Oculomotor, vestibular, reaction time, and cognitive tests as objective measures of neural deficits in patients post COVID-19 infection.

Objective: An alarming proportion (>30%) of patients affected by SARS-CoV-2 (COVID-19) continue to experience neurological symptoms, including headache, dizziness, smell and/or taste abnormalities, and impaired consciousness (brain fog), after recovery from the acute infection. These symptoms are self-reported and vary from patient to patient, making it difficult to accurately diagnose and initiate a proper treatment course. Objective measures to identify and quantify neural deficits underlying the symptom profiles are lacking. This study tested the hypothesis that oculomotor, vestibular, reaction time, and cognitive (OVRT-C) testing using eye-tracking can objectively identify and measure functional neural deficits post COVID-19 infection. Methods: Subjects diagnosed with COVID-19 (n = 77) were tested post-infection with a battery of 20 OVRT-C tests delivered on a portable eye-tracking device (Neurolign Dx100). Data from 14 tests were compared to previously collected normative data from subjects with similar demographics. Post-COVID subjects were also administered the Neurobehavioral Symptom Inventory (NSI) for symptom evaluation. Results: A significant percentage of post COVID-19 patients (up to 86%) scored outside the norms in 12 out of 14 tests, with smooth pursuit and optokinetic responses being most severely affected. A multivariate model constructed using stepwise logistic regression identified 6 metrics as significant indicators of post-COVID patients. The area under the receiver operating characteristic curve (AUC) was 0.89, the estimated specificity was 98% (with cutoff value of 0.5) and the sensitivity was 88%. There were moderate but significant correlations between NSI domain key variables and OVRT-C tests. Conclusions: This study demonstrates the feasibility of OVRT-C testing to provide objective measures of neural deficits in people recovering from COVID-19 infection. Such testing may serve as an efficient tool for identifying hidden neurological deficits post COVID-19, screening patients at risk of developing long COVID, and may help guide rehabilitation and treatment strategies.

The impact on relationships following disclosure of transgenderism: a wife's tale.

WHAT IS KNOWN ON THE SUBJECT?: The experiences of transgender people are becoming increasingly more visible in popular culture, biographical literature and the media. The topic has received little attention within the psychiatric and mental health nursing literature. There is a paucity of literature exploring the impact on relationships following a disclosure of transgenderism. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A narrative account of the consequences for the wife of one transwoman and their relationships with friends and family following the disclosure of transgenderism. The article identifies a range of issues that require further attention in relation to healthcare provision. These include the mental health needs of partners and spouses; attitudes of healthcare professionals towards transgender issues; and the adequacy of the formal support offered to partners and spouses of transgender people. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need for healthcare practitioners to explore their understanding of transgender issues and how these may impact on the mental health of partners and spouses. It is important that healthcare professionals provide a hopeful and supportive environment to enable couples to explore their relationships following disclosure of transgenderism.

Visa refusal following compulsory hospital admission under the Mental Health Act 1983 (England and Wales): fact or fiction?

ACCESSIBLE SUMMARY: Historically, compulsory hospital admission led to discrimination for service users. For example, until recently detention under the Mental Health Act 1983 (England and Wales) would disqualify a person from being a Member of Parliament. There is a belief among mental health professionals that compulsory hospital admission will result in service users being refused a tourist visa. However, there is a paucity of literature on this topic, particularly from an international perspective. Based on the information reviewed in this study, there is no evidence to support this belief. Of 262 travel destinations, 96 (36.6%) require British citizens to obtain a tourist visa. Six (2.3%) destinations require applicants to declare a mental health condition in order to obtain a tourist visa. None of these destinations ask applicants to declare a history of compulsory hospital admission. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health nurses require education to ensure that their knowledge of mental health legislation is up to date. This education should include information on the potential consequences of compulsory hospital admission for the service user's social life following discharge. Service users and their families should be provided with written information on the potential social impact of detention along with a list of organizations that can provide advice on specific issues. ABSTRACT: This study sought to establish whether a history of compulsory hospital admission prevented a person from obtaining a tourist visa. A visa application form and/or other relevant information were obtained for 262 travel destinations visited by British citizens. Ninety-six (36.6%) destinations require British citizens to obtain a tourist visa. All visas are issued subject to travellers meeting a number of conditions, for example being in possession of travel insurance. Six (2.3%) destinations (Australia, China, Guam, Puerto Rico, Russia and the USA) ask applicants to declare a mental health condition. None of these destinations require applicants to disclose whether they have been admitted to hospital, either informal or under a section of the Mental Health Act 1983. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health professionals need to acquire accurate knowledge of the potential consequences of compulsory hospital admission. This will enable them to support service users more effectively. Similarly, service users need to be aware of the implications of detention for their social life following discharge from hospital. Further research is required in this area, particularly from an international perspective.

