Isabelle Skinner

Treatments for people living with schizophrenia in Sub-Saharan Africa: an adapted realist review

AIM To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub-Saharan Africa. BACKGROUND Help-seeking behaviour and the choice of treatment are largely influenced by socio-cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub-Saharan Africa. DESIGN Adapted realist literature review. DATA SOURCES Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL. REVIEW METHODS The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results. RESULTS Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative. LIMITATIONS Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub-Saharan Africa and lack of generalizability. CONCLUSION People living with schizophrenia in Sub-Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region. IMPLICATIONS FOR NURSING AND HEALTH POLICY Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person-centred and culturally relevant mental health services within the primary care context.

Severity and duration of pain after colonoscopy and gastroscopy: a cohort study

AIMS AND OBJECTIVES This study aimed to determine the prevalence, severity, location and duration of pain post-colonoscopy, and to explore possible associations between pain, demographic variables and diagnostic findings. The study also sought to provide information to guide decision-making on CO2 insufflation. BACKGROUND Colonoscopy with sedation is a common day surgery procedure in Australia. Attendance for colonoscopy is influenced by patient expectations, particularly about pain. Research on post-colonoscopy pain has focussed on pain experienced immediately post-procedure, with few studies investigating pain beyond 24 hours. DESIGN Follow-up study using patient-completed Pain Numerical Rating Scales. METHODS Patients undergoing colonoscopy at a single hospital day surgery unit were invited to complete Pain Numerical Rating Scales (where 0 = no pain and 10 = worst possible pain) three times daily for three days post-colonoscopy. RESULTS Among the 277 participants, 124 (45%) reported pain at any time during follow-up. Twenty-one (8%) participants experienced pain on each of the three days. Pain was most commonly experienced in the hypogastric and iliac regions. The severity of pain was low, with only 33 participants self-administering analgesics (paracetamol or nonsteroidal anti-inflammatory drugs) during follow-up. Participants who had both colonoscopy and gastroscopy were not more likely to report pain overall. However, they were more likely to report pain on days 2 and 3 and were also more likely to take analgesics. Pain was not associated with procedure duration, abdominal pressurisation, removal of polyps, diverticulitis, inflammatory bowel disease or the presence of benign or malignant lesions. CONCLUSIONS This research indicates that fewer than half of the patients undergoing colonoscopy will experience post-procedure pain and that just over one in ten patients will require analgesics. Patients undergoing both gastroscopy and colonoscopy are more likely to experience pain for longer and require over-the-counter analgesics. The low prevalence of pain suggests that room air insufflation is an acceptable alternative to more expensive CO2 . RELEVANCE TO CLINICAL PRACTICE The findings provide evidence for nurses and clinicians to advise patients about the likelihood of experiencing pain post-colonoscopy, and the characteristics of this pain. Nurses may reassure patients that pain is not more likely among patients diagnosed with colorectal disease or malignancy. Patients who have persistent pain for longer than 24 hours post-colonoscopy should be advised to seek medical care to investigate the cause of their pain.

Chronic disease, medications and lifestyle: perceptions from a regional Victorian Aboriginal community

Background: Poor medication management may contribute to the increased morbidity and mortality of Aboriginal people in Australia. Yet while there is extensive literature about the perceptions of healthcare providers on this issue, there is limited information on the perceptions of Aboriginal people themselves. Objectives: To investigate the perceptions of a group of Aboriginal people attending a Victorian regional Aboriginal Health Service (AHS) with diagnosed medical conditions requiring medications, of their lifestyle, disease management and medication usage. Methods: Data was collected through one to one in depth interviews using a semi-structured ‘yarning’ process. Twenty patients were invited to participate in the study and were interviewed by Aboriginal Health Workers in a culturally appropriate manner. The interviews were recorded and transcribed verbatim. The data were analysed using descriptive statistics. Results: Our results show that the majority of participants perceived that changes in lifestyle factors such as diet, exercise, and smoking cessation would help improve their health. Most patients reported having been counselled on their medicines, and while the majority reported adherence and acknowledgement of the efficacy of their medicines, there was a lack of clarity regarding long term maintenance on regimens. Finally, while the majority reported taking over the counter products, some did not see the need to inform their doctor about this, or chose not to. Conclusion: Chronic illness was perceived as common in families and community. Patients relied mostly on their health care professionals as sources for their drug information. Patients may have benefited from further counselling in the area of complementary and other over the counter medicines, as well as on the necessity of maintenance of regimes for chronic disease management. Finally, lifestyle changes such as dietary improvements and smoking cessation were identified as areas that may assist in improving health outcomes.

