Mental health nursing standards and practice indicators for Australia: a review of current literature

There are many changes and challenges facing the mental health care professional working in Australia in the 21st Century. Given the significance of their number and the considerable extent to which care is delivered by them, mental health nurses in particular must be at the forefront of the movement to enhance and improve mental health care. Mental health nurses in Australia must not only keep up with the changes, we should be setting the pace for others across the profession worldwide. The increasingly complex field of mental health nursing demands nurses who are not only equipped to face the challenges but are confident in doing so. Definitive guidelines for practice, clear expectations regarding outcomes and specific means by which to evaluate both practice and outcomes are vital. Strengthening the role and vision of mental health nursing so that there is clarity about both and highlighting core values by which to perform will enable us to become focused on our future and what we can expect to both give to and receive from our chosen profession and how we can, and do, contribute to mental health care. The role of the mental health nurse is undergoing expansion and there are new hurdles to overcome along with the new benefits this brings. To support this, nationally adopted, formalised standards of practice and means by which to measure these, i.e., practice indicators formerly known as clinical indicators, are required. It is important to have national standards and practice indicators because of the variances in the provision of mental health across Australia – different legislation regarding mental health policies and processes, different nursing registration bodies and Nursing Councils, for example – which create additional barriers to cohesion and uniformity. Improvements in the practice of mental health nursing lead to benefits for consumer outcomes as well as the overall quality of mental health care available in Australia. The emphasis on rights-based care, particularly consumer and carer rights, demands evidence-based, up-to-date mental health care delivered by competent, capable professionals. Documented expectations for performance by nurses will provide all involved with yardsticks by which to evaluate outcomes. Flowing on from these benefits are advances in mental health care generally and enhancements to Australia’s reputation and position within the health care arena throughout the world. Currently, the ‘Standards for Practice’ published by the Australian New Zealand College of Mental Health Nurses (ANZCMHN) in 1995 and the practice indicators developed by Skews et al. (2000) provide a less formal guide for mental health nurses working in Australia. While these earlier standards and practice indicators have played some role in supporting mental health nurses they have not been nationally or enthusiastically adopted and there are a multitude of reasons for this. This report reviews the current literature available on practice indicators and standards for practice and describes an evidence-based rationale as to why a review and renewal of these is required and why it is important, not just for mental health nurses but to the field of mental health in general. The term ‘practice indicator’ is used, except where a quotation utilises ‘clinical indicator’, to more accurately reflect the broad spectrum of nursing roles, i.e. not all mental health nursing work involves a clinical role.

A survey of contact with offspring and assistance with child care among parents with psychotic disorders

To help improve services for parents with psychotic disorders, patients with such disorders in three treatment agencies in Queensland, Australia, were surveyed about whether they were parents, how much contact they had with their offspring, and who provided assistance with child care. Of the 342 individuals with psychotic disorders mho participated in the study, 124 were parents. Forty-eight parents in the study had children under age 16, and 20 of these parents (42 percent) had their children living with them. Most parents relied on relatives or friends for assistance with child care. Barriers to child care services identified by parents were inability to pay, lack of local services, and fear of losing custody of children.

Assessing perceived need for mental health care in a community survey: development of the Perceived Need for Care Questionnaire (PNCQ)

Background: The Perceived Need for Care Questionnaire (PNCQ) was designed for the Australian National Survey of Mental Health and Wellbeing. The PNCQ complemented collection of data on diagnosis and disability with the survey participants' perceptions of their needs for mental health care and the meeting of those needs. The four-stage design of the PNCQ mimics a conversational exploration of the topic of perceived needs. Five categories of perceived need are each assigned to one of four levels of perceived need (no need, unmet need, partially met need and met need). For unmet need and partially met need, information on barriers to care is collected, Methods: Inter-rater reliabilities of perceived needs assessed by the PNCQ were examined in a study of 145 anxiety clinic attenders. Construct validity of these items was tested, using a multi-trait multi-method approach and hypotheses regarding extreme groups, in a study with a sample of 51 general practice and community psychiatric service patients. Results: The instrument is brief to administer and has proved feasible for use in various settings. Inter-rater reliabilities for major categories, measured by the kappa statistic, exceeded 0.60 in most cases; for the summary category of all perceived needs, inter-rater reliability was 0.62. The multi-trait multi-method approach lent support to the construct validity of the instrument, as did findings in extreme groups. Conclusions: The PNCQ shows acceptable feasibility, reliability and validity, adding to the range of assessment tools available for epidemiological and health services research.

