Embedding clinical research in pre-registration nursing and midwifery programmes.

Background: Within the UK, there is a goal that research is embedded into everyday healthcare practice. Currently education provided to students at pre-registration level is theoretical, with little focus on clinical research delivery. Aims: The paper's aim is to report on the development and evaluation of a pre-registration clinical research resource for nursing and midwifery students with direct application to clinical settings and patient care outcomes. Methods: An initial survey assessed whether the learning resource was useful for nursing pre-registration students. Based on the findings, alongside expert stakeholder input, adaptations were made to the learning resources and a second survey re-evaluated the learning resources. Survey findings were analysed using descriptive statistics. Free text responses were thematically grouped. Results: Ninety-seven pre-registration nursing students responded. Most students agreed that they had enjoyed using the resources, had improved understanding of clinical research, anticipated being actively involved in research and would consider a future clinical research role. Conclusions: The learning resources can help overcome barriers to research engagement by nurses and midwives. The results demonstrate that research can be incorporated into clinical, educational and academic roles, highlighting their worth in supporting the clinical research workforce.

Communication to adult patients undergoing cancer care by non-specialist nurses: a scoping review protocol.

INTRODUCTION: Little is known regarding how non-specialist nurses communicate with patients living with cancer when the patients are receiving care outside of their cancer units/teams. This scoping review aims to identify, examine and report on the currently available evidence about communication by non-specialist nurses when caring for adults living with cancer outside of their cancer care unit/teams. METHODS AND ANALYSIS: A scoping review following the JBI methodology for scoping reviews will be conducted. We will search for empirical studies that meet the inclusion criteria in six databases (MEDLINE, PubMed, CINAHL, Embase, Scopus and PsycINFO). Handsearching in references of included articles will be performed to find additional articles. The population of interest will be non-specialist nurses. Three concepts will be explored, namely (1) all adult patients living with cancer, (2) a focus on three stages of the cancer continuum of care (cancer diagnosis, treatment and survivorship) and (3) a focus on communication between non-specialist nurses and patients living with cancer. We will include studies describing all healthcare settings outside patients' specialised cancer units or oncology teams. After article selection, two reviewers will independently screen titles and abstracts and perform a full-text article review, risk of bias assessments and data extraction. A third reviewer will resolve all disagreements. A narrative summary will provide an overview of how the results relate to the research aims and questions. The included articles will be limited to English and published between 2012 and 2023. ETHICS AND DISSEMINATION: No ethical approval is required since we will use publicly available empirical research sources. This review will provide current research on communication by non-specialist nurses with patients with a cancer diagnosis outside of an oncology setting, evidence that will support effective communication. As such, we aim to disseminate the findings in academic conferences and peer-reviewed journals.

The impact of COVID-19 on clinical forensic medicine and forensic psychiatry: A literature review.

Purpose:The COVID-19 pandemic prompted significant challenges in clinical forensic medicine and forensic psychiatry and emphasised the need for sustainable service delivery. Both fields faced difficulties in maintaining services due to COVID-19 precautions and limited referrals. This review examined the changes in forensic practices, aiming to understand their impact and learn from them to inform future strategies. Methods: A search was conducted across Ovid Medline, Ovid Embase, Ovid Emcare and PubMed, and webpages of governments and other organisations. Studies were included if they assessed any change that occurred in clinical forensic medicine or forensic psychiatry during the pandemic. A narrative review with a systematic approach was undertaken. Results: A total of 27 articles were included. There was a notable decrease in the volume of forensic assessments in early 2020. The numbers gradually rebounded with the easing of restrictions yet have not fully returned to pre COVID-19 levels. Telemedicine and COVID-19 precautions were widely incorporated into forensic services, which were seen to disrupt the patient-doctor dynamics, restrict the setting of examinations and complicate work processes and sample handling steps. Conclusion: This is the first review that describes the pandemic-driven changes in clinical forensic medicine and forensic psychiatry in respect of case trends and incorporation of COVID-19 precautions. The pandemic emphasised the need for adaptability and adoption of new assessment approaches in forensic services. Technology, like telemedicine, emerged as a valuable tool, enhancing accessibility for individuals in remote or high-risk areas. It is necessary to review the changes and re-evaluate their impacts in the post COVID-19 era.

