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"Fraser, Jennifer"
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Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study
Background
Self-care practice within the palliative care workforce is often discussed, yet seemingly under-researched. While palliative care professionals are required to implement and maintain effective self-care strategies, there appears little evidence to guide them. Moreover, there is an apparent need to clarify the meaning of self-care in palliative care practice. This paper reports qualitative findings within the context of a broader mixed-methods study. The aim of the present study was to explore the meaning and practice of self-care as described by palliative care nurses and doctors.
Methods
A purposive sample of 24 palliative care nurses and doctors across Australia participated in semi-structured, in-depth interviews. Interviews were digitally recorded and transcribed prior to inductive qualitative content analysis, supported by QSR NVivo data management software.
Results
Three overarching themes emerged from the analysis: (1)
A proactive and holistic approach to promoting personal health and wellbeing to support professional care of others
; (2)
Personalised self-care strategies within professional and non-professional contexts;
and (3)
Barriers and enablers to self-care practice.
Conclusions
The findings of this study provide a detailed account of the context and complexity of effective self-care practice previously lacking in the literature. Self-care is a proactive, holistic, and personalised approach to the promotion of health and wellbeing through a variety of strategies, in both personal and professional settings, to enhance capacity for compassionate care of patients and their families. This research adds an important qualitative perspective and serves to advance knowledge of both the context and effective practice of self-care in the palliative care workforce.
Journal Article
Engagement and Retention of Families in Universal Australian Nurse-Home-Visiting Services: A Mixed-Methods Study
Family support is offered to Australian parents of young children using a mix of targeted and universal child and family health services including nurse-home-visiting programmes. These rely on the voluntary engagement of families. In this study, the capacity to engage and retain families, including those at risk of becoming involved with child protection services, was examined. The broad objective was to identify nursing practices used at the interface of health and child protection services and to articulate those practices. Child and Family Health Nurses (CFHN) (n = 129) participated in a pragmatic, multilevel mixed-methods study. A questionnaire was used to identify nursing practices in the first phase of this study followed by focus groups in the second phase to describe these practices in more detail. Three practice themes were identified and described: enrolment, retention and conclusion of the nurse–family relationship. Universal child and family health services feature flexible, advanced, and multidimensional family support services including child protection practices. This paper focuses on practices employed by nurses to engage and retain families where child protection concerns are identified.
Journal Article
Hot bodies; Cold War: the forgotten history of breast thermography
Because surgery was one of the primary methods of cancer treatment during the mid-20th century, Lawson would frequently encounter patients with cancer in the operating room. His interest in breast cancer, specifically, seems to have been fully formed by the mid-1950s, when Lawson contributed a chapter on diseases of \"The Breast\" to the second edition of Fred Moseley's Textbook of Surgery.4 He also published a two-page article on breast cancer in the Canadian Medical Association Journal.5 In these works, Lawson drew attention to the rising rates of breast cancer in Canada, characterizing the disease as a substantial health problem for Canadian women from 40 to 60 years of age. Lawson's first foray into the field of diagnostic imaging took place in 1956, when he attempted to find a device that could accurately record the surface temperatures of the female breast. It was this search that led him to the field of infrared technology, an area that had been flourishing in the Cold War context of military weapons development. In February of 1956, Lawson read an article in TIME magazine that described the recent declassification of the Baird Evapograph, an infrared imaging instrument that had been used by the American Department of Defence in the development of heat-seeking missiles and \"night-vision\" surveillance systems.7 Inspired by this article, Lawson thought that this infrared technology could also contribute to the field of breast cancer detection, because it had the capacity to map temperature distribution over the body's surface. Although thermography is now regarded as an inferior practice by many Canadian medical communities, the thermal imaging device crafted by [Ray Newton Lawson] in the late 1950s did much for the development of modern techniques for the screening of breast cancer. Not only did it open the door for noninvasive methods for diagnosis of breast cancer, but his thermal imaging technology also facili- tated the development of better prevention, detection and screening techniques within Canada. Lawson's story also sheds light on how futuristic optimism, military modernization and increased interest in the radiation sciences affected the development of Canadian medical technologies.12 Rather than being remembered as a \"useless procedure,\" breast thermography should be remembered for what it was: a technology of the Cold War that, through medical optimism and technological tinkering, was transformed into a pioneering means of lowering the risk of canceramong women in Canada.
