Linda Nichols

Suicide is a significant public health concern. Attempted suicide by means of hanging is frequently lethal and in Australia it is the most common method of attempting suicide. For those who survive and reach hospital the outcomes can be favourable but are variable. With active and aggressive treatment, it is possible for individuals to make a full recovery despite what is often a dismal and futile presentation. Hanging is a form of asphyxia that occurs when there is constriction of the neck, secondary to the tightening of a ligature under the gravitational weight of the body wholly or part. There are rarely catastrophic structural injuries or instantaneous death associated with “non-judicial” hanging. The process, physics and biomechanics inevitably differ significantly from modern judicial hanging, where death is almost instantaneous. Individuals who survive a hanging episode and reach hospital are referred to as having experienced a near hanging. For this cohort of individuals, those who experienced asphyxia and cardiac arrest are most likely to experience a poor outcome. Despite a limited body of literature this study aims to analyse the available research related to near hangings, with a focus on nursing care and interventions. Methods: This work followed three stages: (a) establishing a clear question; (b) undertaking a systematic search of studies that utilised standardised data (c) analysis and interpretation of findings. As a meta-analysis this study used quantitative pooling of data from a wide range of studies to provide an increased sample size, and to identify consistent patterns across studies that contained a similar endpoint. Weighted averages were utilised to summarise effect size and these were calculated from individual studies. A weighted average is a calculation where some data points contribute more to the result than others, because they are assigned a specific "weight" reflecting their importance, frequency, or volume. Weighted averages ensued that studies with more precise data had a greater influence on the final pooled result. Results: A total of 18 studies were identified that described the demographics of hanging, with a total combined number of 4230 individuals. The weighted average of males was 80.1%, and the combined age range for both sexes was 12–88 years taken from ten studies. The weighted average of individuals who died was 61.3% with a weighted average of 58.4% of individuals experiencing a good outcome. The proportion of indigenous individuals represented a weighted average of 49.4%, a predominance that requires further study. A total of 1571 individuals were identified as having a diagnosed psychiatric illness, which represents a weighted average of 62.1% with self-harm and substance abuse explored separately. A combined total of 2173 individuals experienced a cardiac arrest associated with a near hanging (weighted average of 44.0%). When exploring the GCS category of 3–8 on presentation, there was a weighted average of 61.9%. Cervical region injuries were identified as fractures, laryngotracheal injuries and vascular injuries with the weighted averages being 6.0%, 7.7% and 4.9% respectively. Discussion: Literature that focuses on the management and nursing care of individuals following a near hanging are lacking and limited to a scattering of retrospective studies, case series and individual case studies, with limited prospective studies. An estimated 96% of all near hangings are suicidal in intent (Bennewith et al., 2005). The evidence suggests increasing suicide rates at both age extremities. This study presents a predominance of males and a significant overrepresentation of indigenous individuals. It is estimated that 20–60% of individuals will experience a cardiac arrest associated with a near hanging and with this a poor outcome. Over 50% of individuals will present with a history of psychiatric disorders and less than 20% will present with a GCS of 15 on admission, with cervical spinal injuries even rarer. Neurological outcomes post near hanging varies from complete recovery, impairment and damage to death. Nurse expertise, vigilance and understanding is critical to not only saving lives but also reducing the risk of secondary injury and helping individuals and their loved ones begin to rebuild their lives. Given the prevalence of mental illness in the community, it is vital that all neuroscience nurses understand the incidence, interventions, monitoring and treatment goals associated with near hanging. Conclusion: Hanging is a top mental health priority as it is the most common causes of suicide in many countries including Australia. Injury from hanging is a complex situation that neuroscience nurses are being increasingly faced with. It is often an area where we have limited answers, and our understanding is challenged by each new individual we care for. Hanging can result in a range of injuries including physical, psychological, spinal and neurological. With active and aggressive treatment, it is possible for individuals to make a full recovery despite what is often a dismal and futile presentation. A greater understanding will benefit both neuroscience nurses and the individuals we care for. This research will draw from the available literature and analyse the demographics, emergency interventions, treatment and outcomes post near hanging, with a focus on nursing roles.

