Strategies to improve the magnetic resonance imaging experience for autistic individuals: a cross-sectional study exploring parents and carers' experiences.

BACKGROUND: Autistic individuals encounter numerous barriers in accessing healthcare, including communication difficulties, sensory sensitivities, and a lack of appropriate adjustments. These issues are particularly acute during MRI scans, which involve confined spaces, loud noises, and the necessity to remain still. There remains no unified approach to preparing autistic individuals for MRI procedures. METHODS: A cross-sectional online survey was conducted with parents and carers of autistic individuals in the UK to explore their experiences, barriers, and recommendations concerning MRI scans. The survey collected demographic information and experiential accounts of previous MRI procedures. Quantitative data were analysed descriptively, while key themes were identified within the qualitative data through inductive thematic analysis. RESULTS: Sixteen parents/carers participated. The majority reported difficulties with communication, inadequate pre-scan preparation, and insufficient adjustments during MRI scans for their autistic children. Key barriers included an overwhelming sensory environment, radiographers' limited understanding of autism, and anxiety stemming from uncertainties about the procedure. Recommended improvements encompassed accessible communication, pre-visit familiarisation, noise-reduction and sensory adaptations, staff training on autism, and greater flexibility to meet individual needs. CONCLUSIONS: There is an urgent need to enhance MRI experiences for autistic individuals. This can be achieved through improved staff knowledge, effective communication strategies, thorough pre-scan preparation, and tailored reasonable adjustments. Co-producing clear MRI guidelines with the autism community could standardise sensitive practices. An individualised approach is crucial for reducing anxiety and facilitating participation. Empowering radiographers through autism-specific education and incorporating insights from autistic individuals and their families could transform MRI experiences and outcomes.

Toward Autism-Friendly Magnetic Resonance Imaging: Exploring Autistic Individuals' Experiences of Magnetic Resonance Imaging Scans in the United Kingdom, a Cross-Sectional Survey.

Background: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments, or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed at (i) exploring the MRI scan experiences of autistic adults in the United Kingdom; (ii) identifying barriers and enablers toward successful and safe MRI examinations; (iii) assessing autistic individuals' satisfaction with MRI service; and (iv) informing future recommendations for practice improvement. Methods: We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent, and having had an MRI scan in the United Kingdom. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data. Results: We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination, but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training, and confounding societal factors impacted their MRI experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%). Conclusion: This study highlighted a lack of effective communication and coordination of care, either between health care services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centered MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals' needs/preferences, and well-trained staff.

Why is this an important issue?: Magnetic resonance imaging (MRI) is an examination that shows human anatomy and may explain the causes of symptoms. Autistic people may need MRI scans for various reasons, such as low back pain, headaches, accidents, or epilepsy. They have known sensitivities to sound, light, smell, or touch and increased anxiety, so the narrow, loud, isolating, unfamiliar MRI environment may be overwhelming to them. If MRI scans are, for these reasons, inaccessible, many autistic people will have to live with long-standing conditions, pain, or other symptoms, or have delayed treatment, with impact on their quality of life, and life expectancy. What was the purpose of this study?: We tried to understand how autistic people perceive MRI examinations, things that work, and the challenges they face. We also asked for their suggestions to improve practice and accessibility. What did we do?: We distributed an online questionnaire to autistic adults through social media. We analyzed the data using appropriate statistical and text analysis methods. What were the results of the study?: We received 112 responses. Autistic people rated their overall MRI experience as average. Nearly a third (29.6%) reported they were not sent any information before MRI, and only 17.1% reported that radiographers offered some reasonable environmental adjustments. Most participants (68%) reported that radiographers provided detailed information on the day of the scan. Only 23.2% of them disclosed their autistic identity when booking MRIs. We found that quality of communication, physical environment, patient emotions, staff training, stigma, and timely autism diagnosis impacted their MRI experiences. What do these findings add to what was already known?: Autistic people MRI scan experiences are at the heart of this project. Our project shows that MRI for common symptoms is often inaccessible by autistic people. We should improve the MRI environment, adjust communication format/content for them, and deliver person-centered care in MRI. Health care professionals should receive relevant training, to understand the challenges autistic people might face and better support them in MRI scanning. What are potential weaknesses in the study?: The pandemic has impacted participant recruitment; therefore, the results of this sample may not reflect the full impact on the wider autistic population or adequately represent the autistic community, due to small size and including only people who could consent.These results come from different centers, so there is a lot of variation in the use of MRI equipment. How will these findings help autistic adults now or in the future?: We outline the main challenges associated with MRI, so autistic adults and their families/carers understand more of what they could expect in future examinations; hopefully, researchers and scanner manufacturers will try to tackle these challenges to make MRI scans truly accessible for autistic people.We shared this knowledge with stakeholders to develop guidelines and started using it in training. We want to ensure that MRI is person-centered and more accessible for autistic patients.

