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O'Brien, A. J., Hughes, F., & Kidd, J. D. (2006). Mental health nursing in New Zealand primary health care. Contemporary Nurse, 21(1), 142–152.
Abstract: This article describes the move in mental health from institutional care to community arrangements. It draws on international literature and New Zealand health policy, which gives increased emphasis to the role of the primary health care sector in responding to mental health issues. These issues include the need for health promotion, improved detection and treatment of mild to moderate mental illness, and provision of mental health care to some of those with severe mental illness who traditionally receive care in secondary services. These developments challenge specialist mental health nurses to develop new roles which extend their practice into primary health care. In some parts of New Zealand this process has been under way for some time in the form of shared care projects. However developments currently are ad hoc and leave room for considerable development of specialist mental health nursing roles, including roles for nurse practitioners in primary mental health care.
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Nichols, J. (2004). An exploration of clinical supervision within mental health nursing. Vision: A Journal of Nursing, (November).
Abstract: The purpose of this paper is to shed some light on the concept of clinical supervision specifically in relation to mental health nursing. The author talks briefly about the naming and history of clinical supervision and aims to provide some clarity around defining the concept. There is discussion around the role, value and objectives of clinical supervision before critical examination of two models of clinical supervision within two different contexts. Finally the strengths and weaknesses of each model are discussed, and the differences illustrate some of the contextual factors of clinical supervision.
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Neville, S. J., Gillon, D., & Milligan, K. (2006). New Zealand registered nurses' use of physical assessment skills: A pilot study. Vision: A Journal of Nursing, (14(1)).
Abstract: The objective of this project was to ascertain registered nurses' use of selected physical assessment skills before and after participation in a health assessment course. A pre- (also referred to as part I) and post- (part II) test design was used to investigate the research aim. Participants were obtained via a convenience sample. A questionnaire was completed at the beginning of the educational programme and then four to six weeks after completion of the assessment course. A two tailed t-test was used to identify any significant differences in the characteristics of participants from part I (N = 206) to part II (N = 145), with no differences identified. However, there was an overall mean percentage difference of 17.1% in the use of physical assessment skills after having completed the educational programme. In conclusion, the researchers found that four to six weeks after completion of a health assessment course, nurses were using the skills learned to improve their nursing practice more frequently than before the programme.
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Pirret, A. M. (2003). A preoperative scoring system to identify patients requiring postoperative high dependency care. Intensive & Critical Care Nursing, 19(5), 267–275.
Abstract: The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring. This study describes the development and effect of a nursing preoperative assessment tool to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU. All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool. During the time period studied, acute admissions to ICU/HDU reduced from 40.37 to 19.11%. Only 24.04% of patients who had a PAS >4 were identified by the surgeon and/or anesthetist as being at risk of a postoperative complication, or if identified, no provision was made for improved postoperative monitoring. This study supports the involvement of nurses in identifying preoperatively patients at risk of a postoperative complication and in need of improved postoperative monitoring. The postoperative monitoring requirements for the PAS >4 patients were relatively low technology interventions.
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Egan, M. (1999). The nursing and midwifery practice structure at Healthcare Hawkes Bay: An evaluation and improvement process. Vision: A Journal of Nursing, 5(8), 27–29.
Abstract: This article describes the Nursing and Midwifery Practice Structure, which has been in place at Healthcare Hawkes Bay since 1996. It was developed to provide nurses and midwives in clinical positions with a professional development structure, and uses a framework to recognise and reward competence. It encourages clinical progression and was developed to link nursing competence with remuneration. The Practice Structure, based on the work of Patricia Benner (Benner, 1984), is made up of 4 levels: Beginner/Advance Beginner Practitioner, Competent Practitioner, Proficient Practitioner, Expert Practitioner. The Structure was reviewed in 1998, and a Steering Group was formed to collect feedback from nurses and midwives, identify areas of concern, and make recommendations for improvements. At the time of writing, these recommendations are being implemented and systems are being developed to ensure the Nursing and Midwifery Practice Structure continues to develop.
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McKenna, B., Thom, K., & O'Brien, A. J. (2008). Return to nursing programmes: Justifications for a mental health specific course. Intensive & Critical Care Nursing, 5(1), 1–16.
Abstract: This paper presents the findings from research that investigated the feasibility of developing a specialty return to mental health nursing programme in New Zealand. This was achieved through a scoping of existing return to nursing programmes; a survey of non-active nurses; and stakeholder consultation via interviews or focus groups. Existing generic programmes fail to attract non-active nurses wishing to focus on mental health nursing. The non-active nurses survey found 142 nurses who presently would or might possibly return to mental health nursing and participate in a programme. Most stakeholders supported the idea of implementing such a programme. The findings from this research indicate both feasibility and enthusiasm for the introduction of return to mental health nursing programmes. It is recommended that all aspects of this course mirror the service user focused 'recovery paradigm' that is a central tenet in contemporary mental health service delivery.
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Dellagiacoma, T. (2007). Contracting as a career option for nurses. Kai Tiaki: Nursing New Zealand, 13(1), 20–22.
Abstract: A nurse presents research and her own experiences of contracting. Contracting, as defined in this article, refers to a nurse not employed permanently on a wage. It covers agency nursing, short and long fixed-term contracts and secondments. The author identifies the need to continue to develop professionally, which is now a mandatory requirement under the Health Practitioners Competence Assurance (HPCA) Act. Contractors have little, if any financial support to develop professionally, and time taken to do courses is not paid. Taking study leave within a contract may also not be an option. Options for managing professional development in these conditions are offered, including goal setting, investing in education or training, and considering some longer contracts. Practical financial advice and examples are given, including managing accounts and consideration of employment law. The author recommends that skilled nurses looking for interesting ways to develop their careers and to branch out in an entrepreneurial way should seriously consider taking up contract work.