Background: Large-scale administrative data collection is more efficient than single centre, prospective designs for rare events such as aneurysmal subarachnoid haemorrhage (aSAH). However, there are limited studies reporting data validation of International Classification of Diseases (ICD) search algorithms for aSAH. Equally there are limited examples of utilising coding for neuroscience nursing research. Despite this neuroscience nurses play a critical and functional role in contributing to ICD coding. Nurses are the primary source of clinical data entry, they are at the point of care and complete critical pieces of documentation including admission, transfer and discharge forms as well as daily progress notes and forms. ICD coding is critical in the provision of a standardised and uniform language for classifying diseases, injuries and symptoms. Coding enables accurate health data tracking, comparative research between hospitals, institutions and regions and surveillance of diseases and mortality. Methods: A population-based search of non-traumatic subarachnoid haemorrhages cases was undertaken from 2010 to 2014. The research was undertaken to fulfil the data collection for a PhD thesis. Using sequential combinations of the subarachnoid haemorrhage ICD-10 codes I60.0–I60.9, sensitivity, specificity and positive predictive values (PPV) were calculated on a three-stage basis. Individual access to discharge summary documentation, digital medical records (Gold standard) and data linkage with death registry records and ambulance records was used to validate aSAH cases using the three ICD-10 code algorithms. Results: A total of 414 events were identified, including 282 non-traumatic subarachnoid haemorrhage admissions of which 172 (60.99%) were subsequently confirmed as aSAH. Medical record review of cases within ICD codes I60.0–160.9 resulted in sensitivity and specificity (95% CI) of 0.90 (0.86–0.94) and 0.23 (0.16–0.31) and a PPV of 65.1%. When analysed on a population basis the sensitivity and specificity were 0.74 (0.68–0.79) and 0.25 (0.18–0.33) and a PPV of 67.4% when using ‘160.0–160.9’. When analysing specific aneurysm morphology, the sensitivity and specificity was 0.52 (0.45–0.58) and 0.91 (0.85–0.95) with a PPV of 90.5%. Conclusion: Applying broad administrative database search algorithms to uncommon diseases such as aSAH results in a number of inaccuracies, particularly an overestimation of results when considering the results as representative of a population or when attempting to describe specific aneurysm morphology. For nurses this highlights the importance of ensuring accuracy and completeness when documenting patient files. Whilst nurses do not generally assign ICD-10 codes, they play a vital role in ensuring that there is the necessary clinical information including (but not limited to) flowsheets, transcription of diagnostic details, narratives and care plans. This process of documentation is not only a legal requirement and part of nursing daily practice, but it plays an important role in billing, insurance claims, health service research, resource allocation, policy making and quality development as well as coding.

November 2025 marks 350 years since the passing of Thomas Willis (b. 1621 – d.1675). Thomas was a pious man who was orthodox in his beliefs and charitable to the end. He lived in an era of political and religious instability, however, despite these turbulent times Thomas along with other colleagues made pioneering medical discoveries and completely changed our thinking and understanding of the human body and disease. He rewrote history and set in place our modern knowledge and understanding of the brain, cerebrovascular system and nervous system. As the English Civil War raged, Thomas’ formal medical training was cut short, but he used this to his advantage and undertook a vast range of practical, clinical, experimental and theoretical self-directed learning. Thomas’s discoveries and opportunities to understand the brain were influenced by his collaborative and clandestine partnerships, as well as chance meetings, including that with Anne Greene who had hung at the end of a hangman’s noose for over half an hour, only to be revived by Thomas and his colleagues. Whilst Thomas studied and wrote on many topics, his cumulating opus was the publication of Cerebri Anatome, in which he elicited polarised theories and explanations and changed neurology forever. This manuscript aims to cover Thomas’ life, family, the political and religious influences of the time and the impact of these on both his medical career, and work as a medical practitioner, anatomist, scientist and author. Thomas Willis is undoubtedly the father of neurology and the study of the nervous system. His name is immortalised in the Circle of Willis and whilst every medical and nursing student learns of the Circle of Willis, there is much to learn about the man, his life, his allegiances and devotion to the Church of England, his theories, publications and legacy.

