COVID Crisis, Culture Wars and Australian Higher Education.

The COVID pandemic has had dramatic effects on higher education worldwide, but the impact has been very uneven. The gap between rich and poor has widened further, aid to education has been cut, and abrupt changes introduced to pedagogy, international student and staff mobility, research laboratories, and institutional bottom lines. Anglophone systems with a high dependence on international students (Australia, Canada, UK, New Zealand) have been particularly affected. In Australia, the fact that the COVID crisis occurred in the context of rivalrous US-China relations influenced how the pandemic was understood and its effects, including in higher education. But the specific context was also influential, including lingering tensions between Australia's geography and history. A further complication was that higher education had become overly dependent on international student fee income, with higher education becoming Australia's largest service-sector export. It is argued that the longstanding underfunding of the higher education system, the abrupt closing of international borders, and the impact to the rising US-China Culture War have combined to produce major effects on the higher education system, the results of which will continue for some time.

The quandary of registered nurses untrained in adult intellectual disability nursing when caring for this diverse patient group in acute care settings: An integrated literature review.

AIMS AND OBJECTIVES: To critically appraise relevant literature on the lived experiences of registered nurses caring for adults with intellectual disability in the acute care setting in Australia to determine current knowledge and gaps in the literature. BACKGROUND: People with intellectual disability have the right to the highest attainable health care the same as everyone else. However, inequities still exist in the delivery of health care across the globe, including Australia that result in poorer health outcomes for this population group. Part of the problem is a lack of understanding of the complexities of ID care due to an absence of ID specific content in undergraduate curricula. DESIGN: Integrative literature review. METHODS: Electronic databases were searched for relevant empirical and theoretical literature. Additional articles were found by reviewing reference lists of selected articles resulting in ten articles for review. Selected articles were critically appraised using JBI critical appraisal tools. Data were analysed using comparative thematic analysis. PRISMA checklist completed the review. RESULTS: Two main themes emerged from the data that informed the gap in knowledge: (a) Defining nursing practice; and (b) Confidence to practice. CONCLUSIONS: There was limited qualitative research published on the topic. International studies revealed that a lack of understanding of the ID condition due to inadequate education left registered nurses feeling underprepared, unsupported and struggling to provide optimal care. No studies were located on the phenomenon within the Australian context. A study exploring the lived experiences of RNs in Australia is needed to offer a deeper understanding of the phenomenon that will help inform practice. RELEVANCE TO PRACTICE: Including ID care in national undergraduate and postgraduate nursing curricula must become a nursing educational and professional priority to support nurses more fully in their practice to ensure patients with ID receive the highest attainable standard of nursing care.

Back from the Brink: The Experience of Hospital after a Suicide Attempt, and What Happens When You Go Home.

Key proponents of suicide prevention around the world have been calling for research to focus on people who have survived a suicide attempt in the belief that people with this experience are an important but neglected source of information, with a great deal to contribute to the field of suicidology. This paper concerns the period in the immediate aftermath of a suicide attempt: the experiences of being hospitalised; discharged; returning home to the same struggle with suicidality and mental illness; difficulties with other people; and the side effects of medication. The methodology underpinning the study was descriptive phenomenology in the tradition of Edmund Husserl. The researcher conducted taped, face-to-face interviews of 1-2 hours with eight, adult volunteers and asked them to share their experience of re-engaging with life after a suicide attempt. What is of particular interest in this research are new findings on the way patients can help each other find a pathway to self-acceptance and the beginning of hope; and on the experience of returning home following a suicide attempt. These findings have the potential to inform mental health professionals, and improve existing mental health and suicide prevention practice by providing insight into the personal experiences of service users at this critical time in their life.

Current practice for genetic counselling by nurses: An integrative review.

