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This issue of Nurse Researcher focuses on ethnographic research in nursing. The three themed papers provide an overview of the ethnographic accomplishment dealing with methodological issues in the conduct of ethnographic work and how nursing and nurses' work is represented. The authors take account of how contemporary approaches to ethnography are shaped by understandings of and approaches to nursing.

Mental health disorder and alcohol and other drug comorbidity is prevalent in Australia. This qualitative study used semistructured interviews (N = 20) to elicit clinicians' and workers' knowledge, experiences, and opinions regarding issues pertaining to service needs of people with comorbidity in a metropolitan region of South Australia. The study revealed barriers to effective access and delivery of comorbidity care by MH and AOD services. Participants reported difficulties with identification, access, suitability, policy, funding, and collaboration between sectors and services responding to comorbidity. Results suggest that these models of practice were inadequate influencing the delivery, consistency, and reliability of comorbidity care.

Objective: This study identified barriers to and facilitators of mental health (MH) and alcohol and drug (AOD) comorbidity services, in order to drive service improvement., Method: Participatory action research enabled strong engagement with community services, including Aboriginal and refugee groups. Surveys, interviews and consultations were undertaken with clinicians and managers of MH, AOD and support services, consumers, families, community advocates and key service providers. Community participation occurred through consultation, advisory and working party meetings, focus groups and workshops., Results: Barriers included inadequate staff training and poor community and workforce knowledge about where to find help. Services for Aboriginal people, refugees, the elderly and youth were inadequate. Service fragmentation ('siloes') occurred through competitive short-term funding and frequent re-structuring. Reliance on the local hospital emergency department was concerning. Consumer trust, an important element in engagement, was often lacking., Conclusions: Comorbidity should be core business of both MH and AOD services by providing consistent 'no wrong door' care. Non-governmental organisations (NGOs) need longer funding cycles to promote stability and retain skilled workers. Comorbidity workforce training for government and NGO staff is required. Culturally appropriate comorbidity services are urgently needed. Despite the barriers, collaboration between clinicians/workers was valued., (© The Royal Australian and New Zealand College of Psychiatrists 2016.)

Aim: This article analyzes the prevalence of use of concurrent multiple antipsychotics and high dosage treatment in people with mental illness, to assess the burden of antipsychotic drug-related side-effects associated with multiple use, and to identify strategies shown to reduce antipsychotic polypharmacy., Methods: Literature reviewed was sourced from MEDLINE, Embase, CINAHL, InformIT, PsycINFO, International Pharmaceutical Abstracts, Cochrane Library database and Joanna Briggs Institute databases to identify Australian studies published between January 2000 and February 2015. Studies that reported prevalence of multiple antipsychotic use or addressed the issue of antipsychotic drug-related side-effects were included. Systematic reviews, randomized controlled trials, and observational pre-post studies of Australian and international interventions aiming to reduce multiple antipsychotic use in mental health settings were also identified., Results: Nineteen studies reporting prevalence of multiple antipsychotic use were identified. The proportion of patients taking more than one antipsychotic ranged from 5 to 61%. Of the studies assessing dosages used, between one-third and one-half of all patients taking multiple antipsychotics received doses higher than recommended. Data from one national study reported that people taking multiple antipsychotics were more likely to experience at least one side-effect in comparison to consumers taking a single antipsychotic (90 verses 80%).International evidence of direct trials of conversion from treatment regimens involving multiple antipsychotics to those based on monotherapy show that between 50 and 75% of people with serious mental illness could be successfully converted to single-agent treatment, with up to 25% obtaining an improvement in health and the remaining 50% staying well managed., Conclusion: Use of multiple antipsychotics is common among Australian people with mental illness, despite guidelines recommending that only one antipsychotic should be used in most cases. People taking more than one antipsychotic at a time are more likely to experience side-effects, and to receive higher than recommended antipsychotic doses. Direct trials that aimed to reduce multiple antipsychotic use suggest it is possible to effectively reduce therapy in the majority of people without worsening outcomes. Simple educational programmes targeting health professionals have not been found to be effective; however, complex multifaceted programmes and quality improvement programmes have demonstrated effect.