Acute concomitant injury and intoxication in complainants of recent sexual assault: A review.

BACKGROUND: Sexual assault remains a highly prevalent crime worldwide and has the potential to cause a number of short and longer-term health sequelae. Complainants of recent sexual assault may undergo forensic and/or medical examinations for medical treatment or evidence collection, or both. However, the frequency and severity of acute health concerns requiring medical intervention in these patients at the time of examination is not well understood and has implications for their clinical care and safety. AIMS & OBJECTIVES: To examine the frequency and severity of acute concomitant health concerns at the time of forensic examination following an allegation of recent sexual assault in post-pubertal (age >13 years) individuals, through a review of existing literature. Concomitant health concerns considered in this review include ano-genital and extra-genital injury, and acute substance intoxication. METHODS: Four online databases (PubMed, Ovid Medline, CINAHL, Embase) were systematically searched with key terms regarding the topics of sexual assault, forensic examination, injury and intoxication. Articles were assessed for relevance based on inclusion and exclusion criteria. RESULTS: Of 562 titles, 53 full-text publications met the inclusion criteria. Frequency of ano-genital and extra-genital injury was highly variable across studies, and severity was inconsistently assessed and rarely reported. Medical treatment or transfer to acute care settings was more commonly required for extra-genital injuries. Non-fatal strangulation (NFS) was found to represent an increasingly frequent feature of sexual assault cases. NFS complainants often exhibit signs and symptoms of potentially lethal complications requiring urgent review in acute care settings. Substance use around the time of sexual assault was commonly reported by patients and detected in toxicological screens, and could have significant implications on patient and staff safety at the time of examination. CONCLUSION: The findings of this review highlight the clinical significance of acute concomitant health concerns following an allegation of recent sexual assault. Ano-genital and extra-genital injury, NFS and both voluntary and involuntary substance use may be more frequent and severe than previously understood. Further investigation into the assessment and management of these acute health needs is required to elucidate their clinical significance and inform evidence-based care for complainants of sexual assault.

HIV contact notification in sexual assault cases-ethical, legal, and procedural challenges.

HIV notification of sexual contacts is an essential public health aspect of reducing transmission. This process can be challenging at times, and even more so in instances of alleged sexual assault. This article highlights the multiple complexities associated with HIV contact notification in sexual assault cases when the complainant is HIV positive, and their sexual contact (the alleged perpetrator) is in police custody. We examine ethical and legal challenges associated with a practitioner's duty of care towards all involved parties, as well as potential issues with consent to notify sexual contact(s). Further, logistical challenges with this process, along with possible investigative implications are discussed. We contend that clinical forensic medical practitioners play a fundamental role in this context of HIV contact notification.

Non-fatal strangulation and COVID-19 common symptoms and signs: considerations for medical and forensic assessment.

Emerging evidence suggests that an onset or escalation of interpersonal violence has been occurring during the COVID-19 pandemic, particularly among persons in intimate or familial relationships. Strangulation (or neck compression) is a common form of interpersonal violence and can result in serious adverse health outcomes, including death. The identification and attribution of injuries from non-fatal strangulation are complex, as there may be an absence of external signs of injury and their appearance may be delayed by many days. There is a heavy reliance on clinician identification of 'red flag' symptoms and signs, the presence of which necessitates urgent further assessment. Additional challenges arise when acute non-fatal strangulation symptoms and signs are shared with other clinical conditions. In such cases, differentiating between the conditions based on the symptoms and signs alone is problematic. We present the diagnostic challenges faced when conducting forensic assessments of COVID-19-positive and suspected COVID-19 (S/COVID) patients following allegations of non-fatal strangulation in the setting of physical and sexual assaults. The implications of shared symptoms and signs, for forensic clinicians, primary healthcare, and emergency practitioners, as well as other frontline service providers, are discussed.