Occupation, hours worked, and leisure-time physical activity

Background. International research indicates that blue-collar employees typically exhibit lower rates of leisure-time physical activity. While lack of time and work demands are commonly reported barriers to activity, the extent to which time-at-work mediates the relationship between occupation and leisure-time physical activity is unclear. This study investigated the association between occupation, time spent in paid employment, and participation in leisure-time physical activity. Methods. This was a secondary analysis of cross-sectional data from the 1995 Australian Health Survey, focusing on employed persons ages 18-64 years (n = 24,454), Occupation was coded as per the Australian Standard Classification of Occupations and collapsed into three categories (professional, white-collar, blue-collar). Hours worked was categorized into eight levels, ranging from 1-14 to more than 50 h per week. Participation in leisure-time physical activity was categorized as either insufficient or sufficient for health, consistent with recommended levels of energy expenditure (1600 METS-min/fortnight). The relationship between occupation, hours worked, and leisure-time physical activity was examined using logistic regression. Analyses were conducted separately for male and female, and the results are presented as a series of models that successively adjust for a range of potential covariates: age, living arrangement, smoking status, body mass index, and self-reported health. Results. Individuals in blue-collar occupations were approximately 50% more likely to be classified as insufficiently active. This occupational variability in leisure-time physical activity was not explained by hours worked. There was a suggested relationship between hours worked and leisure-time physical activity; however, this differed between men and women, and was difficult to interpret. Conclusions. Occupational variability in leisure-time physical activity cannot be explained by hours worked. Therefore, reports that work constitutes a barrier to participation should be explored further. Identification of the factors contributing to occupational variability in leisure-time physical activity will add to our understanding of why population subgroups differ in their health risk profiles, and assist in the development of health promotion strategies to reduce rates of sedentariness and health inequalities. (C) 2000 American Health Foundation and Academic Press.

Caring for someone with dementia in a rural town .1. Family and friends

Caring for someone with dementia at home is a difficult task. Support services call do much to assist carers. However, ill rural areas these may not be readily available or accessible. This paper reports on a qualitative study ill which a group of carers living in a rural community participated in a focus group and interviews. Issues explored included the carers' experiences of caring, and the effects of rural life on this, Through content analysis of the data, it was found that these carers faced many challenges but were also able to access a number of supports, particularly in terms of family and the local community.

How can and do Australian doctors promote physical activity?

Background. Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice, Methods. A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia. Results. We received a 71% response (n = 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience, Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems, Conclusions. There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors, Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored. (C) 1997 Academic Press.

Children and economic development: Family size, gender preferences and human capital formation - theory and Indian cases

In the light of Gary Becker's economic theory of the family, considers how economic cost and benefit factors can influence the size of families that parents decide to have. Some support for the importance of such factors is found from results of structured interviews with wives in Kondh-dominated villages in western Orissa. These results are at variance with the hypothesis of Malthus about population growth. Factors that may alter the optimal family size as development proceeds are discussed. It is found in our sampling that, on the whole, there is a preference for daughters rather than sons although this is not as strong in the Kondh-dominated villages as in poor villages in the Santal tribal belt of West Bengal. While in the Kondh-dominated villages some discrimination in access to education in favour of boys compared to girls is present, little such or no such discrimination occurs in relation to access to food and medical attention. In the villages surveyed in the West Bengal Santal tribal belt, discrimination in favour of boys is more pronounced than in the Kondh-dominated area in Orissa. While economic considerations help to explain gender discrimination between boys and girls, we find that social and cultural factors also play a major role. Parents in a similar economic situation seem to display substantially different patterns of gender discrimination between children depending on their social and cultural content. It seems that the extent to which economic theories of the family explain family preferences and behaviour depend significantly on the social and cultural context in which they are to be applied.

Quantitative analysis of the time courses of enzyme-catalyzed reactions

The catalytic properties of enzymes are usually evaluated by measuring and analyzing reaction rates. However, analyzing the complete time course can be advantageous because it contains additional information about the properties of the enzyme. Moreover, for systems that are not at steady state, the analysis of time courses is the preferred method. One of the major barriers to the wide application of time courses is that it may be computationally more difficult to extract information from these experiments. Here the basic approach to analyzing time courses is described, together with some examples of the essential computer code to implement these analyses. A general method that can be applied to both steady state and non-steady-state systems is recommended. (C) 2001 academic Press.