Aim: This paper will explore the application of situation awareness in nursing to determine its suitability as a framework to study how the decision to admit or not admit a person as an involuntary patient is made., Background: The decision by a specially qualified nurse to admit or not admit a person to a mental health facility against their will remains a central component of contemporary mental health legislation. The decision has an impact on a person's autonomy and human rights. Conversely, the decision to admit may facilitate urgent assessment and treatment and ensure the safety of the individual and others. Research highlights that decision-making in this context is challenging due to the multiple information sources and often incomplete information available to the clinician. Situation awareness is a concept used to explain how practitioners identify, use and make meaning of a multitude of factors and elements relevant to their practice., Design: Discussion paper., Data Sources: A search of terms related to situation awareness and mental health nursing was conducted in the period 2000 - present., Implications for Nursing: Exploring nurses decision-making using a situation awareness framework provides for a more nuanced understanding of nurses knowledge and skill when deciding to admit or not a person as an involuntary patient., Conclusion: The concept of situation awareness provides a framework to better understand the decision-making process associated with the involuntary admission decision., (© 2016 John Wiley & Sons Ltd.)

Cardiovascular disease (CVD) is higher in people with mental illness and is associated with a 30 year higher mortality rate in this population. Erythrocyte docosahexaenoic acid (DHA) plus eicosapentaenoic acid (EPA) (omega-3 index)≤4% is a marker for increased mortality risk from CVD while >8% is protective. Omega-3 polyunsaturated fatty acids are also important for brain function and may ameliorate symptoms of mental illness. We investigated the erythrocyte omega-3 index in people with mental illness. One hundred and thirty adults aged 18-65 years (32.6% male) with schizophrenia (n=14) and depression (n=116) provided blood samples and completed physiological assessments and questionnaires. Both populations had risk factors for metabolic syndrome and CVD. The average omega-3 index was 3.95% (SD=1.06), compared to an estimated 5% in the Australian population. These data indicate an unfavourable omega-3 profile in people with mental illness that could contribute to higher CVD risk., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention., (© 2016 Australian College of Mental Health Nurses Inc.)

Aim: To describe the research model developed and successfully deployed as part of a multi-method qualitative study investigating suicidal service-users' experiences of mental health nursing care., Background: Quality mental health care is essential to limiting the occurrence and burden of suicide, however there is a lack of relevant research informing practice in this context. Research utilising first-person accounts of suicidality is of particular importance to expanding the existing evidence base. However, conducting ethical research to support this imperative is challenging., Discussion: The model discussed here illustrates specific and more generally applicable principles for qualitative research regarding sensitive topics and involving potentially vulnerable service-users., Conclusion: Researching into mental health service users with first-person experience of suicidality requires stakeholder and institutional support, researcher competency, and participant recruitment, consent, confidentiality, support and protection., Implications: Research with service users into their experiences of sensitive issues such as suicidality can result in rich and valuable data, and may also provide positive experiences of collaboration and inclusivity. If challenges are not met, objectification and marginalisation of service-users may be reinforced, and limitations in the evidence base and service provision may be perpetuated.

It has been documented recently that left atrial (LA) deformation in AF patients (while in AF) is predictive of subsequent stroke risk. Additionally, diminished LA deformation during AF correlates with the presence of LA blood stasis. Given that endothelial function is dependent on laminar blood flow, the present study sought to investigate the effect of diminished LA deformation (during AF) on platelet reactivity and inflammation in AF patients. Patients (n = 17) hospitalised with AF underwent echocardiography (while in AF) for determination of peak positive LA strain (LASp). Whole blood impedance aggregometry was used to measure extent of ADP-induced aggregation and subsequent inhibitory response to the nitric oxide (NO) donor, sodium nitroprusside. Platelet thioredoxin-interacting protein (Txnip) content was determined by immunohistochemistry. LASp tended (p = 0.078) to vary inversely with CHA2DS2VASc scores. However, mediators of inflammation (C-reactive protein, Txnip) did not correlate significantly with LASp nor did extent of ADP-induced platelet aggregation or platelet NO response. These results suggest that the thrombogenic risk associated with LA stasis is independent of secondary effects on platelet aggregability or inflammation.

