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.

Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis.

Introduction: Pediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide alternative treatment options for pediatric catatonia. Methods: The study involved a single-site retrospective analysis of a private university hospital in the southern United States. The study included patients under eighteen with catatonia who received psychopharmacologic treatment with an agent other than lorazepam. The patients were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE) at the time of initial evaluation and upon stabilization. A retrospective clinical global impressions-improvement (CGI-I) score was assigned by four authors. Results: 102 pediatric patients diagnosed with catatonia were identified, and 31 met criteria for the study. 20 (65%) were white, 6 (19%) were Black, 4 (13%) were Hispanic, and 1 (3%) were Indian. Most patients (N = 18; 58%) were insured by Medicaid. The mean age at the time of catatonia diagnosis was 13.5 years. All patients were stabilized on either clonazepam or diazepam, with 21 (68%) requiring treatment with an additional medication of either an anti-epileptic, N-methyl-D-aspartate (NMDA) receptor antagonist, and aripiprazole or clozapine. Statistically significant reductions in the BFCRS [t = 11.2, df = 30, std = 6.3, p < 0.001, 95% CI = (7.8, 15.1)], KCS [t = 4.6, df = 38, p < 0.001, 95% CI = (12.0, 31.0)], and KCE [t = 7.8, df = 30, std = 1.8, p < 0.001, 95% CI = (1.9, 3.2)] were observed. For CGI-I the results showed that the estimated probability of observing a score better than no change (>4) is 0.976 [t.s. = 43.2, p < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement. Discussion: In conclusion, all patients responded to these treatments with improvement in their catatonic symptoms. Alternative pharmacologic interventions for catatonia, including benzodiazepines other than lorazepam, valproic acid, NMDA receptor antagonists, and atypical antipsychotics were safe and effective in treating catatonia in this population.

Health and well-being benefits of e-bike commuting for inactive, overweight people living in regional Australia.

INTRODUCTION: Pedal-assisted electric-bikes (e-bikes) are bicycles fitted with electric motors. Motorised functions on e-bikes only operate when the user pedals, allowing riders a moderate amount of physical activity. This study aimed to explore the mental and physical health and well-being impacts related to ebike usage for inactive overweight or obese individuals living in regional Australia. METHODS: Twenty inactive, overweight/obese people who seldom cycled were provided with an ebike over a 12-week period. Individual semi-structured interviews conducted at the end of the trial generated data about participants' experiences of using ebikes. Inductive thematic analysis of interview data using Thomas (2006) data analysis framework and NVivo 12 software was undertaken. RESULTS: Data analysis revealed that e-cycling improved participants' mental and physical well-being and that they felt happier when riding an e-bike. CONCLUSIONS: Riding an e-bike can improve mental and physical health, happiness and overall sense of well-being. Greater uptake of e-bikes would have positive health implications for the wider community. Results from this study can be used to inform active transport policy. SO WHAT?: Our study demonstrated that encouraging active transport in the form of e-cycling can improve the overall health and well-being of overweight and obese Australians. More specifically, e-cycling demonstrated a positive impact on mental health well-being.

Cognitive effects of chemotherapy: An integrative review.

PURPOSE: An estimated 18.1 million new cancer cases (excluding nonmelanoma skin cancers) were diagnosed worldwide in 2020. Despite a rising incidence of cancers worldwide, in developed countries with strong healthcare systems, survival rates are improving as a result of early detection, improved treatments and survivorship care (World Health Organisation (WHO), 2021). Whilst living longer, cancer survivors are often living with side effects of treatment, including chemotherapy related cognitive impairment, often termed "chemobrain". METHOD: An integrative review of contemporary literature answering the research question how does chemotherapy affect cognitive function? was undertaken utilising three computerised databases CINAHL, Medline and PUBMED, between 2015 and 2021. Data was thematically analysed to identify themes within published literature. RESULTS: Thematic analysis identified four broad themes within the literature regarding chemotherapy induced cognitive impairment. Identified themes included; cognition as part of a complex scenario, proof of existence and searching for the cause, learning to play the game and timing of cognitive impairment. CONCLUSIONS: Aggressive treatment with chemotherapy in the adjuvant setting has drastically improved the survival of cancer patients. Subsequent to aggressive treatments, side effects such as cognitive impairment have presented, which may persist in the long term. Despite the exact aetiology of chemotherapy induced cognitive impairment being largely unknown, the consequences of the condition are impacting cancer survivors and their quality of life.