A systematic scoping review of undergraduate nursing hub-and-spoke placement models.

BACKGROUND: While nursing education has been forecast to continue to grow, placement capacity is now the key factor precluding growth in supply. AIMS: To provide a comprehensive understanding of hub-and-spoke placements and their ability to increase placement capacity. METHOD: A systematic scoping review and narrative synthesis were used (Arksey and O'Malley, 2005). PRISMA checklist and ENTREQ reporting guidelines were followed. FINDINGS: The search returned 418 results. After a first and second screen 11 papers were included. Results suggest that hub-and-spoke models were generally evaluated favourably by nursing students, with a range of benefits reported. However, many of the studies included in the review were small and of low quality. CONCLUSION: Given the exponential increase in applications to study nursing, hub-and-spoke placements appear to have the potential to better meet these increased demands, while also providing a number of benefits.

A Rapid Review and Narrative Synthesis of the Consequences of Non-Inclusive Sex Education in UK Schools on Lesbian, Gay, Bisexual, Transgender and Questioning Young People.

Relationships and Sex Education (RSE) in schools are predominantly heterocentric. Consequently, lesbian, gay, bisexual, transgender, and questioning young people have reported feeling excluded. This exclusion results in feelings of being "different" and "other," which in turn leads to further disengagement in the sex education classroom, contributing to poor sexual health literacy, greater risk of abusive relationships, and higher rates of sexually transmitted infections. A rapid review was undertaken to identify the impact of non-inclusive sex education. The review makes recommendations for policy and practice, which includes the provision of training courses to school teaching staff with an emphasis on inclusive RSE, appropriate online resources for lesbian, gay, bisexual transgender, and questioning (LGBTQ) young people, as well as offering 1:1 emotional health support for LGBTQ young people as they begin to question their sexual orientation.

A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia.

LAY ABSTRACT: Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.

Factors influencing older nurses' decision making around the timing of retirement: An explorative mixed-method study.

AIM: This study aimed to understand factors influencing decision making of older nurses around timing of retirement. BACKGROUND: Global nursing shortages require flexible nurse retention strategies. METHODS: An explanatory sequential mixed-method approach: nurses across seven health care organisations within one integrated care system responded to an online survey (n = 524). Semistructured interviews and a focus group were conducted (n = 19). RESULTS: Survey data confirmed age as a key factor influencing nurses' decision making. Factors associated with retention were flexible working conditions, financial considerations and feeling valued. Factors associated with attrition were poor or deteriorating health, stress and wish for more time with family and friends. Logit regression confirmed that flexible work patterns are the strongest predictors for working beyond retirement. Qualitative data revealed that retirement plans are accompanied by personal milestones; the work environment heavily influences these plans. CONCLUSIONS: Reasons for retirement are multifaceted, but many factors are within the control of employers. Organisational policies, practices and workplace culture have a bearing on decisions surrounding the timing of retirement. IMPLICATIONS FOR NURSING MANAGEMENT: Retention strategies that allow older nurses to work part-time are key, and nurse managers need to proactively engage with older nurses to discuss their retirement plans.

An integrative review of the factors influencing older nurses' timing of retirement.

AIMS: To summarize the international empirical literature to provide a comprehensive understanding of older nurses' decision-making surrounding the timing of their retirement. BACKGROUND: The global nursing shortage is increasing. Among some countries it has become an economic imperative to consider raising the state pension age and to extend working lives. DESIGN: An integrative literature review using an integrated design. DATA SOURCES: MEDLINE, CINAHL and Business Source Premier databases were searched for studies between January 2007 - October 2019. REVIEW METHODS: Quality appraisal of the studies was conducted. Findings were summarized, grouped into categories and themes extracted. Two models were developed for data representation. RESULTS: A total of 132 studies were identified by the search strategy. Of these, 27 articles were included for appraisal and synthesis. Sixteen papers were quantitative, seven qualitative, and four mixed methods. The research took place in 13 different geographical locations. Most studies were of a questionnaire design, followed by interviews and focus groups. The total participant sample was 35,460. Through a synthesis of the studies, four themes were identified: Health, Well-being, and Family factors; Employer factors; Professional factors; and Financial factors. CONCLUSION: This review not only revealed the heterogeneity of studies on this subject and confirmed previous findings but also established a ranking of criteria that influences nurses' decision-making: age, followed by personal and organizational factors. Four extracted themes of push and pull factors map onto these factors. No 'one-size-fits-all' strategy exists to ensure the extension of older nurses' working lives. Organizations need to foster an environment where older nurses feel respected and heard and where personal and professional needs are addressed. IMPACT: Organizations need to implement HR policies addressing nurses' personal well-being and retirement preparation. Older nurses are more likely to extend their working lives if they feel committed to their organization and when professional standards are maintained.

