McKenna, B. (1999). Bridging the theory-practice gap. Kai Tiaki: Nursing New Zealand, 5(2), 14–16.
Abstract: The author presents a case study of a joint appointment between a nurse lecturer and a staff nurse in an acute forensic psychiatry unit. He explores the advantages, disadvantages and reasons for success in relation to the findings of a survey of the literature on joint appointments. This technique is seen as a means of narrowing the gap between theory and practice which resulted when nurse training was transferred from hospitals to polytechnics. He highlights the need to develop research methodology to clarify potential benefits of this approach.
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McKenna, B., & Poole, S. (2001). Debating forensic mental health nursing [corrected] (Vol. 7).
Abstract: Forensic mental health nursing roles have developed along different lines in the United States and the United Kingdom. The authors suggest that New Zealand nurses consider the evolution of such roles here.
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Webby, A. (2001). Developing safe nursing practice for Maori. Kai Tiaki: Nursing New Zealand, 7(1), 16–17.
Abstract: A safe mental health nursing practice for Maori is defined as one that includes Maori ways of knowing. The author also notes that Maori mental health nurses must be given the ability to create their own practice to best meet their clients' needs.
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Cook, N., Phillips, B. N., & Sadler, D. (2005). The Tidal Model as experienced by patients and nurses in a regional forensic unit. Journal of Psychiatric & Mental Health Nursing, 15(5), 536–540.
Abstract: This study looks at the effect of implementing the Tidal Model at Rangipapa, a regional secure mental health forensic unit. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four registered nurses and four “special patients”. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse-patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery.
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O'Brien, A. J., & Kar, A. (2006). The role of second health professionals under New Zealand mental health legislation. Journal of Psychiatric & Mental Health Nursing, 13(3), 356–363.
Abstract: The development of generic statutory roles in mental health care has been the subject of discussion by New Zealand nurses for the past decade. One such role is that of second health professional in judicial reviews of civil commitment. Issues identified by New Zealand nurses have also been raised in England, where it seems that nurses are likely to assume the role of Approved Mental Health Worker under English mental health law. A survey of mental health nurses found that few had received any preparation for the role of second health professional and 45% did not feel adequately prepared for the role. Some of these issues are reflected in a New Zealand inquiry which resulted in the Ministry of Health developing a written report form for second health professionals. However, the form has the potential to reduce the mental health nursing role to a narrow legal role. Statutory roles such as that of second health professional challenge mental health nurses to critically reflect on the conceptual and ethical basis of their practice. While traditional concepts such as therapeutic relationships and advocacy need to be reviewed in light of these changes, nurses need to be vigilant in articulating the moral and clinical basis of their roles. The development of guidelines for the second health professional role is suggested as a way of supporting clinical practice in this area.
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O'Brien, A. J. (2001). The therapeutic relationship: Historical development and contemporary significance. Journal of Psychiatric & Mental Health Nursing, 8(2), 129–137.
Abstract: This article examines the therapeutic relationship, a concept held by many to be fundamental to the identity of mental health nurses. While the therapeutic relationship was given formal expression in nursing theory in the middle of the last century, its origins can be traced to attendants' interpersonal practices in the asylum era. The dominance of medical understandings of mental distress, and the working-class status of asylum attendants, prevented the development of an account of mental health nursing based on attendants' relationships with asylum inmates. It was left to Peplau and other nursing theorists to describe mental health nursing as a therapeutic relationship in the 1940s and later. Some distinctive features of colonial life in New Zealand suggest that the ideal of the attendant as the embodiment of bourgeoisie values seems particularly unlikely to have been realised in the New Zealand context. However, New Zealand literature from the 20th century shows that the therapeutic relationship, as part of a general development of a therapeutic discourse, came to assume a central place in conceptualisations of mental health nursing. While the therapeutic relationship is not by itself a sufficient basis for professional continuity, it continues to play a fundamental role in mental health nurses' professional identity. The way in which the therapeutic relationship is articulated in the future will determine the meaning of the therapeutic relationship for future generations of mental health nurses.
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Crowe, M. (2006). Psychiatric diagnosis: Some implications for mental health nursing care. Journal of Advanced Nursing, 53(1), 125–131.
Abstract: This article explores some of the functions of psychiatric diagnosis and the implications this has for mental health nursing care. It critiques the psychiatric diagnosis as a categorisation process that maintains oppressive power relations within society, by establishing and enforcing normality through gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is used to illustrate some of the inherent biases in the diagnostic process. The author argues that mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. To create a true patient-centred partnership in mental health nursing, the nursing focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. NB this is a reprint of article first published in Journal of Advanced Nursing, 2000 Mar; 31(3), 583-9.
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Hardy, D. J., O'Brien, A. P., Gaskin, C. J., O'Brien, A. J., Morrison-Ngatai, E., Skews, G., et al. (2004). Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand. Journal of Advanced Nursing, 46(1), 95–109.
Abstract: The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarised responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4.5 after round 3 was set as the importance threshold. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark. The authors conclude that when rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritising experts' judgements.
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Crowe, M., & Carlyle, D. (2003). Deconstructing risk assessment and management in mental health nursing. Journal of Advanced Nursing, 43(1), 19–27.
