Abstract: The author points to the oppression of colonisation living on in the daily lives of colonised people, and goes on to say that it is vital for nurses to understand the effects of that oppression, as well as the restrictive impacts, and dislocation from one's land and culture to-day. Nurses come from both the descendants of colonisers and the colonised. This thesis is a journey and a quest for insights into the impacts and significances of colonisation by looking at historical and socio-political contexts that have bearing on the health of colonised people who remain mostly powerless and marginalised. It is prompted in response to a cultural safety model which advocates that nurses should become familiar with their own background and history in order to be culturally safe in practice. This reflective autobiographical account is a personal effort and provides the foundation for an exploration of issues during nursing practice encounters, from a colonised ethnic minority perspective. The method was informed by Moustakas research approach and Johnstone's Reflective Topical Autobiographical process. The selection of specific events are deliberate, to make visible some of the many barriers that exist within our health structures as pertinent issues for non-dominant cultures that remain on the margin of our society. Maori issues provide a contrast and became a catalyst for the author while working for kaupapa Maori services. The intention of this thesis is to generate new knowledge about what it means to be a nurse from an ethnic minority working in a kaupapa Maori mental health service, and to encourage other nurses to explore these issues further. Some recommendations are made for nurses in the last chapter.

Abstract: The objective of this paper is to establish if there is any documented research and literature evidence that describe what the presenting clinical symptoms of Mai Aitu is, and also to explore an alternative frame-work to assess Pacific Islanders who present to mental health in crisis. As a community mental health nurse in the Crisis Assessment and Treatment Team (CATT), the author reports being confronted almost every day with an increasing number of Pacific Islanders presenting in crisis with symptoms consistent with the well documented signs of psychosis. For instance, symptoms like hallucinations, delusion and paranoid ideation which are also well known for describing schizophrenia. Her concern is that mental health nurses may be compromising their practice, the safety of the Pacific Island population and possibly the credibility of the profession with what appears like a lack of knowledge and awareness regarding the clinical symptoms of some Pacific Island mental illness. In Tonga it is called Avea Avanga, in Fiji it is referred to as Lialia, in Samoa it is known as Mai Aitu. The author notes that the issue becomes apparent when Samoan clients present in crisis with what appears to be psychosis but the fanau believe their love one is not mentally unwell, that he or she is simply suffering a traditional Samoan illness. Therefore they insist he or she be treated at home, instead of through admission to the psychiatric hospital, and also that they be seen by a Samoan healer instead of a psychiatrist.

Abstract: This thesis traces the journey of the author's inquiry into family members' experience of the relinquishment of the personhood of a loved one with a dementia; a journey in which she reports that her own prior understandings were significantly challenged. The study was prompted by her experience of working in the area of dementia care and hearing, in the course of the working day, comments such as 'there's nobody there' made in relation to someone suffering from severe dementia. Such comments appear to imply that the person of the dementia sufferer in some way is no longer present. They are comments which relate to the very nature of personhood. The study takes impetus from the fact that the ways in which nurses view the personhood of dementia sufferers has significant consequences for the ways in which they respond to dementia sufferers and their families. This thesis, which retells the stories of four family members who each have a loved one with a dementia illness, reveals that rather than there being a unified concept of personhood in dementia, and in spite of the fact that particular understandings of dementia and personhood dominate our cultural conversations, in their day to day lives these four family members managed and made sense of their experience through particular and different ways of looking at the impact dementia has on the personhood of dementia sufferers. Not all did, in fact, relinquish the personhood of their family member. In their lived lives, the four research participants had recourse, each in different ways, to multiple discourses of personhood. For some, in addition to loss, there was also unexpected gain. This finding necessitated and shaped further inquiry into discourse and the role of discourse in shaping, constraining and opening up possibilities for meaning, and into the two substantive areas of dementia and personhood. Nurses work closely alongside the family of dementia sufferers who are daily faced with the challenge of managing and making meaning of that situation. It is critically important that they are able to recognise, validate and support the variety of needs that family members have. Nurses, whose education is traditionally based on a biomedical framework, are nevertheless often required to mediate between different understandings. Not only do they need currency of knowledge in the rapidly changing biomedical field of dementia, but they need also an understanding of the role and the power of discursive constructions of both dementia and personhood. Such understanding will provide insight into alternate ways of understanding these concepts. However, although such understanding is critical for nurses working in this area, the author suggests that nursing literature has not brought these discussions to the fore.

