Abstract: This paper examines the difficulties health professionals face daily when providing care for the mentally disordered offender in the court environment. The role of the court nurse is to provide care for people with mental health needs in the court and health professionals can find this a restrictive environment to work in. This is mainly due to the court's legal processes which are designed to punish rather than offer therapeutic alternatives. By advocating for the mentally disordered offender, the court nurse ensures the court is aware of an individual's mental health needs, thus reducing the prospect of inappropriate sentencing, and the associated stigmatisation that may occur as a result of a criminal conviction.

Abstract: Home Based Treatment in acute mental health care is a relatively new phenomenon in New Zealand, although it has been utilised successfully overseas for many years. This paper considers factors that are integral elements of its successful implementation, specifically considering the relationship of nursing care to crisis intervention methodology. It describes how Home Based Treatment fits with contemporary crisis services and how the adherence to crisis intervention models can enable nurses to create a clearly defined recovery perspective in their practice. The author notes that service users in New Zealand and overseas have openly voiced their concerns around the discrepancies between how services have traditionally been delivered and how they wish services to be. He suggests that, as an alternative to inpatient care, Home Based Treatment is an option that promotes recovery and self determination. It is also an arena in which nurses can deconstruct the traditional power relationships between themselves and clients to create a new and invigorating way of practicing.

Abstract: Te watea taupuhipuhi, the space of symbiosis is a framework for nursing practice. It examines the notion of the nursing presence as holding continuity and multiplicity of viewpoint in space of symbiosis. The author developed a teaching-learning situation as an introduction of key ideas in his work where the Maori word “ako” becomes the catalyst of a particular pedagogy that outlines the central notions of symbiosis. Thus, he notes, his work realises that symbiosis occurs not only on the clinical arena of nursing but in the teaching – learning environment as well, his own space of symbiosis. Four rites of passage coalesce a totality of experience within the space of symbiosis, revealing that the central role of the nursing presence is to surface meaning and sense for all of experience which can be fearful, mysterious, paradoxical and chaotic. These four rites of passage are described as the interpretive, integrative, transformations and transcendent. The twelve dynamics of nursing from the axle around which a praxis of nursing revolves. An analysis of those twelve dynamics in rite of passage is situated within narratives taken from the author's nursing practice. He also draws extensively from Maori ontology and autobiography in positioning his exposition within this local context.

Abstract: This thesis is about caring for males, especially those males who could be considered “difficult” to care for through their use of behaviours such as silence, anger or defensive humour. This thesis is positioned in the view that these behaviours are often expressions of distress, which typically distance males from those who attempt to care for them. The author suggests that the word “distress” more accurately reflects the theme of the thesis, and it is used throughout the work. This thesis explores the interface between gender issues, nursing practice and caring for males. It is informed by a review of relevant literature and data gathered from a focus group of nine registered nurses. The analysis is framed by questions that are developed from a series of reflections on my personal and professional life. Critical social theory, with its emphases on dominant dialogue, power and emancipation is used to inform and guide this analysis. What is most obvious is the contrast between themes arising from the literature and those arising from the focus group. It appears that the literature, in the main, is critical of males in regard to concepts of masculinity, issues related to gender, and men's health. Males are portrayed as arbitrators of their own misfortune, as deliberately choosing a lifestyle that reflects poorly on their health, their self-expression, and communication with others. Concepts such as power and control over others, both at a societal and individual level, often feature. Conversely, the literature is noticeably lacking in regard to information about the health related experiences of males and about caring for males. In contrast, the participants of the focus group frame their discussion in the positive. For example, they suggest that males are interested in their health but require an environment that supports this expression of interest. They support this by identifying a range of behaviours they believe are effective in caring for males. The participants also suggest that it is the registered nurse rather than the male who manages issues to do with power and control. The thesis concludes that creating and sustaining an environment supportive of, and sensitive to the needs of males, is an activity that requires considerable thought, skill and experience. These areas are not adequately addressed in academic dialogue, research activity, or in the education of registered nurses. The thesis suggests that this situation is inconsistent with an ethic of care and that nursing should make a priority of broadening its research and knowledge base to better understand and care for males.

Abstract: Alleviating patient suffering, providing comfort and pain relief are all central to the philosophical caring position nurses have always espoused. Despite this, patients continue to suffer pain although we have the means to provide pain relief. The author notes that research has identified that nurses have a knowledge deficit regarding pain and its management, as well an erroneous attitudes, which combined are blamed for an inability to make significant progress in this area. This study was undertaken to uncover the contextual aspects of working within a New Zealand health care institution that affect nurses' ability to manage their patient' pain effectively. It highlights the difficulties and the complicated nature of working within an institution in the 1990's health care environment, where accountability for pain is absent and where pain is often under-assessed and under-treated. By using focus group of nurses, the author notes she was able to uncover constructions on nursing practice, which, she suggests, have been missing from the literature, but prevent nurses from implementing their knowledge. Using a constructivist research, she used nurse's stories and current literature to argue one way forward in, what she terms, the pain management debacle. This study revealed a diverse range of contextual factors that prevent nurses from using their knowledge. Many of the constraints on nursing practice are the results of complex organisational structures within health reform, which have significantly affected the nurse's ability to provide quality-nursing care. One of the most important factors limiting the management of the patient' pain is the inability of the nurse to autonomously initiate analgesia. While nurses are largely responsible for the assessment of pain, they are usually powerless to access necessary analgesia, without a medical prescription. The author argues that once an initial medical diagnosis has been made, nurses are usually left responsible for patient comfort and the management of pain. To do so effectively, nurses need to able to prescribe both pharmacological and non-pharmacological measures for the patient. Presently nurses are prescribing using a variety of illegitimate mechanisms, needing the endorsement of a doctor. To fulfil this role, nurses must be adequately prepared educationally and given the authority to either prescribe autonomously, of provided with extensive “standing orders”. While legislative changes in New Zealand in 1999 extended prescribing right to a few nurses within certain areas of care, the ward nurse is unlikely to gain prescribing rights in the near future. The author concludes that a way forward may be to encourage and further develop the use of protocols for managing pain via standing orders. Standing orders are common place within nursing practice today, have the support of the Nursing Council of New Zealand and are currently under-going legislative review. An institutional commitment to developing pain protocols for nurses would recognise the nurses active role and expertise in the management of pain and facilitate expedient relief for the patient.

Abstract: This project undertakes a critique and review of a decade (1990-2000) of available New Zealand literature to reveal the current state of nursing informatics utilisation in nursing practice. Since the early 1990s, nurses from diploma and baccalaureate nursing programs have been graduating with knowledge and skills in nursing informatics. Yet, when scrutinising the two main nursing publications for New Zealand, the author found scant publication of articles that pertain to this topic area of nursing. Competencies as product of the 1989 Guidelines for Teaching Nursing Informatics are a key consideration in this discussion, including ways in which the articles may reflect the content or intent of the Nursing Informatics curriculum as prescribed in these guidelines. This commentary discusses how nursing informatics has evolved in New Zealand nursing practice, situating its growth, or lack of, in the context of concurrent sociopolitical influences as well as conditions created by national and international nursing trends. Several recommendations are discussed to guide the future direction of nursing informatics for nursing education and practice in New Zealand.