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.

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.

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.

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.

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.

Crystal structures of CheY from Thermotoga maritima do not support conventional explanations for the structural basis of enhanced thermostability.

The crystal structure of CheY protein from Thermotoga maritima has been determined in four crystal forms with and without Mg++ bound, at up to 1.9 A resolution. Structural comparisons with CheY from Escherichia coli shows substantial similarity in their folds, with some concerted changes propagating away from the active site that suggest how phosphorylated CheY, a signal transduction protein in bacterial chemotaxis, is recognized by its targets. A highly conserved segment of the protein (the "y-turn loop," residues 55-61), previously suggested to be a rigid recognition determinant, is for the first time seen in two alternative conformations in the different crystal structures. Although CheY from Thermotoga has much higher thermal stability than its mesophilic counterparts, comparison of structural features previously proposed to enhance thermostability such as hydrogen bonds, ion pairs, compactness, and hydrophobic surface burial would not suggest it to be so.

Nurses and neuroleptic medication: applying theory to a working relationship with clients and their families.

This paper presents a model for the nursing management of the effects of neuroleptic or antipsychotic medication. The model addresses the contemporary issues facing nurses, their clients and families, while at the same time is congruent with the continua of effects of these medications. For many, nonadherence is directly related to undesired side effects, while for others the reasons may be multidimensional. The proposed model addresses the notion of advocacy and empowerment in the light of interventions that relate to the undesired-desired effects continuum. Underpinning this is the notion of the phases of the nurse-client relationship, which were advocated by Peplau (1952) and have since offered a framework for nursing intervention. While developing the phases of this relationship, nurses can help the client and family by assuming various roles that can enhance the relationship. It is suggested that each of these roles has an element of advocacy and an element of empowerment. It is part of the nurses' professional responsibility to help the client and their family to deal with the issues surrounding medication nonadherence.

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.

Carbon monoxide poisoning: nursing priorities and treatment.

A man in his mid 30s arrived for admission by ambulance to the psychiatric unit of a private hospital after transfer from a small rural hospital. His voluntary admission was the result of a suicide attempt by carbon monoxide (CO) poisoning. On arrival the patient was receiving oxygen via nasal prongs at 3 liters per minute, appeared to be extremely distressed, and complained of severe headache. The nurses became extremely concerned after reading the transfer notes--the poisoning incident had occurred 4 hours prior to arrival at the unit. Furthermore, the patient was discovered unconscious and resuscitated by paramedics. The nursing staff immediately notified the supervisor and requested that the medical registrar examine the patient. The psychiatrist was notified of the concerns of the nursing staff. Eventually, after many tests, phone calls and arrangements, the patient was transferred to a large city hospital for hyperbaric oxygen therapy.

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.

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.

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.

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.

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.

An application of nursing faculty practice: clinical camps.

The incorporation of clinical practice into nursing faculty role expectations has triggered much debate. Despite the urge for the incorporation of practice into faculty roles, past research has demonstrated that the majority of faculties do not in fact include clinical practice. Reasons given for the failure of nurse academics to practise include lack of time, the failure of academia to value the practice, and the failure to include the practice as criteria for tenure and promotion. For faculty practice to occur it has been argued that clinical practice needs to be more a matter of individual intent: adaptable, and creative. Clinical camps provide potential opportunities for clinical practice for faculties. These camps, it is argued, offer the possibility of clinical teaching, promotion of collegial relationships between faculty and health care agencies, development of positive faculty-student relationships, and a valuable research site. For this reason, it is argued that clinical camps be considered a viable venue for faculty practice.