The impact of climate change on country and community and the role of mental health professionals working with Aboriginal communities in recovery and promoting resilience.

This paper emerged from discussions between the authors about our shared and different perspectives of climate change and its impact on the social, emotional, physical, spiritual and cultural wellbeing of Aboriginal Peoples and mental health services in a rural region, heavily impacted in recent years by bushfires and floods. Here we discuss, from the lead authors personal perspective as a Gamilaraay Woman, the experience of Solastalgia as a critical impact of climate change on wellbeing. Specifically, we discuss the relationship of a connection to country from a Gamilaraay, first person perspective through a series of diary entries from the lead author. Authors are researchers from different cultural backgrounds, connected through a medical research futures fund research project, to promote resilience within Aboriginal communities and the health services sector in the New England, North West region. The lead author has cultural connections to some of the communities we work with and our work is informed by these connections. While this paper was written to express an Aboriginal perspective on climate change and wellbeing, it reflects our shared perspectives of how disasters such as bushfires impact the wellbeing of Aboriginal peoples. We also explore the connection between the impact of localised, recurring natural disasters and the increasing demands on mental health services in regional and rural areas and discuss what this means with Aboriginal and non-Indigenous mental health nurses and researchers working in regional and rural areas where access to mental health services often poses considerable challenges. From our perspective, mental health research and nursing play an important role in walking alongside Aboriginal Peoples as we explore, respond and create resilience to the ever-present influence that climate change is having on our lives, communities, country and workplaces.

Psychometric evaluation of the Indonesian version of the Impact of Event Scale-Revised.

The purpose of this research was to translate and to test an Indonesian version of the Impact of Event Scale-Revised (I-IES-R) as a measurement of psychological distress following a natural disaster. Sample of 30 Mt. Merapi residents participated in pilot testing and 110 survivors completed the test-retest of the I-IES-R. Exploratory factor analysis was used to determine construct validity, and Cronbach's alpha was used to assess reliability. The results of the translational phase of the study indicated that the Indonesian version of the IES-R captures the content of the original tool with appropriate adaptation for cultural differences. The Indonesian IES-R revealed a Cronbach's alpha of 0.90 for test and 0.92 for retest for the total score. In addition, the Cronbach alpha for subscales intrusion, avoidance and hyper arousal in the initial scale testing were 0.85, 0.75, and 0.74, respectively, and for the retest 0.88, 0.79, and 0.82, respectively. The reliability coefficient of the test-retest results was 0.75 [95% confidence interval = (0.64, 0.83)], and exploratory factor analysis identified three underlying factors: intrusion, avoidance, and hyper arousal. The I-IES-R can be considered a useful screening tool that can be used by mental health nurses to assess the psychological impact of natural disasters on survivors in Indonesia.

Human rights of the mentally ill in Indonesia.

BACKGROUND: The mentally ill are vulnerable to human rights violations, particularly in Indonesia, where shackling is widespread. AIM: The aim of this study was to understand the provision of mental health care in Indonesia, thereby identifying ways to improve care and better support carers. METHODS: Grounded theory methods were used. Study participants included health professionals, non-health professionals and individuals living with a mental disorder who were well at the time (n = 49). Data were collected through interviews conducted in 2011 and 2012. RESULTS: The core category of this grounded theory is 'connecting care' a term coined by the authors to describe a model of care that involves health professionals and non-health professionals, such as family members. Four main factors influence care-providers' decision-making: competence, willingness, available resources and compliance with institutional policy. Health professionals are influenced most strongly by institutional policy when deciding whether to accept or shift responsibility to provide care. Non-health professionals base their decisions largely on personal circumstances. Jointly-made decisions can be matched or unmatched. Unmatched decisions can result in forced provision of care, increasing risks of human rights violations. LIMITATIONS: Generalization of this grounded theory is difficult as the research was conducted in two provinces of Indonesia. CONCLUSION: Institutional policy was important in the process of connecting care for the mentally ill in Indonesia and needs to be underpinned by legislation to protect human rights. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Strengthening mental health legislation in Indonesia will allow nurses to connect care more effectively.

Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy.