Objective: The purpose of this study was to identify the skills and attributes deployed by rural mental health clinicians when engaging with consumers in the community mental health context., Design: Reflecting the exploratory nature of this research, a semi-structured focus group was conducted., Setting: One community mental health service in regional South Australia (catchment area = approximately 60 000 people)., Participants: Nine mental health clinicians., Interventions: Not applicable., Main Outcome Measures: Participants' focus group comments were explored qualitatively using thematic analysis., Results: Three major themes were identified: (i) limitations to providing mental health care in the rural environment (increased consumer vulnerability, limited services, increased risk, and stigma); (ii) universal engagement approaches (being consumer-focused, appropriate communication, facilitating a connection and normalising the experience); (iii) indicated and targeted strategies for engagement (flexible and creative delivery of care, a whole of community approach, being multiskilled and technology use)., Conclusions: Although engaging with consumers involves many skills and attributes employed universally across mental health settings, the rural clinician's ability to navigate the environment and utilise this to provide consumer care is equally important to the engagement process. Specifically, these findings highlight the preference of rural mental health clinicians towards a person-centred approach, networking with others in the community when providing care. Understanding how best to maximise the nature of a rural environment, such as facilitating relationships between clinicians and others in the community, will contribute to optimised care., (© 2015 National Rural Health Alliance Inc.)

Background: Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities into young adulthood for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in taking the prevention agenda forward., Method: Building on an aetiological model of adult mental illness that emphasizes the importance of intervening during infancy, childhood, adolescence and youth, we adapted a workforce and service planning framework, originally applied to diabetes care, to the analysis of the workforce and service structures required for best-practice prevention of mental illness., Results: The resulting framework consists of 6 steps that include identifying priority risk factors, profiling the population in terms of these risk factors to identify at-risk groups, matching these at-risk groups to best-practice interventions, translation of these interventions to competencies, translation of competencies to workforce and service estimates, and finally, exploring the policy implications of these workforce and services estimates. The framework outlines the specific tasks involved in translating the evidence-base in prevention, to clearly actionable workforce, service delivery and funding recommendations., Conclusions: The framework describes the means to deliver mental illness prevention that the literature indicates is achievable, and is the basis of an ongoing project to model the workforce and service structures required for mental illness prevention.

Successfully engaging with consumers is seen as an essential component of mental healthcare, yet doing so can be challenging and little is understood about the unique engagement skills and attributes employed by mental health clinicians working in the emergency community context. Consequently, this qualitative study explored the engagement experiences of clinicians to identify the attributes used when engaging with consumers in this unique setting. We conducted two semi-structured focus groups in July and August 2011 with 16 clinicians employed at one metropolitan mental health organisation in South Australia. Using thematic analysis, we identified two key themes pertaining to the skills and attributes used for successful consumer engagement: (i) building trust, through communication style, an honest approach, facilitating choice and locating trust networks; and (ii) portraying genuine care, through showing respect, offering practical assistance and taking the least restrictive pathway. These findings highlight the unique nature of engagement in the emergency community mental health setting, as well as the flexibility and resourcefulness required to facilitate it., (© 2014 John Wiley & Sons Ltd.)

Background: Depression is a major public health concern of global significance. The illness diminishes overall quality of life and has been associated with significant distress and disability in physical, interpersonal, and social role functioning. Over the past few decades, a consensus has evolved that cognitive behavioural therapy (CBT) can be an effective treatment for depression in older adults; however, little attention has been given to its effect on them., Aims: The purpose of this review was to examine the current use of CBT and its effect on older adults with depression., Method: A web-based literature search was performed to identify original research articles published from 2000 to 2013 using a three-step search strategy., Results: Evidence indicates that cognitive behavioural therapies are likely to be efficacious in older people when compared with treatment as usual. This is consistent with the findings of several systematic reviews and meta-analyses undertaken across a wider age range., Conclusions: Given that many older adults with depression are reluctant to accept antidepressant medication or unable to tolerate their side effects, CBT can be used as an option in treating depression in older adults.

