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Images and spectra obtained from aberration corrected scanning transmission electron microscopes (STEM) are now used routinely to quantify the morphology, structure, composition, chemistry, bonding, and optical/electronic properties of nanostructures, interfaces, and defects in many materials/biological systems. However, obtaining quantitative and reproducible atomic resolution observations from some experiments is actually harder with these ground-breaking instrumental capabilities, as the increase in beam current from using the correctors brings with it the potential for electron beam modification of the specimen during image acquisition. This beam effect is even more acute for in situ STEM observations, where the desired outcome being investigated is a result of a series of complicated transients, all of which can be modified in unknown ways by the electron beam. The aim in developing and applying new methods in STEM is, therefore, to focus on more efficient use of the dose that is supplied to the sample and to extract the most information from each image (or set of images). For STEM (and for that matter, all electron/ion/photon scanning systems), one way to achieve this is by sub-sampling the image and using Inpainting algorithms to reconstruct it. By separating final image quality from overall dose in this way and manipulating the dose distribution to be best for the stability of the sample, images can be acquired both faster and with less beam effects. In this paper, the methodology behind sub-sampling and Inpainting is described, and the potential for Inpainting to be applied to novel real time dynamic experiments will be discussed.

Objectives The aim of this study was to evaluate the use of mechanical thresholds (MT), measured with the SMALGO (Small Animal ALGOmeter), and to determine whether there was a correlation between MT and Glasgow Feline Composite Measure Pain Scale (CMPS–Feline) scores in cats undergoing ovariohysterectomy. Methods Client-owned cats undergoing flank ovariohysterectomy were recruited. Pain scores for the pre- and postoperative periods were obtained using the CMPS-Feline in each cat by two independent investigators (A and B). Following CMPS–Feline scoring, MT were measured with the SMALGO, in the surgical area, pre- and postoperatively, only by investigator A. Each cat served as its own control for the comparison of pre- and postoperative variables. Reliability statistics were used to assess the level of inter-observer agreement (A vs B) with respect to pre- and postoperative CMPS–Feline scores, while Spearman’s correlation statistics were used to analyse the relationship between MT and CMPS–Feline scores. Results Twenty-nine cats completed the study. Preoperative MT (340 g [range 108–691]) were significantly higher than postoperatively (233 g [range 19–549]; P = 0.001). CMPS–Feline scores were not found to differ significantly between the preoperative period (2 [range 0–7] for investigator A and 3.2 ± 2.3 for investigator B) and postoperative period (2 [range 0–10] for investigator A and 3 [range 0–8] for investigator B) for either investigator. Reliability statistics revealed that the level of inter-observer agreement with respect to CMPS–Feline was fair for the preoperative assessments but poor for the postoperative evaluations. There was no correlation between MT and CMPS-Feline scores. Conclusions and relevance Although there was no correlation with CMPS–Feline scores performed at the same timepoint, MT increased postoperatively vs baseline. Assuming that, despite analgesia, susceptibility of the surgical area to mechanical stimulation would increase after surgery, this finding suggests that MT might be useful to assess feline surgical pain. The poor level of inter-observer agreement with respect to postoperative CMPS–Feline scores highlights the potential limitations of this scale.

Scanning transmission electron microscopy (STEM) provides structural analysis with sub-angstrom resolution. But the pixel-by-pixel scanning process is a limiting factor in acquiring high-speed data. Different strategies have been implemented to increase scanning speeds while at the same time minimizing beam damage via optimizing the scanning strategy. Here, we achieve the highest possible scanning speed by eliminating the image acquisition dead time induced by the beam flyback time combined with reducing the amount of scanning pixels via sparse imaging. A calibration procedure was developed to compensate for the hysteresis of the magnetic scan coils. A combination of sparse and serpentine scanning routines was tested for a crystalline thin film, gold nanoparticles, and in an in-situ liquid phase STEM experiment. Frame rates of 92, 23 and 5.8 s-1 were achieved for images of a width of 128, 256, and 512 pixels, respectively. The methods described here can be applied to single-particle tracking and analysis of radiation sensitive materials.