The number of patients in buprenorphine opioid substitution therapy (BOST) or methadone opioid substitution therapy (MOST) programs is increasing. If these patients require surgery, it is generally agreed that methadone should be continued perioperatively. While some also recommend that buprenorphine is continued, concerns that it may limit the analgesic effectiveness of full mu-opioid agonists have led others to suggest that it should cease before surgery. However, no good evidence exists for either course of action. Therefore, we undertook a retrospective cohort study comparing pain relief and opioid requirements in the first 24 hours after surgery in 22 BOST and 29 MOST patients prescribed patient-controlled analgesia. There were no significant differences in pain scores (rest and movement), incidence of nausea or vomiting requiring treatment, or sedation between the BOST and MOST patient groups overall, or between those patients within each of these groups who had and had not received their methadone or buprenorphine the day after surgery. There were also no significant differences in patient-controlled analgesia requirements between BOST and MOST patient groups overall, or between patients who did or did not receive MOST on the day after surgery. BOST patients who were not given their usual buprenorphine the day after surgery used significantly more patient-controlled analgesia opioid (P=0.02) compared with those who had received their dose. These results confirm that continuation of buprenorphine perioperatively is appropriate.

The experience of weight gain as a result of taking second-generation antipsychotic medications: the mental health consumer perspective.

This interpretive qualitative study aimed to describe and construct the meaning of the experience of living with the weight gain associated with second-generation antipsychotics. A qualitative study that incorporated the tenets of phenomenology and utilized in-depth interviews was conducted with eight mental health consumers. Thematic analysis resulted in three themes: Grappling with the weight; Living with the consequences of being overweight; and Experiencing negative emotions about the weight gain. The findings indicate that consumers struggle to manage the insatiable appetite and the related weight gain associated with second-generation antipsychotic medication, as well as the numerous associated physical and emotional issues. Adherence with prescribed second-generation antipsychotic medication was also affected and a number of the participants indicated they had ceased or considered ceasing their medication because of the weight gain associated with the drugs.

The metabolic syndrome and schizophrenia: the latest evidence and nursing guidelines for management.

The introduction of second-generation antipsychotic drugs for the treatment of schizophrenia has provided significant benefits for clients experiencing this disorder. While they have been found effective in reducing psychotic symptoms, there is evidence that these drugs are also linked with a group of side effects commonly known as the metabolic syndrome. Mental health nurses are well positioned to prevent, detect and/or manage the development of this problematic constellation of symptoms. Guidelines for practice can be useful in prevention and management of the syndrome and enhance nursing care of clients who are taking second-generation antipsychotics.

Antipsychotic drugs and pregnant or breastfeeding women: the issues for mental health nurses.

Antipsychotic drugs and pregnant or breastfeeding women: the issues for mental health nurses Mental illness can affect up to 10% of pregnant women, and women with a pre-existing psychiatric condition are more likely to experience a relapse of symptoms during pregnancy. Antipsychotic drugs are an important part of the treatment of psychotic illnesses; however, their safety with pregnant or breastfeeding women has not been fully established. Given that these drugs will be ordered for pregnant or breastfeeding women diagnosed with a psychosis or with a pre-existing psychiatric condition, it is imperative that mental health nurses and others administering the drugs, or caring for those taking the drugs, be aware of their consequences. A review of the available evidence, albeit at times contradictory, is presented along with a discussion of the implications for mental health nurses. Recommendations for consideration when administering or counselling women regarding the use of antipsychotic drugs in pregnancy or when breastfeeding, are also included.

The biogeography and phylogeny of unicellular cyanobacterial symbionts in sponges from Australia and the Mediterranean.

The distribution, host associations, and phylogenetic relationships of the unicellular cyanobacterial symbionts of selected marine sponges were investigated with direct 16s rDNA sequencing. The results indicate that the symbionts of the marine sponges Aplysina aerophoba, Ircinia variabilis, and Petrosia ficiformis from the Mediterranean, four Chondrilla species from Australia and the Mediterranean, and Haliclona sp. from Australia support a diversity of symbionts comprising at least four closely related species of Synechococcus. These include the symbionts presently described as Aphanocapsa feldmannii from P. ficiformis and Chondrilla nucula. A fifth symbiont from Cymbastela marshae in Australia is an undescribed symbiont of sponges, related to Oscillatoria rosea. One symbiont, Candidatus Synechococcus spongiarum, was found in diverse sponge genera in the Mediterranean Sea and the Indian, Pacific, and Southern oceans, whereas others were apparently more restricted in host association and distribution. These results are discussed in terms of the biodiversity and biogeographic distributions of cyanobacterial symbionts.

The wartime experience of Australian Army nurses in Vietnam, 1967-1971.

