Dr Oya Gumuskaya

This study aimed to provide a critical analysis of the current literature on the use of digital mental health interventions (DMHIs) for the management and treatment of mental health disorders among refugees and asylum seekers. These groups are among the most disadvantaged compared to the general population in terms of health and socio-economic status, due to conflicts and wars. The number of refugees fleeing their home countries is growing exponentially, and refugees experience trauma, torture, persecution and human right abuses, which have a profound effect on their mental health and overall well-being. The researchers conducted an integrative literature review from electronic databases Medline, CINAHL and Google Scholar, selecting articles published in English from 2010 to 2023. The thematic analysis of the 10 articles identified in the review revealed four main themes and two sub-themes: (1) types of digital health intervention/apps used; (2) barriers encountered in digital health intervention; (3) user experience of the digital health intervention and (4) mapping gaps. Two sub-themes were identified located in Theme 2: (2.1) Language and demographic barriers and (2.2) Structural barriers. The study showed that the use of DMHIs was associated with positive experiences among refugees and asylum seekers. Limited mental health care is offered to refugees and asylum seekers due to a range of logistical, political, economic, geographical, language, cultural and social barriers. DMHIs have the potential to overcome and/or moderate these barriers. The study concludes that the scaled implementation of effective DMHIs holds the possibility to improve the wider distribution of mental health care among refugees and asylum seekers. However, further research is needed to confirm the effectiveness of DMHIs and to scale up studies for their utilisation among this group. In summary, this study highlights the potential of DMHIs in improving the mental health care of refugees and asylum seekers. The results of this study have important implications for mental health service providers, policymakers and researchers to address the mental health needs of this vulnerable/priority group.

Background: Post-operative nausea and vomiting (PONV) is the second-most common post-operative complication. Prolonged pre-operative fasting is common in Australia despite guidelines recommending reduced fasting to improve patient outcomes, such as PONV. Commercially prepared preoperative oral carbohydrate (OC) drinks may be used to reduce fasting time. In this study commercial products were replaced with honey, an inexpensive and common food item. Design: Partially blinded, four parallel arms randomised controlled non-inferiority trial compared pre-operative OC loading with overnight fasting. Methods: Adult elective laparoscopic cholecystectomy and thyroidectomy patients having two or more risk factors for PONV were allocated into intervention and control groups by simple randomisation. The intervention group ingested 60g of honey in 100 ml of water at least two hours before surgery as pre-operative OC loading to reduce PONV. Participants and assessors to the group assignment were blinded to the study outcomes. Early PONV (0¿6 hours) was measured with Rhodes index of nausea, vomiting and retching (R-INVR) and a numeric rating scale (NRS). Results: The four groups (N = 142) were control and intervention groups of thyroidectomy patients (n = 72: C = 37, I = 35), and control and intervention groups of laparoscopic cholecystectomy patients (n = 70: C = 37, I = 33) and had similar distributions of variables. The estimated effect size was 140 with a 95 percent confidence interval. The PONV incidence (Pearson ¿2 = 4.54; df = 1; p = 0.03) and severity were significantly lower in the laparoscopic cholecystectomy intervention group (R-INVR: Mann¿Whitney U = 446.5; p = 0.01; NRS: Mann¿Whitney U = 444.5; p = 0.01) and results were not conclusive in the thyroidectomy group (NRS: Mann¿Whitney U = 629.5; p = 0.95; R-INVR: Mann¿Whitney U = 629.5; p = 0.76). Conclusion: Honey could be recommended as an inexpensive pre-operative OC to reduce PONV in adult patients receiving general anaesthesia.

Background: The surgical count process is currently the recommended strategy for preventing unintentionally retained surgical items (RSIs) in Australia. Despite this, RSIs still occur and remain an internationally recognised issue and sentinel event associated with morbidity and mortality. There are numerous new and emerging strategies to prevent inadvertent RSIs, apart from the surgical count, and many involve the use of technology. These strategies are not currently specified in Standards for Perioperative Nursing in Australia (the ACORN Standards). Aim: To provide an integrative synthesis of the literature to identify current and emerging strategies for preventing RSIs during surgical procedures. Design: An integrative review process was undertaken. Method: The literature search was conducted in the CINAHL, ClinicalKey and Medline databases and included primary research papers of any design about RSIs and prevention strategies in humans that were published in English between 2008 and 2022. Data was extracted and developed into a table. Quality assessment was undertaken using the Mixed Method Assessment Tool (MMAT). Findings: Based on the inclusion and exclusion criteria, 186 articles were screened and 18 studies were included following quality assessment. Data were grouped into categories according to the prevention strategies of surgical count, radiography, radiofrequency technology, barcode technology and other technologies. Conclusions: RSIs occur despite the mandated use of the surgical count, a human-based process. The use of adjunct, technological prevention strategies is not yet feasible as more research is needed into efficacy and cost-effectiveness.

Background: Surgical Conscience is a unique concept that is central to the clinical practice of perioperative nurses. It is an abstract phenomenon that explains a nurse's moral obligation to safeguard surgical asepsis and patient safety. Despite being deeply rooted in perioperative tradition, the phenomenon is poorly understood and inadequately described. Aim: To generate insight into the phenomenon of Surgical Conscience by interpreting the experiences and perceptions of perioperative nurses. Methods: Semistructured in-depth interviews were conducted with 15 Australian perioperative nurses. Interview transcripts were reviewed to identify themes and patterns within the experiences and perceptions of the participants. These were then synthesised into a conceptual model of Surgical Conscience. Findings: Surgical Conscience was defined as 'the moral obligation to uphold and defend surgical asepsis and perioperative safety no matter the cost or consequence'. The conceptual model illustrates that a Surgical Conscience is dependent on the presence of three constructs: consciousness (knowing), conscience (feeling), and agency (acting) and is moderated by contextual factors such as education, training, mentorship, environment, culture, and support. Discussion: New insight into this phenomenon makes it evident that nurturing a Surgical Conscience requires a multifaceted approach that targets each of the constructs (knowing, feeling, acting) and the contextual factors. Conclusion: To optimise surgical asepsis and patient safety, perioperative leaders should evaluate their staff and department against the conceptual model and develop an evidence-informed program to address identified deficits.

Background: As obesity affects different dimensions of health, psychosocial wellbeing of patients can be predicted to significantly improve after bariatric surgery. Method: This qualitative study focused on determining the experience of patients who underwent bariatric surgery and the psychosocial impact of it on their daily lives and provides nurses with detailed information regarding patients' experience. While some of these outcomes were in line with the literature, they have also revealed new aspects and provided deeper understanding regarding individuals' experiences. Results: Five themes were identified: limitations in physical activity, social isolation due to negative body image, increased self-esteem, change in romantic relations and fear of weight regain. Conclusion: It is necessary for individuals to be supported for long-term postoperative complications, nutritional state and eating disorders. Nurses can support patients to set achievable goals and realistic expectations in order to obtain satisfactory patient results.