Insulin receptor signaling engages bladder urothelial defenses that limit urinary tract infection

Urinary tract infections (UTIs) commonly afflict people with diabetes. To better understand the mechanisms that predispose diabetics to UTIs, we employ diabetic mouse models and altered insulin signaling to show that insulin receptor (IR) shapes UTI defenses. Our findings are validated in human biosamples. We report that diabetic mice have suppressed IR expression and are more susceptible to UTIs caused by uropathogenic Escherichia coli (UPEC). Systemic IR inhibition increases UPEC susceptibility, while IR activation reduces UTIs. Localized IR deletion in bladder urothelium promotes UTI by increasing barrier permeability and suppressing antimicrobial peptides. Mechanistically, IR deletion reduces nuclear factor κB (NF-κB)-dependent programming that co-regulates urothelial tight junction integrity and antimicrobial peptides. Exfoliated urothelial cells or urine samples from diabetic youths show suppressed expression of IR, barrier genes, and antimicrobial peptides. These observations demonstrate that urothelial insulin signaling has a role in UTI prevention and link IR to urothelial barrier maintenance and antimicrobial peptide expression.

Developing A&E nursing responses to people who deliberately self-harm: the provision and evaluation of a series of reflective workshops

Accident & Emergency (A&E) departments and Medical Admission Units (MAUs) are an essential part of emergency mental health care in the UK. Deliberate self-harm and attempted suicide are particular challenges to nursing staff in such departments. Two registered mental nurses with experience of education facilitated a series of workshops with nurses from four A&E departments, two Minor Injuries Units and two MAUs. These were focused upon the assessment and management of deliberate self-harm and attempted suicide. During the workshops, participants provided systematic information on presentations of deliberate self-harm and attempted suicide, and on their professional responses to such presentations. These accounts provided invaluable information on deliberate self-harm and attempted suicide as seen by nursing staff in A&E and MAUs. Critical reflection upon nursing responses to these presentations revealed particular concerns nurses had relating to their experience with this client group which might inform future practice. Evaluation of the workshops indicated a subsequent decrease in work-related stress, which was probably a consequence of improved professional coping responses by the nurses concerned.

The development and evaluation of a brief risk screening instrument for the psychiatric inpatient setting

This paper reports on the development and evaluation of a risk screening instrument (RSI) intended for use by nursing staff on general acute psychiatric admission wards. The RSI comprised six questions concerning patient status on admission (e.g. sex, legal status, employment) and 11 items of judgement concerning the presentation of the patient (e.g. threatening behaviour, suicidality, family and social support). The interrater reliability of the RSI was calculated to be 85% overall. The predictive value of the RSI was not confirmed when tested against harmful incidents subsequent to admission. However, the mean RSI score of that group of patients involved in harmful incidents tended to be higher than that group of patients not involved in such incidents, and all such incidents were found to occur within eight days of admission. Analysis of other data collected in the course of the study revealed discrete patient groups and provided systematic insights into their characteristics, which are potentially valuable when considering the nursing skills required on acute psychiatric inpatient units. It is concluded that the RSI tested has the potential to contribute to the assessment and management of risk within the acute psychiatric inpatient setting, by augmenting and guiding clinical judgement.

From psychiatric science to folk psychology: an ordinary-language model of the mind for mental health nurses

In this paper it is argued that, if mental health nurses are to integrate the skills necessary to accomplish the diverse tasks that comprise their professional role, then what is required is a conception of mind independent of any particular paradigm in the biophysical and psychosocial sciences. This is proposed as a necessary condition of articulating the professional autonomy of mental health nurses. A four-part model of mental functioning is presented and developed, drawing on the ordinary language of folk psychology. Objections to this strategy are anticipated and answered. The utility of the model is demonstrated by deploying it to analyse emotional states and to show how subjective experience is a necessary component of mental ill-health, which is why empathic understanding is a necessary skill for mental health nurses. Finally, the major research paradigms associated with scientific approaches to the care and treatment of mental ill-health are aligned with the elements of the model to demonstrate the potential of that model for clarifying the rationale of theoretically divergent treatment approaches for the benefit of both nurses and their clients. It is emphasized that the proposed model is 'theory' only in the weak sense of being a 'systematic account' of the mental life.

Problems of service assessment ab intra: research and evaluation relating to a new early intervention community psychiatric nursing service

This paper summarizes a 12-month evaluation of an emergency assessment and community care psychiatric nursing service to demonstrate the possibility and desirability of health service providers evaluating their own service provision. The radical question central to such an assessment is: 'What would have been the case if the service assessed had not existed?' This question is more difficult to answer than might at first appear. However, recent changes in UK legislation concerning health care in general, and community care of the mentally ill in particular, make the assessment of new services of great importance. What is most needed in making such assessments is not technical expertise in data collection and analysis but non-specialized critical acumen in making inferences from data routinely collected in the course of providing any service. This is illustrated using the example of a community psychiatric nursing service which afforded an opportunity to consider the impact of a new project on established services.

On laying the foundations for an empirico-logical model of mental health nursing

This paper argues that nursing is an elemental activity, the first concern of which is a person's experience of illness, not the causes of that experience. Any model of nursing should begin with an account of that experience and deduce from that what it is that nurses ought to do in order to explain what it is that they actually do. The logical form of such a model is delineated. An account of the experience of illness is offered and the nursing imperatives implied by such an account are stated in terms of securing client safety, obviating the client's experience by treatment and motivating the client to sustain or resume ordinary activities of life. These dimensions of nursing care--safety, treatment and motivation--were tested against the actual activities of mental health nurses in three services and were found to have utility as categories of nursing activity. A summary of that research is given and an outline of a model of mental health nursing suggested by the results is given.