Objective: This research aimed to identify challenges encountered by young people from refugee backgrounds with co-existing mental health (MH) and alcohol and other drug (AOD) problems (comorbidity) and sought to compare the perspectives of refugee youth and service providers in a metropolitan region of Adelaide, South Australia., Methods: Semi-structured interviews were conducted with two groups of participants: young people from refugee backgrounds (African, Afghan, Bhutanese) and workers from MH, AOD and refugee support services., Results: The refugee youth reported that the biggest difficulty they face once they develop MH and AOD problems is social disconnectedness. They lacked awareness that services are available to support them. In contrast, clinicians rated difficulty accessing and receiving culturally competent comorbidity care as the greatest challenge. Other reported challenges were relatively consistent across both groups., Conclusions: This study has implications for how we engage these young people in services, prioritise areas of care and effectively treat and support refugee youth experiencing comorbidity. These findings emphasise the need for a combined therapeutic casework approach, addressing needs such as social connectedness, housing, education and employment., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Objective: Comorbidity between mental health and alcohol and other drug (AOD) disorders is common. This study aimed to identify and describe all of the local government and non-government (NGO) mental health and AOD services in a socially disadvantaged urban region in Adelaide, South Australia., Method: Services were identified using telephone directories and the internet, and via information from workers employed by a wide range of mental health and AOD services., Results: Local mental health and AOD services were difficult to locate, but eventually we identified a total of 70 services. Soon after this, reorganisation of the mental health services and a new NGO funding round changed the service configuration, with a decrease in the number of services. The available services were fragmented, and rarely addressed comorbidity specifically., Conclusion: Our real-world study demonstrates the lack of a clear pathway for people to access existing services. Further, changes occur frequently as government funded services generally reorganise every couple of years, and NGO services come and go according to funding. There is a need for a central, widely available database for mental health and AOD services. More services addressing comorbid mental health and AOD disorders are required., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Registered nurses within public mental health services play crucial roles in helping people recover from suicidal crisis. However, there is a lack of understanding of how care is experienced in this context, and available evidence suggests that nurses and consumers are often dissatisfied with the quality of care. There is thus an imperative to generate understanding of needs and experiences of both groups with a view to informing practice development. This article summarizes qualitative findings from a multimethod study undertaken in Australia, which surveyed and interviewed mental health nurses who had recent experience of caring for consumers in suicidal crisis in a hospital setting, and interviewed consumers who had recovered from a recent suicidal crisis. A framework was developed to guide the study and support ethical imperatives; in particular, the promotion of consumer well-being. The findings highlight that therapeutic interpersonal engagement between nurses and consumers was central to quality care. This was particularly noted, as engagement could help reduce consumer isolation, loss of control, distress, and objectification of the delivery of potentially-objectifying common interventions. Of concern, the results indicate a lack of therapeutic engagement from the perspective of both consumers and nurses. Recommendations to promote fuller therapeutic engagement are presented., (© 2014 Australian College of Mental Health Nurses Inc.)

Objectives: This paper describes the implementation of a state-wide clozapine management system to improve the quality of care for those with treatment-resistant schizophrenia. This intervention includes standardised forms, computer-based monitoring and alerting and nurse-led clinics for stable consumers., Methods: Methods used during system development included medical record and clinical information system audit, consensus review of available evidence and qualitative review of existing forms, systems and stakeholder opinion., Results: Nurse-led monitoring safely reduced medical outpatient appointments by 119 per week in metropolitan public clinics. In the 15 months following the implementation of all interventions, mortality associated with physical illness not related to malignancy was reduced from an average of 5 deaths per year to one., Conclusions: Differing interpretations of clozapine guidelines have contributed to confusion around monitoring. Standardised documentation has helped to increase understanding and improve protocol adherence. A regular training programme has increased basic knowledge of risks and protocols. Computer-based documentation and alerting systems have improved communication between hospital and community-based teams and prompted early intervention reducing the risk of adverse events. These factors have combined to help improve outcomes in clozapine management. Nurse-led clinics are a safe and efficient alternative for monitoring clozapine treatment., (© The Royal Australian and New Zealand College of Psychiatrists 2014.)