Unprecedented oxidation of a biologically active aroylhydrazone chelator catalysed by iron(III): serendipitous identification of diacylhydrazine ligands with high iron chelation efficacy

Ligands of the 2-pyridylcarbaldehyde isonicotinoylhydrazone class show high iron (Fe) sequestering efficacy and have potential as agents for the treatment of Fe overload disease. We have investigated the mechanisms responsible for their high activity. X-ray crystallography studies show that the tridentate chelate 2-pyridylcarbaldehyde isonicotinoylhydrazone undergoes an unexpected oxidation to isonicotinoyl(picolinoyl)hydrazine when complexed with Fe-III. In contrast, in the absence of Fel the parent hydrazone is not oxidized in aerobic aqueous solution. To examine whether the diacylhydrazine could be responsible for the biological effects of 2-pyridylcarbaldehyde isonicotinoylhydrazone, their Fe chelation efficacy was compared. In contrast to its parent hydrazone, the diacylhydrazine showed little Fe chelation activity. Potentiometric titrations suggested that this might be because the diacylhydrazine was charged at physiological pH, hindering its access across membranes to intracellular Fe pools. In contrast, the Fe complex of this diacylhydrazine was charge neutral, which may allow facile movement through membranes. These data allow a model of Fe chelation for this compound to be proposed: the parent aroylhydrazone diffuses through cell membranes to bind Fe and is subsequently oxidized to the diacylhydrazine complex which then diffuses from the cell. Other diacylhydrazine analogues that were charge neutral at physiological pH demonstrated high Fe chelation efficacy. Thus, for this class of ligands, the charge of the chelator appears to be an important factor for determining their ability to access intracellular Fe. The results of this study are significant for understanding the biological activity of 2-pyridylcarbaldehyde isonicotinoylhydrazone and for the design of novel diacylhydrazine chelators for clinical use.

The equilibrium penetration of monolayers. Is equilibrium really established?

In studying the penetration of water-soluble surfactants into water-insoluble monolayers the main theoretical problem is to find a relationship that would enable the amount of surfactant that has entered the monolayer to be calculated from a set of equilibrium surface pressure-area isotherms. Despite many attempts, no current theory gives satisfactory results when applied to experimental data (Langmuir 14 (1998) 2148). One possible reason is that equilibrium had not been established when the surface pressure-area curves were measured. The three experiments reported here suggest that equilibrium is extremely difficult to establish in such systems when the area is low or the surface pressure is high. The essence of these experiments is to try to reach the same final condition by two different routes. In the first route, the one nearly always used in equilibrium penetration measurements, the surfactant is injected under the expanded monolayer, which is then slowly compressed in steps, with time allowed at each step for a steady surface pressure to be attained. In the second procedure, the monolayer is first compressed to a high surface pressure and the surfactant then injected. A stepped expansion isotherm may then be observed. Surface pressure-area per monolayer molecule isotherms, reflection spectra, and slow neutron reflectivity data all show the same pattern: if the surfactant was allowed to penetrate while the monolayer was in an expanded state, it was not completely removed when the monolayer was compressed; but if the monolayer was in a highly compressed state when exposed to the surfactant little penetration took place until the film was expanded. There thus appear to be very large energy barriers to the ejection of surfactant from a compressed monolayer and to the penetration of surfactant into a compressed monolayer. Although these experiments have some limitations, it now seems likely that at least some of the penetration data used in evaluating the various thermodynamic treatments of equilibrium penetration were not equilibrium data. (C) 2001 Elsevier Science B.V. All rights reserved.

The leisure participation of clients with a dual diagnosis

People with a dual diagnosis experience disruption in carrying out their daily occupations. This article describes a study in which an occupational therapist explored the leisure participation of clients with a dual diagnosis. In-depth, semi-structured interviews were conducted with four outpatients from an alcohol and drug rehabilitation programme. Inductive analysis of the informants’ interviews identified two main themes: leisure as part of the recovery process and the barriers to leisure participation. This study provides support for the need to understand the leisure occupations of the clients with whom occupational therapists work. Further research is required to examine the interventions that assist clients with a dual diagnosis to develop meaningful leisure activities.