Background In Australia, midwives care closely for women during pregnancy and birth and the immediate postnatal period. This scoping review aimed to explore the experiences of female maternity healthcare professionals when they return to work following a personal pregnancy loss or neonatal death. Methodology: A scoping review was carried out on published and unpublished research and grey literature looking at how maternity healthcare professionals who have had a personal perinatal loss experience working in a maternity setting following the loss. A search of the literature was performed between October and December 2018, with no set limitations. A search for relevant references from included papers was also carried out. The literature was analysed thematically. The types of perinatal loss were defined as per Australian guidelines. Results 10 articles were included in this scoping review. Four themes emerged from the literature and these were: 1) Impact of being asked, “have you got children?”; 2) Impact on professional practice; 3) Impact of pre-existing professional knowledge; 4) Importance of collegial support on return to work. Conclusions Return to work in a maternity setting following a personal perinatal loss is emotionally challenging and requires a range of supports. Further research is needed in this area.

Recently it has been shown that precise dose control and an increase in the overall acquisition speed of atomic resolution scanning transmission electron microscope (STEM) images can be achieved by acquiring only a small fraction of the pixels in the image experimentally and then reconstructing the full image using an inpainting algorithm. In this paper, we apply the same inpainting approach (a form of compressed sensing) to simulated, sub-sampled atomic resolution STEM images. We find that it is possible to significantly sub-sample the area that is simulated, the number of g-vectors contributing the image, and the number of frozen phonon configurations contributing to the final image while still producing an acceptable fit to a fully sampled simulation. Here we discuss the parameters that we use and how the resulting simulations can be quantifiably compared to the full simulations. As with any Compressed Sensing methodology, care must be taken to ensure that isolated events are not excluded from the process, but the observed increase in simulation speed provides significant opportunities for real time simulations, image classification and analytics to be performed as a supplement to experiments on a microscope to be developed in the future., Comment: 20 pages (includes 3 supplementary pages), 15 figures (includes 5 supplementary figures), submitted to Ultramicroscopy

When high-energy electrons from a scanning transmission electron microscope (STEM) are incident on a liquid, the vast majority of the chemical reactions that are observed are induced by the radiolysis breakdown of the liquid molecules. In the study of liquids, the radiolysis products of pure water are well known, and their rate of formation for a given flux of high-energy electrons has been studied intensively over the last few years for uniform TEM illumination. In this paper, we demonstrate that the temporal and spatial distribution of the electron illumination can significantly affect the final density of radiolysis products in water and even change the type of reaction taking place. We simulate the complex array of possible spatial/temporal distributions of electrons that are accessible experimentally by controlling the size, the scan rate and the hopping distance of the electron probe in STEM mode and then compare the results to the uniformly illuminated TEM mode of imaging. By distributing the electron dose both spatially and temporally in the STEM through a randomised “spot-scan” mode of imaging, the diffusion overlap of the radiolysis products can be reduced, and the resulting reactions can be more readily controlled. This control allows the resolution of the images to be separated from the speed of the induced reaction (which is based on beam current alone) and this facet of the experiment will allow a wide range of chemical reactions to be uniquely tailored and observed in all liquid cell STEM experiments.

In this paper, the authors describe a way of doing phenomenology using exemplars drawn from a doctoral study of Australian nurses’ lived experiences following a disaster. Phenomenology is concerned with the essence of things as they are appearing in the conscious awareness of the first person. This paper emphasises a way of doing phenomenology based on maintaining orientation to the uniqueness of the ‘thingness’ of the phenomena being uncovered. While there is no one way to do phenomenology, this paper shows a way of doing phenomenology from obtaining individual narrative and moving to an intersubjective lived-experience description.

