An exploration of women's sexual and reproductive health following traumatic brain injury.

AIMS AND OBJECTIVES: To develop a gendered understanding of sexual and reproductive health for Australian women following traumatic brain injury. BACKGROUND: The intersection of socialised normative expectations of sexuality and sexual health, and being a woman with a disability, can lead to inequity and a misconception that a woman with a disability is asexual. DESIGN: An equal weighting concurrent mixed methods design. METHODS: Twenty women participated in conversational interviews and 49 women completed an online survey. Equal priority was given to both qualitative and quantitative data which were collected concurrently. A separate analysis of data was performed and was later merged. This paper follows the Good Reporting of a Mixed Methods Study guidelines for reporting mixed methods research. RESULTS: Women reported changes in menstruation, reproduction, and sexual activity. Results identified that following traumatic brain injury, routine reproductive, and sexual health screening were neglected. Women revealed a personal reticence to discuss sexual health in a holistic sense and appeared more comfortable discussing reproductive health rather than sex for pleasure. Additionally, they perceived there was a reticence by clinicians to discuss sexual health as part of their rehabilitation. CONCLUSIONS: Shifting the focus to be on women's health through periodic comprehensive health assessments is essential to the delivery of holistic health care. These results can inform the provision of sexual health, sexual safety, and sexual assertiveness education and training for women and girls within a rehabilitation framework and would be a way of addressing what women in this study identified as an unmet need. RELEVANCE TO CLINICAL PRACTICE: Reproductive and sexual health are important elements of routine comprehensive health screening for women. Nurses are well positioned to begin discussions regarding sexual agency, sexual, and reproductive health to ensure person-centred care.

An exploration of women's knowledge and experience of perimenopause and menopause: An integrative literature review.

AIM: To explore the international literature related to women's knowledge and experience of perimenopause and menopause and to inform future directions for research and individualised healthcare delivery. BACKGROUND: Menopause is a normal physiological process experienced by most women. Despite this, care and support is fragmented and the implication on women's long-term health is not sufficiently understood. DESIGN: An integrative review of primary research on women's knowledge and experience of perimenopause and menopause. METHOD: CINAHL, Medline, Wiley Online Library, SCOPUS, PubMed and Google Scholar were searched from 2011 to 2021.Quantitative and qualitative studies written in English exploring women's knowledge and experience of menopause were included. The search strategy for the review complied with PRISMA guidelines. The mixed methods appraisal tool was used to assess quality. Thematic analysis was employed to present a narrative synthesis of the data. RESULTS: A total of 17 studies, comprising 10 quantitative, and seven qualitative studies met the inclusion criteria. The four themes regarding women's knowledge and experience of perimenopause and menopause identified in the literature were as follows: (1) Symptoms associated with perimenopause and menopause; (2) Strategies to manage symptoms; (3) Support and information (4) Attitudes, education and health literacy. CONCLUSION: This integrative review of the international literature highlights that women's knowledge of perimenopause and menopause varies significantly globally and within countries. The experience of perimenopause and menopause for women is heterogenous and influenced by deeply embedded sociocultural patterns. RELEVANCE FOR CLINICAL PRACTICE: This integrative review has shown that individualised support for women during perimenopause and menopause is critical to ensure the diverse needs of women are suitably addressed. NO PATIENT OR PUBLIC CONTRIBUTION: As this was a review of the literature, no patients, service users, caregivers or members of the public were involved in this review.

Workplace gender discrimination in the nursing workforce-An integrative review.

