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Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention.

Purpose Health-care student resilience is a well-researched topic, although the concept continues to evolve, not least as “resilience-building” has become an expected feature of health-care student professional education. The study aimed to understand the concept of resilience from the point of view of student nurses and midwives. Design/methodology/approach The study used a novel arts-informed method, informed by Miller’s and Turkle’s work on “evocative objects.” A total of 25 student nurses and midwives from a London-based university selected “resilience objects” which were photographed and discussed during interviews with an artist-researcher. Findings Analysis of the interviews revealed that “resilience” was founded on identity, connection, activity and protection. “Resilience objects” were used in everyday rituals and “resilience” was a characteristic that developed over time through the inhabiting of multiple identities. Practical implications Given that resilience is intertwined with notions of identity, health-care faculties should enhance students’ sense of identity, including, but not exclusively, nursing or midwifery professional identity, and invite students to develop simple rituals to cope with the challenges of health-care work. Originality/value To the best of the authors’ knowledge, this is the first study to locate health-care students’ resilience in specific material objects. Novel insights are that health-care students used everyday rituals and everyday objects to connect to their sense of purpose and manage their emotions, as means of being resilient.

Background/Aim: Scales used to collect perceptual ratings related to a speaker’s gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps. Methods: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors “very feminine/very masculine” and “very female/very male.” Trans participants also rated their satisfaction with their current voice on a VAS with anchors “very satisfied/very unsatisfied.” Correlation coefficients were calculated to investigate the relationship between collected ratings. Results: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training. Discussion/Conclusion: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice.

Speech-language pathologists (SLPs) utilize counseling to support the psychological wellbeing of people with post-stroke aphasia, however, SLPs receive variable, usually limited, counseling education. Counseling education may be effective in improving SLPs' knowledge, skills, and confidence in counseling in post-stroke aphasia.We aimed to evaluate the feasibility and preliminary efficacy of a novel online counseling education program for SLPs working with people with post-stroke aphasia.Our study was a Phase II, two-arm pilot randomized controlled trial with a waitlist control. Participants (n = 49) were stratified by previous counseling training (≥1 day) and co-work with psychologists when addressing psychological wellbeing in post-stroke aphasia, and randomized to either the education program or waitlist control arm. We developed an education program (7-hours self-directed learning; 3-hour online workshop) for the trial. Feasibility outcomes included SLP recruitment, workshop attendance, and participant attrition at follow-up. Participants' counseling self-efficacy and self-rated competency were assessed pre- and post-program (primary endpoint) and at 5-week follow-up.Forty-four (90%) participants attended the workshop with forty-one (84%) participants completing the trial. There was a significant interaction (large effect size) between time and group supporting a positive effect of the program on counseling self-efficacy,The demonstrated feasibility and preliminary efficacy of this online counseling program warrant a future definitive trial.

Speech-language pathology practice guidelines recommend competency in counselling to support psychological adjustment and well-being in people with communication disability. However, there is limit...

Purpose This paper aims to present a thematic analysis of student nurses’ experiences of an innovative collaboration between a mental health Recovery College and a nursing faculty, where Recovery College trainers’ expertise in co-production and peer facilitation were foregrounded. The aim of this study is to understand how nursing students experienced being peer facilitators of well-being workshops for fellow students following training with Recovery College trainers. Design/methodology/approach Thematic analysis of qualitative data from eight semi-structured interviews and a focus group with 15 participants. Findings The overarching theme that emerged was “The process of being a student Peer Facilitator”. Six themes emerged from the data: “What we brought”; “Conceptualisation”; “Adaptation”; “we’re giving them the tools”; “What we gained”; and “Development”. Practical implications Mental health nurse educators could forge collaborative relationships with Recovery College colleagues with a broader remit than service users’ “lived experience” of mental distress. Student nurses should be given opportunities to be peer facilitators and draw on their lived experience as student nurses as means of addressing their and their peers’ mental health. Originality/value Original findings were that the student experience of being a peer facilitator was different to their other experiences in education and clinical practice. They drew on their lived experience throughout and found that they learned skills to address their well-being through supporting other students to improve theirs.

Purpose This study aims to explore how student nurses conceptualise their well-being and their views on how to improve student nurses’ well-being. Design/methodology/approach Qualitative inquiry using semi-structured interviews with 17 final year students. Tran-scripts were thematically analysed using Braun and Clark’s six-phase approach. Findings Three themes were identified as follows: “student nurses” “experience of the university”, “the meaning of student nurse well-being” and “how the faculty could improve student well-being”. The findings are interpreted with reference to notions of social capital and a sense of belonging. Practical implications University nursing programmes should embed approaches to student well-being. Higher education institutions should ensure that their social and pastoral offer is accessible and relevant to nursing students. Originality/value The study offers unique insight into student nurses’ self-concept as “university students” in the context of their well-being.

