The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person-centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de-emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.

Objectives This review synthesizes recent research on resilience in those who care for a family member with Duchenne muscular dystrophy, identifying the challenges and potential factors moderating resilience. Methods This systematic narrative review is informed by searches on six bibliographic databases between January and June 2016. Forty-one articles were identified to meet the inclusion criteria, and findings were synthesised around three key themes. Results Those who care for someone with Duchenne muscular dystrophy have been described as resilient through building strength in facing the adversity of caring. The main predictors of carer resilience were the child's level of disability, perception of the caring experience and family functioning. The outcomes of resilience were identified as better psychological and physical health as well as psychological adaption. Coping abilities and social support, influenced by individual and environmental factors contribute to resilience. Discussion Research suggested that some carers have the ability to build resilience over time, although limited understanding of coping with the emotional experience of Duchenne muscular dystrophy is conveyed. Social support appears to be a protective factor for Duchenne muscular dystrophy carers but further research is required on its relationship with resilience.

Introduction: End-stage kidney disease causes significant morbidity, mortality, and reduced quality of life. Despite improvements in conventional hemodialysis, these problems persist. In-center nocturnal hemodialysis (INHD) has been shown to be beneficial in observational studies. This report outlines a 4-year renal network experience of INHD from the patient and frontline staff perspective. Methods: Staff and patients' experiences of INHD were evaluated through two work streams. Work stream one: 12 patients who chose to stop INHD and 24 patients who chose to continue with INHD completed an anonymous survey. Work stream two: one-to-one interviews with 20 patients receiving INHD and seven staff working INHD shifts were conducted. Clinical incident reporting for conventional hemodialysis and INHD from April 2014 to December 2018 was reviewed. Findings: Work stream one: Five themes were identified; facilities, time, health and well-being, sleep, and transport. A patient "starter pack" was developed and improvements to the dialysis unit were completed. Work stream two: Patient interviews demonstrated starter packs to aid sleep were well received; sleep itself was not a single reason to discontinue INHD. Staff indicated that their greatest concern was staffing levels; although staff-topatient ratio remains unchanged, total numbers on INHD shifts were fewer, causing concern around less colleague availability for support during an emergency. Safety: 363 clinical incidents were reported across all dialysis

With continued growth in the demand for nursing care, many organizations have incorporated nursing assistants into the acute care workforce. However, role descriptions are often generic and do not provide clarity in specialist areas such as mental health inpatient settings. Issues have been noted regarding the role of assistants, delegation, and their integration with the nursing team. This study extended an existing set of care activities and explored the perceptions of nursing assistants and registered nurses regarding these activities. A modified Delphi approach added 14 new care activities for nursing assistants. A follow‐up survey found significant differences between nursing assistants and registered nurses regarding utilization of the activities, delegation, teamwork, and role clarity. Future research must incorporate the perspectives of those with lived experience of mental health issues, and develop an understanding of the interactions between nursing assistant care activities and other factors such as local supports, skillmix, and the practice environment, as these may impact how an organization can introduce nursing assistants to specialty areas while maintaining consumer and staff safety.

Surgical problems presenting at sea during 100 British Polaris submarine patrols have been reviewed. In 106 patients the medical officer of the submarine made a diagnosis of surgical illness sufficiently serious that in normal practice referral to hospital might be considered necessary. The emergency “operating theatre” has been used on only one occasion. One patrol was broken because of surgical illness but this did not break the continuous deterrent threat. There has been no death at sea and as far as we are aware no maior morbidity has arisen as a result of delayed definitive treatment. The policy of conservative management of surgical problems presenting at sea in submarines is considered fully justified.