Introduction: Cultural and linguistic diversity is a core feature of the Australian population and a valued element of national identity. The proportion of the population that will be overseas-born is projected to be 32% by 2050. While a very active process of mental health system reform has been occurring for more than two decades - at national and state and territory levels - the challenges presented by cultural and linguistic diversity have not been effectively met. A key area in which this is particularly an issue is in the collection, analysis and reporting of mental health data that reflect the reality of population diversity. The purpose of this study was to examine: what is known about the mental health of immigrant and refugee communities in Australia; whether Australian mental health research pays adequate attention to the fact of cultural and linguistic diversity in the Australian population; and whether national mental health data collections support evidence-informed mental health policy and practice and mental health reform in multicultural Australia., Methods: The study consisted of three components - a brief review of what is known about mental health in, and mental health service use by, immigrant and refugee communities; an examination of national data collections to determine the extent to which relevant cultural variables are included in the collections; and an examination of Australian research to determine the extent to which immigrant and refugee communities are included as participants in such research., Results: The review of Australian research on mental health of immigrant and refugee communities and their patterns of mental health service use generated findings that are highly variable. The work is fragmented and usually small-scale. There are multiple studies of some immigrant and refugee communities and there are no studies of others. Although there is a broadly consistent pattern of lower rates of utilisation of specialist public mental health services by immigrants and refugees the absence of adequate population epidemiological data prevents judgments about whether the observed patterns constitute under-utilisation. There are virtually no data on quality of service outcomes. The examination of national data collections revealed multiple gaps in these data collections. The review of papers published in four key Australian journals to determine whether immigrants and refugees are included in mental health research studies revealed a high rate (9.1%) of specific exclusion from studies (usually due to low English fluency) and a much higher rate of general neglect of the issue of population diversity in study design and reporting., Conclusions: While there are many positive statements of policy intent in relation to immigrant and refugee communities in national mental health policies and strategies there is virtually no reporting by Commonwealth or State and Territory governments of whether policies that are relevant to immigrant and refugee communities are effectively implemented. It is not possible, on the basis of the data collected, to determine whether immigrant and refugee communities are benefiting from the mental health system reforms that are being actively carried out. The majority of Australian mental health research does not adequately include immigrant and refugee samples. On the basis of the findings of this study eight strategies have been recommended that will contribute to the development of a culture of inclusion of all Australians in the national mental health research enterprise.

Background: Suicide in older people is a significant public health issue with a predicted future increase. Contemporary research directs considerable attention toward physical, mental, and social risk factors that contribute to suicidality in older people; still, little is understood about the fundamental meanings that older people in suicidal crisis attribute to these factors., Aims: The aim of this qualitative study was to describe, analyze, and compare counselors' and older peoples' perceptions of the suicidal crisis during an emergency telephone conversation., Methods: Data collection consisted of individual interviews with telephone counselors (N = 7) working within an emergency mental health triage service, and listening to telephone calls (N = 14) received by the service responding to people aged 65 years and over in suicidal crisis. Triangulation of the two data sets resulted in the emergence of three key themes., Results: We found (1) congruence in the way risk factors were perceived by counselors and communicated during telephone conversations, (2) dissension between counselors' perceptions of end-of-life issues and older people's feelings of ambivalence about wanting to die and not knowing what to do and (3) the need for working side-by-side with the older person, exploring acute changes and immediate capacity for change., Conclusions: An explicit focus on risk factors alone may preclude counselors from gaining a deeper understanding of suicidal crisis in an older person's life. This research has begun to capture and illuminate how telephone counselors can deliver effective crisis intervention as older people struggle and make meaning through their suffering.