Pain is an expected outcome following spinal surgery. However, increasing evidence indicates that pain is often managed inadequately during the optimisation of patient recovery (Ali, et al, 2018). Following the expected early post-operative pain period, many patients undergoing spinal surgery may experience longer term moderate pain up to six months post-operatively (Prabhakar et al 2022). An exploration of the support required for patients with spine conditions following surgery is presented. Enhanced Recovery After Surgery (ERAS) programs have been introduced globally as evidenced based protocols to provide effective care for surgical patients and are aimed at achieving early and optimal recovery post-surgery (Debono et al., 2021). The aim of this paper is to discuss nursing roles, what constitutes pre-operative risk factors; post operative complications and outcomes; information required for enhanced recovery and effective medications for spinal surgery. A summary of ERAS Programs and the support that is required for patients post spinal surgery is also provided.

Emerging from the foundational efforts of the Lancet Commission on Global Surgery (2015) and the Bogota Declaration (2016), the Boston Declaration 2025 marks a transformative milestone in the Global Neurosurgery movement. It calls for equitable, timely, and affordable neurosurgical care across all regions, especially in low-resource settings. Central to this vision is the active inclusion of Neuroscience Nurses—recognized as frontline caregivers, educators, and advocates—within the neurosurgical nexus. The Boston Declaration uniquely positions Neuroscience Nurses as central architects in this transformation. Nurses serve as essential links across the continuum of care, contributing to frontline service delivery, capacity building, education, policy advocacy, and health system integration. Their inclusion ensures a person-centered approach rooted in lived experience and local context. The Declaration grounded in for an expanded neurosurgical ecosystem that embraces interdisciplinary collaboration—spanning clinicians, engineers, policymakers, and communities—and encourages innovation through data, artificial intelligence, and sustainability. It underscores the urgency of building resilient care systems to address the global neurosurgical burden. As a global blueprint for neurosurgical equity, the Boston Declaration invites all Neuroscience Nurses and professional societies to take an active role in this collective endeavour. Through shared commitment, we can drive transformative progress that reshapes global neurosurgical care and affirms the essential role of nurses in leading change.

The year was 1650 and Anne Green was a 22-year-old maidservant who had been found guilty of infanticide. Anne was found guilty not for her crime but for her class, as the father of the foetus was the son of her employer who was hellbent on seeing her quickly and ruthlessly removed from history. Despite her claims, and the claims of many others in regard to her innocence, she was sentenced to hang at Oxford Castle. Anne bravely faced her fate and for over 30 minutes did she hang. She was taunted and friends tried to expediate her death by pulling on her legs, some using all their weight swinging from her lifeless body, until the executioner was so concerned that the rope might break he put an end to it. When all were satisfied that Anne was indeed dead, a musket butt was rammed into her chest for good measure. Anne’s body was taken down, placed in a simple coffin and sent for delivery to the anatomy table. However when she arrived and the anatomists, Thomas Willis and William Petty, opened the coffin she showed signs of life. All thoughts of an anatomy lesson were quickly dismissed, and attention was focused on reviving Anne. Through measures and interventions, they worked to revive her and she quickly regained consciousness. Within a month she was restored to health. Hanging is one of the oldest methods of execution. Methods and equipment have changed and developed over time; death associated with early hanging occurred secondary to a slow gravitational strangulation. Modern hanging is more effective and associated with a rapid compression of the neck resulting in fracturing of the upper cervical spine vertebra. Self-inflicted hanging can be plagued by unfortunate incidents, and some fortunate survivals. It is these survivals that are often nursed on Neurosurgical units. This manuscript follows Anne Greene’s story, her failed hanging and resuscitation in the anatomy room. The history of hanging and changes in methods is also explored. The literature has also been explored for self-inflicted hanging and the impact on and role of neuroscience nurses when caring for survivors.