AIM: To examine current practice of genetic counselling by nurses. BACKGROUND: Recent debate argues that genetic counselling is a specialist advanced practice role, whilst others argue it is the role of all nurses. Current evidence is required to determine if genetic counselling could be included in all nurses' scope of practice. DESIGN: Integrative literature review. DATA SOURCES: A search of electronic databases (CINHAL, Medline, PubMed, Scopus), and reference lists published between January 2012 and March 2017, was undertaken. REVIEW METHODS: Studies were critically appraised for methodological quality using the Critical Appraisal Skills Programme. Data from each study were extracted and categorized according to their primary findings. RESULTS: The inclusion criteria were met in 10 studies. Main findings were identified: role of genetic counselling, current knowledge, need for further education, and client satisfaction with nurse genetic counsellors. CONCLUSION: This paper concludes that some nurses do engage in genetic counselling, but how they engage is not consistent, nor is there consensus about what should be the scope of practice. Further investigation into credentialing, role recognition support and education for nurse genetic counselling are strongly recommended. As nurses are widely available, nurses can make a significant contribution to supporting those affected by genetic problems.

Using Colaizzi's method of data analysis to explore the experiences of nurse academics teaching on satellite campuses.

BACKGROUND: Phenomenology is a useful methodological approach in qualitative nursing research. It enables researchers to put aside their perceptions of a phenomenon and give meaning to a participant's experiences. Exploring the experiences of others enables previously unavailable insights to be discovered. AIM: To delineate the implementation of Colaizzi's ( 1978 ) method of data analysis in descriptive phenomenological nursing research. DISCUSSION: The use of Colaizzi's method of data analysis enabled new knowledge to be revealed and provided insights into the experiences of nurse academics teaching on satellite campuses. Local adaptation of the nursing curriculum and additional unnoticed responsibilities had not been identified previously and warrant further research. CONCLUSION: Colaizzi's ( 1978 ) method of data analysis is rigorous and robust, and therefore a qualitative method that ensures the credibility and reliability of its results. It allows researchers to reveal emergent themes and their interwoven relationships. Researchers using a descriptive phenomenological approach should consider using this method as a clear and logical process through which the fundamental structure of an experience can be explored. IMPLICATIONS FOR RESEARCH: Colaizzi's phenomenological methodology can be used reliably to understand people's experiences. This may prove beneficial in the development of therapeutic policy and the provision of patient-centred care.

Single mothering as experienced by Burundian refugees in Australia: a qualitative inquiry.

BACKGROUND: Refugee mothers have fled from their homeland to escape persecutions with their children only to find other threats to their well-being in the new country. Building on previous research, it is known that being a new immigrant is challenging and requires adaptation. The adaptation process, known as acculturation, may not be successful leading to psychological distress. It is also known that a generation gap can occur when children acculturate faster than their parents. What was lacking was understanding about the experiences of single refugee mothers. METHODS: Interpretative phenomenological study was undertaken to explore the lived experiences of eight Burundian refugee single mothers in Australia. Data were collected by in-depth interviews. Each interviews were transcribed and analyzed using thematic analysis. RESULTS: Findings revealed three themes. First theme 'Traditional mothering practices of Burundian culture' illustrated mothering strategies as practiced prior to their arrival in Australia including mothering with sufficient social support, strong position of parents, and regular use of physical disciplining. Second theme 'Challenges identified after arrival to new country' revealed that mothers felt their children acculturated faster than themselves which led to intergenerational gap. This has also led participants to live in a continuous dilemma, experiencing inner conflicts and struggles associated with their mothering practices, especially when mothers had arrived with a lack of knowledge relating to acceptable mothering practices in a new culture. Final theme, 'Reforming family life in Australia' highlighted the decisions made by single refugee mothers which is to embrace both new and original cultures, leading to successful acculturation. However, lack of appropriate knowledge of acceptable mothering practices led to involvement of legal authorities who threatening to remove children from the mother's care. This has led mothers feeling change of power from 'mother to child, 'to child to mother', raises concerns for family wellbeing. CONCLUSIONS: A need for parenting information when entering a new country including education about any legal obligations for parents such as a Child Protection Act will assist successful acculturation. As nurses are likely to encounter refugee single mothers, they are well placed to provide support and education to new refugee single mothers.