Right at Home: Living with Dementia and Multimorbidities.

Dementia is recognised as the biggest health crisis of our time in terms of high personal and social costs and wider impact on health and social care systems. Increases in people living with dementia and multimorbidities presents critical challenges for homecare worldwide. Healthcare systems struggle to provide adequate home-care services, delivering limited care restricted to a single-condition focus. This study explored the experiences and expectations of homecare from the multiple perspectives of people living with dementia and multimorbidities and homecare workers providing support. Findings draw from qualititative semi-structured interviews with people with dementia (n=2), their partners (n=2), other partners or family carers (n=6) and homecare workers (n=26). Three themes are idenfiifed: (a) the preference for and value of home; (b) inadequate homecare provision and enhanced care-burden; (c) limited training and education. Despite continued calls for homecare investment, the focus on reduction in costs hides key questions and further dialogue required exploring how people with dementia can be supported to live independendently and flourish at-home. This study considers these complex experiences and care requirements through the prism of disability and human rights frameworks. This paper concludes with consideration of more recent human social rights debate. We critically dicuss what this may mean for people living with dementia and consider the implications for corequisite policy development to optimise available homecare support.

COVID-19 and involuntary detention: An emergency medicine or emergency management responsibility?

The COVID-19 pandemic has thrown up innumerable challenges throughout the world, especially evident in the healthcare system. In emergency medicine, there is a new urgency around the clinical and ethical dilemmas clinicians face as they make decisions that impact upon the lives of their patients. Emergency clinicians are accustomed to upholding duty of care and acting in the best interests of patients. Clinical judgements are made every day about a patient's capacity to make their own decisions and act with free will. It is foreseeable that a duty of care owed to a patient may be in conflict with the responsibility to the health and safety of a community. What is particularly fraught for clinicians is the lack of clarity around this potential duty of care to the community, and navigating the potential conflict with duty of care to the patient. How much danger does the community need to be in, and how definable, imminent and specific does that risk need to be? An attempt to protect the community may well constitute either a breach of confidentiality or a breach of duty of care. This paper will explore the complex issues of respect for autonomy and the principle of non-maleficence, in the setting of COVID-19 and public health orders and illustrate the uncomfortable uncertainty that exists surrounding care of some of the most vulnerable patients in the community when their actions are contrary to public health recommendations.

Sexual assault examination and COVID-19: risk reduction strategies in conducting forensic medical examinations of a suspected or confirmed COVID-19 positive patient in Melbourne hospital hot zones.

The rapidly evolving context of the COVID-19 pandemic has necessitated profound modifications to the provision of health care services on a global scale. The concomitant requirements of lockdowns and social isolation has had marked ramifications for vulnerable individuals at risk of violence. This ripple effect of the pandemic has been observed globally. It is crucial that clinical forensic medical units continue to provide quality and timely essential services to those affected by interpersonal violence. As such, processes in this field must be modified as COVID-19 cases present and knowledge about the disease changes. The experiences of conducting sexual assault forensic examinations of suspected and confirmed COVID-19 positive (S/COVID-19) patients in a hospital hot zone are presented, and additional forensic issues specific to the emerging COVID-19 context are discussed.

Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study.