Amorphous spray-dried dispersions (SDDs) are a key enabling technology for oral solid dosage formulations, used to improve dissolution behaviour and clinical exposure of poorly soluble active pharmaceutical ingredients (APIs). Appropriate assessment of amorphous dissolution mechanisms is an ongoing challenge. Here we outline the novel application using focused beam reflectance measurement (FBRM) to analyse particle populations orthogonal to USP 2 dissolution. The relative impact of polymer substitution and particle attributes on 25% BMS-708163/HPMC-AS SDD dissolution was assessed. Dissolution mechanisms for SDDs were categorized into erosion versus disintegration. Beyond an initial mixing period, FBRM particle counts diminish slowly and particles are detectable until the point where API dissolution is complete. There is correlation between FBRM particle count decay rate, representing loss of SDD particles in the dissolution media, and UV dissolution rate, measuring dissolved API. For the SDD formulation examined, the degree of succinoyl substitution for HPMC-AS, SDD particle size and surface area all had an impact on dissolution. These data indicate the SDD displayed an erosion mechanism and that FBRM is capturing a rate-limiting step. From this screening tool, the mechanistic understanding and measured impact of polymer chemistry and particle properties can inform a risk-assessment and control strategy for this compound.

Sub-sampling during image acquisition in scanning transmission electron microscopy (STEM) has been shown to provide a means to increase the overall speed of acquisition while at the same time providing an efficient means to control the dose, dose rate and dose overlap delivered to the sample. In this paper, we discuss specifically the parameters used to reconstruct sub-sampled images and highlight their effect on inpainting using the beta-process factor analysis (BPFA) methodology. The selection of the main control parameters can have a significant effect on the resolution, precision and sensitivity of the final inpainted images, and here we demonstrate a method by which these parameters can be optimised for any image in STEM. As part of this work, we also provide a link to open source code and a tutorial on its use, whereby these parameters can be tested for any datasets. When coupled with the hardware necessary to rapidly sub-sample images in STEM, this approach can have significant implications for imaging beam sensitive materials and dynamic processes.

Background There is a lack of evidence-based guidelines on perioperative insulin administration and fasting time in diabetic dogs. The aim of this study was to compare two protocols with respect to intraoperative changes in blood glucose (BG) concentrations compared to preoperative values. Methods Thirty-two dogs were included. Dogs of group AM (n = 15) underwent anaesthesia in the morning after 12 hours fasting and received half their usual insulin dose, while dogs of group PM (n = 17) had surgery in the afternoon after 6 hours fasting and received their usual insulin dose; BG was measured before premedication (baseline), after anaesthetic induction, every 30 minutes throughout surgery, at extubation and after anaesthetic recovery. The occurrence of intraoperative complications was recorded. Results There were no differences between groups in perioperative changes in BG over time, and in the proportion of dogs experiencing complications. Common complications were hypotension (53 per cent of dogs in either groups), hyperglycaemia (67 and 65 per cent in groups AM and PM) and hyperkalaemia (20 and 11 per cent in groups AM and PM). Conclusions Either protocols may be used in diabetic dogs undergoing anaesthesia. The occurrence of hyperkalaemia in the study population supports routine intraoperative monitoring of blood potassium concentration.

Beam damage caused during acquisition of the highest resolution images is the current limitation in the vast majority of experiments performed in a scanning transmission electron microscope (STEM). While the principles behind the processes of knock-on and radiolysis damage are well-known (as are other contributing effects, such as heat and electric fields), understanding how and especially when beam damage is distributed across the entire sample volume during an experiment has not been examined in detail. Here we use standard models for damage and diffusion to elucidate how beam damage spreads across the sample as a function of the microscope conditions to determine an "optimum" sampling approach that maximises the high-resolution information in any image acquisition. We find that the standard STEM approach of scanning an image sequentially accelerates damage because of increased overlap of diffusion processes. These regions of accelerated damage can be significantly decelerated by increasing the distance between the acquired pixels in the scan, forming a "spotscan" mode of acquisition. The optimum distance between these pixels can be broadly defined by the fundamental properties of each material, allowing experiments to be designed for specific beam sensitive materials. As an added bonus, if we use inpainting to reconstruct the sparse distribution of pixels in the image we can significantly increase the speed of the STEM process, allowing dynamic phenomena, and the onset of damage, to be studied directly.