AIMS: To provide a synthesis of the experience of nursing in the Vietnam War. RATIONALE: War and nursing are linked unequivocally. As battles have raged over the centuries, nurses have attended the ill and wounded soldiers, nursing them back to health or into death and the study of this phenomenon forms a significant part of Australia's nursing history. However, a review of the Australian scholarly nursing and military history literature revealed that the experiences of Australian nurses in the Vietnam War has not been widely published. In an attempt to redress this gap in Australian nursing and military history, the aim of this study was to analyse the nature of the nursing work in the Vietnam War, and to increase awareness and understanding of the experience of nurses in the war within the nursing profession. METHODS: Using oral history interviews, this study investigated the nature of nursing work as experienced by 17 Australian Army nurses who served in the Australian Military Hospital in Vung Tau between 1967 and 1971. FINDINGS: The vast majority of the nursing sisters sent to Vietnam knew little about the type of work or the environment into which they were entering and were, therefore, clinically unprepared. It appeared that, by virtue of their being a nurse, it was an expectation that the nurses would adapt to the nature of their work in the war zone. However, this study also revealed that, although the nurses adapted professionally, their memories of their experiences have affected many personally. CONCLUSIONS: This paper will increase current knowledge significantly regarding the phenomenon of nursing in the Vietnam War, enabling a greater understanding of the experience.

The plug domain of FepA, a TonB-dependent transport protein from Escherichia coli, binds its siderophore in the absence of the transmembrane barrel domain.

FepA, an outer membrane iron siderophore transporter from Escherichia coli, is composed of a 22-stranded membrane-spanning beta barrel with a globular N-terminal "plug" domain of 148 residues that folds up inside the barrel and completely occludes the barrel's interior (1). We have overexpressed and purified this plug domain by itself and find that it behaves in vitro as a predominantly unfolded yet soluble protein, as determined by circular dichroism, thermal denaturation, and NMR studies. Despite its unfolded state, the isolated domain binds ferric enterobactin, the siderophore ligand of FepA, with an affinity of 5 microM, just 100-fold reduced from that of intact FepA. These findings argue against the hypothesis that the plug domain is pulled intact from the barrel during transport in vivo but may be consistent either with a model where the plug rearranges within the barrel to create a channel large enough to allow transport or with a model where the plug unfolds and comes out of the barrel.

Taking neuroleptic medications as the treatment for schizophrenia: A phenomenological study.

Research in the area of neuroleptic medications has traditionally relied on quantitative methodologies which view the problem from the researcher's perspective. This phenomenological study was undertaken to explore the experience of taking neuroleptic medications from the individual's perspective using a research approach which has the potential to illuminate and respect participant experiences. Interviews were conducted with 10 individuals who take neuroleptic medications as their main treatment for schizophrenia. Interviews were analysed using an interpretive method which seeks to generate a deeper understanding of the phenomenon under study. The experience of taking neuroleptic medications emerged as incorporating hope for recovery, learning to live with the side-effects, embodiment of illness, experiencing issues of control, and struggling to stay well. The results have relevance for practicing and novice mental health nurses, for teachers of undergraduate nursing and allied health students, and carer and consumer groups.

Mental health nurses' PRN psychotropic medication administration practices.

PRN psychotropic medications (medications given with the aim of changing the patient's mental state on an 'as needed' basis) are frequently prescribed and administered in mental health facilities. Their administration is largely an autonomous nursing role. However, little research has explored this important area of nursing practice in any detail and therefore the use of this intervention by mental health nurses is not fully understood. A descriptive project was undertaken to explore the factors involved in the administration of PRN psychotropic medications. It utilized a retrospective chart audit, conducted at one regional and one urban setting in Queensland, Australia. The results indicate a lack of clarity surrounding psychotropic PRN medication administration practices, confusion surrounding decision-making processes related to this intervention, and poor documentation practices. The study found a high incidence of PRN psychotropic medication administration when compared to similar studies, and an excessive reliance on the use of typical antipsychotics over benzodiazepines. This practice is not supported by contemporary literature. As a result of our findings, we recommend further studies in areas of related importance, in order to increase our understanding of the complexities surrounding this important nursing intervention, and an investigation into documentation practices in inpatient mental health settings.

Effective communication in an intensive care setting: nurses' stories.

Effective communication has been long considered an important aspect of nurse-patient interactions. However, follow up of people who have been patients in intensive care units (ICUs) indicates that nurses' communication in this setting is at times unsatisfactory. Patients have described how they were left feeling frustrated and alienated by this failure in the communication process and unconscious patients report how they were aware of nurses' attempts at communication with them while unconscious (Lawrence, 1995). Because most of the research to date has focused on patients' perceptions of nurses' communication in an intensive care unit, this study sought to explore what nurses believed constituted effective communication in an intensive care setting. Therefore, a qualitative study was undertaken to explore nurses' perceptions of effective communication with patients in an intensive care setting. The stories of four intensive care nurses were utilized as the means of data collection. The analysed data revealed the following themes: nurses' perceptions, presencing and reassurance. The findings have relevance for nurses in many settings.

