Abstract: This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard's (1988) postmodern philosophy of 'regimes of phrases' and 'genres of discourse,' the nurses' stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs.

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.

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.

Abstract: This research is informed by the interpretive phenomenology of van Manen, and explores the lived experience of nursing from the perspective of nurses who provide care for people with a co-existing intellectual disability and mental health problem. Although nursing research is commonly informed by phenomenology, there is a dearth of literature of any description written from the perspective of nurses who provide care for people with intellectual disabilities and mental health problems. As a result of the closure of many large institutions in New Zealand there are not many nurses who work with people who have intellectual disabilities and co-existing mental health problems. The study participants were four nurses purposefully selected because they provided care for people with intellectual disabilities and mental health problems. Data was collected using semi-structured interviews, and the researcher identified and wrote about the recurring themes in the transcribed interview data, which best captured the lived experience of the participants. The themes were: criticism of services, holistic caring, working with the client, issues of status, need for specialist knowledge, enduring relationships, diagnostic issues, advocating, modelling good practice; and working alongside. After further analysis the themes were encompassed within the larger interrelated themes of “Status and positioning” and “Advocating practices”, and finally within a single theme of: “The status and positioning of the nurse and the client leads to advocating practices.” These themes were found to be consistent with the nursing literature and with the researcher's own lived experience as a nurse who works in a specialist mental health intellectual disability service. The findings of this research have implications for a number of groups in New Zealand. Among the author's conclusions are that input is required from the Nursing Council of New Zealand, the nursing profession, nurse educators and the government to raise the status of clients with co-existing intellectual disabilities and mental health problems and the nurses who work with this client group. In addition, the roles for nurses who work with this client group are emerging and are likely to be diverse and there is a need for further research to capture the different experiences of these nurses.

Abstract: This paper is an analysis of the cultural and traditional factors that the author presents as essential considerations in the treatment of Samoan people who have been diagnosed with a mental illness. Just as important to any clinical diagnosis, is the spiritual nature of Samoan culture and traditions, which inform belief systems. A full understanding of these will explain how the traditional beliefs and cultural values of Samoan people have an impact on their perception of mental illness, its causes and cures. The thesis places emphasis on 'ma'i -aitu', the Samoan term for most ailments pertaining to the mind or psyche. The focus is on defining 'ma'i -aitu' as part of a Samoan world view and likewise a description of a similar type of manifestation in the Papalagi (western) context of a psychiatric disorder and how treatment and management is usually undertaken. The issues addressed in this paper aim to highlight the Samoan client's world view from a Samoan perspective of mental illness which then poses the question of how they can be managed holistically and appropriately under the Papalagi medical system. Furthermore, it questions if the traditional belief system of Samoans run deeper than originally thought and can the replacement thereof by a foreign culture be responsible for the increased mental problems in Samoans living in New Zealand? This paper emphasises the importance of integrating the western medical model and Samoan health models, for appropriate mental health service delivery to Samoan people.

Abstract: This study draws upon Gadamer's philosophical hermeneutics to explore the understandings that four men have had of their past suicidal experiences. The interpretations developed in this study, as far as possible, make explicit use of the author's own particular horizon of meaning as researcher and mental health nurse. In addition, by consciously bringing an anti-essentialist perspective of masculinity to this process, he explores the way in which gender impacts on men's suicidality. The primary source of information for this study is in-depth, open-ended conversations with four men of European descent in their middle adult years who were asked to talk about their past experiences of suicidality. The interpretations developed here show that for these men, the hermeneutic fusion of history, language, and sociocultural context, provided limited possibilities with which they were able to construe themselves as 'fitting in' with normative standards. These constraints, that are otherwise taken-for-granted and invisible, became explicit through their experience of ongoing victimisation. Furthermore, early understandings of these experiences became a potent horizon of meaning from which they then came to understand later difficult experiences. Victimisation became constitutive of an understanding of self as fundamentally different and (hierarchically)'less-than' other men. Ultimately, suicidality emerged out of a background of ever-present psychological pain accompanying a construction of self as being unable to see themselves as ever 'fitting in'. These men did not regard themselves as having recovered from suicidality, but remain in a process of recovering. This process did not mean figuring out how to 'fit in', or become 'normal' men, but rather, to live meaningfully as men in spite of not 'fitting in' with the sociocultural ideal. Recovering was a continual and idiosyncratic process, rather than an outcome of a specific technique or knowledge. The position taken in this study is that mental health nursing seeks to engage with people and work with them in collaborative, respectful, human relationships. It is argued that mental health nurses work with an individual's situated understandings rather than delivering prescribed treatment determined by diagnosis. Hence, viewing suicidality as socioculturally situated and historically emergent suggests mental health nurses must closely attend to the way in which we bring ourselves into relationships with our clients so that we are then able to create opportunities for change.

Abstract: This thesis discusses the findings of a research study, informed by the work of van Manen (1997b), which explored the lived experiences of five mental health nurses who have had a patient die through suicide. Narrative was used as a method in interviews to uncover the essence of their lived experiences. Five interwoven themes uncovered in each of the interviews were: impact, support, feelings, closure and paradox. All of the nurses interviewed experienced a wide range of feelings about their patient's suicides, ranging from shock to guilt, to anger and sadness, and described their patient's suicide as having a significant impact on them. Support received by the nurses following their patient's suicide was variable, and they were often in the difficult position of trying to offer support to the patient's family. Common to all of the nurses was the lack of closure following the suicide. Paradox was found to be the overall essence of the experience of the mental health nurses interviewed. Three main paradoxical themes or statements were identified that are in many respects a summary of all of the themes that emerged. These were: unavoidable – responsible; inevitable – unprepared; duty of care – respect for patient's decision to end their life. The author suggests that the ability of the nurses interviewed to accept and reconcile the paradoxical issues that arise in relation to patient suicide, and accept the lack of closure they experience, is a fundamental element in their ability to continue to work in the mental health setting, despite the significant impact their patient's suicide has had on them. Four recommendations are made based on the insights gained from this research. These are: that every mental health service should have a suicide response policy; that undergraduate nursing education includes the impact of patient suicide; the development of policies which promote dialogue about suicide within the community; and the need for further research in this topic.

Abstract: This project was initiated by the Ministry of Health to ensure a nationally coordinated approach to mental health nursing. The purpose of the project is to provide a national strategic framework for mental health nursing that will strengthen both nursing leadership and practice within the multi-disciplinary clinical environment. The framework reviews a range of key workforce issues identified by the Ministry of Health and provides strategies to move mental health nursing forward. The framework integrates directions from government mental health strategies, policies and directions, national and international literature as well as professional nursing requirements which aim to create a sustainable mental health nursing workforce using evidence based practice. The framework considers a range of key workforce issues identified by the Ministry of Health including: nursing leadership, nurse practitioners, standards, skill mix, clinical career pathways, professional supervision, education, research and recruitment and retention.