Generalist health professionals (GHPs) or those healthcare professionals working in nonmental health facilities are increasingly being required to provide care to consumers with a mental illness. The review aimed to synthesize the qualitative research evidence on the meanings and interpretations made by GHPs (nonmental health professional) who interact with consumers with mental illness in nonmental health settings. A systematic review of the qualitative literature was undertaken for the years 1994-2016. The following electronic databases were searched: CINAHL, MEDLINE, PsycINFO, and Sociological Abstracts. Using narrative synthesis methods, the following themes were identified: mental health knowledge (the GHPs' knowledge level about mental illness and how this impacts their experiences and perceptions); GHPs perceive mental illness as a safety risk (GHPs concern over harm to the consumer and themselves); organizational support (the system response from the environmental design, and expert support and care); and emotional consequences of care (the feelings expressed by GHPs based on their experiences and perceptions of consumers). The results suggest that GHPs provide care in a setting which consists of multiple understandings of what care means. Efforts beyond educational initiatives such as organizational and system-level changes will need to be implemented if we are to progress care for this consumer group.

Sugars are a near-ubiquitous ingredient in food products, yet rising rates of obesity and related illnesses have prompted a drive to reduce their content. The use of amorphous sugars in confectionery may be one way of achieving this by providing a similarly sweet sensation due to increased dissolution rate. However, accurate amorphous and crystalline form characterisation and quantification of complex foodstuffs can be difficult. \ud In this study, a method for the quantification of crystalline and amorphous sugars in chocolate precursors, using powder X ray powder diffraction, is presented. The method was first validated by the use of known compositions of mixtures of amorphous and crystalline sugars, then employed in assessing two chocolate crumb samples. The results show that the method can reliably determine the absolute quantity of amorphous and crystalline components in a confectionery sample, whilst maintaining sample integrity, apart from the addition of an inert internal standard. As such, it is a valuable addition to other techniques currently used.

AIMS AND OBJECTIVES To investigate the feasibility of a 13-week mentoring programme in providing social support to promote hope for recovery in anorexia nervosa. BACKGROUND With no clear first-line psychological treatment for people with anorexia nervosa, mentoring support programmes, as an adjunct to treatment, may provide the social support necessary to promote hope for recovery. DESIGN A mixed-method study; participatory action research. METHODS Women (n = 11), recovering and who had recovered from anorexia nervosa, participated in the programme and completed self-report questionnaires related to quality of life, distress and the mentoring relationship at different time points. Qualitative feedback from logbooks, workshop evaluation questionnaires, interviews and focus groups was also collected to assess the programme's acceptability. RESULTS General compliance for completing most study outcome questionnaires was 90%; however, the mentoring relationship questionnaires were not completed to the same degree. Five key themes emerged from the focus group/interview data: (i) she understands me and could relate to me; (ii) reconnecting with the world-asking questions and being challenged; (iii) mentors' altruistic motivations and the transformation and discovery of self; (iv) instilling hope-recovery is possible; and (v) effective communication-the key to successful mentoring. CONCLUSIONS Further research is needed; however, the results provide preliminary support for the mentoring programme's feasibility as an adjunct to treatment. We found that having someone who understands, to talk and share with, met a clear need for people with anorexia nervosa. RELEVANCE TO CLINICAL PRACTICE While further research is warranted mentoring support or recovered mentors, may play a potentially valuable role in supporting those in community settings.

Sustainable commercial use of native wildlife is an alternative economic means of land use by Indigenous people in remote rural areas. This situation applies within large tracts of land owned by Indigenous people across northern Australia. The commercial use of saltwater crocodilesCrocodylus porosusis a growing industry in Australia's Northern Territory. Although Indigenous people sell crocodile eggs and hatchlings, the majority of harvesting and incubation is done by non-indigenous people from less remote areas. One Indigenous community has been heavily involved in this industry and now manages its own harvest and incubation programme. We present a case study of this programme, which has transitioned from outside agencies managing the harvest, to complete local ownership and management. Egg harvests and incubation success rates declined by 40% following the switch to local management. Income increased, as did production costs; in particular, royalty payments made to Indigenous landowners. The declines reflect the community's motives for engaging in the industry, which have been socially rather than commercially driven, and damage to nesting habitat by feral animals. The increase in royalties reflects the need to compete with non-indigenous harvesters from outside the township, who are strictly commercially driven. Harvesting, incubation and trade in crocodile eggs and hatchlings can form a viable and sustainable enterprise for remote Indigenous communities. However, efficiency needs to be improved to fulfil the need for a reliable and dependable supply chain, and regulatory institutions should give Indigenous harvesters sufficient freedom to pursue innovative and viable livelihood options.