Section 5(4) (nurse's holding power) of the Mental Health Act 1983: a literature review.

Section 5(4) (nurse's holding power) of the Mental Health Act 1983 permits nurses of the 'prescribed class' to detain an informal inpatient. The patient must already be receiving treatment for mental disorder. The section lasts for up to 6 h. Section 5(4) is over 30 years old; however, there is relatively little literature exploring its use. Existing literature has limited itself to surveys and audits investigating: nurses' opinions of Section 5(4); nurses' knowledge of Section 5(4); and trends associated with the implementation of Section 5(4). The literature review suggests that what is known about the implementation of Section 5(4) is incomplete. For example, there are no accounts of how and why the holding power is implemented from both a nursing and patient perspective. Section 5(4) (nurse's holding power) of the Mental Health Act 1983 in England and Wales accounts for 10% (n = 1714) of all detentions after admission to hospital. It is followed by further detention in 66% of cases and may require nurses to restrain, seclude or closely observe the patient to prevent them harming themselves and/or others. To conduct a literature review of empirical articles concerning the implementation of Section 5(4), a literature search was undertaken in ASSIA, British Nursing Index, Medline, PsycINFO and Lawtel, using a combination of the keywords 'Section 5(4)', 'nurse's holding powers', 'holding powers', 'Mental Health Act 1983', 'MHA', 'compulsory detention', 'formal detention', 'emergency psychiatric interventions', 'containment interventions' and 'involuntary commitment'. Twenty-five articles were included in the review. Existing literature has focused on surveys and audits investigating: nurses' opinions of Section 5(4); nurses' knowledge of Section 5(4); and trends associated with the implementation of Section 5(4). While this literature has provided some insights into the implementation of Section 5(4), it is clear that what is known about its use is incomplete. Further research is required to examine a number of areas, for example, how and why the section is implemented.

Section 5(4) (The nurse's holding power): patterns of use in one mental health trust (1983-2006).

The majority of studies exploring the use of Section 5(4) (Nurses' holding power) of the Mental Health Act 1983 are now dated, report on small numbers and have been undertaken over relatively short periods of time. A retrospective study was undertaken which sought to identify the factors associated with the use of the section in one mental health trust over a 24-year period (1983-2006). Section 5(4) was applied on 803 occasions, an average of 33.4 times per annum. The majority of sections were applied to female patients (58.4%) by male nurses (54.9%) within adult acute inpatient settings (93.4%). Significant differences were noted in the use of the section over the 24-h period but not for month of the year or day of the week. A total of 349 (43.5%) sections were implemented during doctors' 'office hours' (Monday-Friday, 9:00 h to 17:00 h). The mean length of time spent on the section was 140 min; 80.6% of patients were assessed by a doctor within 4 h; and 8.3% remained on the section for 6 h or more. The holding power was converted to another section of the Act on 642 (80%) occasions. A similar, multi-sited prospective study could be undertaken to validate the findings of this study.

Nurses' accounts of locked ward doors: ghosts of the asylum or acute care in the 21st century?

The practice of locking acute ward doors in the UK to manage patient care has been reported with increasing frequency in a number of recent official documents; however, there is little research examining the practice. This study explores the perceptions and experiences of mental health nurses working on acute wards where the doors are locked for all or part of a shift. Audio-taped, semi-structured interviews were undertaken with 11 qualified mental health nurses and analysed using content analysis. Six broad categories were identified: policies and documentation, locking and unlocking the doors, communicating the decision, reasons for locking the doors, benefits and concerns. The findings suggest that there is a need for mental health nurses to reflect on the reasons for, and wider implications of locking ward doors before their wholesale implementation is considered in the UK.

