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 research project is concerned with the risk of vicarious traumatisation for psychiatric mental health nurses. Vicarious traumatisation is an occupational hazard that is largely unrecognised and unaddressed in the profession. The paper explores the nature of vicarious traumatisation, and its contemporary conceptualisation in the literature on helping-induced trauma. Findings from the literature search and understanding of the construct of vicarious traumatisation are considered against the essence of psychiatric mental health nursing, the therapeutic relationship and use of self, and the nature of daily practice. After consideration of the potential risk of vicarious traumatisation for the profession it is argued that it is a real risk and is likely to impact on all areas of psychiatric mental health nursing practice. Support for the position that vicarious traumatisation is not well recognised and understood is offered. The paper concludes with recommendations that psychiatric mental health nurses and the profession take serious note of vicarious traumatisation as a risk, and there is an ethical imperative for psychiatric mental health nurses to take measures to inform themselves of and engage in processes of risk management for nurses and clients.

Abstract: Based on the author's thesis, this research project explored nurses' perceptions of clinical leadership in mental health nursing practice. From personal experience and discussion with colleagues the author argues that clinical leadership in terms of support and guidance for nurses is often minimal and that there is a relationship between qualities of clinical leadership and poor retention rates of mental health nurses.

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.

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.

Abstract: This study compared the perceptions that registered psychiatric nurses have of their roles with their actual practice. Following the closure of large scale psychiatric institutions in New Zealand, there was was an increased demand for limited beds in acute inpatient facilities for acutely mentally ill patients. This change in location and downsizing of acute inpatient beds challenged traditional roles of mental health nursing, resulting in confusion over what roles mental health nurses should now perform in the new context of care. This qualitative descriptive exploratory study observed nursing practice on three selected wards and used focus group interviews to establish from registered nurses what they perceived their roles to be. A key finding of this study was that many of the nursing roles related to delivering care from a crisis management perspective, which covers aspects such as assessment, stabilisation of symptoms and discharge planning. Participants also believed that the therapeutic relationship was a fundamental role in inpatient care. Nurses used any opportunity to make it a reality such as kitchen organisation, medications, or dealing with a challenging patient. This study highlighted the complexity of the roles that nurses performed and went some way to give voice to what at times seems an invisible practice.