This pilot study evaluated a high-energy, high-protein, peptide-based, (medium-chain triglycerides) MCT-containing enteral tube feed (Nutrison Peptisorb Plus HEHP®, Nutricia Ltd., Trowbridge, BA14 0XQ, UK.) containing 1.5 kcal/mL and 7.5 g protein/100 mL. Fifteen community-based, enterally tube-fed adults (42 (SD 16.3) years) received the intervention feed daily for 28 days, with gastrointestinal tolerance, compliance and nutrient intake assessed at baseline and after the intervention period. Incidence and intensity of constipation (p = 0.496), nausea (p = 1.000), abdominal pain (p = 0.366) and bloating (p = 0.250) remained statistically unchanged, yet the incidence and intensity of diarrhoea improved significantly after receiving the intervention feed (Z = -2.271, p = 0.023). Compliance with the intervention feed was significantly greater compared to the patient's baseline regimens (99% vs. 87%, p = 0.038). Compared to baseline, use of the intervention feed enabled patients to significantly increase total energy (1676 kcal/day (SD 449) to 1884 kcal/day (SD 537), p = 0.039) and protein intake (73 g/day (SD 17) to 89 g/day (SD 23), p = 0.001), allowing patients to better achieve energy (from 88% to 99%, p = 0.038) and protein (from 101% to 121%, p < 0.001) requirements. This pilot study demonstrates that a high-energy, high-protein, peptide-based, MCT-containing enteral tube feed maintains gastrointestinal tolerance and improves compliance, energy and protein intake in complex, enterally tube-fed, community-based adult patients, though more work is recommended to confirm this.

Understanding the training and education needs of homecare workers supporting people with dementia and cancer: A systematic review of reviews.

Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer.

Understanding and Measuring the Wellbeing of Carers of People With Dementia.

BACKGROUND AND OBJECTIVES: To determine how the wellbeing of carers of people with dementia is understood and measured in contemporary health research. RESEARCH DESIGN AND METHODS: A systematic review of reviews was designed, registered with PROSPERO, and then conducted. This focused on systematic reviews of research literature published from 2010 onwards; with the wellbeing of carers of people with dementia being a primary focus. N = 19 studies met the inclusion criteria. Quality appraisal was conducted using the AMSTAR tool (2015). A narrative synthesis was conducted to explore how wellbeing is currently being understood and measured. RESULTS: Contemporary health research most frequently conceptualizes wellbeing in the context of a loss-deficit model. Current healthcare research has not kept pace with wider discussions surrounding wellbeing which have become both more complex and more sophisticated. Relying on the loss-deficit model limits current research in understanding and measuring the lived experience of carers of people with dementia. There remains need for a clear and consistent measurement of wellbeing. DISCUSSION AND IMPLICATIONS: Without clear consensus, health professionals must be careful when using the term "wellbeing". To help inform healthcare policy and practice, we offer a starting point for a richer concept of wellbeing in the context of dementia that is multi-faceted to include positive dimensions of caregiving in addition to recognized aspects of burden. Standardized and robust measurements are needed to enhance research and there may be benefit from developing a more mixed, blended approach to measurement.

The epidemiology of sexual assault of older female nursing home residents, in Victoria Australia, between 2000 and 2015.

Sexual assault is the least acknowledged, detected, and reported type of assault against nursing home residents. Nursing home staff are responsible for reporting suspected allegations to the police, who will contact a clinical forensic examiner to conduct a forensic medical examination. This study examined the epidemiology of sexual assaults of older women (aged 65 years and older) residing in nursing homes in Victoria, Australia, between 2000 and 2015, whose alleged incidents were referred to a clinical forensic examiner for a forensic medical examination. A retrospective analysis of alleged sexual assaults reported to the Clinical Forensic Medicine Unit at the Victorian Institute of Forensic Medicine between 1 January 2000 and 31 December 2015 was conducted. The study identified 28 forensic medical examinations performed for alleged sexual assault. The alleged victims frequently had cognitive impairments; injuries were infrequent; and alleged victims were cooperative. The forensic medical examiner responded within 72 h of reporting; and frequently noted limitations to physical examinations of the alleged victim. The actual number of sexual assaults during this period may be masked by under-reporting and, lack of identification by nursing home staff. There are many unresolved issues including: incidence, levels of reporting, nature of investigations, responses required to assist the victim, and the interventions needed to prevent sexual assault. Better data is vital. This data should be standardized, validated, reliable, and gathered prospectively across Australia and internationally.

