Student nurses' experiences of discrimination and racism on work placements: What can higher education institutions do?

BACKGROUND

There is persistent interpersonal, institutional and structural racism within the health sector and higher education. Such anti-Black and anti-Brown racisms are experienced by nursing students, nursing apprentices and fully qualified nurses. This discrimination intersects with other characteristics, namely gender and student status, which can make the nursing profession an unsafe environment for many.

OBJECTIVES

To understand student nurses' experiences of racism and intersecting oppressions, at university and on work placement.

DESIGN

A qualitative descriptive study with individual interviews and focus groups.

SETTINGS

A widening participation higher education institution in London, UK.

PARTICIPANTS

Twenty-four student nurses and nurse apprentices studying on an adult nursing programme.

METHODS

Students were recruited through purposive sampling. In-depth data relating to student nurses' perspectives and experiences were gathered through two focus groups and three individual interviews conducted by student nurse peers. Interviews were transcribed verbatim and open coding was used to analyse transcripts using comparison and thematic analysis.

RESULTS

Three key themes arose: safety and support in the university space; hierarchical treatment in work placements due to intersecting race and 'student' identities, and; direct racism by patients and staff in work placements.

CONCLUSIONS

Student nurses expressed their vulnerability to discrimination and racism whilst on placement in the National Health Service. More opportunities within university curricula are needed for student nurses to learn about, reflect on, and gain support for managing experiences of discrimination in the health system.

PYY3-36 infused systemically or directly into the VTA attenuates fentanyl seeking in male rats

More effective treatments for fentanyl use disorder are urgently needed. An emerging literature indicates that glucagon-like peptide-1 receptor (GLP-1R) agonists attenuate voluntary opioid taking and seeking in rodents. However, GLP-1R agonists produce adverse malaise-like effects that may limit patient compliance. Recently, we developed a dual agonist of GLP-1Rs and neuropeptide Y2 receptors (Y2Rs) that attenuates fentanyl taking and seeking at doses that do not produce malaise-like effects in opioid-experienced rats. Whether activating Y2Rs alone is sufficient to reduce opioid taking and seeking, however, is not known. Here, we investigated the efficacy of the Y2R ligand PYY3-36 to reduce fentanyl self-administration and the reinstatement of fentanyl-seeking behavior, a model of relapse in humans. Male rats were allowed to self-administer fentanyl (2.5 μg/kg, i.v.) for 21 days on a fixed-ratio 5 (FR5) schedule of reinforcement. Rats were then pretreated with vehicle or PYY3-36 (50 μg/kg s.c.; 0.1 and 1.0 μg/100 nL intra-VTA) prior to fentanyl self-administration test sessions. There were no effects of systemic or intra-VTA PYY3-36 on intravenous fentanyl self-administration. Opioid taking was then extinguished. Prior to subsequent reinstatement test sessions, rats were pretreated with vehicle or PYY3-36 (50 μg/kg s.c.; 0.1 and 1.0 μg/100 nL intra-VTA). Both systemic and intra-VTA administration of PYY3-36 attenuated fentanyl reinstatement in male rats at doses that did not affect food intake or produce adverse malaise-like effects. These findings indicate that Y2R agonism alone is sufficient to decrease fentanyl-seeking behavior during abstinence in opioid-experienced rats and further support strategies aimed at targeting Y2Rs for treating opioid use disorders.

Exploring apprentice nursing associates' experiences of their home placements in primary care or social care

BACKGROUND

An increasing number of apprentice nursing associates undertake their home placement in primary care or social care, but there is limited understanding of apprentice nursing associates' experiences in these settings.

AIM

To explore apprentice nursing associates' experiences of a home placement in primary care or social care and provide initial insight into what may support or hinder their professional development in these settings.

METHOD

A mixed-methods study design was used with qualitative interviews complemented by a quantitative survey. Participants were recruited among 27 current or former apprentice nursing associates studying at one London university. Eleven current or former apprentices were interviewed and 15 completed the survey.

FINDINGS

Participants' motivations for applying to become nursing associates were to develop professionally and advance their careers. They experienced supportive learning environments where they felt part of the team, but also unsupportive learning environments where they were denied protected learning time and supervised practice. Several participants experienced unfair treatment and abuses of power, including non-payment for university days and external placements, sexual harassment and marginalisation.

CONCLUSION

Apprentice nursing associates can have suboptimal experiences of home placements in primary care or social care and be subjected to unfair treatment and abuse. Urgent action is required from higher education institutions and employers to ensure apprentice nursing associates are adequately supported.

Epigenetic effects of folate and related B vitamins on brain health throughout life: Scientific substantiation and translation of the evidence for health improvement strategies

Suboptimal status of folate and/or interrelated B vitamins (B12 , B6 and riboflavin) can perturb one-carbon metabolism and adversely affect brain development in early life and brain function in later life. Human studies show that maternal folate status during pregnancy is associated with cognitive development in the child, whilst optimal B vitamin status may help to prevent cognitive dysfunction in later life. The biological mechanisms explaining these relationships are not clear but may involve folate-related DNA methylation of epigenetically controlled genes related to brain development and function. A better understanding of the mechanisms linking these B vitamins and the epigenome with brain health at critical stages of the lifecycle is necessary to support evidence-based health improvement strategies. The EpiBrain project, a transnational collaboration involving partners in the United Kingdom, Canada and Spain, is investigating the nutrition-epigenome-brain relationship, particularly focussing on folate-related epigenetic effects in relation to brain health outcomes. We are conducting new epigenetics analysis on bio-banked samples from existing well-characterised cohorts and randomised trials conducted in pregnancy and later life. Dietary, nutrient biomarker and epigenetic data will be linked with brain outcomes in children and older adults. In addition, we will investigate the nutrition-epigenome-brain relationship in B vitamin intervention trial participants using magnetoencephalography, a state-of-the-art neuroimaging modality to assess neuronal functioning. The project outcomes will provide an improved understanding of the role of folate and related B vitamins in brain health, and the epigenetic mechanisms involved. The results are expected to provide scientific substantiation to support nutritional strategies for better brain health across the lifecycle.

‘Most Important Events’ and Therapeutic Factors: An Evaluation of Inpatient Groups for People with Severe and Enduring Mental Health Difficulties

People with severe and enduring mental health difficulties attending groups on 10 inpatient wards were asked to identify the ‘Most Important Event’ (MIE) in each group session they attended, as part of a routine service evaluation. Using the methods of thematic analysis, five main themes were identified from the 192 Most Important Events recorded over the course of one year: Being part of a group, Communication, Help and support, Hope for the future, and Relationships. The main themes and subthemes were largely compatible with Yalom’s therapeutic factors, but also suggested that more fundamental levels of therapeutic factors may be present in groups with people with severe and enduring mental health difficulties. These factors include feeling connected, communication, and a sense of belonging. This evaluation of Most Important Events in inpatient groups adds to the evidence base in the field of group analysis and group psychotherapy.

Community learning disability teams: the need for objective methods of prioritization and discharge planning

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

Caseload management in learning disabilities

Like most health and social services, community learning disability teams are under increasing pressure to manage burgeoning caseloads without extra resources, both in terms of finances and staffing. This paper describes how one team set out to help practitioners manage their caseloads by developing tools to standardise workloads and prioritize referrals according to client need.