Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross-sectional survey.

AIMS: The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences. DESIGN: Cross-sectional survey conducted January to April 2020. METHODS: All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored. RESULTS: Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health. CONCLUSIONS: Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work. IMPACT: This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution.

Functional insight into a neurodevelopmental disorder caused by missense variants in an RNA-binding protein, RBM10.

The RNA-binding motif protein 10, RBM10, is an RNA splicing regulator essential for development. Loss-of-function RBM10 variants are associated with TARP syndrome, a severe X-linked recessive condition in males. We report a 3-year-old male with a mild phenotype, consisting of cleft palate, hypotonia, developmental delay, and minor dysmorphisms, associated with a missense RBM10 variant, c.943T>C, p.Ser315Pro, affecting the RRM2 RNA-binding domain. His clinical features were similar to a previously reported case associated with a missense variant. The p.Ser315Pro mutant protein was expressed normally in the nucleus, but its expression level and protein stability were slightly reduced. Nuclear magnetic resonance spectroscopy showed that the structure and the RNA-binding ability of the RRM2 domain with the p.Ser315Pro were unaffected. However, it affects the alternative splicing regulations of downstream genes, NUMB and TNRC6A, and its splicing alteration patterns were variable depending on target transcripts. In summary, a novel germline missense RBM10 p.Ser315Pro variant that causes functional changes in the expression of its downstream genes results in a non-lethal phenotype associated with developmental delays. The functional alteration effects depend on the residues affected by missense variants. Our findings are expected to bring broader insights into the RBM10-associated genotype-phenotype relationships by delineating the molecular mechanism of RBM10 functions.

CRISPR-induced null alleles show that Frost protects Drosophila melanogaster reproduction after cold exposure.

The ability to survive and reproduce after cold exposure is important in all kingdoms of life. However, even in a sophisticated genetic model system like Drosophila melanogaster, few genes have been identified as functioning in cold tolerance. The accumulation of the Frost (Fst) gene transcript increases after cold exposure, making it a good candidate for a gene that has a role in cold tolerance. Despite extensive RNAi knockdown analysis, no role in cold tolerance has been assigned to Fst CRISPR is an effective technique for completely knocking down genes, and is less likely to produce off-target effects than GAL4-UAS RNAi systems. We have used CRISPR-mediated homologous recombination to generate Fst-null alleles, and these Fst alleles uncovered a requirement for FST protein in maintaining female fecundity following cold exposure. However, FST does not have a direct role in survival following cold exposure. FST mRNA accumulates in the Malpighian tubules, and the FST protein is a highly disordered protein with a putative signal peptide for export from the cell. Future work is needed to determine whether FST is exported from the Malpighian tubules and directly interacts with female reproductive tissues post-cold exposure, or whether it is required for other repair/recovery functions that indirectly alter energy allocation to reproduction.

Defining the role of a forensic hospital registered nurse using the Delphi method.

AIM: A Delphi survey was undertaken to refine the position description of a registered nurse working in a forensic hospital, in New South Wales, Australia. BACKGROUND: Prior to commencing operation in 2008, position descriptions were developed from a review of legislation, as well as policies and procedures used by existing forensic mental health services in Australia. With an established workforce and an evolving model of care, a review of the initial registered nurse position description was required. METHOD: An online Delphi survey was undertaken. Eight executive (88.9%) and 12 (58.3%) senior nursing staff participated in the first survey round. A total of four survey rounds were completed. RESULTS: At the final round, there was consensus (70%) that the revised position description was either very or somewhat suitable. There were a total of nine statements, from 31 originally produced in round 1, that did not reach consensus. CONCLUSIONS: The Delphi survey enabled a process for refining the Forensic Hospital registered nurse position description. IMPLICATIONS FOR NURSING MANAGEMENT: Methods that facilitate executive and senior nursing staff consensus in the development and review of position descriptions should be considered in nursing management.

A Hermeneutic Phenomenological Examination of the Lived Experience of Incarceration for those with Autism.