How Do Coroners' Findings in Australian Jurisdictions Apply to Health Care Practitioners within Safety-I and Safety-II Paradigms?

The modern-day coroner sits uniquely at the interface between health care provision, patient safety and the law, playing an important role in informing health care practices to improve patient safety. In the 21st century, the health care system has rapidly developed in the field of patient safety. First came the Safety-I approach of looking at what went wrong, then the Safety-II approach of understanding why things go right. The advent of Safety-II has flipped the way some health care organisations view their systems and it is now time for the coronial jurisdiction to do the same. By applying the Safety-I/Safety-II Model for coronial investigations into health care-related deaths, coroners can address both the positive and negative factors in each case and refine the lessons in their findings. A Safety-II approach allows their role to evolve even further, firmly entrenching their preventive ethos as they become architects of resilience for the health care system.

Regenerative medicine: Stroke survivor and carer views and motivations towards a proposed stem cell clinical trial using placebo neurosurgery.

BACKGROUND: Few studies explore stroke survivor views and motivations towards stem cell therapy (SCT). This qualitative study explores the views and motivations of both stroke survivors and their partners/carers towards a proposed 2-arm Phase III Randomised Controlled Trial (RCT) comparing intracerebral insertion of stem cells with placebo neurosurgery in stroke survivors with disability. OBJECTIVE: To explore views and motivations towards a proposed 2-arm stem cell trial and identify factors that may impede and enhance participation. DESIGN: This study adopts a naturalistic design to explore the complexity of this field, employing a participatory action-research approach comprising a specialized Conversation (World) Café form of focus group. Data were collected via 5 Conversation Cafés with stroke survivors (age 40-75) and partners/carers between June and October 2016. Of 66 participants, 53 (31 male, 22 female) were stroke survivors and 13 (6 female, 7 male) were partners/carers. Qualitative data were analysed using a thematic approach. DISCUSSION AND CONCLUSION: Stroke survivor views and motivations reflect anticipation of the personal and future benefits of regenerative medicine. Partners/carers sought to balance the value of stroke survivor hope with carrying the weight of hope as carer, a conflict burden adding to known caregiver burden. All participants expressed the need for during and post-trial psychological support. This study provides a rare opportunity to explore the prospective views and motivations of stroke survivors and their partners/carers towards a proposed Phase III 2-arm RCT. This adds weight to qualitative evidence exploring capacity, consent, decision making, perceptions of treatment risk and supports required for clinical trial participation.

A Systematic Review of Sexual Assaults in Nursing Homes.

Purpose of the Study: The dramatic growth in the older adults (65 years+) has created an equivalent increase in the number of nursing home (NH) residents. NH residents often lack physical and cognitive abilities, making them particularly vulnerable to assault. Although sexual assault is among one of the most shocking types of assault, it is also the least acknowledged, detected, and reported type of assault against NH residents. This systematic review examines victim/perpetrator sociodemographic and relationship characteristics as well as the forensic characteristics of sexual assaults occurring in NH. Design and Methods: A 7 database systematic search of studies published between January 1, 1949 and October 26, 2015 was conducted that examined sexual assaults in NH. Articles reporting on sexual assault in NH and other institutional settings were eligible. Community-dwelling populations and studies not describing sexual assault or physical aspects of sexual assault were excluded. Sexual assault was not restricted to a single definition, study method, or country. Results: Fifteen studies met inclusion criteria. Sexual assault was the least reported type of assault in NH. Victims of sexual assault were likely to be females with cognitive or physical impairments. Perpetrators were likely to be male residents, although staff members were also substantiated. Forensic characteristics and investigative data were limited. Study limitation included inconsistencies between study purposes and small sample sizes. Implications: This review highlights a gap in knowledge regarding sexual assaults in NH and demonstrates a need for better staff training in detecting, examining, and managing sexual assaults in NH.