Objectives: Using 2 sequential studies in HOPE (Heart Outcomes Prevention Evaluation) study-type patients, the aims of this study were: 1) to test the hypothesis that ramipril improves platelet nitric oxide (NO) responsiveness: and 2) to explore biochemical and physiological effects of ramipril in a cohort selected on the basis of platelet NO resistance., Background: Ramipril prevents cardiovascular events, but the bases for these effects remain uncertain. NO resistance at both the platelet and vascular levels is present in a substantial proportion of patients with diabetes or ischemic heart disease and is an independent risk factor for cardiovascular events., Methods: Study 1 was a double-blind, randomized comparison of ramipril (10 mg) with placebo in a cohort of patients (n = 119) with ischemic heart disease or diabetes plus additional coronary risk factor(s), in which effects on platelet responsiveness to NO were compared. Study 2 was a subsequent short-term evaluation of the effects of ramipril in a cohort of subjects (n = 19) with impaired platelet NO responsiveness in whom additional mechanistic data were sought., Results: In study 1, ramipril therapy increased platelet responsiveness to NO relative to the extent of aggregation (p < 0.001), but this effect occurred primarily in patients with severely impaired baseline NO responsiveness (n = 41). In study 2, ramipril also improved platelet NO responsiveness (p < 0.01), and this improvement was correlated directly with increased NO-stimulated platelet generation of cyclic guanosine monophosphate (p < 0.02) but not with changes in plasma thrombospondin-1 levels., Conclusions: Ramipril ameliorates platelet NO resistance in HOPE study-type patients, with associated increases in soluble guanylate cyclase responsiveness to NO. This effect is likely to contribute to treatment benefit and define patients in whom ramipril therapy is particularly effective., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: The aim of this paper is to examine high-level evidence in early intervention in psychosis and scope the potential role of the mental health nurse-practitioner in the treatment of management of early psychosis., Background: Psychosis imposes complex symptoms that impact on the individual and their social network, often resulting in long-term disability. As specialised early intervention in psychosis is emerging, the nurse-practitioner role in mental health is also gaining momentum. The background literature highlights several critical synergies between nurse-practitioners' scope of practice and needs of patients with early psychosis., Design: Literature review., Method: Electronic databases including Cochrane Library, CINAHL, Medline, TRIP and EMBASE. Searching was limited to articles published between 1988-2009. Eligible studies were limited to systematic reviews and randomised controlled trials., Results: Two systematic reviews and five randomised controlled trials met the inclusion criteria. No studies were located which specifically addressed the nurse-practitioner role in early psychosis., Conclusions: Specific interventions require further research but there is emerging evidence that specialised intervention for people in the early phase of psychotic illness is achievable and possibly essential. It is within the scope of practice of mental health nurse-practitioners to ensure patient and carer education and support, adherence to medication and other treatments, promotion of social inclusion and social connectedness., Relevance to Clinical Practice: Mental health nurse-practitioners have the potential to provide specialist support to meet the needs of this complex group. Central to this is an ability to build an evidence-base around the treatment and management of people with early psychosis and deliver effective education and leadership across clinical, inter-professional and organisational domains. The paper concludes by positing a set of recommendations for nurse-practitioners in the field of early psychosis in the Australian mental health setting., (© 2011 Blackwell Publishing Ltd.)

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses., (© 2011 Blackwell Publishing Asia Pty Ltd.)