This study aimed to examine the lived experience of incarceration for those with autism using a hermeneutic phenomenological approach. Eight adults who were incarcerated in New South Wales, Australia, were interviewed. The lived experience of incarceration for the participants was about being in an unpredictable environment characterised by ever-changing routines and complex social situations. Participants were deprived of their ability to create predictability in their environment, and experienced confusion and distress when forced to comply with actions that were in conflict with their logic. Mental health nursing case management is recommended to address the needs of incarcerated persons with autism.

Evaluation of a support and challenge framework for nursing managers in correctional and forensic health.

AIM: This study evaluated a framework for nursing managers which entailed supporting and challenging participants to critically analyse the effectiveness of their workplace behaviours in facilitated discussion groups using context-laden real-life scenarios. BACKGROUND: Leadership development in nursing managers has been shown to reduce burnout and promote workplace satisfaction. METHOD: Ninety per cent of nursing managers (n = 63) employed in the organisation participated in the study. Data relating to burnout, workplace satisfaction and leadership practices were collected prior to and after participation in the support and challenge framework. Qualitative feedback was sought through a survey administered at follow-up. RESULT: Nursing Unit Managers were significantly less satisfied in their intrinsic domain of workplace satisfaction at follow-up. Qualitative feedback indicated that participants experienced benefits related to networking, personal development and role development. CONCLUSION: The experience of critiquing and challenging leadership when shared with peers who practice in a similar context was qualitatively reported as beneficial and valuable, in spite of a decrease in workplace satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing manager's leadership development is a continuous process. Supporting and challenging nursing managers is likely to generate uncertainty related to self and role. The sharing and testing of this uncertainty with peers is welcomed and warrants further exploration.

Eliciting expert judgements to underpin our understanding of faecal indicator organism loss from septic tank systems.

Septic tank systems (STS) in rural catchments represent a potential source of microbial pollution to watercourses; however, data concerning the risk of faecal indicator organism (FIO) export from STS to surface waters are scarce. In the absence of empirical data, elicitation of expert judgements can provide an alternative approach to aid understanding of FIO pollution risk from STS. Our study employed a structured elicitation process using the Sheffield Elicitation Framework to obtain expert judgements on the proportion of FIOs likely to be delivered from STS to watercourses, based on 36 scenarios combining: (i) septic tank effluent movement risk, driven by soil hydro-morphological characteristics; (ii) distance of septic tank to watercourse; and (iii) degree of slope. Experts used the tertile method to elicit a range of values representing their beliefs of the proportion of FIOs likely to be delivered to a watercourse for each scenario. The experts judged that 93 % of FIOs would likely be delivered from an STS to a watercourse under the highest risk scenario that combined (i) very high STS effluent movement risk, (ii) STS distance to watercourse <10 m, and (iii) a location on a steep slope with gradient >25 %. Under the lowest risk scenario, the proportion of FIOs reaching a watercourse would likely reduce to 5 %. Expert confidence was high for scenarios that represented extremes of risk, while uncertainty increased for scenarios depicting intermediate risk conditions. The behavioural aggregation process employed to obtain a consensus among the experts proved to be useful for highlighting both areas of strong consensus and high uncertainty. The latter therefore represent priorities for future empirical research to further improve our understanding of potential pollution risk from septic tanks and in turn enable better assessments of potential threats to water quality in rural catchments throughout the world where decentralised wastewater systems are common.

Present-day thermal and water activity environment of the Mars Sample Return collection.