Journal Article
Silver nanoparticles promote the emergence of heterogeneic human neutrophil sub-populations
Neutrophil surveillance is central to nanoparticle clearance. Silver nanoparticles (AgNP) have numerous uses, however conflicting evidence exists as to their impact on neutrophils and whether they trigger damaging inflammation. Neutrophil’s importance in innate defence and regulating immune networks mean it’s essential we understand AgNP’s impact on neutrophil function. Human neutrophil viability following AgNP or Ag Bulk treatment was analysed by flow cytometry and AnV/PI staining. Whilst AgNP exposure did not increase the total number of apoptotic neutrophils, the number of late apoptotic neutrophils was increased, suggesting AgNP increase transit through apoptosis. Mature (CD16
bright
/CD62L
bright
), immature (CD16
dim
/CD62L
bright
) and apoptotic (CD16
dim
/CD62L
dim
) neutrophil populations were evident within isolated neutrophil preparations. AgNP exposure significantly reduced CD62L staining of CD16
bright
/CD62L
bright
neutrophils, and increased CD16 staining of CD16
dim
/CD62L
bright
populations, suggesting AgNPs trigger neutrophil activation and maturation, respectively. AgNP exposure dramatically increased IL-8, yet not classical pro-inflammatory cytokine release, suggesting AgNP triggers neutrophil activation, without pro-inflammation or damaging, necrotic cell death. For the first time, we show AgNPs differentially affect distinct sub-populations of circulating human neutrophils; activating mature neutrophils with the emergence of CD16
bright
/CD62L
dim
neutrophils. This may stimulate particle clearance without harmful inflammation, challenging previous assumptions that silver nanomaterials induce neutrophil toxicity and damaging inflammatory responses.
Journal Article
Characterisation of autophagy induction by the thiopurine drugs azathioprine, mercaptopurine and thioguanine in THP-1 macrophages
Activating autophagy may be therapeutically beneficial, and we have previously shown that azathioprine (AZA), an immunomodulatory drug, induces autophagy. Here, we evaluated the induction of autophagy by the thiopurines AZA, mercaptopurine (6-MP) and thioguanine (6-TG) in THP-1 macrophages and investigated the mechanism of action in the context of this cellular process. The cytotoxicity of thiopurines was evaluated using an LDH assay. Induction of endogenous LC3 by thiopurines was evaluated using immunostaining. To confirm autophagy activation by thiopurines, a GFP-RFP-LC3 reporter plasmid was used to monitor the maturation of autophagosomes to autolysosomes. Induction of apoptosis by thiopurines was evaluated using Annexin V/PI staining, and ER stress was assessed via RT‒PCR analysis of
XBP1
splicing. To gain insight into the mechanism of action of thiopurines, mTORC1 activity and eIF2α-S51 phosphorylation were evaluated by immunoblotting. Thiopurines were not cytotoxic to cells and induced strong time- and concentration-dependent autophagy. Thiopurines activate autophagy with complete progression through the pathway. Induction of autophagy by thiopurines occurred independently of apoptosis and ER stress. Immunoblotting revealed that AZA inhibited mTORC1 activity, and AZA and 6-TG increased eIF2α-S51 phosphorylation. In contrast, 6-MP had a minor effect on either signalling pathway. Thiopurines are strong inducers of autophagy, and autophagy induction should be considered among the mechanisms responsible for patient response to thiopurines.
