these interviews were analysed using manual content analysis methods. Based on the research findings, a total of 14 C&D Waste Management (WM) issues were identified specifically in the Demolitions and Repurpose Stage in Sri Lanka. For each issue, suitable strategies were proposed to overcome them effectively. Furthermore, the study examined the impact of CE strategies on minimizing these issues within the context of the project management iron triangle. Similarly, the Material Recovery and Production Stage of the building presented eight C&D WM issues, each accompanied by corresponding strategies to address them. The research also explored the influence of CE strategies in mitigating these issues, considering the project management iron triangle. During the demolitions and repurpose stage, CE strategies focus on reducing waste generation and optimizing resource utilization. This involves carefully deconstructing buildings to salvage and recover materials that can be reused or repurposed.

School-based multidisciplinary student-led clinics in health and Australian accreditation standards: A scoping review.

INTRODUCTION: Student-led clinics can provide health services to marginalised groups where service offerings are sparse or difficult to access, such as rural areas. Offering these services to children and young people can promote health and well-being by addressing the individual challenges and the social determinants of health. There is uncertainty, however, as to whether student-led clinics can meet Australian accreditation standards for health professionals completing degree programs. OBJECTIVE: This study aims to determine the capacity for health student placements in school-based student-led clinics to meet accreditation standards. DESIGN: A systematic scoping review was conducted based on Arksey and O'Malley's framework and the PRISMA-ScR statement. SETTING: Several databases were examined, including Ebsco (Academic Source and CINAHL), ProQuest (PsycINFO, ERIC) and grey literature sources along with a desktop review of accreditation standards across seven health disciplines. Two independent reviewers screened eligible studies. FINDINGS: The search retrieved 1037 records with 65 full-text papers assessed for eligibility. Eleven papers met the inclusion criteria. Based on the evidence, both nursing and exercise and sports science accreditation standards were best suited to student-led clinics. DISCUSSION: Although broad categories of work-integrated learning activities were applied, it appears feasible to expect accreditation standards for health disciplines at an Australian university to be a good fit for health student-led school-based clinics. CONCLUSION: Increasing health student placement opportunities within student-led clinics can improve the health and well-being of children and young people in regional, rural and remote (RRR) areas of Australia who may otherwise have limited access to allied health services.

Analysis of changes in the national mental health nursing workforce in England, 2011-2021.

WHAT IS KNOWN ON THE SUBJECT?: Nurses work in mental health services around the world, constituting the largest professional group. Nurses have been identified as being potentially able to carry out a much wider range of functions than are typically allowed in practice, when provided with suitable training. There are long-term concerns regarding shortages of mental health nurses in England and many other countries. Workforce data is rarely subject to analysis in peer-reviewed journals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a case study of the workforce patterns of a national mental health nurse (MHN) workforce overtime allowing comparison with other countries and specialities. MHN numbers reduced from 2011 to 2017, then increased to near the 2011 level by 2021, not meeting ambitious national plans for increasing numbers. The mental health nursing proportion of the total NHS nursing workforce decreased through this period. Advanced practice roles and skills are widely, but unevenly, distributed and are provided by a small proportion of nurses. The proportion of nurses working in community settings has increased to constitute more than half of all nurses for the first time. The ratio of support workers to nurses increased in inpatient settings and will continue to change. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Historical challenges in recruiting MHNs suggest that future plans to expand the profession are overly optimistic. To support the development of advanced practice roles and new skill sets, clearer research evidence of impact is required and clearer national guidance regarding best practice models. Good workforce data are essential to inform good workforce planning. ABSTRACT: Introduction Data regarding changes in characteristics of the MHN workforce is commonly cited in governmental publications, but is rarely analysed in peer-reviewed journals, despite ongoing concerns regarding high vacancy rates within mental health services. Aim The aim of the study was to characterize changes in the MHN workforce, implementation of new nursing roles/skills and alignment with national policy. Method Analysis of nationally published workforce data, peer-reviewed publications and governmental policy/planning documents. Results Nurse numbers declined from 2011 to 2017, subsequently returning to near 2011 levels, but remaining below national targets. Nurses in community settings increased to constitute more than half of all nurses, whilst inpatient numbers declined, although more slowly than bed numbers. The ratio between nurses and support workers changed due to more support workers in inpatient settings. New advanced skills and roles for nurses have increased, but are unevenly distributed, constituting a small proportion of the total workforce. Implications for Practice This paper provides a case study against which comparisons may be made with the nursing workforce in other countries and specialities. Even clear policy commitment to nursing growth may not deliver planned changes in numbers and introducing new roles may have uneven impact, especially in the absence of a robust evidence base.