AIM: To critically synthesise the literature that explores the experiences of workplace gender discrimination from the perspective of registered nurses. DESIGN: Integrative review. REVIEW METHODS: Primary research articles reporting on the experience of workplace gender discrimination towards registered nurses in any setting were eligible for inclusion. Studies were critically appraised for methodological quality using a modified Critical Appraisal Skills Program list. The six phases of thematic analysis proposed by Braun and Clarke (2006) were used to guide the analysis. Data were extracted and coded, and themes were identified according to the review aims and significant findings of each study. DATA SOURCES: CINAHL, MEDLINE, SCOPUS, Cochrane Library, published between January 2012 and June 2022. RESULTS: Twenty studies met the inclusion criteria. Major themes identified were (1) career progression, (2) career interruption, (3) positioning of men in nursing and (4) positioning of women in nursing. CONCLUSION: This review shows that both men and women in nursing experience workplace gender discrimination; however, the forms and consequences of this discrimination differ substantially by gender. IMPLICATIONS FOR THE PROFESSION: It is important that the pursuit of greater numerical representation of men in nursing does not result in further reinforcing patriarchal advantage. Professional development for nurse leaders in managing gender issues is recommended. IMPACT: This integrative review presents current issues on workplace gender discrimination for men and women in nursing. The findings suggest gender roles and norms have an effect on the careers of both men and women in nursing. The time has come to alter restrictive gender norms and to challenge notions of hegemonic masculinity and femininity. REPORTING METHOD: We have adhered to relevant EQUATOR guidelines-PRISMA. NO PATIENT OR PUBLIC CONTRIBUTION: For this literature review on workplace gender discrimination for registered nurses, we did not engage members of the patient population, nor the general public.

The experience of workplace gender discrimination for women registered nurses: A qualitative study.

AIM: To explore the experiences of female registered nurses (RNs), who encounter workplace gender discrimination in nursing. DESIGN: This study used a qualitative exploratory design informed by feminist perspectives and was underpinned by social constructionism. METHODS: Women who were RNs (N = 10) and employed in New South Wales (NSW) were purposively selected to convey their experiences of workplace gender discrimination. Data were collected through semi-structured interviews, between April and July 2020. Analysis was guided by the work of Anderson and Jack (Women's words; 1991) who recommend three ways of listening. Interviews were transcribed verbatim and Braun and Clarke's (Qualitative Research in Psychology, 3, 77-101; 2006) six-step guide was used to develop themes. RESULTS: Thematic analysis revealed five overarching themes: It's a man's world; Gender stereotypes; Being a woman and nurse; Reluctance to call out gender discrimination and The status quo. Findings from this study highlighted that participants believed men's career progression in nursing were favoured over women. CONCLUSION: Findings from this research highlight that socially constructed gendered norms continue to form the basis of inequality for women in the workplace. Fostering and sustaining workplace cultures that support family and work life balance, and that do not discriminate against women, is fundamental to ensuring equality for women. IMPACT: There is limited qualitative research into women's experiences of workplace gender discrimination in nursing. This research highlights the need for workplace strategies to be implemented to ensure women are better supported and equally represented in leadership positions and advanced practice roles in nursing. All nurses should be given equal consideration based on experience and qualifications. Career development and progression opportunities should be fair, equitable and transparent with clearly documented criteria.

Women's tenacity following traumatic brain injury: Qualitative insights.

AIM: To explore perspectives of Australian women who had sustained a traumatic brain injury to develop a gendered understanding of their experiences. DESIGN: Qualitative findings from a concurrent mixed methods study. METHODS: Australian women who had sustained a traumatic brain injury participated in conversational interviews. Data were collected from June 2017 - May 2018. Women's narratives were listened to in various ways (Anderson & Jack, Learning to listen: Interview techniques and analyses, 1991) and analysed using thematic analysis (Braun & Clark, Thematic analysis, 2016). RESULTS: Two overarching themes Loss-A life once lived and Realigning Self-A new way of being were identified. Women discussed many losses due to injury, loss of income and potential earnings, loss in relationships and loss of identity. These all took time to reconfigure in their lives, as they adjusted to a range of ongoing impairments from the traumatic brain injury. CONCLUSION: Socially constructed gendered norms continue to at times negatively inform delivery of health care for women following traumatic brain injury. Loss associated with the injury is felt for decades and regardless of time since injury realigning of self, requires remarkable tenacity. Readjustment often continues without end; therefore, individualized health and rehabilitation services must be offered across women's lifespans. IMPACT: There is limited research into women's experiences of traumatic brain injury which suggests experiences will be the same for men and women. This research highlights biological sex differences and socialized gendered roles are important factors to consider for women following traumatic brain injury. Differences are influenced by sociocultural factors and they relate to sexual and reproductive health and gendered roles such as caring for children, caring for ageing parents, employment and projected earnings. These findings should be used to inform the development of individualized health and rehabilitation services which women in this study have identified and must be offered across their lifespans.

