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.

Marked improvements in Indigenous health can be achieved by increasing the participation of Indigenous people in the health professions. Currently in Australia the participation by Indigenous people in the health professions is low and the Indigenous people of Australia continue to have poor health outcomes. This qualitative study utilised interviews with 22 Indigenous students enrolled in undergraduate nursing degrees across Australia, to explore the challenges they faced and uncover the strategies they had found helpful to their progress in the course. The findings indicate that students are challenged by financial hardship, staff insensitivity to cultural issues, discrimination, lack of Indigenous mentors, poor study skills, lack of adequate educational preparation, lack of resources, and ongoing family commitments. Strategies identified as particularly helpful to tenure within the course include specific Indigenous support units, adequate financial support, interested academics, Aboriginal Tertiary Assistance Scheme (ATAS) tutors, support from family and friends, and support from other students.

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This paper highlights the inadequacy of existing research for the purposes of evidence-based prn (Latin, pro re nata or 'as needed') medication practice in psychiatric settings and notes the absence of relevant evidence-based clinical practice guidelines and policies, both nationally and internationally. The professional, ethical and legal importance of PRN medication practices is also discussed, and shown to add to the urgency of developing a research agenda which will serve as an adequate basis for good clinical practice. This paper summarises the relevant research and identifies problems that can arise for clinicians involved in the administration of prn medications in mental health settings. It concludes by highlighting key issues which urgently require empirical investigation.

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