A survey of mental health nurses' experiences of stalking.

Although an increasing amount of literature has appeared in recent years on the subject of stalking, little is known about mental health nurses' (MHNs) experiences of this phenomenon. The aims of the study were to investigate: (1) the incidence of stalking among a sample of MHNs in the UK; (2) who the perpetrators were; (3) the impact of stalking on MHNs; and (4) how MHNs manage their experiences. Employing a survey design, the British version of the Rutgers-Penn clinicians and stalking questionnaire was distributed to a convenience sample of 400 MHNs in the UK. Data were analysed by means of descriptive statistics and McNemar test. The findings reveal that: (1) 50% (n = 56) of MHNs who completed the questionnaire had been stalked; (2) on the whole, victims were female (78.6%) and stalkers males (82.1%); (3) stalkers were from a variety of social groups including mental health service users and MHNs; (4) victims were threatened, followed, physically assaulted and received unwanted communication; (5) MHNs reported a variety of stress-related (psychological and behavioural) responses to their experiences; and (6) employed a range of coping strategies. This study serves to raise awareness of a number of issues surrounding an under-reported phenomenon in mental health nursing and points to the need for further research to explore the reliability and consequences of the findings.

A study on how mental health practitioners address ethical issues in clinical audit.

Although much debate has taken place within the literature on the differences between research and clinical audit, the ethical dimensions of audit have frequently been neglected. Furthermore, no research has of yet explored what ethical issues auditors consider in relation to their projects or how they manage them in practice. Using data collected from audit documentation, semi-structured interviews and a researcher-administered questionnaire, this study sought to advance this position by exploring how 14 clinicians undertook audits in one mental health Trust addressed the ethical dimensions of their project. Analysis of the data revealed that the Trust had no formal mechanisms for reviewing and monitoring audit projects whilst other informal mechanisms were not utilized by all auditors. A number of projects had contact with both clinicians and service users through interviews, focus groups and questionnaires; however, issues such as informed consent, confidentiality and anonymity were not adequately addressed by auditors. The implications of these findings are discussed and recommendations for practice outlined.

"Unlearning" automatic biases: the malleability of implicit prejudice and stereotypes.

The present research suggests that automatic and controlled intergroup biases can be modified through diversity education. In 2 experiments, students enrolled in a prejudice and conflict seminar showed significantly reduced implicit and explicit anti-Black biases, compared with control students. The authors explored correlates of prejudice and stereotype reduction. In each experiment, seminar students' implicit and explicit change scores positively covaried with factors suggestive of affective and cognitive processes, respectively. The findings show the malleability of implicit prejudice and stereotypes and suggest that these may effectively be changed through affective processes.

Patterns of self-disclosure among mental health nursing students.

Self-disclosure, a process by which we let ourselves be known to others, is an important skill across a diverse range of therapeutic approaches used in mental health nursing. Previous studies of nurses' self-disclosure have been confined to small samples of female, adult nurses. This study aims to extend existing knowledge by providing information on a sample of male and female mental health nursing students.A modified version of Jourard's 25-item self-disclosure questionnaire (JSDQ) was utilized in the study. The findings from this study show that mental health students disclosed more items than adult students sampled in earlier studies (Jourards 1961, Burnard & Morrison 1992). However, students disclosed significantly fewer items to the patient as target-person than to other categories. No differences were observed in disclosure patterns for males and females. A discussion of these findings and their implications is offered.

Nursing scholarship within the British university system.

This article is a review of how a school of nursing and midwifery might promote scholarship within the university system. It is argued that the emphasis on research in universities has undermined the importance of scholarship within education and practice. The difficulties of recognizing scholarly processes as opposed to products such as publications is outlined in relation to three areas of potential scholarship within nurse education, i.e. research, teaching and practice. Issues are raised about how scholarship might be promoted in these three areas in practical terms. It is argued that systems of recognition and reward should be equitably distributed between these wide areas of potential scholarship. This will mean universities accommodating different models of scholarship and nurses recognizing their responsibility to contribute to scholarly activity.