The Mars Sample Return mission intends to retrieve a sealed collection of rocks, regolith, and atmosphere sampled from Jezero Crater, Mars, by the NASA Perseverance rover mission. For all life-related research, it is necessary to evaluate water availability in the samples and on Mars. Within the first Martian year, Perseverance has acquired an estimated total mass of 355 g of rocks and regolith, and 38 µmoles of Martian atmospheric gas. Using in-situ observations acquired by the Perseverance rover, we show that the present-day environmental conditions at Jezero allow for the hydration of sulfates, chlorides, and perchlorates and the occasional formation of frost as well as a diurnal atmospheric-surface water exchange of 0.5-10 g water per m2 (assuming a well-mixed atmosphere). At night, when the temperature drops below 190 K, the surface water activity can exceed 0.5, the lowest limit for cell reproduction. During the day, when the temperature is above the cell replication limit of 245 K, water activity is less than 0.02. The environmental conditions at the surface of Jezero Crater, where these samples were acquired, are incompatible with the cell replication limits currently known on Earth.

Vicarious Trauma and Health Outcomes in Forensic Mental Health Nurses.

BACKGROUND: Nurses working in forensic mental health settings are at risk of vicarious trauma because of their exposure to traumatized patients and distressing material such as the aversive details of patient crimes. AIM: The aim of this study was to determine the incidence of vicarious trauma and explore its impact on health and absence from work. METHODS: A cross-sectional descriptive correlational study was undertaken. All 205 forensic mental health nurses working in a high-security inpatient facility were invited to participate. An online survey included the Vicarious Trauma Scale and the SF-36v2 to measure mental and physical health. Absence from work was also explored. RESULTS: Sixty-seven respondents completed the survey. Almost half of respondents had a moderate level of vicarious trauma, and only over one-quarter experienced high levels. Higher levels of vicarious trauma were associated with poorer mental health (r = -0.59, p < 0.000) and absence from work (r = 0.27, p < 0.010). CONCLUSIONS: Forensic mental health nurses are at a greater risk of vicarious trauma than nurses working in mainstream mental health services, given their exposure to aversive details of patients' violent crimes. Adverse mental health consequences of vicarious trauma, and other forms of workplace trauma experienced by forensic mental health nurses, are likely to include trauma-related symptoms, depression, and anxiety. Forensic mental health nurses experiencing vicarious trauma may use sick leave as time away from work to care for their own mental health or a coping mechanism for workplace-induced psychological distress.

Forensic Mental Health Nurses' Experiences of Clinical Supervision.

BACKGROUND: Clinical supervision may support forensic mental health nurses with personal and professional growth in a work environment characterized by therapeutic, ethical, and practical challenges. AIM: The aim of this study was to describe the experiences of forensic mental health nurses participating in a clinical supervision program. METHODS: Seven forensic mental health nurses and two allied health professionals, working in a high-security forensic mental health hospital, were interviewed regarding their experiences of participating in a clinical supervision program. FINDINGS: Participants expressed a need for clinical supervision and were motivated to participate in the program. Benefits of clinical supervision experienced by participants included improved communication with their colleagues, being supported in their career development, and developing habits and techniques to reflect on practice issues. Participants described being able to connect with their supervisor, enabled by both trust and confidence in the supervisor's expertise. CONCLUSION: Staff showed engagement in the clinical supervision process and expressed experiencing positive outcomes related to personal and professional growth and development. IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE: To support nurses with the forensic mental health context-specific challenges they face, organizations should enable and promote access to clinical supervision. Considerations for forensic mental health organizations to increase uptake and effectiveness of clinical supervision include use of externally based clinical supervisors with adequate skills and experience with providing clinical supervision to clinical staff who work in a secure environment.

Orbital and In-Situ Investigation of Periodic Bedrock Ridges in Glen Torridon, Gale Crater, Mars.