The purpose of this study was to explore the way Australian national sport organisations (NSOs) create, develop and implement their policies relevant to trans athletes. Representatives of nine NSOs were interviewed utilising in-depth semi-structured interviews. Four key themes emerged from the organisation spokespersons’ accounts: a) finding the right policy, b) underfunded and under resourced, c) challenges of educating employees and the public, and lastly, d) communication between NSOs and the trans athletic community. Findings revealed that only two NSOs reported had specific policies directed at trans athlete’s sport participation. Several NSOs indicated that they had plans to develop separate policies for the different levels of competition to assist trans athletes to participate in their sport as their identified gender. This is the first study to explore the perspective and views of NSOs on the participation of trans athletes in sport.

WHAT IS KNOWN ON THE SUBJECT?: There are insufficient nurses to meet current demand for mental health care. This is an international concern. Within England, the impact of staff shortages on the quality of patient care in forensic high secure settings has been highlighted by the national regulatory body for hospitals. Forensic hospital nursing is a distinct specialism within mental health. Forensic nurses must negotiate the therapeutic, ethical and practical challenges of caring for high-risk patients in a locked environment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: There has been no previous study to ask frontline high secure forensic nurses, union representatives, senior nurses and workforce leads about what factors may be affecting recruitment and retention in their setting. As well as the specialized and challenging nature of the work, participants identified that workforce sustainability was affected by unequal working terms and conditions, the hospital locations and wider national factors, such as changes to how nurse training was funded. They also identified that some strategies that were employed to address workforce shortages, such as day-to-day movement of staff within the hospital and incentive packages for new recruits could be demotivating for established staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Forensic high secure nursing workforce strategies should include training, development and career pathways that are specific to the specialism and extend beyond preceptorship for newly qualified staff. There should be clear and equitable employment terms and conditions with remuneration packages that are consistent within and between organizations. Hospital managers should address the effect that movement of staff between wards may have on nurses' morale, therapeutic relationships and safety culture. ABSTRACT: Introduction There has been no previous study of stakeholders' views on recruitment and retention concerns in high secure forensic settings. Aim To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method Framework analysis of data from fifteen interviews and three focus groups with frontline nurses, nurse leaders, recruitment leads and union representatives from three high secure hospitals in England. Results Six themes emerged from the data: (a) the unique nature of high secure nursing; (b) the impact of short staffing; (c) wider factors affecting the high secure nursing workforce; (d) the location; (e) staff being on different terms and conditions of work; (f) recruitment strategies. Discussion Multiple factors are likely to simultaneously affect high secure hospital recruitment and retention. Findings on the unique nature of high secure work reflect previous qualitative research. The themes of location, working terms and condition and recruitment strategies have not been previously identified in forensic nursing research. Implications for practice Employers should ensure that employment terms and conditions are equitable and consistent. Furthermore, hospital managers should address the effect that movement of staff between wards may have on morale and therapeutic relationships.

To develop a self-efficacy questionnaire for voice modification related to gender affirmation and to examine the internal consistency and test-retest reliability of the questionnaire among a cohort of trans women.This study was undertaken in two phases. In phase I, four Speech- Language Pathologists (SLPs) and four trans women informed the development of the Self-Efficacy Scale for Voice Modification in Trans Women (SES-VMTW). In phase II, using classical test theory, data from 31 Australian and 27 Swedish trans women who completed the SES-VMTW twice with an interim period of 3-6 weeks were analyzed for internal consistency and test-retest reliability. During this second phase, the 19 items of the SES-VMTW were subcategorized by consensus among the authors into like groups.Phase I resulted in the 19-item SES-VMTW and four subcategories were identified: 1) Change (items related to changing voice); 2) Perception (items related to the ability to perceive changes in voice; 3) Psychological (items related to engaging in voice practice despite psychological barriers; 4) Logistical (items related to engaging in voice practice despite logistical barriers). In Phase II, initial psychometric analysis was applied to the full questionnaire as well as to the subcategories. The Cronbach's alpha for the full questionnaire (α = 0.86) at both the test and retest timepoints indicates a high level of internal consistency. Item-total correlation analysis indicated that individual items correlated with the questionnaire total score, but that they generally correlated more strongly with the total score for the relevant subcategory. The Cronbach's alpha for the four subcategories of the SES-VMTW were variable but all coefficients exceeded 0.6, thus supporting the reliability of the new scale. Good test-retest reliability was demonstrated for the full questionnaire (intraclass correlation coefficient = 0.84; 95% confidence interval, 0.73-0.90, P0.001) and was moderate to good for the four subcategories.The findings of the current study are promising, suggesting that both the full SES-VMTW and the four subcategories can provide consistent and reliable insight into self-efficacy for trans women aiming to modify their voice as part of their gender affirmation.