In the present study, we investigated a unique set of historical health-care records of women admitted to a psychiatric hospital in Sydney, Australia with a diagnosis of psychosis or mania after childbirth in the post-World War II (WWII) period, from 1945 to 1955. This research is part of a larger project examining how the descriptions of these women documented in the health-care records from 1885 to 1975 affected their treatment and the outcome of their admission. In the present paper, we report on the findings from an intensive examination of the post WWII documents. Eighteen health-care records from a psychiatric facility (Gladesville Hospital) were identified from admission registers housed in the State Records Office of New South Wales in 2014. Although seven records had been destroyed, 11 were transcribed verbatim. The records contain demographic information; descriptions of the women's signs and symptoms on admission; and information about the women before, during, and after their admission found in letters from relatives or medical staff. A content analysis of admission information showed how the women were described by health-care professionals, but a textual analysis of the records revealed that there were other factors that could have contributed to the women's condition, which might not have been taken into consideration when treatment and care were devised. The present study demonstrates the value of investigating historical health-care records to understand how prevailing attitudes and practices might affect diagnosis and treatment.

Background Husserl's descriptive phenomenology is a popular methodology in health research as it provides a way to understand people's experiences. Positioned in Husserl's phenomenology, Colaizzi's approach offers a way to analyse data and develop trustworthy findings. However, it can pose methodological and practical challenges. Aim To present a discussion of the application and tailoring of Colaizzi's phenomenological approach to a study conducted in a hospital. Discussion Applying Colaizzi's approach to interview data concerning health professionals' decisions about transferring older people in hospital to residential care provided a decision trail. However, Colaizzi's final step - member-checking - is controversial so was tailored to enhance the development of trustworthy findings. Conclusion Validating findings is an important part of conducting research. Tailoring the final step of member-checking in Colaizzi's approach supports trustworthy findings while staying connected to phenomenological epistemology. Implications for practice Phenomenology is a popular methodology for nurse researchers. Tailoring Colaizzi's approach provides strategies to augment phenomenological methods, ensuring dependable findings. Nurse researchers conducting phenomenological research can use these strategies.

AIMS AND OBJECTIVES This article presents the generation of a model of care encompassing "function" and "affect" based on findings from a 2011 research project aimed at improving care delivery for people with advanced dementia. Objectives were to provide comprehensive and sustainable care, honouring and respecting the person. BACKGROUND Dementia is a debilitating, progressive, and terminal disease with a trajectory ranging from approximately 3 to 16 years, yet attention to end-of-life care, promoting comfort, alleviating suffering, and maximizing quality of life is frequently overlooked for people living in the advanced stages of the disease. METHODS The research project from which the model was drawn used a three-phase mixed methods approach at three residential aged care facilities (nursing homes) providing high care in New South Wales, Australia. Thematic analysis was elicited from focus group discussions with staff, family members, and carers of residents. FINDINGS Themes describe distinct dimensions of a model of care: "function" (dedication, designation, and deliberation) and "affect" (the personal outcomes revealed in relaxation, stimulation, and transformation). CONCLUSION Reframing nursing practice from task and disease orientation to person centred and relationship focused is essential in meeting the complete needs of people with advanced dementia. This transformational model of care may be useful in adapting to other end-of-life care settings.

Generalist health professionals, often without formal mental health training, provide treatment and care to people with serious mental illness who present with physical health problems in general hospital settings. This article will present findings from a constructivist grounded theory study of the work delivered by generalist health staff to consumers with mental illness on the general medical/surgical wards of two metropolitan hospitals in Sydney, Australia. The results analysed included three participant observations, two focus groups, and 21 interviews and hospital policy and protocol documents. A substantive theory of mental health work in general hospital settings is illustrated which conceptualizes the following categories: (i) the experience: conflicting realities and ideals; (ii) The Context: facilitating social distancing; and (iii) the social processes: invisibility affecting confidence. The categories are understood through the theoretical lens of symbolic interactionism with the theory providing insights into how the generalist health professionals understand their sense of self or identity.

