Therapeutic and informal interactions with nurses are integral to the quality of care that psychiatric patients receive. How well these interactions are performed, and their impact on the experience and outcomes of inpatient care, have not been subject to systematic evaluation. The aim of the present study was to examine patients' perceptions of the personal and professional qualities of nursing staff and how these contribute to the ward environment. Patients (n = 119) from 16 acute psychiatric wards were interviewed using a schedule developed by a service-user researcher. Transcriptions of interviews were coded and organized into six themes: staff duties, staff disposition, control, communication and engagement, therapeutic ward environment, and consistency. Patients recognized that nurses have a difficult and stressful job, but frequently expressed feelings of anger, frustration, and hopelessness about their experience of the wards. Patients frequently felt that nursing staff did not understand issues from their perspective or attempt to empathize with them. The findings indicate poorly-communicated and inconsistent care. Initiatives to improve patients' experiences of acute psychiatric wards are urgently needed.
Accessible Summary People with intellectual disabilities who have limited, or no verbal communication can be involved in research. Ethnographic observations and interview techniques can work together with photovoice. More research needs to be completed directly involving people with intellectual disabilities. Abstract BackgroundInclusive research requires adapting methodologies to meet the needs of people with all degrees of intellectual disabilities. However, it must also balance this with the requirements of academic research. Building from previous research a study was completed to illustrate how photovoice could not only be adapted to meet the needs of people with intellectual disabilities who have limited or no verbal communication but to also explore how they express their identity. MethodsA qualitative multiple case study method was used to explore identity expression amongst three participants with intellectual disabilities and limited or no verbal communication. The methodology integrated ethnographic observations, photovoice and interview techniques. FindingsIntegrating the ethnographic observations, photovoice and interview techniques offered families and carers the opportunity to become curious about participants' identities, and this methodology was considered valuable in getting to know more about the person. ConclusionsIt is hoped that through conducting research that directly involves people with intellectual disabilities, more creative and inclusive methods can be explored, verified and applied across various research contexts.
Iron is one of the most abundant metals in the human body. However, it is only recently that many of the molecular mechanisms involved in the absorption and metabolism of this essential trace element have been elucidated. Dietary non-haem iron is absorbed via the divalent metal transporter (DMT1) following conversion from Fe(III) to Fe(II) by both dietary reducing agents and the endogenous ferric reductase Dcytb. Efflux of iron into the plasma is achieved by the IREG1 protein working in concert with a ferrioxidase, hephaestin to allow Fe(III) to be loaded onto transferrin for onward transport in the plasma. Current consensus suggests that the regulation of intestinal iron absorption relies on signals generated in the main sites of iron storage (the liver) and utilization (the bone marrow) to indicate body iron status, which together co-ordinate intestinal uptake with body requirement. This information, conveyed by factors such as transferrin saturation and serum levels of hepcidin, is integrated by the duodenal crypt cells, which act as iron sensors and pre-programme the level of expression of the iron transport proteins relative to body iron status. Recent data suggest that mature enterocytes also possess significant plasticity and can respond rapidly (within minutes to a few hours) to local changes in dietary iron levels, fine-tuning absorption to efficiently match the body's metabolic requirements. DMT1 expression is also down-regulated by other heavy metals thought to be substrates for this transporter. This may be an adaptive mechanism to avoid toxic build up of these metals in the body.
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