A medical play experience: Preparing undergraduate nursing students for clinical practice.

BACKGROUND: Undergraduate nursing programs are required to prepare nursing students to care for people across the lifespan, however due to limited paediatric nursing content in undergraduate nursing curricula and limited paediatric clinical placements, nursing graduates may lack competence and experience in caring for children. OBJECTIVES: The aim of this study was to enhance undergraduate nursing students' work readiness and confidence to care for children by immersing them in a mock paediatric ward experience where students could practice using medical play to communicate and engage with children. PARTICIPANTS: Participants (n = 22) were undergraduate nursing students recruited across all years from a Bachelor of Nursing program. DESIGN: Participants were involved in a mock paediatric hospital experience providing them the opportunity to engage with children from 2 to 8 years. METHODS: A mixed methods approach was used. Participants completed a confidence scale questionnaire pre and post the mock paediatric ward experience and a satisfaction scale post the experience. Inductive thematic analysis was used to analyse qualitative data. Quantitative data was analysed using the Wilcoxon Signed-Ranked Test. RESULTS: Findings indicated a marked improvement in paediatric nursing skills and work readiness among the student nurses post intervention. Participants developed confidence in the use of medical play in the mock paediatric nursing setting. Improvements in paediatric nursing skills in relation to clinical learning, clinical reasoning and clinical confidence were reported. CONCLUSIONS: The mock children's ward provided a real time paediatric experience for undergraduate nursing students to practice using medical play to communicate and engage with children. Nursing students had the opportunity to experience children's play, practice age related communication and provide explanations to children about hospital related procedures that children may encounter. With the lack of paediatric placements, it is necessary that nursing curricula examine strategies to enhance the learning for undergraduate students about paediatrics.

Providing support to nursing students in the clinical environment: a nursing standard requirement.

AIM: This discussion paper poses the question 'What enables or deters Registered Nurses to take up their professional responsibility to support undergraduate nursing students through the provision of clinical education?'. BACKGROUND: Embedded within many nursing standards are expectations that Registered Nurses provide support and professional development to undergraduate nursing students undertaking clinical placements. Expectations within nursing standards that Registered Nurses provide support and professional development to nursing students are important because nursing students depend on Registered Nurses to help them to become competent practitioners. RESULTS: Contributing factors that enable and deter Registered Nurses from fulfilling this expectation to support nursing students in their clinical learning include; workloads, preparedness for the teaching role, confidence in teaching and awareness of the competency requirement to support students. CONCLUSION: Factors exist which can enable or deter Registered Nurses from carrying out the licence requirement to provide clinical education and support to nursing students.

Little people, big lessons: an innovative strategy to develop interpersonal skills in undergraduate nursing students.

Learning the skills of child health nursing requires more than technical skill development. Humanistic attributes such as being genuine, accepting and empathic are imperative in gaining the trust of a child and in helping them feel comforted and safe in a health care setting. Interpersonal theory has a long history in nursing and numerous contemporary theories have drawn on the seminal work of Peplau to advance nursing practice. However, rarely has this theory been applied to simulation learning. This paper reports on an innovative simulation technique that blends interpersonal theory with puppets. Qualitative evaluation using focus group method with fifteen undergraduate nursing students revealed that the pedagogy had a positive impact on characteristics of the learner, the learning process and on interpersonal communication skills development. The study deepened insights about the educative process and led to learning impacts that suggest that puppet-based learning is a powerful medium to bridge theory and practice, bringing the importance of interpersonal theory to life for students.