The large and diverse bodies of literature on refugee child and adolescent mental health have not been matched by a commensurate interest in help-seeking. Most help-seeking research has centred on Western and, to a lesser extent, non-refugee ethnic minority adult populations. An emerging child and adolescent help-seeking literature consistently reports widespread underutilization of mental health services by children in the general population. Current research and opinion suggest a similar trend for refugee and other ethnic minority children. While service underutilization appears to be an issue for all children, those from refugee backgrounds may be at increased risk of mental health problems and have greater difficulty accessing mental health care. From a policy and practice perspective, the most important explanation for low uptake of services by refugee families concerns an overall failure of Western mental health systems to accommodate the needs of ethnically diverse populations in general and refugees in particular. In order to effectively plan for the mental health needs of refugee children and adolescents, Western host country governments need a clear understanding of help-seeking behaviour.

Emergency nurses see refugees and asylum seekers at the very point of their distress. This clinical update is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help nurses assess, care and comfort refugees and asylum seekers in this predicament.

This article examines the impact of the Balkan conflict on the culture and emotional health of a community of Serbian Australians. It discusses how an intimate reconnection with their cultural identity, Serbian Australians, without formal mental health service supports, managed the complex and dynamic interplay between homeland events, mainstream media reports, ethnonational bonds, and mental health issues in Australia. Ethnographic techniques revealed that although the Balkan conflict bared a multitude of potent health and emotional concerns for Serbian Australians, their coping was enhanced by an intimate sense of belonging and reassociation with their historical, religious, cultural, and national identities. By engaging in spiritual connections with their culture and ethnicity, the transglobal effects of the Balkan war on Serbians in Australia revealed that mental health and healing could no longer be seen as a localized phenomenon. It must also be seen as something that transcends the nations and communities in which people live.

The present study sought to understand the rural and remote influences on people's identification of, and response to, mental health problems. Twenty-two key informants living in northern and western South Australia were interviewed. They included mental health and generalist health professionals, other human service workers and mental health consumers. Three themes are reported here: reluctance to acknowledge mental health problems and the avoidance of appropriate help; stigma and the avoidance of mental health services; and the influence of rural and remote circumstances. Most informants considered that many mental health problems were amenable to help from generalist workers, with backup support from mental health specialists. Informants thought this intervention to be appropriate because a common view of mental health problems as 'insanity' and a culture of self-reliance created a reluctance to seek help from a mental health specialist. These themes need to be taken into account when designing mental health interventions for rural and remote communities.

This paper reverses the usual argument about the relationship between research and nursing by showing how mental health nursing knowledge can be used to facilitate ethnographic research. It focuses on the use of mental health nursing in ethnographic data generation from Serbian Australian participants living in the shadow of the Balkan war 1991-96. Beginning with a fieldwork episode at the scene of property damage, it traces the main features of participants' distress, and describes a mental health nursing response to a threat of violence against the author. A background in mental health nursing facilitated a productive and safe interaction under difficult and extremely emotionally charged circumstances.

In recent years, the world has been subjected to violent ethnic wars for autonomy and secession. Violent conflicts over national and international territorial boundaries are marked by a murderous mistrust, hatred and a perpetual life-and-death struggle in the present. For the mental health nurse, the world-wide persistent global circumstance of international catastrophe and increasing nationalism mediated through war is inextricably linked to practice as well as the significant health and lifestyle concerns of displaced people. Central to the discussion in this paper will be the mechanisms used by the mental health nurse to maintain empathy and clinical excellence during highly sensitive practice issues; in particular, the management of feelings of frustration, anger, guilt, loneliness and sleeplessness, and repeated mental images of suffering and human butchering, because these issues intersect with national and cultural identity. In rising to the challenges these issues present, mental health nursing must co-exist with critical world events and the globalisation of national identity in cultural diversity.

Worldwide catastrophic events such as civil war have forced 1 in every 130 people in the world to flee her or his home and become a refugee or displaced person. The article draws upon contemporary refugee experiences from Afghanistan, the Sudan, and the former Yugoslavia to introduce the role of nursing during the refugee journey from flight to asylum seeking. It is hoped that the article will provide nurses with a beginning awareness of the nurse's role in the care and comfort of refugees and displaced people. Central to this role is the gathering of humanitarian, sociocultural, and personal information to enable extensive networking and relationship building with refugees for ongoing empowerment and increased problem-solving capabilities.