Nurses working in intellectual disability-specific settings talk about the uniqueness of their role: A qualitative study.

AIMS: To explore the perceptions of Australian nurses working in disability-specific settings and/or roles, about: (a) nursing people with intellectual and developmental disability living in Sydney; and (b) the utility and applicability of professional practice standards designed specifically for intellectual and developmental disability nursing. DESIGN: A qualitative research design was used to guide the study and our analysis utilized the constant comparative approach to thematic data analyses. METHODS: Individual in-person interviews were conducted with 18 nurses working in intellectual and developmental disability-specific settings and/or roles across the state of New South Wales between July - December, 2017. Participants described what it is that sets intellectual and developmental disability nursing apart from other nursing specialties, and the rewards and challenges of their role. Questions were also asked about professional practice standards in general and more specifically intellectual and developmental disability professional practice standards. Data were analysed thematically. FINDINGS: Three themes reflected intellectual and developmental disability nurses' perceptions: (a) a unique investment in the nurse/patient dyad; (b) a bridge between disparate systems; and (c) an ambiguous future. Nurses reported variable understanding of professional practice standards designed for intellectual and developmental disability nursing, but also a belief in their importance. CONCLUSION: The intellectual and developmental disability nurses' experience of care accounts for the specific needs of patients with intellectual and developmental disability and suggests the importance of professional practice standards which acknowledge the changing landscape of care in Australia prompted by the implementation of the National Disability Insurance Scheme.

Phenotypes of organ involvement in sarcoidosis.

Sarcoidosis is a highly variable, systemic granulomatous disease of hitherto unknown aetiology. The GenPhenReSa (Genotype-Phenotype Relationship in Sarcoidosis) project represents a European multicentre study to investigate the influence of genotype on disease phenotypes in sarcoidosis.The baseline phenotype module of GenPhenReSa comprised 2163 Caucasian patients with sarcoidosis who were phenotyped at 31 study centres according to a standardised protocol.From this module, we found that patients with acute onset were mainly female, young and of Scadding type I or II. Female patients showed a significantly higher frequency of eye and skin involvement, and complained more of fatigue. Based on multidimensional correspondence analysis and subsequent cluster analysis, patients could be clearly stratified into five distinct, yet undescribed, subgroups according to predominant organ involvement: 1) abdominal organ involvement, 2) ocular-cardiac-cutaneous-central nervous system disease involvement, 3) musculoskeletal-cutaneous involvement, 4) pulmonary and intrathoracic lymph node involvement, and 5) extrapulmonary involvement.These five new clinical phenotypes will be useful to recruit homogenous cohorts in future biomedical studies.

Understanding the contemporary role of the intellectual disability nurse: A review of the literature.