A cross-sectional survey using electronic distribution of a questionnaire to subscribers of educational material written by clinicians, for clinicians, to evaluate whether practice change resulted from reading the Clinical Communiqué.

OBJECTIVE: To explore whether subscribers reported clinical practice changes as a result of reading the Clinical Communiqué (CC). Secondarily, to compare the characteristics of subscribers who self-reported changes to clinical practice with those who did not, and to explore subscribers' perceptions of the educational value of the CC. DESIGN, SETTING AND PARTICIPANTS: Online cross-sectional survey between 21 July 2015 and 18 August 2015 by subscribers of the CC (response rate=29.9%, 1008/3373), conducted by a team from Monash University, Australia. MAIN OUTCOME MEASURES: Change in clinical practice as a result of reading the CC. RESULTS: 53.0% of respondents reported that their practice had changed after reading the CC. Respondents also found that the CC raised awareness (96.5%) and provided ideas about improving patient safety and care (94.1%) leading them to discuss cases with their colleagues (79.6%) and review their practice (75.7%). Multivariate analysis indicated that working in a residential aged care facility (p<0.05) and having taken part in an inquest (p<0.05) were significantly associated with practice change. CONCLUSION: The design and content of the CC has generated a positive impact on the healthcare community. It is presented in a format that appears to be accessible and acceptable to readers and achieves its goals of promoting safer clinical care through greater awareness of the medico-legal context of practice.

Lost in transition: women experiencing infertility.

This paper illustrates key findings from a qualitative doctoral research project exploring women's experience of infertility. Six women maintained treatment diaries, reflecting on their experiences prior to, during and beyond infertility treatment. The following key themes are identified: hopefulness, adaptation, transitioning and shifting focus. The data suggest that treatment, clinic experience and living a life 'on hold' act as turning points within the individual life course. It is at the intersection between treatment and outcome that difficulties negotiating the expected and anticipated life course become illuminated, revealing limited connectivity and transitioning through and beyond the treatment process. This is a critical focus area and one that sets the scene for effective future adaptation. The data suggest that the accessibility of supportive care moving through and beyond treatment is limited. This paper argues that the infertility clinic is a critical space and place and one where effective supportive care may enable effective transitioning beyond the experience of infertility as an unanticipated life course disruption.

Women's experiences of infertility - towards a relational model of care.

AIMS AND OBJECTIVES: To consider the effectiveness of current models of patient-centred infertility care. BACKGROUND: Patient centredness is defined as one of six key dimensions of quality of care. In the field of infertility, a new interaction model of patient-centred infertility care is proposed. Despite positive moves, this model reveals shortcomings in knowledge about the lived experience of infertility and lacks the shift in attitudes and approach that effective patient-centred care requires. DESIGN: The study has a qualitative research design. Nine women living with and through infertility participated in online life-story interviews. METHODS: Data were analysed using a layered strategy influenced by the voice-centred relational method, emphasising narrative content, form and function. RESULTS: Women reveal a complex experience. Three key themes were found: Approaching the clinic narratives are infused with personal expectations while deeply reflective of cultural expectations and social norms. Relatedness recognises women's experiences cannot be neatly separated into distinct domains. Liminality and infertility describes women's experiences lost in transition through and beyond infertility treatment. CONCLUSIONS: The current model of patient-centred infertility care requires further development. Women in this study found themselves lost in transition and irrespective of treatment failure or success. Conceptual development must embrace a relational understanding of patient's experience to ensure that patient-centred infertility care is realistic and relevant to patients, clinical staff and the system as a whole. RELEVANCE TO CLINICAL PRACTICE: Psychosocial skills are recognised as core competences for fertility nurses. A relational conceptualisation of patient's experiences, living with and through infertility, provides further information for the development of staff and enhanced knowledge and practice skills.