Motivations of nursing students regarding their educational preparation for mental health nursing in Australia and the United Kingdom: a survey evaluation.

BACKGROUND: There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. METHODS: This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received. RESULTS: The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care. CONCLUSIONS: A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing.

Clinical placements in mental health: a literature review.

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

Women's experiences of learning to breastfeed.

AIM: This research explores women's experiences of learning to breastfeed. DESIGN: A purposive cohort of healthy mothers participated in individual audio recorded interviews late pregnancy and then 2 and 8 weeks after birth. All interviews were transcribed verbatim and analysed using van Manen's approach. SETTING AND PARTICIPANTS: Participants were 13 first time mothers based in a rural municipality in Victoria, Australia. KEY FINDINGS: Women's voices gave rich descriptions of their experience of learning to breastfeed. Women shared the physicality of having 'great big engorged breasts' or 'sore nipples', and 'learning to latch' while 'having so very many things happening'. CONCLUSION: Many participants felt overwhelmed with learning to breastfeed at the same time as coping with caesarean wounds, perineal trauma, uterine bleeding and extreme fatigue. FUTURE IMPLICATIONS: Parenting education needs to be offered early in pregnancy so couples can explore birthing and its potential outcomes and to introduce infant cues and behaviours as a base for understanding how these impact on breastfeeding and problem solving.

Ethical challenges for nurses delivering coercive interventions in community mental health settings: A scoping review.

The number of Australians subject to coercive interventions in community mental health services continues to increase. This is in the context of a growing awareness of the harms from coercion, increasing concerns about potential breaches of human rights and an ongoing uncertainty regarding the clinical benefits of community treatment orders, the primary instrument of legislated coercion in community mental health services. Nurses in community mental health services are on the frontline with regard to coercion. They police the requirements of the community treatment order, administer medication to people in community settings without their consent and facilitate re-hospitalisation if indicated. Coercive practice contradicts the person-centred, recovery-oriented and trauma-informed care principles that inform contemporary mental health nursing. This contradiction may generate ethical challenges for nurses and result in ethical distress. The aim of this scoping review was to map the research literature on how nurses in community mental health settings recognise and manage the harm associated with the administration of coercive interventions and consider the ethical challenges that may arise within this practice. The search strategy yielded 562 studies with author consensus determining a total of three articles as meeting the inclusion criteria. The resulting literature identified three themes: (1) maintaining the therapeutic relationship, (2) promoting autonomy and (3) using subtle forms of control. This review demonstrated that there is minimal research that has considered the ethical challenges related to the use of coercion by nurses in community mental health settings.

The phenomena of auditory hallucination as described by Indonesian people living with schizophrenia.

This study was a phenomenological inquiry of the experience of auditory hallucinations as described by 13 Indonesian people diagnosed with schizophrenia. The interviewees included 6 men and 7 women and they were aged between 19 and 56 years. Four themes emerged from this study: feeling more like a robot than a human being; voices of contradiction--a point of confusion; tattered relationships and family disarray; and normalizing the presence of voices as part of everyday life. The findings of this study have the potential to contribute to new understandings of how people live with and manage auditory hallucinations and so enhance client-centered nursing care.

The 5-As framework for including sexual concerns in mental health nursing practice.

Available evidence informs us that sexual health concerns of consumers are commonly avoided within mental health services. This paper describes the findings of a qualitative exploratory research project. This research was conducted in three stages, all involving in-depth interviews with 14 nurses working in a mental health setting. Stage 1 involved an exploration of participants' views about including sexual concerns in their practice and included an educational intervention designed to encourage sexual inclusivity in practice. Stage 2 involved follow up interviews 4-6 weeks later to discuss the effectiveness of the intervention and whether practice change had resulted. Stage 3 was conducted two years later with the aim of determining the extent to which practice changes had been sustained. The themes emerging throughout the research emphasised five main stages in the nurses' experience: avoidance; awareness; applying; approval; and acknowledgement. Avoidance of the topic was commonly noted in the early stages of the research. The education program led to awareness raising of sexual concerns and approval towards the importance of this area to which lead to applying it to practice. This ultimately resulted in acknowledgement of the need for sexual concerns to become part of mental health nursing practice. These five stages are represented in the Five A's for including sexual concerns in mental health nursing practice, the framework developed by the first author.