Analysis of potential clinical management issues in unreported mortality data from an Australian health service.

BACKGROUND: We have previously reported incomplete data submission to the Victorian Audit of Surgical Mortality (VASM) by a large health service. We have further examined the source health service clinical data to assess whether any clinical management issues (CMI) occurred and should have been reported. METHODS: The previous study identified 46 deaths that should have been reported to VASM. The hospital records of these patients were further analysed. Data recorded included the patient's age, gender, admission type and clinical course. Any potential clinical management issues were recorded and classified using the VASM definitions (area of consideration or concern, adverse event). RESULTS: Median age of the deceased patients was 72 (range 17-94), with 17 (37%) being female. Patients were under the care of nine different specialties with general surgery being the most common (18/46). Only four (8.7%) of the cases were electively admitted. 17 (37%) patients had at least one CMI with 10 (21.7%) classified as adverse events. Most deaths were not considered preventable. CONCLUSION: The proportion of CMI in the unreported deaths was consistent with the previously reported VASM data, however current findings show a high percentage of adverse events. The underreporting may be due to inexperienced medical staff or coders, poor quality notes or confusion about what should be reported. These findings reinforce the importance of data collection and reporting at the health service level, and a number of important lessons and opportunities to improve patient safety have been lost.

The experience of claiming mental health disability benefits: A qualitative analysis of clients' perspectives.

WHAT IS KNOWN ON THE SUBJECT?: The decision to apply for disability benefits may be an important breakthrough in the life of people with severe mental illness. The literature regarding the process of applying for mental health disability benefits is scarce. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is, to the best of our knowledge, the first to fully describe the experience of submitting a claim for mental health disability benefits, as experienced by those diagnosed with severe mental illness. The process of applying for recognition of a mental health disability has three chronological stages-before the claim submission, during the claims process and after recognition. Clients approach the process without any prior knowledge, and therefore they need professional help when submitting their claim. A deterioration in clients' mental health prompts them to apply. A lack of trust in the system affects the application decision/process. The medical committee hearing is described as a complex and multifaceted experience. Clients reported being extensively preoccupied with stigma throughout the process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professional assistance throughout the claims process is a key factor with the potential to change clients' experience of the entire process. It is important to educate mental health nurses about the disability applicating process. Mental health professionals are encouraged to be mindful of the facilitating/hindering mechanisms that are dominant at each stage of the process. There is a need for liaising with relevant agencies that act as advocates for those diagnosed with a mental health illness. ABSTRACT: INTRODUCTION: The decision to apply for disability benefits may be an important breakthrough in the life of those diagnosed with severe mental illness (SMI). Nevertheless, the literature regarding the application process is scarce. AIM: The aim of the study was to explore how people who receive mental health disability benefits retrospectively perceive the process of applying for and receiving these benefits. METHODS: Twenty-four in-depth qualitative interviews were conducted with people whose mental health disability was recognized in the past few years. RESULTS: Analysis revealed three themes describing the process's chronological stages: Before submitting the claim (from deterioration to trust), during the claim process (from bureaucracy to understanding), after receiving recognition (from stigma to gratitude). Each stage includes facilitating factors (e.g. encouragement from professionals) and hindering factors (e.g. stigma, lack of knowledge and trust). DISCUSSION: This is the first study to fully describe the experience of applying for mental health disability benefits, as experienced by clients. The decision to apply is perceived as complex and difficult. Although clients are extensively preoccupied with stigma throughout the process, they are able to express gratitude for the opportunities made available to them. IMPLICATIONS: Professional assistance throughout the claim is a key factor with the potential to change clients' experience of the entire process.

The experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement.