Six women were recruited through ‘Methadone Clinics’ in a metropolitan local health district in Sydney, Australia to examine how mothers accessing opioid treatment programmes in the perinatal period make meaning of their interactions with universal and targeted health services. Narrative inquiry informed data collection and analysis, with the two main themes of judgement and hope juxtaposed throughout the mothers’ stories, and movement towards a change of identity from ‘drug user’ to ‘good mother’. Fear of removal of their child by child protection services, self-judgement and judgement by health professionals as a ‘bad mother’ reduced interactions with services. This contrasted with increased mothering confidence and hope for a better future where staff were non-judgemental and supported the mothers in the care of their baby. Knowledge of the importance of the transition to motherhood, or motherhood again, for this group has implications for individual professional practice and services aiming to...

This study investigated changes in the 'atmosphere' of an acute adult mental health setting following relocation to a new purpose-built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital-based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose-built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less 'staff control' in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer 'involvement' in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the 'atmosphere' of a health facility, for both staff and consumers.

This article presents the mental health aspects of ‘touch’ associated with a funded research project: Avoiding ‘high tech’ through ‘high touch’ in end-stage dementia: Protocol for care at the end-of-life. These mental health aspects highlight the human need for touch that continues up until and inclusive of the final stages of life. This study was informed by Simard's (2007) ‘high touch’ protocol based on the End-of-Life Namaste Care programme for people with dementia. The article is situated in relation to the research project which used a three-phase mixed methods approach. Data explored in this article are derived from focus groups conducted at three residential aged care facilities located in metropolitan and regional areas of NSW, Australia. The exploration of touch vis-a-vis mental health fell under two broad themes: touch by others and touch by the person. Sub-elements of these themes comprised touch towards a physical objective, touch towards an emotional objective, touch of objects and touch of others. The overarching outcome of interconnectedness embraced environmental awareness and human and life awareness. These two broad themes, with their accompanying elements, express the essential nature of mental health as a reciprocal connectedness, with reciprocal impacts on both those people with advanced dementia and their carers.

AIM To discuss the application of the principles of participatory action research (PAR) in a project that developed and evaluated a mentor-mentee support programme for women with anorexia nervosa. BACKGROUND A programme was developed and implemented in which mentors and mentees participated in workshops, social activities and focus groups that sought to support and develop resilience for those experiencing anorexia nervosa. DISCUSSION PAR principles were mirrored in the programme, paying respect to the views and needs of each participant, an open trajectory to possible conclusions and a continuous feedback cycle. Mentees had a sense of empowerment, ownership of the programme and hope that recovery was possible. It allowed their voices to be heard and provided them with belief they could begin new relationships and friendships. CONCLUSION The principles of PAR suited a project aimed at developing self-determination and resilience in women with anorexia nervosa. IMPLICATIONS FOR RESEARCH/PRACTICE PAR would be readily transferable to a number of mental health settings where empowerment is of paramount concern.

Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress.

Aims and objectives. To report the findings of a service review – specifically the strategy to provide early childhood services ‘on site’ at opioid treatment clinics to address access difficulties. Background. Child and family health nurses are skilled in the assessment and support of families during early childhood. However, women with a history of substance abuse are often cautious when engaging with universal and other health services, with the result that the infant may miss recommended developmental screening and early referral to improve health outcomes. Design. In 2006, an internal review was undertaken of the integration of early childhood and parenting services at opioid treatment clinics in a large Area Health Service of New South Wales, Australia. Methods. A qualitative study design, using semi-structured interview questions was used. Data were collected via six focus groups (4–15 participants in each group) and individual interview of child and family health nurses, nurse unit managers and clinical staff (n = 58). Results. Three key components of a model for providing early childhood support in collaboration with opioid treatment services were identified. First, the importance of building a trusting relationship between the woman and the child and family health nurses, second, maintaining continuity of care and a multidisciplinary/multiagency approach, and finally the importance of staff education, support and professional development. Conclusion. The provision of early childhood and parenting services on site, as part of a multidisciplinary ‘one stop shop’ approach to service delivery was a clear recommendation of the review. Relevance to clinical practice. Reduction of access difficulties to specialised early childhood support is of benefit to clients, community health services attempting to provide a service to this difficult to reach population and to drug and alcohol services seeking to provide a high level of holistic care for clients.