Gender affirming voice training is a service provided by speech language pathologists to members of the trans and gender diverse community. While there is some evidence to support the effectiveness of this training, the evidence base is limited by a lack of prospective studies with large sample sizes. Finally, there has been only limited research investigating the effectiveness of this training when delivered on intensive (compressed) schedules, even though such schedules are used in clinical practice and may have practical benefits such as increasing service access for this vulnerable population.This study aimed to investigate and compare the effectiveness gender affirming voice training among 34 trans individuals presumed male at birth who shared a goal of developing a 'female-sounding voice'. Among these 34 participants, 17 received their training on a traditional schedule (one 45-minute session per week over 12 weeks) and 17 on an intensive scheduled (three 45-minute sessions per week over 4 weeks). Building on a previous mixed methodological study which indicated that these two training groups were equally satisfied with training outcomes, the current study utilised a wide range of self-report, acoustic, and auditory-perceptual outcome measures (including self-ratings and listener-ratings of voice) to investigate training effectiveness.Results from this study indicated that both training programs were similarly effective, producing positive statistically significant change among participants on a range of outcome measures. Participants in both groups demonstrated significant auditory-perceptual and acoustic voice change and reported increased satisfaction with voice, increased congruence between gender identity and expression, and a reduction in the negative impact of voice concerns on everyday life. However, as has been the case in past studies, training was not sufficient for all participants to achieve their specific goal of developing a consistently 'female-sounding voice'.This study provides evidence to suggest that gender affirming voice training for transfeminine clients may be similalrly effective whether delivered intensively or traditionally. This study provides evidence to support the practice of using a wide range of outcome measures to gain holistic insight into client progress in gender affirming voice training programs.

A review of Kerry Houston, Maria McHale, and Michael Murphy (eds), Irish Musical Studies 12: Documents of Irish Music History in the Long Nineteenth Century (Dublin: Four Courts Press, 2019). ISBN 9781846827242

To identify the experiences of nursing in high secure forensic mental health settings that may affect staff recruitment and retention.Recruitment and retention of Registered Nurses is a vital international concern in the field of mental health. The high secure forensic setting presents unique challenges for the nurse. Studies of nurse's experiences in this setting have not previously been reviewed in the context of workforce sustainability pressures.An integrative review (Whittemore and Knapfl, 2005).A systematic search of data sources: MEDLINE (PubMed), PsycINFO, EMBASE, CINAHL, International Bibliography of the Social Sciences, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, ProQuest Social Sciences Premium collection (IBSS, PAIS, and Sociological Abstracts), and Web of Science from inception to December 2019.Data extraction, quality appraisal, and convergent qualitative synthesis.Fifteen papers were selected for inclusion in the review, describing 13 studies. Six studies were quantitative, all cross-sectional surveys. There were seven qualitative studies, using a variety of methodologies. Four themes were identified: engagement with the patient group, the ward social environment, impact on the nurse, and implications for practice.When policymakers address workforce shortages in high secure forensic nursing they must take account of the unique features of the setting and patient group. Nurses must be adequately prepared and supported to function in an ethically and emotionally challenging environment.This study identified factors affecting workforce pressures in the speciality of forensic mental health nursing. Findings are of interest to national nursing policymakers and workforce leads in mental health service provider organizations, seeking to promote forensic nursing as a career option and retain nursing staff.目标: 了解在高安全性司法心理健康环境中的护理人员经验,可能会对护士的招聘和留用产生影响。 背景资料: 招聘和留用注册护士是精神卫生领域的一个重要的国际问题。高安全性司法环境对护士提出了独特的挑战。以往并未在员工可持续性压力的背景下对此种环境下的护士经历进行过研究回顾。 设计: 综合回顾(怀特莫尔和克诺普夫勒,2005年)。 数据来源: 数据来源的系统性搜索:联机医学文献分析和检索系统(国际文献数据库(PubMed))、心理学文摘(PsycINFO)、荷兰医学文摘数据库(Embase)、护理学数据库(CINAHL)、国际社会科学杂志、应用社会科学索引与摘要(ASSIA)、社会服务学文摘 、ProQuest社会科学特选系列(IBSS、PAIS和社会学摘要)以及科学网从成立之初至2019年12月的内容。 评审方法: 数据提取、质量评估和收敛性定性合成。 结果: 回顾中纳入了15篇论文,对13篇研究做出了描述。六篇研究为采取横断面分析的定量调查。七篇定性研究采取了多种方法论。确定了四大主题:与患者群体的接触、病房的社会环境、对护士的影响以及对实践的影响。 结论: 当决策者解决高安全性法医护理的人员短缺问题时,他们必须考虑到环境和患者群体的独特特征。护士必须做好充分的准备和支持,以便在具有伦理和情感挑战的环境中发挥作用。 影响: 本研究旨在探讨影响司法心理健康护理专业员工压力的因素。国家护理政策制定者和精神卫生服务提供者组织的负责人员都对这些研究发现深感兴趣,便于他们寻求出将法医护理作为一种职业选择,并留住护理人员的方法。.