WHAT IS KNOWN ON THE SUBJECT?: Regular and effective clinical supervision for mental health nurses and healthcare assistants (HCAs) is an important tool in helping to reduce stress and burnout, and in ensuring safe, effective and high-quality mental health care. Previous studies of clinical supervision within secure mental health environments have found both a low availability of clinical supervision, and a low level of staff acceptance of its value, particularly for HCAs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In previous studies, the understanding shown by HCAs and nurses around the benefits of clinical supervision may have been limited by the methods used. This study was specifically designed to help them best express their views. In contrast to previous studies, both nurses and HCAs showed a good understanding of the function and value of clinical supervision. Significant improvements in the experience of, and access to, clinical supervision for nurses and HCAs working in secure mental health services may be achieved by raising staff awareness, demonstrating organizational support and increasing monitoring of clinical supervision. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations should consider reviewing their approach to supervision to include raising staff awareness, multidisciplinary supervision, group supervision, and recording and tracking of supervision rates. Organizations should be mindful of the need to provide effective clinical supervision to HCAs as well as nurses. ABSTRACT: Introduction Studies have found a low availability and appreciation of clinical supervision, especially for healthcare assistants (HCAs). Qualitative research is needed to further understand this. Aims Increase understanding of nurses' and HCAs' experiences of, and access to, clinical supervision. Identify nurses' and HCAs' perceptions of the value and function of clinical supervision. Assess how interventions affect staff's experiences of clinical supervision. Methods In 2013, HCAs and nurses in a secure adolescent service were surveyed about clinical supervision. Forty-nine HCAs and 20 nurses responded. In 2014, interventions to facilitate supervision were introduced. In 2016, the study was repeated. Forty HCAs and 30 nurses responded. Responses were analysed using a mixed methods approach. Results Significantly more HCAs found supervision to be a positive experience in 2016, and both nurses and HCAs reported significantly fewer challenges in accessing supervision. HCAs and nurses understood the value of clinical supervision. Discussion Significant improvements in the experience of clinical supervision were achieved following increased staff awareness, multidisciplinary and group supervision, and recording supervision rates. HCAs and nurses understood the consequences of inadequate supervision. Implications for practice Organizations could adopt the interventions to facilitate clinical supervision. Supervision should not be overlooked for HCAs.

Palliative Care Considerations for Patients With Head and Neck Cancer With Children at Home.

Adult patients diagnosed with head and neck cancer (HNC) who may have contact with children in the home setting are at risk of experiencing distress because of embarrassing and challenging oral symptoms often associated with an HNC diagnosis and the side effects of required treatments. This article features a case study involving a patient diagnosed with HNC and details how oncology nurses can provide patients with HNC and their caregivers with resources and support.

Soft palate trauma induced during GlideScope intubation.

The GlideScope (GVL; Saturn Biomedical Systems, Burnaby, British Columbia, Canada) is a rigid indirect video laryngoscope device that facilitates exposure of the larynx for placement of the endotracheal tube. This blade also reduces the requirement for anterior displacement of the tongue. A unique feature is the acutely angled blade which provides an improved glottic view. Herein, we present 2 instances of soft palate trauma, a rare oropharyngeal complication linked to GlideScope use. In the first case, the GlideScope was used for pedagogical purposes for intubation in a knee surgery. In the second case, GlideScope was used to secure the airway of an obese patient with a Mallampati class 3 airway and, therefore, presumed difficult intubation. Use of the GlideScope requires less lifting force (approximately 0.5-1.5 kg) than direct laryngoscopy to achieve visualization of the glottis, so less traction is applied to soft tissue. However, meticulous care must be taken even by experienced operators to ensure correct use to decrease the incidence of oropharyngeal injuries, especially in patients with difficult airways. Increased vigilance makes the GlideScope an invaluable tool despite its potential complications.

Transorbital endotracheal intubation: a nonstandard approach to a difficult airway.

We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for optic neuropathy, complicated by medial wall dehiscence. His course was also complicated by severe radiation trismus, for which he was scheduled to undergo bilateral mandibular coronoidectomies. Given his limited mouth opening, the surgeon requested a nasal endotracheal tube. Because of concerns of traumatizing his nare, we utilized a flexible fiberoptic bronchoscope to perform asleep transorbital intubation. Airway management in patients with severe trismus may require ingenuity.

Potential Benefits of Oral Cryotherapy for Chemotherapy-Induced Mucositis.

Mucositis is a common side effect of cancer therapies that causes painful, erythematous lesions to develop in the gastrointestinal tract. These lesions can lead to malnutrition, increased risk for serious infection, prolonged hospital stays, and reduced quality of life. Oral cryotherapy, or the use of ice chips to cool the mucous membranes during bolus chemotherapy infusions (e.g., 5-fluorouracil [Adrucil®] and melphalan [Alkeran®]), is the most readily accessible and cost-effective intervention available. Although many factors may contribute to the development of mucositis during cancer treatment, studies have found a reduction in the incidence and the severity of mucositis with the use of oral cryotherapy.