A ward-based writing coach program was piloted at a metropolitan hospital in Australia to produce a quality improvement in nursing documentation. This paper describes the education program, which consisted of two writing workshops, each of one-hour duration followed by one-to-one coaching of nurses. This program could be carried out in any clinical area as a part of the regular education program. Nurses are encouraged to view their documentation practices in a critical light to ensure that the documentation is meaningful to readers within or outside the profession. The importance of nursing documentation as a communication tool for all health care professionals is emphasised. Barriers to meaning, such as fragmentary language or the use of unofficial abbreviations, are discussed. Nurses are also encouraged to document the patient's condition, care and response to care using defined principles for nursing documentation. This program would be transferrable to any clinical setting looking for a ward-based education program for nursing documentation.

JEFFERIES D., JOHNSON M., NICHOLLS D., LANGDON R. & LAD S. Evaluating an intensive ward-based writing coach programme to improve nursing documentation: lessons learned. International Nursing Review59, 394–401 Aim: This study aimed to develop a ward-based writing coach programme to improve the quality of patient information in nursing documentation. Background: Omissions in the patient information make nursing notes an unreliable source for care planning. Strategies to improve the quality of nursing documentation have been unsuccessful. An education programme, with one-to-one coaching in the clinical environment, was tested. Method: A concurrent mixed methods approach including a pre–post test intervention and control design for the quantitative component combined with a qualitative approach using a focus group (eight nurses) was used. Healthcare records for 87 patients (intervention) (46 pre and 41 post) and 88 patients (control) (51 pre and 37 post) were reviewed using the Nursing and Midwifery Content Audit Tool for quality nursing documentation. Sixteen nurses from two intervention wards participated in an introductory workshop with 2 weeks of coaching. No intervention was given to the control ward. Results: No significant differences were found between the wards across the 14 criteria representing quality documentation; most criteria were present in 75% or more of the records. Improvements were demonstrated in both the intervention and comparison units. Themes identified from the focus groups included the impact these changes had on nurses and patients, perceived difficulties with nursing documentation, medicolegal aspects and the attributes of an effective writing coach. Conclusion: Writing coaching is a supportive approach to improving nursing documentation. Also, regular auditing prompts nurses to improve nursing documentation. Further research using larger sample sizes can further confirm or refute these findings.

Aims and objectives. This study presents a minimum data set designed for an electronic system to complement verbal nursing handover. Background. Poor communication of patient information at handover has been implicated in adverse events with changes to clinical handover being proposed as a solution. This study developed a minimum data set for an electronic patient summary tool. Design. Using an observational design the scope of information being presented by nurses at handover was identified in relation to a generic Nursing Handover Minimum Data Set. Method. Patient handovers (n = 195) were observed and digitally recorded across diverse specialties. Results. Content analysis confirmed the frequent use of the Nursing Handover Minimum Data Set items across all specialties. The use of the items was affected by the patient context and the clinical setting. Aged care patients often had several clinical alerts reported (pressure areas, falls risk). Rapid changes in patient condition in emergency emphasised the need for a focus on observations and presenting problems. Mental health and maternity required further refinement of the items. Conclusion. The generic Nursing Handover Minimum Data Set can direct nurses to give a comprehensive account of their patient’s condition and care. The data set needs to be flexible and adaptable to the patient context and setting and complements structured content verbal handover. This minimum data set provides an excellent framework for system development by clinicians, managers and information technologists. Educators can use this tool to teach student nurses, new graduates and experienced staff, about the patient information to be presented at handover. Relevance to clinical practice. The Nursing Handover Minimum Data Set for electronic nursing handover complements verbal handover and provides a tool to give clinicians access to comprehensive information about all patients within the ward area.