Intensive schedules in behavioral voice therapy and training have been proposed to have a range of positive benefits including enhanced outcomes, high client and clinician satisfaction, and reduced client attrition. In the sub-field of behavioral voice training for trans and gender diverse clients, intensive schedules may also present a means of increasing service access opportunities for a vulnerable population. Despite the proposed benefits there has been limited research investigating client experiences in intensive voice training programs. The current study utilized a mixed-methodological approach to compare participant experiences in an intensively scheduled (three 45-minute sessions per week, over 4 weeks) versus a traditionally scheduled (one 45-minute session per week, over 12 weeks) voice training program for trans and gender diverse participants aiming to develop a perceptually feminine-sounding voice. Participant experiences were compared using a satisfaction questionnaire delivered to both training groups as well as thematic analysis of semi-structured interviews conducted with participants in the intensive group. Results suggested that individuals in the intensive training program had both positive and negative experiences related to the intensive schedule, but all viewed the program favorably and expressed a preference for intensive training based on their experiences. However, it was also found that overall satisfaction and attrition did not differ significantly between the intensive and traditional training groups and that many factors contributing to participant satisfaction in the intensive program were unrelated to the intensive schedule. Results from the current study also suggest that experiences in intensive programs may be highly variable and mediated by factors such as clients' individual personalities and preferences. The current study concludes that intensive schedules present a viable alternative to traditional schedules in practice, with additional considerations and directions for future research also discussed.

BACKGROUND: Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches. OBJECTIVE: This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches’ vocally reliant occupational participation, and (ii) consider vocal ergonomic factors. METHODS: This research was undertaken at an international tournament for floorball (also known as ‘Innebandy’, ‘Salibandy’, or ‘Unihockey’). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis. RESULTS: Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1–2 directly supported coaches’ voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes. CONCLUSIONS: These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.

OBJECTIVE To determine whether treatment effectiveness can be established for a range of vocal cord dysfunction (VCD) interventions in adolescents and adults. DESIGN A systematic review of the literature and risk of bias appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Data were qualitatively synthesized in the broad intervention groups of glottic airway and respiratory retraining, pharmacological therapies, airway device therapies and psychological therapies. DATA SOURCES Nine electronic databases, two clinical trial registries and the grey literature were searched from inception to September 2021 for articles on VCD interventions or equivalent terms. ELIGIBILITY CRITERIA Studies were included if they were randomized controlled trials, non-randomized controlled trials, quasi-experimental pre- and post-test studies and within-subject repeated measure designs, participants were 13 years or older, VCD was diagnosed using laryngoscopy or CT larynx, VCD intervention was provided and outcome measures reported on VCD symptoms. RESULTS The search yielded no randomized controlled trials. There were 17 quasi-experimental studies that met the eligibility criteria, and these studies reported on glottic airway and respiratory retraining, botulinum toxin injections, inspiratory muscle strength training and amitriptyline; all were associated with VCD symptom reduction. In addition, 2 within-subject repeated measure studies reported inspiratory muscle strength training and respiratory retraining to be effective in reducing symptoms in participants with exertional VCD. The included studies were reported in full-text publications (11) and conference proceedings (8). There was a high risk of bias and low quality of evidence across all intervention areas. CONCLUSION Glottic airway and respiratory retraining, botulinum toxin injections, low-dose amitriptyline and inspiratory muscle strength training devices have been associated with symptom reduction in adults and adolescents with vocal cord dysfunction. Limited objective data exist to support the effectiveness of these interventions, and robust controlled trials are needed in this area. Systematic Review Registration: CRD42018092274 (PROSPERO).

Summary Aims The primary aim of this study was to provide normative formant frequency (F) values for male and female speakers of Australian English. The secondary aim was to examine the effects of speaker sex, age, vowel quality, and geographical location on F. Method The first three monophthong formant frequencies (F1, F2, and F3) for 244 female and 135 male speakers aged 18–60 years from a recent large-scale corpus of Australian English were analysed on a passage reading task. Results Mixed effects linear regression models suggested that speaker sex, speaker age, and vowel quality significantly predicted F1, F2, and F3 (P = 0.000). Effect sizes suggested that speaker sex and vowel quality contributed most to the variations in F1, F2, and F3 whereas speaker age and geographical location contributed a smaller amount. Conclusion Both clinicians and researchers are provided with normative F data for 18–60 year-old speakers of Australian English. Such data have increased internal and external validity relative to previous literature. F normative data for speakers of Australian English should be considered with reference to speaker sex and vowel but it may not be practically necessary to adjust for speaker age and geographical location.

