Abstract: This retrospective quasi-experimental study reviewed assaults in two adult mental health inpatient rehabilitation units. The majority of clients in this area experience enduring mental health illnesses and have complex physical health issues. The service comprises of an intensive rehabilitation unit and a secure extended rehabilitation unit. Between May and August 2001 the service moved to purpose built facilities. The opportunity was taken to review clients' assaultive behaviour in the new environment and to compare the incidents with those in the old environment to see if there had been any significant changes. Data on assault incidents including time of assault, place of assault, who was involved and what preventative actions were suggested were collected from the Incident and Accident Hazard Reports (IAHR) dating from 1 April 2000 until 31 May 2002. Staff were expected to complete IAHR reports on all assault incidents. The research examined whether the change in environmental conditions impacted on clients' wellbeing in relation to assaultive behaviour. Trends within the IAHR reports were also examined in order to compare these to similar studies completed in other parts of the world. There were 141 IAHR reports of assault incidents. Fifty of these occurred in the pre move period, 38 in the transition phase and 53 in the post move. There was no significant difference in the rate of assaults in the pre-move to post move period. Completion of the IAHR forms was seen to be very problematic, especially in relation to legal status of perpetrators and documentation of prevention strategies. An urgent audit of existing practice is now required to establish if problems found with the quality and completion of the IAHR forms continues to be evident in the rehabilitation service and if present staff education is needed to improve the standard of documentation. Research is also needed to establish the extent to which staff implement strategies to prevent assaults, and to reduce recidivism.

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.

Abstract: Student nurses rely on their teachers, both academic and clinical, to assist them to develop their capacity to practice safely. Yet, in relation to cultural safety, relatively little has been written to assist the integration of theoretical knowledge to the world of practice. This article presents the findings of a small project undertaken by lecturers whose experiences supporting students' learning during clinical placements in Auckland stimulated interest in the students' attempts to use their classroom learning to begin their journey towards culturally safe nursing practice. A qualitative descriptive approach was used to explore the experience of nursing clients from cultures other than one's own and to describe culturally safe practice from the perspective of third year students.

Abstract: Cultural safety is taught in all undergraduate nursing programmes in Aotearoa/New Zealand. There is a predominance of Pakeha nurse educators in teaching this content. There is little explanation of what being Pakeha entails. This perpetuates a silence and continues the dominant hegemonic position of Pakeha in Aotearoa/New Zealand. This study suggests that as Pakeha cultural safety nurse educators we examine our dominance and critique the delivery of cultural safety education. This autobiographical study undertakes to explore the Pakeha identity of a cultural safety nurse educator. The author discusses identity in the context of a globalised world, and challenges the idea of a definitive Pakeha identity. There are multiple descriptions of Pakeha, all underdeveloped and inadequate for the purposes of cultural safety education. In this study, the author uses the heuristic process of Moustakas (1990) and Maalouf's (2000) ideas of vertical and horizontal heritage to locate and present the essence of the self. In keeping with the purpose of cultural safety education, the author considers her ethnic cultural self as described by Bloch (1983) and explores Helms' (1990) theory of White racial identity development. This thesis describes the position of one Pakeha in the context of teaching cultural safety in an undergraduate nursing degree programme in Aotearoa/New Zealand. For Pakeha cultural safety nurse educators the author argues that exploration of one's heritages and location of a personal Pakeha identity is pivotal to progressing the enactment of cultural safety in Aotearoa /New Zealand.

Abstract: The transition from student to registered nurse is a challenging and often stressful time in a nurse's career. This thesis is a case study research project that explores the graduate nurses' perceptions of preceptorship as a strategy to support this transition at Lakes District Health Board (DHB). As a provider of graduate nurse programmes since 1995, Lakes DHB has provided preceptorship for the nurse in the initial period of clinical practice. Annual evaluation by questionnaire identified that this has been applied in a range of ways in different clinical settings with varying degrees of effectiveness. Further inquiry into graduate nurses' perceptions of the preceptored experience during the first twelve weeks of practice within Lakes DHB forms the basis of this research project. The intention is to utilise this insight to further inform the development of preceptor education programmes and application of the preceptor role in the practice setting. Using the case study research method, data has been collected from fourteen participants using semi-structured interviews, focus groups and secondary data from the previous year's questionnaire undertaken by preceptors and graduate nurses. Thematic analysis of the data has resulted in two categories, each with three associated themes. The first category relates to functional factors in the way the preceptorship role is applied. This explores the role of the Clinical Nurse Educator (CNE), organisation within the unit and the teaching of clinical skills. The second category relates to psychosocial considerations and includes the graduate's sense of being scared and advocacy of the preceptor, socialisation and team support, and the preceptor's own experience as a registered nurse. Recommendations from the research include the allocation of a dedicated preceptor selected with consideration for relational ability; complementary rostering and workload allocation to ensure that the preceptor and graduate nurse work together; early notification when preceptor arrangements break down; implementation of a clinical coaching plan; and strengthening the CNE's role as a leader facilitating and supporting preceptorship in the units. Opportunities for further research that arise from the study include the perceptions of the preceptors and the nursing leadership in clinical areas. Structuring the application of preceptorship, to ensure that all of these aspects are woven throughout the graduate nurse's transition results in Korowai Aroha, a cloak of covering for a supported transition that facilitates the development of practice.

Abstract: This study, which is undertaken in the Southland area, explores the effect of the increasing specialisation of nursing services in what is a rural/urban environment. It is indicated in the literature that systemic changes in health, such as the health reforms, and the increase in the use of technology have meant that nurses are required to function in disease oriented roles rather than according to their more traditional generalist roots. A significant event, which also affected nursing scope of practice, was the transfer of nurse education to the tertiary education institutions environment from the hospitals in the mid 1970s. The traditional nursing hierarchy and its nurse leadership role disappeared and the adoption of specialist nurse titles increased, and identified with a disease or disorder, for example 'diabetes' nurse. The increase in specialist categories for patients contributed to the nurse shortage by reducing the available numbers of nurses in the generalist nursing pool. The nurses in this rural/urban environment require generalist nurse skills to deliver their nursing services because of the geographical vastness of the area being a barrier to specialist nurses. Workforce planning for nurses in the rural/urban then must focus on how to reshape the nursing scope of practice to utilise the existing resources. This study explores how key areas of health services could be enhanced by reclaiming the nurse role in its holistic approach, in mental health, public health, geriatric services and psychiatric services.