Abstract: This paper seeks to understand the aetiology of stigma. The word stigma comes from the Greek language and refers to a brand, a mark of shame. Society has used this phenomenon to mark those who do not fit with the stereotypical virtual identity expected by a group. Stigma has persisted throughout the ages to enforce norms and sanction rules. Stigma is a term used to broadly define an attitude to negative attributes. It is a way of treating people that indicates to the individual, they are different from the norm. Research indicates the general population has discriminatory attitudes to those who have experienced mental illness. This discrimination impacts on the lives of those people. Their stories tell of shame, sadness and anguish. Families too, feel the ongoing effects of stigma. Psychiatric mental health professionals are said to perpetuate the discrimination arising from the stigma of mental illness. This is shown in the literature to persist through labelling and disempowering practices. The attitude of nurses in particular is critical to promoting healing environments. It is thought that a humanistic altruistic approach to nursing practice will help to eliminate discriminatory practice by nurses. It is hoped that this approach will create collaborative care that gives the individual the respect, response, choice and support they need to assist in recovering from mental illness.

Abstract: The transition of patients from intensive care to the ward environment is a regular occurrence in intensive care. Today patients are often transferred earlier and sicker due to the demands for intensive care beds. This results in patients with higher acuity being cared for in the wards. Here ward nurses have to meet the ongoing complex demands of caring for higher acuity patients, alongside managing high patient-to-nurse ratios, staffing concerns, and varying levels of experienced nurses. This research explored the experiences of ward nurses receiving patients transferred from intensive care. The aims were to identify any areas of concern, highlight specific problems that occur on transition and to address what information is pertinent to ward nurses when receiving patients from intensive care. A qualitative descriptive methodology using focus groups was utilised to gather information about these experiences. Three focus groups were held with ward nurses from various wards within the study setting hospital. All participants had considerable contact with intensive care and were familiar with the processes of transferring patients. Five themes emerged from the focus groups – Patients as intensive care staff say they are; Time to prepare the biggest thing; Documentation as a continuation of patient care; They forget what its like; and Families, a need to know about them. The theme Patients as intensive care staff say they are relates to reliable information sharing focused on the patient, their needs and condition. Participants expressed their concern that patients were not always in the condition that the intensive care staff stated they were on the referral. Having adequate time to prepare was considered important for the majority of ward nurses receiving patients from intensive care. Documentation was highlighted in the theme Documentation as a continuation of patient care particularly in relation to fluid balances and vital sign history. The theme They forget what its like suggests there is a perception that intensive care nurses have a lack of understanding of what the ward staff can actually manage. Decreased staffing levels during certain shift patterns and a lack of appropriately experienced staff on the wards is a common concern for ward nurses. Ward nurses also recognised that caring for families was part of their role. Patients and families may respond differently to the transfer process and their inclusion in transfer planning was seen as essential. Communication was a reoccurring element throughout all themes.The author concludes that communication is the paramount factor that impacts on a 'smooth transition' for ward nurses. A 'smooth transition' refers to the transfer of patients from intensive care to the next level of care. Subsequently, nurses' perceptions need to change, whereby transfer planning from ICU should be the focus rather than discharge planning. Transfer planning and education for all nursing staff is vital if the transfer process is to be improved. Consequently, transitional care within the context of ICU aims to ensure minimal disruption and optimal continuity of care for the patient. The knowledge gained from this research may provide better understanding of the multifaceted issues linked with transitional care that may be adapted for a wider range of patients in various clinical environments.

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: October 2003 marked the centenary of Wellington district nursing. Annie Holgate, a 'trained, professional' nurse, was employed to care for the sick poor in 1903. The Wellington St John Ambulance District Nursing Guild funded district nursing for over fifty years. The first president, Sarah Ann Rhodes, left a legacy of a solid financial and administrative base for the whole of the Guild's existence. From 1945 the Wellington Hospital Board assumed responsibility for district nursing and expanded the service to the greater Wellington region. In 1974 the Community Health Services were formed, with Pauline MacInnes as the nurse leader. Expansion of healthcare in the community ensued, with district nurses pivotal to client-centred, community-based, collaborative healthcare. This service was dismantled in the wake of health sector restructuring in 1989. The philosophy and operation of the Community Health Service of this period bears a striking resemblance to the current concept of Primary Health Care. Primary sources from Wellington St John, Kai Tiaki and data from official publications were used to compile this history. Emergent themes are the autonomy of district nurses' practice, the invisibility of district nursing and the impact of visionary leadership. All have implications for the future of district nursing. District nursing, initially dependent on philanthropy, has been publicly funded in New Zealand since 1944. District nursing is now an essential component of health care.