Gale crater, the field site for NASA's Mars Science Laboratory Curiosity rover, contains a diverse and extensive record of aeolian deposition and erosion. This study focuses on a series of regularly spaced, curvilinear, and sometimes branching bedrock ridges that occur within the Glen Torridon region on the lower northwest flank of Aeolis Mons, the central mound within Gale crater. During Curiosity's exploration of Glen Torridon between sols ∼2300-3080, the rover drove through this field of ridges, providing the opportunity for in situ observation of these features. This study uses orbiter and rover data to characterize ridge morphology, spatial distribution, compositional and material properties, and association with other aeolian features in the area. Based on these observations, we find that the Glen Torridon ridges are consistent with an origin as wind-eroded bedrock ridges, carved during the exhumation of Mount Sharp. Erosional features like the Glen Torridon ridges observed elsewhere on Mars, termed periodic bedrock ridges (PBRs), have been interpreted to form transverse to the dominant wind direction. The size and morphology of the Glen Torridon PBRs are consistent with transverse formative winds, but the orientation of nearby aeolian bedforms and bedrock erosional features raise the possibility of PBR formation by a net northeasterly wind regime. Although several formation models for the Glen Torridon PBRs are still under consideration, and questions persist about the nature of PBR-forming paleowinds, the presence of PBRs at this site provides important constraints on the depositional and erosional history of Gale crater.

The dynamic atmospheric and aeolian environment of Jezero crater, Mars.

Despite the importance of sand and dust to Mars geomorphology, weather, and exploration, the processes that move sand and that raise dust to maintain Mars' ubiquitous dust haze and to produce dust storms have not been well quantified in situ, with missions lacking either the necessary sensors or a sufficiently active aeolian environment. Perseverance rover's novel environmental sensors and Jezero crater's dusty environment remedy this. In Perseverance's first 216 sols, four convective vortices raised dust locally, while, on average, four passed the rover daily, over 25% of which were significantly dusty ("dust devils"). More rarely, dust lifting by nonvortex wind gusts was produced by daytime convection cells advected over the crater by strong regional daytime upslope winds, which also control aeolian surface features. One such event covered 10 times more area than the largest dust devil, suggesting that dust devils and wind gusts could raise equal amounts of dust under nonstorm conditions.

The development of a parenting program for incarcerated mothers in Australia: a review of prison-based parenting programs.

The increasing population of children with an incarcerated parent is a significant public health issue. A literature search highlighted that children of incarcerated parents experience psychological stressors that may potentially impact on health and behavioural outcomes. Parenting programs for prisoners may be of benefit as early parenting experiences during childhood have a significant impact on a child's future experiences as an adolescent and adult. A review of identified evaluation-based studies of parenting programs for prisoners (N = 11), although varied in program delivery approaches and evaluation methods, suggest that such programs have the potential to improve the parenting skills, knowledge and confidence of incarcerated parents. Finally, this paper provides an outline of the development of an Australian based parenting program for incarcerated mothers and their young children.

Exposure to workplace trauma for forensic mental health nurses: A scoping review.

BACKGROUND: Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role. OBJECTIVES: To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses. DESIGN: A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. METHODS: Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence. RESULTS: Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature. CONCLUSIONS: While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.

A modified hermeneutic phenomenological approach toward individuals who have autism.

Individuals with autism have a unique cognitive processing style characterized by impaired abstraction, impaired theory of mind, and visual as opposed to linguistic processing of information. A consequence of this unique cognitive processing style is that traditional ways of hermeneutical phenomenological examination may be inadequate to achieve the kind of understanding of experience toward which this method is directed. In order to stay true to Heidegger's hermeneutic phenomenology, we needed to develop modifications to this research methodology, which include the use of visual aids to promote participant engagement and access the eidetic memory of a participant with autism, so as to elicit concrete descriptors of an experience.

Can mental health nurses diagnose in Australia?

The naming of health related conditions has been the traditional province of the medical profession. Occasional concessions have been made in specific narrow domains, such as psychology or speech-related pathology, but diagnosis typically has been seen as medical practitioner business. "Ownership" of language is worthy of critical discussion. The answer to why the tradition has persisted, and nurses have invested lots of energy within the established rules of who can say what, may well be found through the lens of psycholinguistics. Nurses can name states of health and ill health using the currently accepted nomenclature. The authors argue that there is an unconditional "yes," to the question of can nurses diagnose, as long as they are not holding themselves out to be a medical practitioner by doing so. Additionally it is argued that advanced practice nurses must diagnose in order to fulfill their role as advanced practice clinicians.