Abstract: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organisation. The authors conclude that the mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.
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Crowe, M., O'Malley, J., & Gordon, S. (2001). Meeting the needs of consumers in the community: A working partnership in mental health in New Zealand. Journal of Advanced Nursing, 35(1), 88–96.
Abstract: The aim of this study was to evaluate whether the services that community mental health nurses provide are meeting the needs of consumers in the community. This was a joint project between nurses and consumers. It was a service-specific descriptive research project utilising qualitative methods of data collection and analysis that provides a model for working in partnership. The results of this research identify collaboration in planning care and sharing information as two areas of concern but generally the consumers were very satisfied with the care provided by community mental health nurses. The analysis of the data suggests that consumers value nursing care because nurses provide support in their own home; they help consumers develop strategies for coping with their illness and their life; they provide practical assistance when it is required; they are vigilant about any deterioration or improvement; and they are available and accessible. The results of this study have demonstrated that nurses will remain critical to the success of community-based care because of their ability and willingness to be flexible to the demands of their own organisation and the users of services.
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O'Brien, A. P., O'Brien, A. J., Hardy, D. J., Morrison-Ngatai, E., Gaskin, C. J., Boddy, J. M., et al. (2003). The New Zealand development and trial of mental health nursing clinical indicators: A bicultural study. International Journal of Nursing Studies, 40(8), 853–861.
Abstract: This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5-89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.
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McKenna, B., Poole, S., Smith, N. A., Coverdale, J., & Gale, C. (2003). A survey of threats and violent behaviour by patients against registered nurses in their first year of practice (Vol. 12).
Abstract: For this study, an anonymous survey was sent to registered nurses in their first year of practice. From the 1169 survey instruments that were distributed, 551 were returned completed (a response rate of 47%). The most common inappropriate behaviour by patients involved verbal threats, verbal sexual harassment, and physical intimidation. There were 22 incidents of assault requiring medical intervention and 21 incidents of participants being stalked by patients. Male graduates and younger nurses were especially vulnerable. Mental health was the service area most at risk. A most distressing incident was described by 123 (22%) of respondents. The level of distress caused by the incident was rated by 68 of the 123 respondents (55%) as moderate or severe. Only half of those who described a most distressing event indicated they had some undergraduate training in protecting against assault or in managing potentially violent incidents. After registration, 45 (37%) indicated they had received such training. The findings of this study indicate priorities for effective prevention programmes.
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Farrow, T., McKenna, B., & O'Brien, A. J. (2002). Advanced 'prescribing' of nurses' emergency holding powers under New Zealand mental health legislation. International Journal of Mental Health Nursing, 11(3), 164–169.
Abstract: A new approach to mental health legislation has seen the involvement of a range of health professionals in legislated mental health roles, including the power of registered nurses to detain patients in hospital under Section 111 of the New Zealand Mental Health (Compulsory Assessment and Treatment) Act (1992). Under this Section, a nurse who believes that a voluntary patient meets the legal criteria of the Act can independently detain the patient for a period of up to six hours, pending further assessment by a medical practitioner. However, anecdotal evidence and a clinical audit undertaken by the authors suggest some doctors 'prescribe' Section 111 at the time of admission. This practice instructs nurses to initiate Section 111 if particular voluntary patients choose to leave hospital. This study outlines practice issues resulting from 'prescribing' Section 111; provides a legal critique of medical practitioners' involvement in this practice; and makes recommendations for guidelines toward a more constructive use of Section 111.
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Cowan, L. M., Deering, D., Crowe, M., Sellman, D., Futterman-Collier, A., & Adamson, S. (2003). Alcohol and drug treatment for women: Clinicians' beliefs and practice. International Journal of Mental Health Nursing, 12(1), 48–55.
Abstract: The present paper reports on the results of a telephone survey of 217 alcohol and drug treatment clinicians on their beliefs and practice, in relation to service provision for women. Nurses comprised the second largest professional group surveyed. Seventy-eight percent of clinicians believed that women's treatment needs differed from men's and 74% reported a range of approaches and interventions, such as assisting with parenting issues and referral to women-only programmes. Several differences emerged in relation to approaches and interventions used, depending on clinician gender, work setting and proportion of women on clinicians' caseload. Implications for mental health nursing include the need to more systematically incorporate gender-based treatment needs into practice and undergraduate and postgraduate education and training programmes.
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Farrow, T. (2002). Owning their expertise: Why nurses use 'no suicide contracts' rather than their own assessments. International Journal of Mental Health Nursing, 11(4), 214–219.
Abstract: 'No suicide contracts' are a tool commonly used by nurses in community crisis situations. At times this tool is utilised because the clinician believes that it is beneficial. However, there are other occasions when 'No suicide contracts' are introduced in a manner that runs counter to the clinical judgement of the crisis nurse. This paper discusses the results of a qualitative study that addressed the question of why nurses use 'No suicide contracts' in such situations, rather than relying on their own expertise. This analysis suggests that underlying concerns of clinicians can determentally affect decision-making in such circumstances, and recommends that rather than subjugating nursing expertise, underlying issues be addressed directly.
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