Reflecting on holistic nursing: the contribution of an academic with lived experience of mental health service use.

The educational preparation of registered nurses is presumed to reflect a holistic approach with emphasis on the bio-psycho-social model of care. The broader literature suggests this goal is not always realised. The aim of this study is to present the views, experiences, and perceptions of undergraduate nursing students who were taught by an academic with a lived experience of mental health service use. In particular, we wanted to look at the expected impact of this approach to learning on their nursing practice. A qualitative, exploratory approach was used, involving in-depth individual interviews with 12 undergraduate nursing students completing the course, "recovery for mental health nursing practice," as part of a major in mental health nursing in a university in Queensland, Australia. Students were asked to reflect upon and discuss their experiences of being taught by a person with lived experience of mental health service use. Data were analysed following Colaizzi's steps to identify the main themes. The three main themes were (1) recovery--bringing holistic nursing to life; (2) influencing practice; and (3) gaining self-awareness through course assessment: challenge and opportunity. These themes suggest an appreciation for holistic nursing and an increased capacity for reflective understanding. The responses from participants suggest the Recovery course had a significant impact on their attitudes to nursing and that their nursing practice would be positively enhanced as a consequence.

Keeping nurse researchers safe: workplace health and safety issues.

AIM: This article is a report of a qualitative study of workplace health and safety issues in nursing research. BACKGROUND: Researcher health and safety have become increasing concerns as there is an increased amount of research undertaken in the community and yet there is a lack of appropriate guidelines on how to keep researchers safe when undertaking fieldwork. DESIGN: This study employed a descriptive qualitative approach, using different sources of data to find any references to researcher health and safety issues. METHODS: A simple descriptive approach to inquiry was used for this study. Three approaches to data collection were used: interviews with 15 researchers, audits of 18 ethics applications, and exploration of the literature between 1992 and 2010 for examples of researcher safety issues. Data analysis from the three approaches identified participant comments, narrative descriptions or statements focused on researcher health and safety. RESULTS: Nurse researchers' health and safety may be at risk when conducting research in the community. Particular concern involves conducting sensitive research where researchers are physically at risk of being harmed, or being exposed to the development of somatic symptoms. Nurse researchers may perceive the level of risk of harm as lower than the actual or potential harm present in research. Nurse researchers do not consistently implement risk assessment before and during research. CONCLUSIONS: Researcher health and safety should be carefully considered at all stages of the research process. Research focusing on sensitive data and vulnerable populations need to consider risk minimization through strategies such as appropriate researcher preparation, safety during data collection, and debriefing if required.

Reported Levels of Exhaustion by the Graduate Nurse Midwife and Their Perceived Potential for Unsafe Practice: A Phenomenological Study of Australian Double Degree Nurse Midwives.

BACKGROUND: The experiences of graduate nurses and midwives transitioning into the clinical environment as beginning practitioners has been reported as a time period of great challenge. For the graduate double degree nurse midwife, often transitioning into two disciplines of practice concurrently, their experiences have the potential to be heightened. The aim of this research was to explore the transition to practice experiences of double degree graduate nurse midwives practicing in either or both nursing and midwifery in the Australian health care system. METHODS: This research used a Husserlian descriptive phenomenological approach to understand the experiences of 23 double degree graduate nurse midwives working in 20 different health care facilities across Australia. RESULTS: The findings showed that most participants experienced exhaustion from an emotional, physical, and mental perspective during their first year of practice. These experiences were linked with cognitive saturation, professional loneliness, sleep deprivation, and an inability to achieve a work-life balance. The data also highlighted the graduate nurse midwife's concerns for safe practice when feeling mentally, physically, and emotionally depleted. CONCLUSION/APPLICATION TO PRACTICE: Safe practice is paramount for both patient and health care worker. The levels of exhaustion described by the participants in this study influenced their perceived ability to practice safely. As a result, it should be recognized that the graduate nurse midwife's health and well-being is central to their perceptions of safe practice and is fundamental to a positive transition to practice experience.