Purpose The purpose of this paper is to explore occupational health (OH) clinicians’ perspectives on employee mental health in the mental health workplace in the English National Health Service. Design/methodology/approach Thematic analysis of data from seven semi-structured interviews is performed in this paper. Findings Three themes emerged under the core theme of “Situating OH services”: “the Uniqueness of the mental health service setting”, “the Limitations of OH services” and “the Meaning of mental health at work”. An important finding came from the first theme that management referrals in mental health may be due to disputes about workers’ fitness to face violence and aggression, a common feature of their working environment. Research limitations/implications This was a small scale study of a previously unresearched population. Practical implications These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers’ potential “lived experience” of mental illness as features of the mental health care workplace. Originality/value This is the first study to explore OH clinicians’ perspectives on the mental health service working environment.

Background: Fibreoptic endoscopic evaluation of swallowing (FEES) is an imaging technique used by speech-language pathologists (SLPs) and some other health professionals to assess swallowing. Objectives: The primary aim was to gain an insight into FEES practices in Australia by characterising SLPs who use FEES and identifying areas of consistency and variation in practice. The secondary aim was to explore factors associated with variation in practice. Method: Cross-sectional survey methodology was used. The link to a web-based survey was e-mailed to 351 SLPs who practised in adult dysphagia. Results: The participation rate for the study was 18.8% (n = 66). Twenty-two SLPs (38.6%) used FEES. These SLPs represented a cross-section of workplace settings, caseloads, clinical and training experiences. Consistency and variation in FEES procedural and assessment practices were identified. Some procedural aspects of FEES varied according to whether a medical practitioner was present, type of FEES training, and number of FEES conducted per month. Conclusion: This research represents a benchmark in the knowledge of how FEES is used in Australia. Despite the small number of participants, the findings provide a foundation from which future research questions can be generated. More extensive examination of the use of FEES by SLPs is warranted. Further research is also required to establish methods for attaining and maintaining competency and to achieve consensus on which aspects of swallowing are assessed when using FEES and how the examination should be conducted.

Background: High levels of active task practice are recommended after stroke. However, the in-patient rehabilitation day is largely spent sitting. Understanding patterns of sitting across the rehabilitation week may facilitate strategies to promote greater activity. We aimed to compare differences in weekday and weekend sitting time and 24-hour activity patterns during the last week of in patient rehabilitation. Methods: Participants with stroke (n=34) from two rehabilitation units wore an activity monitor continuously during the final 7-days of in-patient rehabilitation. Linear mixed models (adjusted for waking hours) were performed with activity time as the outcome and weekday and weekend as the exposure. Patterns of activity accumulation were determined by averaging patient activity in 60-minute epochs, and then generating a heat map of activity level as a function of time. Results: Participant mean age was 68 [SD 13] years (53% male) mean NIHSS score 7 [SD 5]. There was no significant difference in total sitting time between weekdays and weekends. On the weekend, mean walking time was 8.35 minutes less (95% CI -12.13, -4.56 p ≤0.001), and steps/day were 624 fewer (95% CI -951, -296 p ≤0.001) than during the week. Activity patterns were similar across weekdays and weekends, with more morning than afternoon activity observed. Conclusion: Sitting time did not change in relation to the 7-day rehabilitation week, while walking (time and steps) was less on weekends. Morning activity was observably greater than afternoon activity across the 7-days. Strategies targeting afternoon, evening and weekend activity may increase overall physical activity during rehabilitation.

Antipsychotic medication is effective in reducing psychotic symptoms but use is associated with weight gain. Weight gain is associated with an increased risk of a number of life threatening health conditions. Multicomponent lifestyle interventions are the recommended non-pharmacological way of tackling weight gain and its consequences. This literature review summarises the evidence for the effectiveness of multicomponent lifestyle interventions in reducing weight and waist circumference in adults taking antipsychotics. The review of eight studies found that such approaches are effective; however, multiple factors affect success, for example tailoring of information to the cognitive abilities of participants and the use of individual combined with group approaches. There were some unexpected results within studies, where some control groups lost weight or decreased waist circumference as well as intervention groups. Reasons for significant weight change in control groups was attributed to possible access to weight loss activities outside of the intervention programmes. Adherence to intervention programmes was also important for success. Nurses who support patients taking antipsychotics to lose weight should promote multicomponent approaches that are tailored to the specific needs of this group.