AIMS AND OBJECTIVES: To identify the specialist role/s that nurses perform and the specialist skills that nurses use when caring for people with intellectual disability. METHODS: Adhering to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," various subject headings were used to systematically search six electronic databases for articles published in English between 2000 and 2017. A total of 27 articles were reviewed. RESULTS: The literature demonstrates that similarities exist between the physical care delivered to people with intellectual disability and that delivered to people without intellectual disability. However, skills in the areas of communication, advocacy and person-centred care differ between these two groups. DISCUSSION: Our findings suggest that the skill set of the specialist intellectual disability nurse is not uniquely technical but it is uniquely relational that incorporate increased patience and resilience when developing relationships with the people they care for. CONCLUSION: This review has provided insights into the main differences in the skills required when working with people with intellectual disability compared to working with those without. However, minimal literature was identified that adequately describes what is unique about the performance of the role of specialised intellectual disability nurses-especially in Australia. RELEVANCE TO CLINICAL PRACTICE: Understanding the skills required of nurses caring for people with intellectual disability provides the opportunity for more nurses to develop these specialised relational skills and for this branch of nursing to attract professional recognition that is currently limited.

An exploration of the practice, policy and legislative issues of the specialist area of nursing people with intellectual disability: A scoping review.

The specialist field of intellectual disability nursing has been subjected to a number of changes since the move towards deinstitutionalisation from the 1970s. Government policies sought to change the nature of the disability workforce from what was labelled as a medicalised approach, towards a more socially oriented model of support. Decades on however, many nurses who specialise in the care of people with intellectual disability are still employed. In Australia, the advent of the National Disability Insurance Scheme offers an apt moment to reflect upon these decades of specialised nursing care as the context of this nursing care will continue to evolve. A review of the published literature was conducted to explore what has shaped the field in the past and how this might inform the future of this speciality area under new policy and service contexts. People with intellectual disability have specific health and support needs that require a specialised workforce. Specialist nurses continue to be needed for people with intellectual disability.

Use of pragmatism to explore women's experiences of traumatic brain injury: a kaleidoscopic view of the world.

BACKGROUND: Although more men than women sustain a traumatic brain injury (TBI), approximately one quarter of people with TBIs are women. The experiences of TBI reported in the literature are informed from the masculine perspective and do not adequately represent women's experiences. Pragmatism provides an overarching methodological framework to explore and critique a broader perspective of health, including psychosocial, cultural, spiritual, political and environmental factors, while attempting to address gender inequity. AIM: To describe the philosophical background validating the use of pragmatism to research women's experiences of TBI. DISCUSSION: Given the limited understanding of the interplay of socially constructed barriers with the complex impairments women have following TBI, a novel approach to research is required. Pragmatism offers a way to incorporate critical thinking and advocacy into research designs. CONCLUSION: The critical feminist transformative framework presented in this paper demonstrates the strengths of using pragmatism as a framework to explore complex phenomena. IMPLICATIONS FOR PRACTICE: This paper illustrates how methodology, which is influenced by various philosophical perspectives, can be woven throughout the design of a research project.

"I was just a shell": Mental health concerns for women in perimenopause and menopause.

Early detection of deteriorating mental health for women who are experiencing symptoms associated with perimenopause and menopause is critical to ensure the well-being of women. Unfortunately, many women during this phase of their lives find it difficult to access relevant and timely treatment. This concurrent mixed methods study using an online survey and qualitative interviews explored Australian women's knowledge and experiences of perimenopause and menopause and specifically reports on findings associated with women's mental health. Four hundred and eleven women completed the online survey in its entirety and 25 women participated in semi-structured interviews between April and July 2022. Survey data were analysed using SPSS and, in this article, data are presented as descriptive statistics. Qualitative interviews were analysed using thematic analysis guided by Braun and Clarke (2013; 2019). Quantitative and qualitative data specific to women's mental health were integrated into three themes: (1) increased anxiety and depression, (2) a negative impact on emotions and (3) a negative impact on self-worth. Findings from this study will help to inform clinical services for women as it highlights the need to improve education about perimenopause and menopause for healthcare providers and women.

Non-severe COVID-19 is associated with endothelial damage and hypercoagulability despite pharmacological thromboprophylaxis.