General practitioners' perceptions on their role in light of the NHS five year forward view: a qualitative study.

BACKGROUND: The NHS is undergoing unprecedented change, central to which is policy aimed at integrating health and social care services, resulting in the implementation of new care models. GPs are at the forefront of this change. However, there is lack of academic literature on General Practitioners' perceptions on their role in light of the new models of care proposed by the NHS Five Year Forward View which this small-scale study begins to address. OBJECTIVES: This study aims to produce a description of how GP's construct their current and future general practice, professional status and identify within the context of the current NHS transformation agenda. METHODS: Qualitative study using semi-structured interviews and one focus group to gather the perspective of GPs (n = 10) working across three clinical commissioning groups in South East England. RESULTS: While the GPs embraced the principles underpinning the new care models, they were both willing and reluctant to adopt their new roles, struggled with inter-organisational and cultural barriers and their changing professional identity. CONCLUSION: Multi-professional education in primary and community care could be an effective model to offer support and resources to the development of the clinical and leadership skills GPs will require to respond effectively to the transformation agenda. The emergence of community education provider networks, innovative network organisations designed to support workforce transformation through education and training, can provide the vehicle through which clinical and leadership skills training are sourced and coordinated.

How modifiable factors influence parental decision-making about organ donation.

A global shortage of organs from children and adults available for transplantation is compounded by the failure of next of kin to consent for organs to be donated after death. Non-modifiable and modifiable factors influence decision-making in this area. Modifiable factors are of interest when examining families' decision-making about the donation of organs from their deceased child. A scoping review was undertaken to determine how modifiable factors influence parental decision-making about organ donation. Thematic analysis identified two themes: interactions with healthcare professionals and pre-disposition to organ donation. Satisfaction with experiences of hospital care, the information provided and the way it was communicated, as well as interactions pertaining to emotional support were all found to be modifiable factors that influenced decision making. Likewise, a predisposition to organ donation and knowing the deceased's wishes were associated with the consent decision. Nurses working in critical care environments need to be able to support parents during this difficult time. This article aims to raise awareness of modifiable factors that influence parental decision-making, highlighting their relevance for children's nursing practice.

Behavioural correlates of energy drink consumption among adolescents: A review of the literature.

Despite regulatory measures on the labelling of energy drinks (EDs), their consumption among adolescents continues to grow in popularity, but teachers increasingly report significant behavioural concerns among students who disclose habitual ED consumption. A review of papers published between January 2010 and October 2016 was undertaken to determine whether an association between adverse behaviour and consumption of ED exists. Findings indicate that ED consumption among adolescents is associated with alcohol and substance use, risky behaviours and psychological states including sensation seeking, depression and anxiety symptoms. ED consumption impacts negatively on executive functions and increases hyperactivity/inattention symptoms among adolescents. An inverse association between ED consumption and sleep duration exists. The findings highlight the need for greater awareness of the potential risk of ED consumption among adolescents.

School Nurses' Experiences of Managing Young People With Mental Health Problems: A Scoping Review.

Prevalence of mental health disorder is increasing among young people. It is recognized that early intervention is essential in supporting young people, and care provided within schools to support emotional well-being is recommended as part of this process. A scoping review was undertaken examining school nurses' experiences of supporting the mental health of schoolchildren. Findings suggest that school nurses have a central role in supporting young peoples' mental health, although a number of barriers exist which impact on school nurses' preparedness for this aspect of their role. While there are inconsistencies in the provision of mental health training available to support school nurses, when training is implemented it has positive outcomes for service provision and quality of care. A number of challenges for school nurses were also identified, and recommendations for practice are suggested in the article.

Attitudes towards young people who self-harm: age, an influencing factor.

