RESUMO
The aim of this study was to identify nurses' interventions, views, and attitudes concerning critical incidents. Using semi-structured interviews, a descriptive study was conducted among mental health nurses working in three major psychiatric hospitals. Analysis of nurses' audio-recorded data indicated that they had used a number of different interventions under six main categories: counseling, performing security practices, monitoring thinking disturbances, contacting the psychiatrist on-call, contacting the chief nurse on-call, and administering medication. The need for specialized training was noticed and problems like accountability, nurse-patient interactions, and nurse-doctor relationships were considered crucial by the mental health nurses.
Assuntos
Intervenção em Crise , Comparação Transcultural , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/enfermagem , Enfermagem Psiquiátrica , Doença Aguda , Adulto , Comportamento Cooperativo , Aconselhamento , Feminino , Grécia , Hospitais Psiquiátricos , Humanos , Capacitação em Serviço , Comunicação Interdisciplinar , Masculino , Transtornos Mentais/tratamento farmacológico , Relações Enfermeiro-Paciente , Relações Médico-Enfermeiro , Enfermagem Psiquiátrica/educação , Psicotrópicos/administração & dosagem , Medidas de Segurança , PensamentoRESUMO
The locus coeruleus (LC) is the major source for norepinephrine (NE) in the brain and projects to areas involved in learning and memory, reward, arousal, attention, and autonomic functions related to stress. There are three types of adrenergic receptors that respond to NE: alpha1-, alpha2-, and beta-adrenergic receptors. Previous behavioral studies have shown the alpha1-adrenergic receptor (α1AR) to be present in the LC, however, with conflicting results. For example, it was shown that α1ARs in the LC are involved in some of the motivational effects of stimulation of the medial forebrain bundle, which was reduced by α1AR antagonist terazosin. Another study showed that during novelty-induced behavioral activation, the α1AR antagonist prazosin reduced c-fos expression in brain regions known to contain motoric α1ARs, except for the LC, where c-fos expression was enhanced. Despite new research delineating more specific connectivity of the neurons in the LC, and some roles of the adrenergic receptors, the α1ARs have not been localized at the subcellular level. Therefore, in order to gain a greater understanding of the aforementioned studies, we used immunohistochemistry at the electron microscopic (EM) level to determine which neuronal or glial elements in the LC express the α1AR. We hypothesized, based on previous work in the ventral periaqueductal gray area, that the α1AR would be found mainly presynaptically in axon terminals, and possibly in glial elements. Single labeling immunohistochemistry at the EM revealed that about 40% of labeled elements that contained the α1AR were glial elements, while approximately 50% of the labeled neuronal elements were axon terminals or small unmyelinated axons in the LC. Double labeling immunohistochemistry found the α1AR expressed in GFAP-labeled astrocytes, in both GABAergic and glutamatergic axon terminals, and in a portion of the α1AR dendrites, colocalized with tyrosine hydroxylase (TH, a marker for noradrenergic neurons). This study sheds light on the neuroanatomical framework underlying the effects of NE and pharmaceuticals acting directly or indirectly on α1ARs in the LC.