BACKGROUND: Hypercoagulability and endothelial dysfunction are hallmarks of coronavirus disease 2019 (COVID-19) and appear to predict disease severity. A high incidence of thrombosis despite thromboprophylaxis is reported in patients with moderate to severe COVID-19. Recent randomized clinical trials suggest that therapeutic-intensity heparin confers a survival benefit in moderate-severity COVID-19 compared to standard-intensity heparin, potentially by harnessing heparin-mediated endothelial-stabilizing and anti-inflammatory effects. OBJECTIVE: We hypothesized that patients with moderate-severity COVID-19 exhibit enhanced hypercoagulability despite standard-intensity thromboprophylaxis with low molecular weight heparin (LMWH) compared to non-COVID-19 hospitalized patients. METHODS: Patients with moderate COVID-19 and a control group (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]-negative hospitalized patients) receiving LMWH thromboprophylaxis were recruited. Markers of endothelial damage and plasma thrombin generation parameters were assessed. RESULTS: Tissue plasminogen activator levels were significantly increased in the COVID-19 group (8.3 ± 4.4 vs. 4.9 ± 2.4 ng/ml; P = .02) compared to non-COVID-19-hospitalized patients. Despite thromboprophylaxis, mean endogenous thrombin potential was significantly increased among COVID-19 patients (1929 ± 448 vs. 1528 ± 460.8 nM*min; P = .04) but lag time to thrombin generation was significantly prolonged (8.1 ± 1.8 vs. 6.2 ± 1.8 mins; P = .02). While tissue factor pathway inhibitor (TFPI) levels were similar in both groups, in the presence of an inhibitory anti-TFPI antibody, the difference in lag time between the groups was abrogated. CONCLUSIONS: Collectively, these data demonstrate that COVID-19 of moderate severity is associated with increased plasma thrombin generation and endothelial damage, and that hypercoagulability persists despite standard LMWH thromboprophylaxis. These findings may be of clinical interest given recent clinical trial data which suggest escalated heparin dosing in non-severe COVID-19 may be associated with improved clinical outcomes.

Kynurenic Acid Protects Against Reactive Glial-associated Reductions in the Complexity of Primary Cortical Neurons.

Brain glia produce neuroactive metabolites via tryptophan-kynurenine catabolism. A role for kynurenine pathway (KP) metabolites is proposed in reactive glial associated neurodegeneration. The aim of this investigation was to assess the role of KP induction and KP metabolites in driving reactive glial associated neuronal atrophy. Rat primary mixed glia, and enriched microglial and astroglial cultures were stimulated with IFNγ (10 ng/ml) for 24 hours. KP induction in mixed glial cells was confirmed by raised expression of the rate limiting KP enzyme indoleamine 2,3 dioxygenase (IDO) and raised concentrations of KP metabolites kynurenic acid (KYNA) and quinolinic acid (QUIN) in the conditioned media. Conditioned media was transferred onto immature (3 days) and mature (21 days) primary cortical neurons in vitro for 24 hours. IFNγ-stimulated mixed glial conditioned media reduced neurite outgrowth and complexity of both immature and mature neurons and co-localised expression of synaptic markers determined by immunocytochemistry. Pre-treatment of mixed glial cells with the IDO inhibitor, 1-methyltryptophan (1-MT) (L) prevented these effects of IFNγ-stimulated mixed glial conditioned media. KYNA increased complexity and synapse formation in mature cortical neurons and protected against reduced neuronal complexity and co-localised expression of synaptic markers induced by conditioned media from IFNγ-stimulated mixed glia and by treatment of neuronal cells with QUIN (1 µM). Overall, this study supports a role for the KP in driving neuronal atrophy associated with reactive glia and indicates that inhibition of the KP in glia, or raising the concentration of the astrocytic metabolite KYNA, protects against reactive microglial and QUIN-associated neuronal atrophy.

A qualitative study of nurses' perspectives of caring for children with intellectual disability and their families in a paediatric acute care setting.

