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.

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.

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.

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.

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.

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.

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.

Men are from Mars: The challenges of communicating as a male nursing student.

Male-female communication within nursing is often fraught with difficulties especially for male nurses as the try and assimilate themselves into a female dominated profession. It is clear that men and women possess different communication styles. Men tend to be forthright and to the point. Women on the other hand often view the world as a network of connections, as a negotiation for closeness and support and therefore centred on maintaining solidarity. The aim of this study was to explore the lived-experience of a group of male nursing students using Colaizzi's seven step data analysis within the phenomenological empirical framework. The central theme "Men are from Mars" identified two subthemes which included: calling a spade a spade in world of shovels and conscientious objector from the margins. Communication for the men in this study was difficult. The participants were sensitive of what and how they communicated could be misinterpreted which often left them feeling isolated. They were often perplexed how the female students spoke to and about each. The men on the other hand were open and honest in the way they communicated with each other; there was not misinterpretation the men knew exactly where they stood with each other.

Nursing is for men: a descriptive phenomenological study.

BACKGROUND: The reasons men come into nursing is because of career stability, career progression and financial security. AIM: The aim of this study was to explore the lived-experience of a group of male nursing students as to the attraction of nursing as a career choice. METHOD: A descriptive phenomenological approach using Colaizzi's seven step data analysis within the phenomenological empirical framework was used. FINDINGS: The central theme developed from the transcripts was Nursing is for Men. Seven sub-themes were identified from the significant statements which included: Nursing is for me; wanting a new career; the jobs in the bag; striving to succeed; Men together; Family approval and Mate-ship realigned. CONCLUSION: The men in this study found the decision to become a nurse and undertake their nursing education challenging. Moreover, it was reconciling with family, friends and work colleagues that many felt was the biggest obstacle.

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.

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.

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.

Mammalian cell transient expression, non-affinity purification, and characterization of human recombinant IGFBP7, an IGF-1 targeting therapeutic protein.

Targeted inhibiting insulin-like growth factor 1 is an effective approach for cancer therapy. Insulin-like growth factor binding protein 7 (IGFBP7) is considered as a potential therapeutic protein. However, producing high quality of such non-IgG proteins in mammalian cells is still a challenge in biopharmaceutical development. Here, we report a rapid production process by using transient gene transfection in HEK 293E cells. A set of constructs combining several expression promoters, leader sequences, and 5' un-translated regions were generated and optimized, from which the best vector with expression level at ~50mg/L was selected for production at 2L cell culture scale. Comparison study in downstream purification methods led to development of a scalable, non-affinity chromatography strategy through Super Q, Fast Flow Q, and Heparin columns. The product was characterized in purity (99%), isoelectric point, molecule weight, glycosylation, and stability by using SEC-HPLC, SDS-PAGE, isoelectric focusing and mass spectrometry. The highly purified product shows IGF-1 binding activity and inhibits IGF-1-induced cell proliferation. This process not only provides a remarkable high expression at ~50mg/L and pure glycosylated mammalian rhIGFBP7, also highlights that transient gene expression technology is practical to be used for production and early development of recombinant non-IgG therapeutic proteins.

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.

Social media used as a health intervention in adolescent health: A systematic review of the literature.

OBJECTIVE: Adolescents are known to be high users of social media, and social media is beginning to be used in health care. The primary objective of this review was to determine the current state of play on the use of social media as a health intervention in addressing the health of adolescents. METHODS: Six databases were searched: CINAHL, Medline, Scopus, ProQuest, Psych Info and Science Direct, from 2000-2013. The review process followed PRISMA guidelines with quality assessments of the selected articles undertaken. RESULTS: Three studies used social media as a health intervention in adolescent health. Facebook was the social media of choice. The way this social media tool was incorporated as the intervention varied. None of the social media interventions had a significant or sustained impact on the primary outcomes of the studies reviewed. Measures of social media process were limited and lacked meaning. CONCLUSIONS: The selected papers provided insight into the beginning phase of using social media as a health intervention to address adolescent health. The review highlights three important areas for consideration when undertaking research on the use of social media as a health intervention for adolescents: the newness of using social media as a health intervention, the importance of the use of rigorous methodological processes when using social media as a health intervention, and the need to develop further knowledge on adolescents' use of social media, in particular their hidden world of social media.

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.

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.

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.