Assessing therapeutic intervention used by NHS Direct nurse advisers.

The National Service Framework for Mental Health has identified NHS Direct as a "new point of access" to appropriate mental health services. Mental health calls account for approximately 4% of all calls received by NHS Direct but raise the greatest level of anxiety among advisers and take twice as long to deal with as other calls. In order to provide adequate advice, it is essential to ensure nurse advisers can deal with this type of call. As a first step in meeting these needs this short research article reports on the types of interventions deployed by 18 nurse advisers during role-plays with a mental health "client" expressing self-harm.

The pharmaceutical industry and mental health nursing.

Mental health nurses (MHNs) have a long and varied relationship with the pharmaceutical industry, including the attendance of educational seminars and the acceptance of promotional material. This article presents evidence that suggests MHNs may need to review this relationship regardless of their beliefs about the role of pharmacological interventions in the treatment of mental illness. It also explores the influence of advertising within professional journals and calls for greater debate on this issue.

Clinical supervision in mental health nursing courses.

The Department of Health (DoH, 1994) advocated the introduction of clinical supervision into mental health nursing practice and suggested that student nurses be prepared in what to expect from this process. The ENB (1995) supported this recommendation but has offered no guidelines on how it is meant to be implemented. This article reports on an educational initiative in which group supervision was implemented within one cohort of preregistration mental health nursing students. The students reported a number of perceived benefits: a greater understanding of the purpose and benefits of clinical supervision; skill development; the opportunity to reflect on practice; and the reduction of stress.

Immediate angioplasty for acute myocardial infarction: a community hospital's experience.

This study describes prospective outcome data from 100 consecutive patients presenting with acute myocardial infarction and treated with immediate angioplasty in a community hospital setting. Successful angioplasty was achieved in 86% of patients with a mean reperfusion time of 77.5 minutes. Only 4 patients did not survive initial hospitalization; three of these initially presented with cardiogenic shock. The survival rate in noncardiogenic shock patients was 98.9%. Four patients underwent repeat angioplasty of the infarct-related artery and 6 patients were referred for coronary artery bypass surgery during initial hospitalization. During the 6 month follow-up, nine patients required repeat hospitalization. Seven of these patients presented with recurrent ischemia; four underwent repeat angioplasty and 3 coronary artery bypass surgery. There were no subsequent deaths or reinfarctions during the 6 month follow-up. The angioplasty success rate and clinical outcomes in this study compare favorably to previous trials performed in select interventional centers and suggest that immediate angioplasty can be the preferred reperfusion therapy in a community hospital setting.

The nurse's holding power: patterns of use in mental health.

Implementation of the nurse's holding power (Section 5(4) of the Mental Health Act 1983) is an important, yet poorly researched aspect of mental health nursing practice. Data collected from the Mental Health Act records of all patients detained under Section 5(4) in one trust from 1983 to 1997 suggest that detainees generally came from the acute mental health services, were female, were detained by male registered mental nurses and were held for an average of 2 hours and 24 minutes before being placed on another section of the Mental Health Act. The use of Section 5(4) seems to be influenced by the time of day, but not the day of the week, or month of the year. Peaks of Section 5(4) usage corresponded to such factors as the changeover of shifts, the absence of medical staff, visiting time and medicine rounds. The importance of these findings for clinical practice is discussed.

Student nurses perceptions of their interpersonal skills: a re-examination of Burnard and Morrison's findings.

Heron's six category intervention analysis is a component of many counselling courses and is used extensively by teachers of interpersonal skills within nursing curricula. The popularity of this framework has generated a number of studies which have attempted to offer empirical support for the theory. The aim of this study was to re-evaluate some of these findings. Utilising an earlier research instrument, a set of findings are offered and comparisons made with previous work. Our findings suggest that student nurses perceive themselves to be most skilled in the use of supportive, prescriptive and cathartic interventions and least skilled in the use of informative, catalytic and confronting interventions. A discussion of the new findings and their implications is offered.