Children with intellectual disability (ID) experience chronic and pervasive limitations across intellectual and adaptive functioning. They are also at risk of developing co-morbidities. They are likely to be hospitalised more frequently and for longer periods of time than other children. The purpose of this study was to understand the experiences of nurses when caring for children and teenagers with ID in an acute paediatric hospital setting. The aim of the research was to inform future directions for the delivery of equitable and effective care for this vulnerable population. This study used a qualitative thematic analysis of individual interviews conducted with eight registered and enrolled nurses who provided care to children and adolescents with ID in an Australian paediatric acute hospital setting. Themes which emerged from this analysis were (1) Recognising similarities and managing differences; (2) Nurse-parent relationships; and (3) Caring for children with ID requires additional time. This study highlights that navigating care delivery and relationships when working with young people with ID and their caregivers in an acute care setting is complex. Nursing children with ID in hospital requires sophisticated skills. To ensure quality healthcare for patients with ID, a range of strategies are proposed.

Narrative literature review: Health, activity and participation issues for women following traumatic brain injury.

OBJECTIVE: This narrative review will draw attention to the current limitations within the literature related to women following traumatic brain injury in order to stimulate discussion and inform future directions for research. BACKGROUND: There is a wide-ranging body of research about traumatic brain injury with the higher incidence of brain injury among males reflected in this body of work. As a result, the specific gendered issues facing women with traumatic brain injury are not as well understood. METHOD: A search of electronic databases was conducted using the terms "traumatic brain injury", "brain injury", "women", "participation", "concussion" and "outcomes". RESULTS: The 36 papers revealed the following five themes (1) Relationships and life satisfaction; (2) Perception of self and body image; (3) Meaningful occupation; (4) Sexuality and sexual health; and (5) Physical function. CONCLUSIONS: Without research, which focuses specifically on the experience of women and girls with traumatic brain injury there is a risk that clinical care, policy development and advocacy services will not effectively accommodate them. Implications for rehabilitation Exploring the gendered issues women may experience following traumatic brain injury will enhance clinicians understanding of the unique challenges they face. Such information has the potential to guide future directions for research, policy, and practice. Screening women for hormonal imbalances such as hypopituitarism following traumatic brain injury is recommended as this may assist clinicians in addressing the far reaching implications in regard to disability, quality of life and mood. The growing literature regarding the cumulative effect of repeat concussions following domestic violence and women's increased risk of sport-related concussion may assist clinicians in advocating for appropriate rehabilitation and community support services.

Humor-A Rehabilitative Tool in the Post-Intensive Care of Young Adults With Acquired Brain Injury.

PURPOSE: The aim of the study was to describe how paid carers use humor in providing compassionate post-intensive rehabilitation care to young adults with acquired brain injury (ABI) who are unable to perform or direct their own care. DESIGN: This is a qualitative study underpinned by symbolic interactionism. METHODS: Paid carers in a residential aged care facility were interviewed. Interview data were analyzed using grounded theory methods of coding, comparative analysis, memoing, and theoretical sampling. FINDINGS: With young adult's assent, paid carers appropriately used humor, at times even crude humor, as a rehabilitative tool to activate and elicit responses from young people with ABI who could not perform or direct their own care. The use of humor while caring for this population demonstrated that compassion still exists within nursing; however, it may not always be reverent. CONCLUSIONS/CLINICAL RELEVANCE: Humor may be an effective way to provide compassionate care and can be used as a rehabilitative tool to elicit responses from young people with ABI who have no means of verbal communication.

Young people with brain injury in nursing homes: not the best option!

We discuss the growing needs for appropriate accommodation for young people with acquired brain injury by exploring the accommodation of young people with brain injury in nursing homes. While the actual number is not clear, it is certainly expected to grow. Reviewing the literature and drawing on clinical experience exposes how nursing home becomes an option for these people. We argue that this should not be an option for this typically young male population, and give some suggestions for more appropriate accommodation.