This article looks at the effect of using fragmentary language in nursing documentation. Fragmentary language is defined as phrases and abbreviations found in records of nursing care that are understood at the local ward level but would make it difficult for anyone reading the documentation beyond this local level to construct meaning. Sixty-seven entries of nursing documentation were investigated using textual analysis. Each entry was examined to determine how grammatical and linguistic features of the text could impede meaning. Three entries are discussed in detail to demonstrate possible difficulty for readers in understanding the patient's condition and care. Education programs that encourage nurses to view their documentation as a crucial aspect of care are recommended. Writing nursing documentation in a manner that allows readers from both within and outside the profession to understand the patient's condition and care required is supported. If readers cannot understand what is written in nursing documentation, there is a danger that misinterpretations could lead to clinical errors and adverse events.

Aims and objectives. This paper aims to explore the effectiveness of the mental health nurse practitioner role in the emergency department in the context of the growing use of special units or segregated areas to manage particular kinds of mental health presentations, often complicated by substance use. Background. In recent years, there has been a significant increase in mental health presentations to emergency departments, often complicated by substance abuse. Emergency departments have introduced a variety of mechanisms to address this growing problem. With the introduction of mental health nurse practitioners, opportunities arise to reconsider these mechanisms. Design. Discursive paper. Methods. In this discursive paper, contemporary practices are described in relation to ‘special care areas’, ‘psychiatric emergency centres’ and ‘short-stay units’. The mental health nurse practitioner role in training and capacity building is also explored and the notion of ‘locational processes’ described. Rather than being presented as an alternative to short-stay units, the mental health nurse practitioner role is explored in its potential to enhance mental health nursing practice in a sometimes difficult clinical environment. Results. The paper provides evidence from literature and practice that the clinical outcome for consumers is enhanced through the mental health nurse practitioner role. Conclusions. It is argued that the introduction of the mental health nurse practitioner role in the emergency department leads to increased staff competence and confidence in interacting with those presenting with mental health issues. The mental health nurse practitioner role also addresses the serious problem of stigma associated with those with a mental health issue. Relevance to clinical practice. It is expected that those presenting with mental health issues to the emergency department will benefit through the increased assessment and management skills of staff.

Objective: This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility. Method: Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility. Results: Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit. Conclusions: The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.

This paper explores the workforce development issues that arose in the course of an Australian repeat pilot study. The aim of the pilot study was to introduce, within a different setting, a planned approach to the assessment of, and interventions in, emotional states of service users that may lead to episodes of behavioural disturbance within psychiatric units. The pilot study necessitated training of staff in the use of an assessment tool. During the course of the study, a novel element was encountered with regard to staff understanding of service user involvement in treatment. This element, presented here as 'integral self‐intervention', emerged in conjunction with the development of two wall charts: an acute arousal management process chart for staff, and a patient safety chart for service users. The paper will outline the collaborative process towards the partial realisation of this element of integral self‐intervention, and associated workforce development issues.

Results During workshop discussions, participants (4 mentors and 5 mentees) defined the program, examined roles and responsibilities, partnerships, interaction, use of funds, conflict resolution and risk management. The workshop, conducted informally in a setting that simulated a home environment, reduced anxiety levels. Uncertainty evolved into an appreciation for the program, development of new relationships, learning that everyone had similar reservations yet reassurance that people were there to support and encourage recovery. Participants were positive and optimistic for the program’s trial. Conclusion PAR is an apt research method for actively engaging stakeholders in the development of a tailored program to support recovery.

Patient safety is compromised if vital clinical information is not available to all members of the healthcare team. Therefore, it is important to understand the differences between patient information found in nursing documentation and information presented at clinical nursing handover. Content and textual analyses of two data sets were undertaken: one containing 67 examples of nursing documentation and the other containing 195 transcripts of clinical handover to understand the scope and construction of patient information found in each communication system. Clinical handover produced a comprehensive picture of the patient's condition and care whereas nursing documentation tended to present a series of descriptions of tasks performed by nurses. There is a need to investigate new systems of communication promoting congruence between clinical handover and nursing documentation to ensure that all patient information can be accessed by all interested parties.