Navigating Nuances of Language and Meaning: Challenges of Cross-Language Ethnography Involving Shona Speakers Living With Schizophrenia:

For people living with schizophrenia, their experience is personal and culturally bound. Focused ethnography enables researchers to understand people’s experiences in-context, a prerequisite to providing person-centered care. Data are gathered through observational fieldwork and in-depth interviews with cultural informants. Regardless of the culture, ethnographic research involves resolving issues of language, communication, and meaning. This article discusses the challenges faced by a bilingual, primary mental health nurse researcher when investigating the experiences of people living with schizophrenia in Zimbabwe. Bilingual understanding influenced the research questions, translation of a validated survey instrument and interview transcripts, analysis of the nuances of dialect and local idioms, and confirmation of cultural understanding. When the researcher is a bilingual cultural insider, the insights gained can be more nuanced and culturally enriched. In cross-language research, translation issues are especially challenging when it involves people with a mental illness and requires researcher experience, ethical sensitivity, and cultural awareness.

Association between short sleep duration and body mass index in Australian Indigenous children

Associations between short sleep duration and obesity and the relationship between obesity and chronic illness are well documented. Obese children are likely to become obese adults. To date, there is a paucity of information regarding sleep duration and quality for Indigenous Australian people. It may be that poor‐quality, short sleep is contributing to the gap in health outcomes for Indigenous people compared with non‐Indigenous adults and children. This study sought to investigate the possibility that poor sleep quality may be contributing to health outcomes for Indigenous children by exploring associations between sleep duration and body mass index (BMI).

The foot-health of adult diabetics in regional Australia: baseline findings from an epidemiological study

Background There is limited epidemiological research that reports on the foot-health of people with diabetes within Australian regional settings. This study reports on the baseline characteristics of a large prospective cohort study. The objective of this baseline analysis is to explore the relationship between demographic, socio-economic and diabetesrelated variables with diabetes-related foot morbidity in people residing in regional and rural Australia.

Nursing and midwifery: Pillars of rural and remote health innovation and development

This issue showcases multidisciplinary rural and remote health research from a nursing and midwifery perspective. It incorporates health systems research and development; it showcases innovative research methods. This issue provides all readers interested in rural and remote health insights into the relevance, breadth and depth of rural and remote nursing and midwifery research. The nursing and midwifery workforces have always been pillars of rural and remote health. Nurses and midwives are relatively well distributed across the geographic landscape of Australia in proportion to the population, especially when compared with doctors. However, the average age of rural and remote nurses and midwives is older than that of their counterparts in major cities, leading to well-founded fears that a ‘retirement bubble’ will soon burst, resulting in demographic changes and workforce shortages. Nurses and midwives have worked in isolated settings and communities providing a broad range of continuous and essential health care with limited access to mainstream and specialist services for a very long time. These diverse practices began long before the advanced scope of practice nurse and the nurse practitioner were introduced as part of national health workforce reforms. Aboriginal and Torres Strait Islander and small isolated communities often rely on a remote area nurse as their first and sometimes only point of contact for primary health care. Greater attention needs to be paid to these unique groups of nurses in the development of national and state health workforce strategies, particularly in light of greater role complexity and projected workforce shortages of rural and remote nurses. Much-needed advocacy, support and resources for remote health practitioners are being provided by organisations such as CRANA Plus, which started as the Council of Remote Area Nurses Australia, and is now multidisciplinary, and the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM). The Australian Journal of Rural Health (AJRH) was founded by a rural nurse, Professor Desley Hegney, and has also played an important part in raising awareness of the vital work of rural and remote nurses and midwives by publishing evidence about their practice. This edition of the AJRH celebrates the ongoing contribution of nursing and midwifery to the health and well-being of rural and remote Australians. The papers selected showcase contemporary rural and remote nursing and midwifery practice, and the complex issues faced by both professions. As governments consider national health reform, consideration must be given to the contribution made by both professions alongside development of strategies to maximise nurses’ and midwives’ scope of practice and their future role in sustainable health service provision in the bush. Four papers in this edition deal with Aboriginal and Torres Strait Islander health, ranging from policy implementation in child health screening, through to the preparation of midwifery students for future practice. Bradshaw et al. show, for example, that when nurses work at the level of state-wide policy in partnership with Aboriginal health using an implementation strategy and guidelines, then capacity can increase to deliver child health services to Aboriginal communities in Western Australia. ONeil et al. looked at the value of nurse practitioners in early detection and management of chronic kidney disease for a primary health care service. The benefit of child health nurses working in partnership with peer support workers is demonstrated in the Halls Creek Community Program, which required attention to communication, education and also organisational strategies (Munns et al.). Thackrah et al. describe the selfawareness gained by midwifery students while on a health promotion placement in a remote Aboriginal community. The importance of strong partnerships with the local community is shown as essential; students learned to respect the local context, and to be flexible and creative, which are fundamental skills in remote settings. Two midwifery service papers by Sweet et al. and Haines et al. cover 20 years of changes to birthing practices and the development of a rural caseload model over this time. Sweet et al. provide a detailed examination of the changing midwifery practice and birthing landscape in South Australia. Haines et al. provide the clinical outcomes and offer insider insights on the sustainability of a caseload midwifery model, highlighting the need for strong leadership, flexibility in the work environment and a trusting relationship with obstetricians. Introduction of the model led to birthing outcomes that reflect national outcomes and challenge us to consider why there has not been broader rural uptake of such caseload midwifery models.