Lipid, sugar and liposaccharide based delivery systems

Although there are formidable barriers to the oral delivery of biologically active drugs, considerable progress in the field has been made, using both physical and chemical strategies of absorption enhancement. A possible method to enhance oral absorption is to exploit the phenomenon of lipophilic modification and mono and oligosaccharide conjugation. Depending on the uptake mechanism targeted, different modifications can be employed. To target passive diffusion, lipid modification has been used, whereas the targeting of sugar transport systems has been achieved through drugs conjugated with sugars. These drug delivery units can be specifically tailored to transport a wide variety of poorly absorbed drugs through the skin, and across the barriers that normally inhibit absorption from the gut or into the brain. The delivery system can be conjugated to the drug in such a way as to release the active compound after it has been absorbed (i.e. the drug becomes a prodrug), or to form a biologically stable and active molecule (i.e. the conjugate becomes a new drug moiety). Examples where lipid, sugar and lipid-sugar conjugates have resulted in enhanced drug delivery will be highlighted in this review.

The development and application of a novel safety-catch linker for BOC-based assembly of libraries of cyclic peptides

Cyclic peptides are appealing targets in the drug-discovery process. Unfortunately, there currently exist no robust solid-phase strategies that allow the synthesis of large arrays of discrete cyclic peptides. Existing strategies are complicated, when synthesizing large libraries, by the extensive workup that is required to extract the cyclic product from the deprotection/cleavage mixture. To overcome this, we have developed a new safety-catch linker. The safety-catch concept described here involves the use of a protected catechol derivative in which one of the hydroxyls is masked with a benzyl group during peptide synthesis, thus making the linker deactivated to aminolysis. This masked derivative of the linker allows BOC solid-phase peptide assembly of the linear precursor. Prior to cyclization, the linker is activated and the linear peptide deprotected using conditions commonly employed (TFMSA), resulting in deprotected peptide attached to the activated form of the linker. Scavengers and deprotection adducts are removed by simple washing and filtration. Upon neutralization of the N-terminal amine, cyclization with concomitant cleavage from the resin yields the cyclic peptide in DMF solution. Workup is simple solvent removal. To exemplify this strategy, several cyclic peptides were synthesized targeted toward the somatostatin and integrin receptors. From this initial study and to show the strength of this method, we were able to synthesize a cyclic-peptide library containing over 400 members. This linker technology provides a new solid-phase avenue to access large arrays of cyclic peptides.

Trade and environment: Evidence from China's manufacturing sector

This paper focusing on the Chinese manufacturing sector assesses the environmental impact of trade liberalization in China. The results show that China's experience with the trade liberalization-environment nexus is consistent with international evidence. On one hand, trade liberalization has had various positive effects on the environment. Firstly, it promoted specialization in areas of comparative advantage, which, in general, included industries that contributed less to environmental degradation. Secondly, it allowed China to access and adopt the best international practices in pollution abatement technology. Thirdly, it enabled China to transfer environmental costs to other countries by importing intermediate products whose production contributed to environmental degradation. On the other hand, these positive effects were overwhelmed by a negative scale effect, which was the result of a huge increase in the demand for Chinese exports. The paper concludes that if China is to prevent pollution from reaching a critical threshold, environmental regulations need to be tightened. Copyright (C) 2002 John Wiley & Sons, Ltd and ERP Environment.

Drosophilidae (Diptera) of Australia's Northern Territory: Ecology and biogeography

The drosophilid fauna is well documented in eastern Australia but is poorly known in other parts of the continent. This paper summarises what is known of this fauna in the Northern Territory (NT), and includes results from banana trapping in the humid and arid zones. The 42 recorded species include species that breed in fruit, fungi and/or flowers, and a larval predator of scale insects. Drosophilids occur in all three major climate zones (humid, semiarid and arid) but predominate in the humid zone. Banana-attracted species in the humid zone (wet-dry tropics) were common in all sampled habitats: urban, rainforest and open woodland. They included predominantly urban and/or rainforest species. Of the species collected in open woodland, some are likely to be breeding there, whereas others may have been intercepted during movement across the area. The semiarid fauna is a depauperate version of that found in the humid region. Only three species have been recorded in the arid region: an endemic arid specialist, and two cosmopolitan species (D. simulans and D. melanogaster ) in urban Alice Springs. Overall, the NT drosophilid fauna represents a depauperate version of that found in eastern Australia, probably because of climatic factors and natural barriers to range expansion. There is little evidence of regional endemism, with probably only one (and at most three) species endemic to the NT, and no evidence of independent, natural dispersion from nearby Indonesia.