What you ask is what you get: learning from interviewing in qualitative research.

This paper outlines some important issues discovered about undertaking qualitative interviews. A description of a study that involved interviewing the authors' students is followed by discussion of aspects of the interviewing process that became apparent during analysis of those interviews. Problems that were encountered with retrospective interviews, power differentials, question sequencing, some interview techniques, and a prior knowledge of the students are illuminated to assist other qualitative interviewers to be aware of these potential areas of difficulty.

Moving from technical to critical reflection in journalling: an investigation of students' ability to incorporate three levels of reflective writing.

This paper outlines a research project aimed at changing the levels of reflection of preregistration nursing students in a tertiary institution. Whilst reflection is widely espoused now in nursing, few studies have been found that identify whether the level of reflective writing can be identified or developed by students. Anecdotal and research evidence (Powell 1989; van Manen 1977) however indicates that most student reflective writing occurs at the technical level. A descriptive exploratory study using both qualitative and quantitative techniques was undertaken to apply van Manen's (1977) levels in a structured way in an attempt to facilitate the student's understanding and use of the levels in their reflective writing. The findings of the study indicate that student self evaluation and identification of the levels in their own writing can lead to change in the levels of critical reflective writing achieved by undergraduate students.

Constitutive activity of the light-sensitive channels TRP and TRPL in the Drosophila diacylglycerol kinase mutant, rdgA.

Mutations in the Drosophila retinal degeneration A (rdgA) gene, which encodes diacylglycerol kinase (DGK), result in early onset retinal degeneration and blindness. Whole-cell recordings revealed that light-sensitive Ca2+ channels encoded by the trp gene were constitutively active in rdgA photoreceptors. Early degeneration was rescued in rdgA;trp double mutants, lacking TRP channels; however, the less Ca2+-permeable light-sensitive channels (TRPL) were constitutively active instead. No constitutive activity was seen in rdgA;trpI;trp mutants lacking both classes of channel, although, like rdgA;trp, these still showed a residual slow degeneration. Responses to light were restored in rdgA;trp but deactivated abnormally slowly, indicating that DGK is required for response termination. The findings suggest that early degeneration in rdgA is caused by uncontrolled Ca2+ influx and support the proposal that diacylglycerol or its metabolites are messengers of excitation in Drosophila photoreceptors.

Testis unis, testis nullas: one witness is no witness. Criticisms of the use of oral history in nursing research.

In research, there is no perfection: no perfect method, no perfect sample, and no perfect data analyses tool. Coming to this understanding helps the researcher identify the inadequacies of their preferred method. This paper discusses the criticisms of the oral history method, drawing reference to its challenges and difficulties in relation to its use in nursing research. Oral history has the advantage over more traditional historical approaches in that the narrators can interpret events, personalities and relationships within the interview that are not accessible from written sources. The oral history interview may also provide a forum for unveiling documents and photographs, which might not have been otherwise discovered. Nonetheless, oral history, like most methodologies, is not flawless. This paper discusses the limitations of oral history and suggests ways in which a nurse can use oral history to provide an account of aspects of nursing history.

Metabolic effects of mislocalized mitochondrial and peroxisomal citrate synthases in yeast Saccharomyces cerevisiae.

Genes CIT1 and CIT2 from Saccharomyces cerevisiae encode mitochondrial and peroxisomal citrate synthases involved in the Krebs tricarboxylic acid (TCA) cycle and glyoxylate pathway, respectively. A Deltacit1 mutant does not grow on acetate, despite the presence of Cit2p that could, in principle, bypass the resulting block in the TCA cycle. To elucidate this absence of cross-complementation, we have examined the ability of Cit1p to function in the cytosol, and that of Cit2p to function in mitochondria. A cytosolically localized form of Cit1p was also incompetent for restoration of growth of a Deltacit1 strain on acetate, suggesting that mitochondrial localization of Cit1p is essential for its function in the TCA cycle. Cit2p was able, when mislocalized in mitochondria, to restore a wild-type phenotype in a strain lacking Cit1p. We have purified these two isoenzymes as well as mitochondrial malate dehydrogenase, Mdh1p, and have shown that Cit2p was also able to mimic Cit1p in its in vitro interaction with Mdh1p. Models of Cit1p and Cit2p structures generated on the basis of that of pig citrate synthase indicate very high structural and electrostatic surface potential similarities between the two yeast isozymes. Altogether, these data indicate that metabolic functions may require structural as well as catalytic roles for the enzymes.