Recognising and responding to non-fatal strangulation in domestic abuse.

Victims/survivors (the authors use this term throughout the article but acknowledge that individuals may use various terms to describe their experiences) of non-fatal strangulation associated with domestic abuse are at risk of further serious harm or death, but often do not disclose the assault. In addition, some of the signs and symptoms are not immediately apparent or obvious. Nurses have a professional responsibility to respond to suspicions about and/or disclosure of any type of domestic abuse by initiating safeguarding and protection procedures and must provide effective care. This article discusses non-fatal strangulation in domestic abuse, including the presenting signs and symptoms and barriers to disclosure, and describes the role of the nurse. The authors include a fictional case study to demonstrate the type of situation nurses may experience when they encounter a victim/survivor of non-fatal strangulation.

Recognising and responding to bruising in children.

Bruises are commonly seen in children and are usually easily explained by play or accidents. However, bruises are also common in children who have been physically abused. For this reason, nurses must determine if the reasons for bruising that are given by parents or carers provide a suitable explanation. This will in part depend on the veracity of the reasons given, as well as the type of bruising, its location and any pattern to the bruising. This article explains how nurses can identify various types of bruises and how these should be documented. The author also details how nurses should raise any suspicion of child physical abuse with the child, parents or carers, and how nurses can escalate any concerns.

From Teams to Teamness: Future Directions in the Science of Team Cognition.

OBJECTIVE: We review the current state-of-the-art in team cognition research, but more importantly describe the limitations of existing theories, laboratory paradigms, and measures considering the increasing complexities of modern teams and the study of team cognition. BACKGROUND: Research on, and applications of, team cognition has led to theories, data, and measures over the last several decades. METHOD: This article is based on research questions generated in a spring 2022 seminar on team cognition at Arizona State University led by the first author. RESULTS: Future research directions are proposed for extending the conceptualization of teams and team cognition by examining dimensions of teamness; extending laboratory paradigms to attain more realistic teaming, including nonhuman teammates; and advancing measures of team cognition in a direction such that data can be collected unobtrusively, in real time, and automatically. CONCLUSION: The future of team cognition is one of the new discoveries, new research paradigms, and new measures. APPLICATION: Extending the concepts of teams and team cognition can also extend the potential applications of these concepts.

Understanding the nurse's role as a professional witness.

Nurses working in any setting may be required to assist the courts or coroners by preparing statements or giving evidence in court. Nurses can act as 'professional witnesses' who provide evidence of something they have seen, heard or been involved with as part of their professional duties. This article outlines how nurses should respond to requests for written statements and suggests a format for providing such statements. It also explains the typical approach to providing oral evidence in court and how nurses should prepare and present themselves in the witness box.

Acute behavioural disturbance: recognition, assessment and management.

Acute behavioural disturbance (ABD) is a clinical emergency which typically affects overweight men in their mid-thirties who chronically misuse illicit stimulants. People with ABD are most likely to be seen in police custody or emergency departments, therefore nurses working in these areas must be able to recognise the signs and symptoms and know how to respond appropriately. Presentation varies, but the signs and symptoms commonly include extreme agitation, hyperthermia, hostility and exceptional strength without fatigue. Further, it is important to recognise that people with ABD are at risk of developing metabolic acidosis, hyperkalaemia, rhabdomyolysis or disseminated intravascular coagulation. This article gives an overview of ABD and describes the main elements of management and treatment.

Assessing and managing people exposed to conducted energy device (Taser) discharge.

The use of conducted energy devices - better known under the brand name Taser - by police officers is subject to scrutiny. Consequently, the clinical assessment and management of people who have been exposed to Taser discharge is also subject to scrutiny. In 2021 the Conducted Energy Device Joint Working Group published a new guideline on assessment in police custody after Taser discharge. The guideline enables any appropriately trained and competent healthcare professional, including nurses, to undertake post-Taser assessments and determine the person's fitness to be detained in police custody. This would be done in the first instance by nurses working in police custody suites, but emergency department (ED) nurses may also be involved, as people who have been 'tasered' may need referral to the ED. This article explains how Tasers work, their physiological effects and potential complications, and the required approaches to clinical assessment and management as outlined in the new guideline.

Physiological Stress in Rescued Wild Koalas (Phascolarctos cinereus) Being Held in a Rehabilitation Sanctuary: A Pilot Study.