AIM: To determine the attitudes of emergency care staff towards young people (aged 12-18 years) who self-harm and to gain an understanding of the basis of attitudes that exist. BACKGROUND: Young people frequently attend emergency services following self-harm; it is unclear whether being a young person influences attitudes held. DESIGN: Mixed methods using a triangulation convergent design. METHODS: Survey of 143 staff members from four accident & emergency departments and one ambulance service. Semi-structured interviews with seven children's A&E nurses and five ambulance personnel from the same locality. Data were collected during 2010. RESULTS/FINDINGS: Pearson's product moment correlation coefficient confirmed a strong positive correlation between scores on the two scales used to measure attitudes; paired samples t-test revealed a statistically significant difference in scores across the scales; practitioners held more positive attitudes towards young people who self-harmed than young people per se. Both data sets confirmed the presence of ambivalence and ambiguity in attitudes held. The qualitative data revealed that because of their age and immaturity young people were not held responsible for their self-harming behaviours. Being young did though influence subsequent admission, with particular difficulty in securing admission for those aged 16-17 reported. CONCLUSION: Age is a factor in shaping practitioners' attitudes; age also directs and influences a young person's journey through emergency care, although due to ambiguity there is inconsistency in determining where those aged 16-17 years of age fit.

Attitudes of emergency care staff towards young people who self-harm: a scoping review.

AIM: To determine whether reported attitudes towards patients who attend A&E following self-harm extend to young people. BACKGROUND: Historically A&E staff have displayed negative attitudes towards patients who self-harm, although more recent research suggests that attitudes have shifted. There is retrospective evidence of low satisfaction with A&E services by individuals who self-harmed as adolescents, with comparatively little research which has specifically examined attitudes towards adolescent self-harm available. METHOD: A scoping review of papers published from 2000 to 2012 was undertaken, papers accessed through the following databases, British Nursing Index, CINAHL, Medline, Psychology and Behavioural Science Collection, and PsychINFO. Hawker et al.'s (2002) methodology for critical appraisal was adopted. RESULTS: Eleven papers derived from nine studies were located; three studies adopted qualitative methods, two mixed methods; the remainder were quantitative adopting a survey approach to measure attitudes. The studies revealed inconsistent findings, although the setting, patients' characteristics and education and training all appear to have a bearing on attitudes towards young people who self-harm. CONCLUSION: Further research is required which considers attitudes of emergency care practitioners within the context of emergency care work, and which investigates whether being a young person per se has an influence on attitudes.

Characteristics and trends of self-harming behaviour in young people.

Deliberate self-harm is recognized as a serious public health issue in young people. There is evidence that young people who self-harm are more likely to repeat self-harm, and this in turn increases their risk of completed suicide. Prevalence studies have identified that the rate of self-harm among young people is on the increase, information largely based on data arising from review and analysis of hospital attendances. However, community-based studies indicate that the prevalence is much higher, with those seen in emergency departments representing the 'tip of the iceberg' (Hawton and Rodham, 2006). Young people's motives for self-harm are discussed, as are research findings which indicate that nurses can have negative attitudes towards patients who self-harm. The article considers the implications of this for young people and identifies areas for future research.

Sexual health promotion: the barriers school nurses face.

This paper reports on the findings of a study which aimed to determine the contribution of school nurses to promoting sexual health within schools and whether occupational and professional boundaries impinged on the school nurses' ability to undertake this aspect of their role. The research was carried out across three Primary Care Trusts (PCTs). Data were collected using semi-structured interviews, a total of 30 school nurses (n=30) from across the three PCTs were included in the study. Analysis of the data indicated that barriers in the form of gate-keepers were present and they could impede the school nurse in fulfilling her role as a health educator. This gate-keeping existed across three 'tiers': the school governors, the school (as a collective organisation) and teachers. Nurses employed a variety of strategies to negotiate their way through these gatekeepers in order to access the classroom setting, key among them was their willingness to collaborate and co-operate, by 'slotting in' with the school, the curriculum and its timetable and 'fitting in' with the teachers, as their needs dictated.

Developing expertise - the contribution of paediatric accident and emergency nurses to the care of children, and the implications for their continuing professional development.

AIM: The purpose of this paper is to explore the contribution of paediatric accident and emergency nurses to the care of children. METHOD: Using a case study approach, the paper focuses on the experiences of three nurses working in this setting, obtained through working alongside the nurses and discussing and observing their experiences. FINDINGS: It became apparent that the nurses were regarded as "experts" in the care of children in this setting. The nurses themselves however, did not share this perception. Their experiences are analysed with reference to literature on expertise, focussing specifically on published accounts of children's nurses' experiences, and research which has explored the concept of expertise within the context of accident and emergency work. The implications for continuing professional development needs are discussed within the context of recent government reports, which make recommendations in respect of access and delivery of on-going professional education. To this end it is advocated that a multi-professional approach is adopted, with children's nurses sharing learning and thus access to, courses customarily provided to adults nurses working in this setting.