Systematic preclinical evaluation of CD33-directed chimeric antigen receptor T cell immunotherapy for acute myeloid leukemia defines optimized construct design.

BACKGROUND: Successful development of chimeric antigen receptor (CAR) T cell immunotherapy for children and adults with relapsed/refractory acute myeloid leukemia (AML) is highly desired given their poor clinical prognosis and frequent inability to achieve cure with conventional chemotherapy. Initial experiences with CD19 CAR T cell immunotherapy for patients with B-cell malignancies highlighted the critical impact of intracellular costimulatory domain selection (CD28 vs 4-1BB (CD137)) on CAR T cell expansion and in vivo persistence that may impact clinical outcomes. However, the impact of costimulatory domains on the efficacy of myeloid antigen-directed CAR T cell immunotherapy remains unknown. METHODS: In this preclinical study, we developed six CAR constructs targeting CD33, a highly expressed and validated AML target, comprised of one of three single-chain variable fragments with CD3ζ and either CD28 or 4-1BB costimulatory domains. We systematically compared the preclinical in vitro and in vivo efficacy of T cells lentivirally transduced with CD33 CAR constructs (CD33CARTs) against human AML. RESULTS: We observed potent in vitro cytokine production and cytotoxicity of CD33CARTs incubated with human CD33+ AML cell lines, as well as robust in vivo antileukemia activity in cell line and childhood AML patient-derived xenograft (PDX) models. Gemtuzumab-based CD33CARTs were unexpectedly toxic in vivo in animal models despite observed in vitro anti-leukemia activity. CD28-based CD33CARTs consistently induced more robust inhibition of leukemia proliferation in AML cell line and PDX models than did 4-1BB-based CD33CARTs. A 'best-in-class' lintuzumab-CD28/CD3ζ CAR construct was thus selected for clinical translation. CONCLUSIONS: CD33 is a critical antigen for potential immunotherapeutic targeting in patients with AML. Based on this rigorous preclinical evaluation, our validated clinical grade lintuzumab-CD28/CD3ζ CD33CART immunotherapy is now under evaluation in a first-in-child/first-in-human phase 1 clinical trial for children and adolescents/young adults with relapsed/refractory AML. TRIAL REGISTRATION NUMBER: clinicaltrials.gov; NCT03971799.

Safety and Stability of Antibody-Dye Conjugate in Optical Molecular Imaging.

PURPOSE: The development of molecularly targeted tracers is likely to improve the accuracy of diagnostic, screening, and therapeutic tools. Despite the many therapeutic antibodies that are FDA-approved with known toxicity, only a limited number of antibody-dye conjugates have been introduced to the clinic. Thorough evaluation of the safety, stability, and pharmacokinetics of antibody conjugates in the clinical setting compared with their parental components could accelerate the clinical approval of antibodies as agents for molecular imaging. Here we investigate the safety and stability of a near-infrared fluorescent dye (IRDye800CW) conjugated panitumumab, an approved therapeutic antibody, and report on the product stability, pharmacokinetics, adverse events, and QTc interval changes in patients. PROCEDURES: Panitumumab-IRDye800CW was made under good manufacturing practice (GMP) conditions in a single batch on March 26, 2014, and then evaluated over 4.5 years at 0, 3, and 6 months, and then at 6-month intervals thereafter. We conducted early phase trials in head and neck, lung, pancreas, and brain cancers with panitumumab-IRDye800CW. Eighty-one patients scheduled to undergo standard-of-care surgery were infused with doses between 0.06 to 2.83 mg/kg of antibody. Patient ECGs, blood samples, and adverse events were collected over 30-day post-infusion for analysis. RESULTS: Eighty-one patients underwent infusion of the study drug at a range of doses. Six patients (7.4 %) experienced an adverse event that was considered potentially related to the drug. The most common event was a prolonged QTc interval which occurred in three patients (3.7 %). Panitumumab-IRDye800CW had two OOS results at 42 and 54 months while meeting all other stability testing criteria. CONCLUSIONS: Panitumumab-IRDye800CW was safe and stable to administer over a 54-month window with a low rate of adverse events (7.4 %) which is consistent with the rate associated with panitumumab alone. This data supports re-purposing therapeutic antibodies as diagnostic imaging agents with limited preclinical toxicology studies.