Early Recognition and Management of Posterior Reversible Encephalopathy Syndrome: A Newly Recognized Complication in Patients Receiving Tyrosine Kinase Inhibitors.

BACKGROUND: Adult patients with cancer receiving antineoplastic, targeted, and other immunosuppressive therapies are at risk for severe side effects. Studies link posterior reversible encephalopathy syndrome (PRES) with immunosuppressants used for patients undergoing transplantation, as well as select tyrosine kinase inhibitors (TKIs) and other targeted therapies used in patients with cancer. PRES is a reversible condition with early recognition and management; however, permanent neurologic toxicities have been reported. OBJECTIVES: This article aims to educate oncology nurses on signs, symptoms, and management of PRES in patients receiving TKIs. METHODS: The literature was reviewed to develop an educational session about causes, manifestations, pathophysiology, and management of PRES. Using a case study and flipped classroom model, staff participated in an online lecture and concept engagement exercise. Education for nurses included frequent neurologic and mental status assessments, blood pressure monitoring with mean arterial blood pressure goal, and seizure precautions. Nursing knowledge was evaluated with pre- and post-testing. FINDINGS: Evaluation revealed improved knowledge in recognizing and managing patients with PRES related to TKIs. The flipped classroom approach was perceived as a valuable tool for busy staff nurses.

The global eradication of peste des petits ruminants (PPR) within 15 years--is this a pipe dream?

Gordon Scott did much to inspire the eradication of rinderpest, probably the most outstanding veterinary achievement of the twentieth century, and one currently inspiring is the proposed eradication of peste des petits ruminants (PPR), a disease of sheep and goats caused by a closely related Morbillivirus. The evolution and geographic spread of PPR along with its epidemiological characteristics are discussed and related to ways in which its spread can be reduced through the provision of diagnostic aids to sanitary livestock movement at local level. Taking a historical look at rinderpest eradication, it was shown that much could be achieved using a legislation-backed zoosanitary approach or, once developed, the build up of herd immunities in isolated populations. As the final cap to this (circa), two hundred-year-long process, major national and internationally funded vaccination programmes falling within the informal coordinatorship of the OIE and FAO showed that final eradication could be achieved with remarkable rapidity if the seat of infection was known and if appropriate national and international interventions were aimed at ending virus transmission. Were such international cooperation to be forthcoming once more, the understanding, tools and experiences now on offer suggest that PPR could be controlled and eradicated far more rapidly than rinderpest.

Management of HIV/AIDS in older patients-drug/drug interactions and adherence to antiretroviral therapy.

Patients with human immunodeficiency virus (HIV) are living longer with their disease, as HIV has become a chronic illness managed with combination antiretroviral therapy (cART). This has led to an increasing number of patients greater than 50 years old living successfully with HIV. As the number of older adults with HIV has increased, there are special considerations for the management of HIV. Older adults with HIV must be monitored for drug side effects and toxicities. Their other non-HIV comorbidities should also be considered when choosing a cART regimen. Older adults with HIV have unique issues related to medication compliance. They are more likely than the younger HIV patients to have vision loss, cognitive impairment, and polypharmacy. They may have lower expectations of their overall health status. Depression and financial concerns, especially if they are on a fixed income, may also contribute to noncompliance in the aging HIV population.

Risk Prediction Tools in Oncology.

Cancer prediction tools are widely available to clinicians, and the data retrieved from these tools can assist with patient counseling sessions on risk, prognosis, treatment, and recurrence. Current tools are able to synthesize data in a concise, unbiased, and evidence-based method, allowing patients to make better-informed decisions about their treatment options. As useful as these tools can be, clinicians must understand their limitations and evaluate the tools for quality and applicability.
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Mental health: outcomes of 10 babies of mothers with a history of serious mental illness.

Women with serious mental illness are frequently on antipsychotic medications to maintain their mental health. During pregnancy there is much debate as to whether to continue or cease these medications. The possibility of adverse effects is of concern to clinicians and the women. This study used a case study methodology to identify the outcomes for 10 babies of women with a history of serious mental illness. The results provide further evidence in regard to women and the use of antipsychotic medications throughout pregnancy and during the first year after birth. Separation of mother and baby occurred in five of the 10 babies. This study identifies the neonatal complications for these vulnerable babies as not outside the norm for births in Australia. The high rate of mother-baby separation is of great concern and needs further longitudinal studies.