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Hunt, M. (2006). Nurses can enhance the pre-operative assessment process. Kai Tiaki: Nursing New Zealand, 12(10), 20–22.
Abstract: This reports on an initiative at Whakatane Hospital, where a Nurse-Led pre-assessment (NLPA) was delivered at an outpatients clinic. NLPA involves taking a comprehensive medical history, a nursing assessment, physical examination, airway assessment, ordering appropriate investigations and carefully documenting the process and results. More valuably, it provides an opportunity for the patient to participate in planning their care. The aim of this initative was to short circuit delays and congestion in existing pre-assessment clinics, streamline the pre-assessment process and reduce the number of patient visits to hospital. Reducing cancellations of surgery (often on the day of surgery) and “did not appear” (DNA) numbers were also objectives. After a small pilot, a six-month trial was funded by the Ministry of Health. Over the six-month trial, 373 patients attended NLPA; 178 patients required anaesthetist review before surgery, and 198 could proceed directly to surgery following NLPA. An anonymous postal survey was made of patients, who indicated satisfaction with the service. Other outcomes are discussed, and the trial was deemed successful. Follow up plans have been disrupted by restructuring at the hospital and the clinic has yet to be implemented.
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Flint, V. (2005). The place of ECT in mental health care.11(9), 18–20.
Abstract: The author reviews the controversial treatment of electroconvulsive therapy (ECT) which has re-emerged as a safe and effective treatment for major depressive disorders. She first addresses the popular conceptions of ECT, which are based on early misuse of the treatment when it was delivered unmodified, or forcefully and without anaesthetic. She then uses a case study to illustrate the benefits of ECT for catatonia and catatonic states. Diagnostic criteria for catatonia include motoric immobility, excessive motor activity, extreme negativism or mutism, peculiarities of voluntary movement, and echolalia or echopraxia. The treatment of a patient is detailed, and the role of the ECT nurse is outlined. The ECT nurse is a co-ordinator, an educator, liaises with other services and families, and is a point of contact about ECT within the mental health service generally and in the ECT unit in particular. The case study showed successful use of ECT. A series of eight ECT treatments were administered to the catatonic patient, after which he was discharged home with minor depression and showing signs of enjoying life once again.
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Gregory, R., & Kaplan, L. (2008). Understanding residuals in Guillain-Barre Syndrome. Kai Tiaki: Nursing New Zealand, 10(7), 16–18.
Abstract: The authors review the literature on the residual effects of Guillain-Barre Syndrome (GBS), which can include fatigue, foot drop or numbness, reduced mobility and nerve tingling. In GBS the peripheral nerves are attacked by the body's defence system, an auto-immune attack, and as a result, the myelin sheath and axons of nerves are impaired. The pathophysiology of the illness and long term effects are presented, and implications for nursing care and rehabilitation are discussed. Two case studies are included which illustrate coping with the long-term effects of GBS, the effect of GBS residuals on extreme fatigue and depression.
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Lewer, D. (1999). Analysing the Mental Health Act. Kai Tiaki: Nursing New Zealand, 5(8), 14–16.
Abstract: Changes brought by the Mental Health Act (MHA) to clinical practice, and some of the problems it has created for nurses, are examined in this article. Compulsory assessment and treatment orders (CATO) and the role of Duly Authorised Officers (DAO), and moral dilemmas that can arise as a consequence of CATOs used by DAOs are examined. The requirement for DAOs to act as patient advocates and to safeguard cultural beliefs are highlighted. The MHA promotes self responsibility and a treatment philosophy rather than detention of the mentally ill.
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Crowe, M., Ward, N., Dunnachie, B., & Roberts, M. H. (2006). Characteristics of adolescent depression. International Journal of Mental Health Nursing, 15(1), 10–18.
Abstract: This is a descriptive study of the characteristics of depression in a sample of 121 adolescents attending an outpatient specialist adolescent mental health service in New Zealand. The adolescents were required to complete two self-report measures to assess presence of depressive symptoms, severity of depression, and particular characteristics of the depression. The findings revealed that irritability was the most common characteristic along with other interpersonal and thought processing symptoms. It is important that mental health nurses are able to identify the specific characteristics of adolescent depression that may differ from adult depression in order to manage this patient population effectively.
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Crowe, M., & Luty, S. (2005). Recovery from depression: A discourse analysis of interpersonal psychotherapy. Nursing Inquiry, 12(1), 43–50.
Abstract: This paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression. It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression. The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recover from her depression. The process of recovery is underpinned by an understanding of women's depression as promoted by contemporary social and cultural expectations for detachment and reflexivity. This paper shows how IPT provides an opportunity for recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. The discourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information, exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alternative subject positions.
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Bishop, D., & Ford-Bruins, I. (2003). Nurses' perceptions of mental health assessment in an acute inpatient setting in New Zealand: A qualitative study. International Journal of Mental Health Nursing, 12(3), 203–212.
Abstract: This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semi-structured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.
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Palmer, S. G. (2003). Application of the cognitive therapy model to initial crisis assessment. International Journal of Mental Health Nursing, 12(1), 30–38.
Abstract: This article provides a background to the development of cognitive therapy and cognitive therapeutic skills with a specific focus on the treatment of a depressive episode. It discusses the utility of cognitive therapeutic strategies to the model of crisis theory and initial crisis assessment currently used by the Community Assessment & Treatment Team of Waitemata District Health Board. A brief background to cognitive therapy is provided, followed by a comprehensive example of the use of the Socratic questioning method in guiding collaborative assessment and treatment of suicidality by nurses during the initial crisis assessment.
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