Perceptions of the psychological well-being and care of older home care clients: clients and their carers.

AIM: To explore and compare older home care clients' (65+) and their professionals' perceptions of the clients' psychological well-being and care and to identify possible differences in these perceptions. BACKGROUND: Psychological well-being is considered an important dimension of quality of life. With advancing age, older people require home care support to be able to remain in their own home. The main goal of care is to maximise their independence and quality of life. DESIGN: Descriptive, survey design with questionnaire. METHODS: A postal questionnaire was distributed to 200 older home care clients and 570 social and health care professionals in 2007. The total response rate was 63%. The questionnaire consisted of questions about clients' psychological well-being and the provision of care by home care professionals. The differences in responses between clients and professionals were analysed using cross-tabulations, the Pearson Chi-Square Test and Fisher's Exact Tests. RESULTS: The professional group believed that their clients did not have plans for the future. They believed that their clients felt themselves depressed and suffering from loneliness significantly more often than the client group did. The client group were also significantly more critical of the care (motivating independent actions, physical, psychological and social care) they got from the professional group than how the professionals evaluated the care they gave. CONCLUSIONS: To be able to support older clients to continue living at home, professionals need to provide a service that meets client's own perceptions and complex social and health care needs as well as personal sense of well-being. RELEVANCE TO CLINICAL PRACTICE: The findings offer useful insights for the professional in planning and delivering appropriate home care services. A better understanding of differences between clients' and professionals' perceptions could lead to a better individualised care outcome.

A naturalistic inquiry of registered nurses' perspectives and expectations of psychodynamic therapeutic care in acute psychiatric inpatient facilities.

Within contemporary inpatient mental health nursing practice, the psychodynamic model of care considered previously to be central to the nurse-patient relationship now seems a radical concept. It appears to exist only within primary care facilities and public health care practice settings. This naturalistic inquiry aimed to explicate mental health nurses' perspectives and expectations of providing psychodynamic therapeutic care in acute inpatient psychiatric facilities. Ten registered nurses working in acute inpatient mental health facilities were interviewed. Five themes emerged: a career for life, relating in a psychodynamic manner, swimming against the current, adopting a position of difference, and hopeful expectancy.

The phenomenon of resilience as described by adults who have experienced mental illness.

AIM: This paper is a report of a study to explore the phenomenon of resilience in the lives of adult patients of mental health services who have experienced mental illness. BACKGROUND: Mental illness is a major health concern worldwide, and the majority experiencing it will continue to battle with relapses throughout their lives. However, in many instances people go on to overcome their illness to lead productive and socially engaged lives. Contemporary mental health nursing practice primarily focuses on symptom reduction, and working with resilience has not generally been a consideration. METHOD: A descriptive phenomenological study was carried out in 2006. One participant was recruited through advertisements in community newspapers and newsletters and the others using the snowballing method. Information was gathered through in-depth individual interviews which were tape-recorded and subsequently transcribed. Colaizzi's original seven-step approach was used for data analysis, with the inclusion of two additional steps. FINDINGS: The following themes were identified: Universality, Acceptance, Naming and knowing, Faith, Hope, Being the fool and Striking a balance, Having meaning and meaningful relationships, and 'Just doing it'. The conceptualization identified as encapsulating the themes was 'Viewing life from the ridge with eyes wide open', which involved knowing the risks and dangers ahead and making a decision for life amid ever-present hardships. CONCLUSION: Knowledge about resilience should be included in the theoretical and practical education of nursing students and experienced nurses. Early intervention, based on resilience factors identified through screening processes, is needed for people with mental illness.