Journal Article
hASH1 nuclear localization persists in neuroendocrine transdifferentiated prostate cancer cells, even upon reintroduction of androgen
Neuroendocrine prostate cancer (NEPC) is thought to arise as prostate adenocarcinoma cells transdifferentiate into neuroendocrine (NE) cells to escape potent anti-androgen therapies however, the exact molecular events accompanying NE transdifferentiation and their plasticity remain poorly defined. Cell fate regulator ASCL1/hASH1’s expression was markedly induced in androgen deprived (AD) LNCaP cells and prominent nuclear localisation accompanied acquisition of the NE-like morphology and expression of NE markers (NSE). By contrast, androgen-insensitive PC3 and DU145 cells displayed clear nuclear hASH1 localisation under control conditions that was unchanged by AD, suggesting AR signalling negatively regulated hASH1 expression and localisation. Synthetic androgen (R1881) prevented NE transdifferentiation of AD LNCaP cells and markedly suppressed expression of key regulators of lineage commitment and neurogenesis (REST and ASCL1/hASH1). Post-AD, NE LNCaP cells rapidly lost NE-like morphology following R1881 treatment, yet ASCL1/hASH1 expression was resistant to R1881 treatment and hASH1 nuclear localisation remained evident in apparently dedifferentiated LNCaP cells. Consequently, NE cells may not fully revert to an epithelial state and retain key NE-like features, suggesting a “hybrid” phenotype. This could fuel greater NE transdifferentiation, therapeutic resistance and NEPC evolution upon subsequent androgen deprivation. Such knowledge could facilitate CRPC tumour stratification and identify targets for more effective NEPC management.
Journal Article
Preferential activation of HIF-2α adaptive signalling in neuronal-like cells in response to acute hypoxia
Stroke causes severe neuronal damage as disrupted cerebral blood flow starves neurons of oxygen and glucose. The hypoxia inducible factors (HIF-1α and HIF-2α) orchestrate oxygen homeostasis and regulate specific aspects of hypoxic adaptation. Here we show the importance of HIF-2α dependant signalling in neuronal adaptation to hypoxic insult. PC12 and NT2 cells were differentiated into neuronal-like cells using NGF and retinoic acid, and exposed to acute hypoxia (1% O2). Gene and protein expression was analysed by qPCR and immunoblotting and the neuronal-like phenotype was examined. PC12 and NT2 differentiation promoted neurite extension and expression of neuronal markers, NSE and KCC2. Induction of HIF-1α mRNA or protein was not detected in hypoxic neuronal-like cells, however marked induction of HIF-2α mRNA and protein expression was observed. Induction of HIF-1α target genes was also not detected in response to acute hypoxia, however significant induction of HIF-2α transcriptional targets was clearly evident. Furthermore, hypoxic insult dramatically reduced both neurite number and length, and attenuated expression of neuronal markers, NSE and KCC2. This correlated with an increase in expression of the neural progenitor and stem cell-like markers, CD44 and vimentin, suggesting HIF-2α molecular mechanisms could potentially promote regression of neuronal-like cells to a stem-like state and trigger neuronal recovery following ischaemic insult. Our findings suggest the HIF-2α pathway predominates over HIF-1α signalling in neuronal-like cells following acute hypoxia.
Journal Article
Social Justice Work in the University: Understanding Student and Staff Perceptions and Aspirations for Decolonising the Curriculum from a University-Wide Survey
In recent years, we have seen social movement-based calls for social justice and decolonisation in universities around the world. Some of these have been in response to specific events such as the murder of George Floyd in 2020, while others are rooted in longer standing social movements such as Rhodes Must Fall. These movements have served as catalysts for universities to rethink their commitments to social justice. This article presents the preliminary findings of a university-wide research initiative focused on understanding student and staff perceptions of decolonisation and their aspirations for decolonial work within a post-1992 institution in the United Kingdom. Positioned within the university’s broader commitments to anti-racism and as part of a student–staff partnership project focused on interrogating contemporary coloniality, this research investigates how participants understand and experience decolonial initiatives as well as the perceived impact of these efforts on curriculum, relationships, and institutional culture. By conducting a survey, we sought to unravel the complexities surrounding how students and staff conceptualise decolonisation, articulate their aspirations for decolonial initiatives, and envision the potential of student–staff partnerships as catalysts for transformative social justice work within the university. This study aims to enrich the discourse on social justice work in higher education by offering a critical lens on decolonial efforts and highlighting opportunities for collective action to rethink knowledge production and pedagogical practices. Grounded in the belief that decolonial research partnerships between students and staff are essential, the survey and article were developed by six researchers—three staff members and three students.
Journal Article