© 2019 Royal College of Speech and Language Therapists Background: Speech–language therapists use counselling to address the psychological well-being of people affected by post-stroke aphasia. Speech–language therapists report low counselling knowledge, skill and confidence for working in post-stroke aphasia which may be related to a lack of counselling training specific to the needs of this client group. Aims: To identify current training in counselling for speech–language therapists to address psychological well-being in people affected by post-stroke aphasia. Specifically, the intent was to establish the objectives, content, amount, teaching methods and outcomes of counselling training provided to speech–language therapists working with people affected by post-stroke aphasia. Methods & Procedures: Eleven databases were searched from inception to January 2018 using terms relating to counselling, psychological well-being, speech–language therapy, stroke, aphasia and training. Studies using any research methodology and design were included. Nine studies were critically appraised and synthesized as a systematic review using the Search, AppraisaL, Synthesis and Analysis (SALSA) framework. Main Contribution: Information on counselling training came from the UK, United States and Australia. Student speech–language therapists received training in goal-setting and generic counselling skills. After qualification, speech–language therapists received counselling training from mental health professionals within stroke workplaces, from external providers and further education. A range of teaching techniques and counselling approaches were described. Self-report and themes from qualitative data were the primary measures of counselling training outcomes. Moderate correlations were reported between counselling training and levels of speech–language therapists’ knowledge, comfort, confidence and preparedness to counsel people affected by post-stroke aphasia. Conclusions: Research in counselling training for speech–language therapists working in post-stroke aphasia is limited, with a small number of primarily low-quality studies available. Training in generic counselling skills and brief psychological approaches with support from mental health professionals in the stroke workplace enabled speech–language therapists to feel knowledgeable, skilled and confident to address the psychological well-being of people affected by post-stroke aphasia. Evidence about the effectiveness of counselling training on speech–language therapists’ confidence and competence in practice and on client outcomes in psychological well-being in post-stroke aphasia is required.

Within mental health legislation in England and Wales the Responsible Clinician for specific patients should be the Approved Clinician with the most appropriate expertise to meet their primary assessment and treatment needs. The study aimed to explore nurse and psychologist perspectives on becoming a Responsible Clinician in the context of their limited uptake of the role and calls for an increase in advanced practice roles within mental health. It comprised a qualitative inquiry in the form of a thematic analysis of 12 semi-structured interviews. Four sub-themes emerged under the theme of 'becoming a Responsible Clinician'. They were: (i) the Responsible Clinician amongst other roles; (ii) developing in the role; (iii) working with psychiatrist colleagues; and (iv) organisational context. Responsible Clinicians were juggling the role with other senior clinical responsibilities, often without a coherent programme of ongoing educational development or organisational support structures. If mental health service provider organisations adopt this extended role more widely then role-specific support and supervision arrangements should be in place as part of a coherent workforce strategy. This is particularly important given the legal and ethical responsibilities of the Responsible Clinician.

Summary Aims The aim of this study was to provide a description of normative speaking fundamental frequency (fos) characteristics for adult speakers of Australian English. The effects of age, sex, and geographical location on fos were also examined to assess whether variations existed. Methods fos data for 244 female and 135 male speakers aged 18–60 years from a recent large-scale corpus of Australian English were analyzed on a passage reading task. Creak phonation frequencies were first separated from the modal phonation frequencies algorithmically. Descriptive statistics were then generated for modal voice. Results The mixed effects linear regression model suggested that geographical location had no effect on fos (P = 0.0677). The multiple linear regression model suggested that both sex (P = 0.000) and age (P = 0.000) significantly predicted fos. fos of the female speakers was greater than males by 76 Hz, when accounted for by age, and for every increase in age by one year, fos decreased by 0.37 Hz. Normative data on fos were therefore provided with reference to speaker sex and age only. Conclusion Both clinicians and researchers are provided with normative fos data for 18–60 year-old speakers of Australian English. These updated data have increased internal and external validity relative to previous literature. These increases were achieved by having a larger sample size, systematically sampling speakers of different age groups and geographical locations, sampling contemporary speakers of Australian English and excluding speakers with known concomitant factors that affect fos.

Summary Introduction There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training. Aim The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery. Method A case report and literature review was undertaken. Results Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (fo) ranging from 70–344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean fo of 108 Hz on reading, 100 Hz in monologue, and a fo range of 85–134 Hz across these tasks. Conclusion This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function.

Aim The aim of this article is to present selected findings from a doctoral study on the subjective well-being and subjective experience of mental health problems in UK mental health nurses. Here the concept of 'nurses' well-being' is explored. Method Data were drawn from a survey of 237 mental health nurses about their mental health and well-being and from interviews with 27 mental health nurses with personal experience of mental health problems and high subjective well-being. Results While nurses' subjective well-being is relatively low, some use strategies to support their well-being in and outside the workplace. Activities outside work that improved their wellbeing were physical exercise, mindfulness practice, spending time in nature and listening to music. Well-being was associated with clear boundaries between home and work life, regular clinical supervision and translating learning from work with patients to nurses' own lives. Conclusion Healthcare employers' staff health and well-being strategies should be informed by nurses' insights into what works for them. This may mean offering opportunities to take part in well-being activities. There are also opportunities to improve staff well-being through shared initiatives open to nurses and patients, and through an inclusive and empowering approach to staff engagement.

