Abstract: The authors report on a recent study investigating the statutory role of responsible clinician. Statutory roles under mental health legislation offer mental health nurses a means of having advanced practice skills recognised, as well as contributing to improved access to services. There is a proliferation of roles intended to develop nursing readership, but in most cases they are not primarily clinical roles. The concept of “advanced practice” has become a means of developing clinical leadership roles in nursing. Research on responsible clinician role is presented along with the results of a survey of the 11 Registered Nurses practicing as responsible clinicians, five senior nurses from each of the 21 district health boards, and the Auckland Regional Forensic Psychiatry Services (n = 121). Respondents were asked whether the responsible clinician role was a legitimate one for nurses and whether they were motivated to attain or maintain that role. They were also asked which competencies for the role they believed they met, their perceptions of credentialing processes and the educational requirements needed to achieve the role. A clear majority of the respondents felt the role of the responsible clinician was a legitimate advanced practice role for mental health nurses. Despite this, some respondents expressed ambivalence about taking on the role. The research highlighted deficits in knowledge and skills that could become a focus of education for advanced practitioners seeking appointment as responsible clinicians. Deficits included some assessment skills, knowledge of a range of interventions and knowledge of other legislation affecting mental health legislation.

Abstract: The authors report a clinical audit that, combined with anecdotal evidence, verifies the practice of putting section 8B medical certificates on the files of voluntary mental health patients at the time of admission. This is seen as a strategy to balance the requirement to support and promote the autonomy of voluntary patients with the need to protect those patients or other people. A conceptual analysis of these issues indicates that such a practice is both legally questionable and ethically inappropriate. The authors suggest an alternative framework for practice that is legally and ethically preferable for both nurses and patients.

Abstract: The authors outline the Clinical Career Pathways (CCPs) for nurses, which were first established in New Zealand during the late 1980s. This paper introduces a new instrument, the Clinical Career Pathway Evaluation Tool (CCPET) designed to assess nurses' and midwives' knowledge of and attitudes towards their Clinical Career Pathway. The 51 item instrument takes the form of a self-report questionnaire. The development of the CCPET is described and results from an initial application of the instrument with 239 nurses and midwives in a New Zealand hospital are presented. Results indicate that knowledge levels were moderate in this sample and were correlated with both positive and negative attitudes. Results of t-test comparisons indicated that, on average, the group who had already completed a CCP portfolio had greater knowledge and more positive attitudes than the group who had not.

Abstract: The authors introduce the Kaupapa nursing service at Te Puna Hauora, Tauranga Hospital. It implements an indigenous health model, the Whanaungatanga Model of Care, to guide nursing practice. This paper describes the concept of care it applies to serving its Maori population and the role of the Kaiawhina Social Worker. The authors highlights the interface between primary and secondary care after patients are discharged. The authors address the shortfall of Maori practitioners in the nursing service and the aims of a year-long pre-entry Kaupapa Health Professional Programme.

Abstract: The authors evaluated a nurse-led cardiovascular disease and diabetes (CVD) management project. The Ministry of Health funded the project to implement models of nurse service delivery, with care pathways for risk reduction of CVD and diabetes based on national guidelines, with quality assurance, audit and nurse leadership. The paper presents the components required to implement and sustain a nurse CVD risk assessment and management service, which were identified and clarified through the action research process.

Abstract: The authors defines health assessment and argue that it is a tool nurses should be using as a means of improving health outcomes for clients. The skills involved in health assessments are analysed, and four levels of data gathering are identified. The authors present an historical perspective, tracing the development of these skills as they have been incorporated in nursing practice in North America and Australia.

Abstract: The author, an occupational health nurse, examines rationale for and effectiveness of the pre-employment assessment, which has become an accepted practice. Reasons for doing assessments include the reduction of risk to the employer from lower accident rates and absenteeism, compliance with legislative requirements and the provision of baseline health measures for general health surveillance. The costs of the screening process, along with the benefits are weighed up, in conjunction with international research in the area. The author found little research on the process in New Zealand. The opportunity for primary health care and health promotion practice as an aspect of this screening is highlighted as an important, though underestimated, benefit. Regular auditing is recommended to ensure that the outcomes of the process meet the criteria required.

Abstract: The author's interest in this study came from working as a mental health nurse with mainly older women with depression and developed from her concern that depression for older people is frequently misdiagnosed, not recognised or is under-treated. To date, research has rarely paid attention to the voices of people who have actually experienced depression and even less is known from the perspective of older women. This hermeneutic phenomenological study, informed by Martin Heidegger and Max van Manen, describes what it is like for four older women to live with depression. Multiple interviews were conducted with the participants. Heidegger's philosophical concepts of Being-in-the-world and Being-with-others structured the analysis. Depression was found to have a significant effect on the participants' Being-in-the-world. The themes that emerged were: something is wrong; the search for reasons; self-loathing; being overwhelmed by the feelings; hiding from the world; loss of self; loss of meaning; the struggle of everyday life; and living circumspectly. Being-with-others was difficult for the participants and the themes that emerged were: maintaining relationships when well; Being-alone; misinterpreting self and other people; the stigma of mental illness – society and self; and seeking understanding from other people. The author suggests that the findings have implications for nurses and other health professionals.