Koalas (Phascolarctos cinereus) are one of Australia's most charismatic native small marsupial species. Unfortunately, populations of koalas are rapidly declining throughout Australia as they continue to face increasing pressure from a changing ecosystem. All wildlife species to some degree will use their hypothalamic-pituitary-adrenal (HPA) axis in response to stress. Depending on the duration of activation, the stress response can lead to either acute or chronic side effects and is modulated through the neuroendocrine stress system with the release of catecholamines and glucocorticoids (e.g., cortisol). It is well known that rehabilitation sanctuaries are inherently stressful for all animals, in particular for rescued wild koalas, as it is an unfamiliar environment where the animals cannot predict or control what will happen to them. In this pilot study, we set out to quantify faecal and fur cortisol metabolites in wild rescued koalas undergoing wildlife rehabilitation. Absolute levels of acute and chronic stress were indexed non-invasively, with faecal samples taken to evaluate acute stress, and fur samples taken to evaluate chronic stress. Sampling occurred sporadically over four months (the start of September 2018 to the end of December 2018), and was performed on three rescued koalas (Maree, Tai, and Solstice) being held at the rehabilitation centre. Results of this study show that between the three koalas, the highest recorded faecal cortisol result was 241 ng/g, and the lowest recorded faecal cortisol result was 4 ng/g, whereas the highest recorded fur cortisol result was 1.75 ng/g, and the lowest recorded fur cortisol result was 0.10 ng/g. Statistically, there was a significant difference between all three koalas and their faecal cortisol responses, as well as their fur cortisol responses. Statistically for Maree and Solstice, there was a significant difference in their faecal cortisol response between days when a stressor was recorded, and days when a stressor was not recorded. However, statistically for Tai, this was not the case, as there was no significant difference in his faecal cortisol response between days when a stressor was recorded, and days when a stressor was not recorded. In summary, the hypothesis that faecal glucocorticoids and fur glucocorticoids between koalas will differ based on individual responses to stressors was true as a whole, but individually, this hypothesis was true for Maree and Solstice, but untrue for Tai. The use of biological samples such as faeces and fur to obtain readings of glucocorticoids is a method of measuring absolute levels of physiological stress that is still evolving for koalas, and there is no current glucocorticoid baseline with which to compare the results of this study; although, measuring faecal and fur glucocorticoids is the first step in understanding how koalas undergoing wildlife rehabilitation respond to stressors.

Assessment of people who have been tasered.

The use of Tasers® by the police is subject to intense scrutiny and controversy. With increasing numbers of police officers carrying Tasers, it is important that nurses in pre-hospital, emergency department and police custody settings understand how Tasers work, and the physiological effects. This article describes Tasers, their mechanisms and physiological effects, and explains how nurses should undertake assessment of people who have been subjected to Taser discharge.

Assessing an individual's fitness to be interviewed in police custody.

Nurses working in police custody settings may be called on to assess a detainee's fitness to be interviewed by police, for example where the person is thought to have a mental disorder or vulnerability. This article outlines the role of the custody nurse in the fitness-to-interview assessment. This assessment is complex and multifaceted. It requires custody nurses to assess a detainee's medical, mental health, educational and social history, as well as any substance misuse. It should include a mental state examination and, where appropriate, a physical examination. Fitness-to-interview decisions should be rigorous to prevent miscarriages of justice or significant harm to detainees. Custody nurses should advocate for detainees who are mentally vulnerable and ensure appropriate safeguards are in place, where necessary. Further work is required to reduce the subjectivity of the fitness-to-interview assessment, along with increased investment in appropriate adult services. Equally, custody nurses working at this advanced level of practice require relevant postgraduate knowledge and skills.

Opportunities to preserve forensic evidence in emergency departments.

Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.

Assessing fitness to detain in police custody.

This article outlines the role of the custody nurse in assessing an individual's fitness to be detained. It addresses all aspects of the assessment, including consent, responsibilities and the structure of the clinical examination. It explores ways to ensure that the detainee's rights and welfare are maintained and their healthcare needs are met. It offers guidance on preparing a care plan for detained individuals that the police can implement.

Rupture of Stochastically Occurring Vesicle Clusters Limits Bilayer Formation on Alkane-PEG-Type Supports: Uncoupling Clustering from Surface Coverage.

Polymer-supported bilayers (PSBs) are a recognized tool for drug discovery through function-interaction analysis of membrane proteins. While silica-supported bilayers (SSBs) spontaneously form from surface-adsorbed vesicles, successful PSB formation via a similar method has thus far been limited by an insufficient understanding of the underlying vesicle-remodelling processes. Here, we generated a polymer support through the incubation of poly-L-lysine conjugated to alkyl-chain-terminated poly(ethylene)glycol on silica. This polymer-coated silica substrate yielded efficient vesicle adsorption and spontaneous bilayer formation, thereby providing a rare opportunity to address the mechanism of PSB formation and compare it to that of SSB. The combined use of super-resolution imaging, kinetics, and simulations indicates that the rupture of stochastically formed vesicle clusters is the rate-limiting step, which is an order of magnitude higher for silica than for polymer-coated silica. This was confirmed by directly demonstrating increased rupture rates for surface adsorbed multivesicle assemblies formed by vesicle cross-linking in solution. On the basis of this key insight we surmised that a low propensity of cluster rupture can be compensated for by an increase in the number density of clusters: the deposition of a mixture of oppositely charged vesicles resulted in bilayer formation on another alkane-PEG type of interface, which despite efficient vesicle adsorption otherwise fails to support spontaneous bilayer formation. This potentially provides a universal strategy for promoting bilayer formation on resistant surfaces without resorting to modifying the surface itself. Therefore, multivesicle assemblies with tailored geometries not only could facilitate bilayer formation on polymers with interesting functional properties but also could instigate the exploration of vesicle architecture for other processes involving vesicle remodelling such as drug delivery.

Care bundles: resuscitation of patients with severe sepsis.

This article outlines a nurse-led system to identify patients with severe sepsis outside critical care settings. It also discusses how the Surviving Sepsis Campaign's severe sepsis resuscitation care bundle can be initiated. Patient outcome and audit results are examined.