Purpose The aim of this study was to provide a systematic review of the aspects of verbal communication contributing to listener perceptions of speaker gender with a view to providing clinicians with guidance for the selection of the training goals when working with transsexual individuals. Method Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines were adopted in this systematic review. Studies evaluating the contribution of aspects of verbal communication to listener perceptions of speaker gender were rated against a new risk of bias assessment tool. Relevant data were extracted, and narrative synthesis was then conducted. Meta-analyses were conducted when appropriate data were available. Results Thirty-eight articles met the eligibility criteria. Meta-analysis showed speaking fundamental frequency contributing to 41.6% of the variance in gender perception. Auditory-perceptual and acoustic measures of pitch, resonance, loudness, articulation, and intonation were found to be associated with listeners' perceptions of speaker gender. Tempo and stress were not significantly associated. Mixed findings were found as to the contribution of a breathy voice quality to gender perception. Nonetheless, there exists significant risk of bias in this body of research. Conclusions Speech and language clinicians working with transsexual individuals may use the results of this review for goal setting. Further research is required to redress the significant risk of bias.

This study explored the experiences of university students who identified as always having had reading difficulties. Thirty-three participants, all from one Australian university, were surveyed and 10 were also interviewed. Findings revealed that many shared academic challenges related to studying, along with a belief that their difficulties were not well understood by staff or peers. While participants disclosed many similar personal struggles related to completing their studies, positive attributes such as determination and time management strategies were frequently mentioned as instrumental in allowing them to reach university. Experiences were more variable regarding awareness of, access to, and satisfaction with university-based support and academic adjustments. To facilitate optimal inclusive educational practices, this study supports the need for greater awareness among staff about challenges faced by these university students along with a more individualised and targeted approach to providing them with academic supports and accommodations.

Background The Transsexual Voice Questionnaire (TVQMtF) was designed to capture the voice-related perceptions of individuals whose gender identity as female is the opposite of their birth-assigned gender (MtF women). Evaluation of the psychometric properties of the TVQMtF is ongoing. Aims To investigate associations between TVQMtF scores and (1) self-perceptions of voice femininity and (2) acoustic parameters of voice pitch and voice quality in order to evaluate further the validity of the TVQMtF. A strong correlation between TVQMtF scores and self-ratings of voice femininity was predicted, but no association between TVQMtF scores and acoustic measures of voice pitch and quality was proposed. Methods & Procedures Participants were 148 MtF women (mean age 48.14 years) recruited from the La Trobe Communication Clinic and the clinics of three doctors specializing in transgender health. All participants completed the TVQMtF and 34 of these participants also provided a voice sample for acoustic analysis. Pearson product-moment correlation analysis was conducted to examine the associations between TVQMtF scores and (1) self-perceptions of voice femininity and (2) acoustic measures of F0, jitter (%), shimmer (dB) and harmonic-to-noise ratio (HNR). Outcomes & Results Strong negative correlations between the participants’ perceptions of their voice femininity and the TVQMtF scores demonstrated that for this group of MtF women a low self-rating of voice femininity was associated with more frequent negative voice-related experiences. This association was strongest with the vocal-functioning component of the TVQMtF. These strong correlations and high levels of shared variance between the TVQMtF and a measure of a related construct provides evidence for the convergent validity of the TVQMtF. The absence of significant correlations between the TVQMtF and the acoustic data is consistent with the equivocal findings of earlier research. This finding indicates that these two measures assess different aspects of the voice-related experience. Conclusions & Implications Evidence supporting the validity of the TVQMtF is strong and indicates that it is a sound measure for capturing the MtF woman's self-perceptions of her vocal functioning and how her voice impacts on her everyday life.

Summary Objectives The Transsexual Voice Questionnaire (TVQ MtF ) is a population-specific self-report tool designed to capture the perceptions of male-to-female transsexual women (MtF women) regarding their vocal functioning and the voice-related impact on their everyday life. The aim of this study was to further the psychometric evaluation of the TVQ MtF by examining its construct validity and confirming its reliability. Study Design This is a prospective validity and reliability study. Methods One hundred fifty-one MtF women provided data for principal components analysis with oblimin rotation. Data from 133 of these participants were also analyzed to evaluate the internal consistency of the TVQ MtF . Results Principal components analysis identified a two-factor structure. The largest component (accounting for 51.99% of the variance) captured individuals' perceptions of their vocal functioning and included items related to the link between voice and gender identity. This component was labeled vocal functioning . The second component (5.82% of the variance) contained items that related to the impact of voice on the individual's participation in everyday life and was labeled social participation . Internal consistency was high (Cronbach's α = .97). Conclusions The findings support the construct validity of the TVQ MtF . Additionally, the high internal consistency of the TVQ MtF found in the current study confirms that the content of the TVQ MtF reliably measures the self-perceptions of MtF women regarding their voice. The current findings also support the clinical utility of the TVQ MtF providing a means of organizing TVQ MtF responses to inform the voice training process.