The evaluation of a 12-month health service manager mentoring program in a corrections environment.

Mentoring programs are believed to positively influence the professional development of nurses where a system is provided to promote skill and knowledge base enhancement within a supportive relationship between mentor and mentee. This study aimed to evaluate a 12-month health manager mentoring program within a correctional facility in New South Wales, Australia. Over the period of the mentoring program, there was an improvement in professional behavior and a decline in the rating of supervisees. Work stress increased and job satisfaction decreased over the 12-month period, although not to a statistically significant level. Qualitative feedback suggested that participants found the program to be useful.

A Survey of Stress and Burnout in Forensic Mental Health Nursing.

BACKGROUND: Although it is known that forensic mental health nurses (FMHNs) work in a stressful environment, their experience of stress and burnout remains largely unexplored. AIM: The study aimed to measure levels of burnout and workplace stressors experienced by FMHNs. METHODS: A survey of 205 FMHNs was undertaken. Respondents completed the Maslach Burnout Inventory and the Nursing Stress Scale. FINDINGS: Fifty-seven FMHNs completed the survey, representing a response rate of 27.8%. Only five respondents (8.8%) experienced high levels of burnout across all three Maslach Burnout Inventory subscales. The most reported workplace stressors were related to "workload," "conflict with other nurses," and "conflict with physicians." A correlation between total Nursing Stress Scale score and both "emotional exhaustion" and "cynicism" were found (r = 0.45, p < 0.001, and r = 0.34, p < 0.011, respectively), indicating that FMHNs who reported higher workplace stress are at an increased risk of burnout. CONCLUSION: Most FMHNs in the current study experienced moderate levels of burnout, although they continued to feel self-assured in their practice and found their work rewarding. Consistent with other nursing populations, the FMHNs in this study reported feeling stressed by their workload and as the result of conflict with other nurses and physicians. IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE: Reduced well-being, associated with stress and burnout, may lead to increased absences from work and the delivery of poor-quality forensic mental health consumer care. The implementation of staff well-being strategies is recommended to address stress and burnout in FMHNs.

Forensic mental health nursing and evidence-based practice: a quantitative study.

Background: Little is known about the personal, professional and workplace factors that influence evidence-based practice for forensic mental health nurses. Aim: This study describes the sources of practice knowledge for forensic mental health nurses, and the factors that influence the implementation of evidence-based practice. Design: This research study utilised a cross sectional survey design. Methods: All nurses (n = 244) working in one forensic mental health in-patient facility were sent an electronic invitation to complete the Developing Evidence Based Practice Questionnaire. Data was analysed to calculate descriptive statistics. Findings: Fifty-three respondents completed the survey. Respondents reported using experiential knowledge and locally derived sources of information more frequently than research-based evidence to inform their practice. Respondents reported being least skilled at finding, reviewing and using research evidence to change practice. The most frequently rated barriers to evidence-based practice were having insufficient time and resources to both finding and reviewing information and to implement changes in practice. Conclusions: Forensic mental health nurses tend to express a bias towards valuing social or qualitative sources of information to inform practice. Exploring the relationships between individual and organisational factors in the context of forensic mental health is recommended in order to gain further insights into the translation of evidence into practice for forensic mental health nurses. Impact statement: Unique contextual aspects of the forensic mental health environment may influence the implementation of evidence-based practice. Our study highlights that further support, resources and training is required to promote the use of research-based evidence in forensic mental health nursing.

Application of a model for the development of a mental health service delivery collaboration between police and the health service.

Changing societal trends have revealed an increased prevalence of mental illness and diminished health resources from which to offer services. This has lead to a need to develop new and more efficient police and health service models of practice. Services offered by the police department in the management of mental health crisis in the community are essential in minimising the risk of individuals with mental health problems causing harm to themselves or a member of the public. In addressing the difficulties associated with police playing an important role in the management of mental health crisis in the community, but having little training in mental health issues, this paper discusses a proposed innovation for New South Wales police in Australia through the development of a Crisis Intervention Team model.