Because of the increasing number of transgender people requesting speech-language pathology services, because having gender-incongruent voice and communication has major negative impacts on an individual's social participation and well-being, and because voice and communication training is supported by an improving evidence-base, it is becoming more common for universities to include transgender-specific theoretical and clinical components in their speech-language pathology programs. This paper describes the theoretical and clinical education provided to speech-language pathology students at La Trobe University in Australia, with a particular focus on the voice and communication training program offered by the La Trobe Communication Clinic. Further research is required to determine the outcomes of the clinic's training program in terms of student confidence and competence as well as the effectiveness of training for transgender clients.

Background\ud Responsible Clinicians are professionals who are primarily accountable for the care and treatment of patients detained under the Mental Health Act, 1983 in England and Wales. The role has only been taken up by under 100 nurses and psychologists since 2007. The aim of this study was to explore the experiences of non-medical Responsible Clinicians, to inform our understanding of interprofessional dynamics and professional identity in contemporary mental healthcare.\ud \ud Methods\ud A qualitative study comprising thematic analysis of interviews with twelve non-medical Responsible Clinicians.\ud \ud Results\ud A major theme of ‘Interpretations of responsibility’ emerged, with two sub themes: ‘Responsibility as leadership ‘and ‘Responsibility as decision making’. Taking on the role had implications beyond the care of specific patients. Participants saw themselves as having the power to shape their team and service whilst exercising their authority to make difficult decisions about risk and restrictions.\ud \ud Conclusions\ud More widespread adoption of the non-medical Responsible Clinician role should not be seen solely as a solution to workforce shortages or lack of opportunities for professional advancement. Consultant nurses and psychologists who take on this role are seising the opportunity to steer service developments more widely, influencing team dynamics and perceptions of accountability.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Objective: midwifery student mental wellbeing is an important consideration for the sus-tainability of the profession, however it has seldom been the subject of empirical research. Previous studies of the lived experience of midwifery students have focused on the impact of transition experiences and student satisfaction, rather than specifically on mental health and students’ views on support for their mental wellbeing. Design: a qualitative descriptive study using semi-structured interviews. Setting: a midwifery undergraduate programme in one university in the South of England. Participants: 20 BSc midwifery students. Findings: two inductive themes were developed from our analysis. The theme of ‘the rollercoaster’ encapsulated students’ experience over the length of the course, characterised by multiple culture shocks of being in different worlds, from one clinical placement to the next, from university to clinical placement. This experience was emotionally taxing. The theme of ‘being noticed, feeling connected’ encapsulated midwifery students’ views on what could help them enjoy their training. They wanted to be seen as individuals by at least one educator, they wanted opportunities to connect with their peers and they wanted the support available to them to be consistent. Conclusions: listening to students’ insights into the lived experience of being a midwifery student can enable midwifery educators to improve the way courses are designed and support structures are put in place. The importance of having consistent contact with peers and educators cannot be underestimated. Implications for practice: The emotional demands of midwifery training must be acknowledged. Educators should identify ways in which they can provide students with consistent individualised support and regular opportunities to meet with their peers.

There is growing concern about the mental wellbeing of both midwives and university students.?This integrative review presents a summary of the evidence on the state of midwifery students? mental health and wellbeing.?There is insufficient evidence to define the ?state of? midwifery student mental health, when compared to other students or healthcare professionals.?Qualitative studies on the midwifery student experience report that experiences in both the academic and clinical setting impinge on student wellbeing, including lack of support from mentors and bullying by qualified staff.?Future research should focus on interventions, longitudinal and cross-site comparisons.

The recently developed Transsexual Voice Questionnaire (TVQMtF) is a self-report tool that assesses the perceptions of male-to-female transsexual women (MtF women) regarding their voices and the impact of voice on their everyday lives. Initial psychometric evaluation has demonstrated strong reliability of the TVQMtF, however, there has been relatively little investigation of its validity. There is evidence in the literature to support the notion that MtF women who have undergone gender reassignment surgery (GRS) have different perceptions of their voice than MtF women who have not undergone GRS. This information was used to examine the validity of the TVQMtF using a known-groups analysis. Method: The TVQMtF scores of 26 MtF women who had undergone GRS were compared with the scores of 27 MtF women who had not undergone GRS. A one-way analysis of variance (ANOVA) was used to compare the total TVQMtF scores. Mann Whitney U tests were used for comparison across individual items. Results: Individuals w...

Students with invisible disabilities such as mental illness or acquired brain injury (ABI) experience multiple barriers that reduce their likelihood of postsecondary course completion. The present study conducted a systematic search of research reporting interventions for students experiencing mental illness or ABI to participate in postsecondary education. Nine databases were searched and a framework for categorising interventions and outcomes was developed. Forty-two studies revealed that most interventions were focused at the individual student level aiming to support students to build skills, grow confidence, or compensate for challenges through educational adjustments. There was wide diversity in research approaches used and a dearth of rigorous research designs. This review offers a more consistent way to define interventions and outcomes to guide future research and facilitate more meaningful comparisons between studies. The impacts of specific interventions on students’ attainment of qualifications and subsequent workforce participation need further investigation.