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.

Abstract: The last twenty years, particularly the early 1990s, ushered in major mental health sector reforms inclusive of deinstitutionalisation policies and subsequent development of community services. Concurrent changes to student nurses' education left registered nurses as the workforce mainstay on inpatient units. However, the author suggests, an emerging global shortage of nurses and implementation of the Employment Contracts Act (1991) negatively impacted on recruitment and retention of registered nurses. Inpatient nurses either left nursing or moved to community positions for better money and increased job status. The author suggests that, as a consequence, the 'critical mass' of experienced and skilled nurses who traditionally provided nursing leadership disappeared resulting in compromised standards of care for patients. As the manager of an inpatient unit, the author proposed the establishment of advanced nursing practice roles as one initiative to provide nursing leadership in order to attract and retain nurses. This study explored five inpatient nurses' perceptions of advanced practice and whether these roles could assist to provide leadership and improve standards of care. The research was a qualitative exploratory descriptive study using a focus group interview as the data collection method. A thematic analysis of the group discussion transcription revealed three key themes: 1) the 'makeup' of advanced nursing practice, 2) moving forwards: establishing roles, 3) moving sideways: barriers to role development. The themes are critically discussed in relation to selected literature. The thesis includes recommendations that could be used by nurses responsible for planning and implementing advanced practice roles on inpatient units.

Abstract: This dissertation is an exploration of what underpins and informs clinical nursing practice by telephone in mental health emergency settings. A critical review of the literature provides the foundation for discussion. Points of reflection explore links between the literature and the author's own experience and thoughts about clinical practice. Findings are presented within three main sections. 'Historical Context' considers the development and function of mental health emergency service telephone work. Practical aspects are discussed under `Service Provision Context.' 'Nursing Context' explores the fundamental skills involved in clinical reasoning and the preparation of staff for telephone work. Whilst 'Best practice' in the area of nursing by telephone is yet to be well defined, this work aims to provide a foundation for further inquiry, research and dialogue.

Abstract: This social-cultural history explores the changing context, culture, and identity of psychiatric nurses working in New Zealand public mental hospitals between 1939 and 1972. Primary documentary sources and oral history interviews provided the data for analysis. The thesis is divided into two periods: 1939 to 1959 when asylum-type conditions shaped the culture of the institutional workforce, and 1960 to 1972 when mental health reform and nursing professionalisation challenged the isolation and distinct identity of mental hospital nurses. Between 1939 and 1959 the introduction of somatic treatments did not substantially change nursing practice in mental hospitals. Overcrowding, understaffing and poor resources necessitated the continuance of custodial care. The asylum-type institutions were dependent on a male attendant workforce to ensure the safety of disturbed male patients, and the maintenance of hospital farms, gardens, and buildings. Although female nurses provided all the care and domestic work on the female side, the belief that psychiatric nursing was physically demanding, potentially dangerous, and morally questionable, characterised the work as generally unsuitable for women. Introduction of psychiatric nursing registration which was a move toward professionalisation did little to change the dominance of a male, working-class culture. From 1960 to 1972 psychiatric nurses' identity was contested. New therapeutic roles created the possibility of the nurses becoming health professionals. Their economic security and occupational power, however, was tied to an identity as unionised, male workers. As psychiatric nurses were drawn closer to the female-dominated nursing profession through health service changes and nursing education reform, both men and women acted to protect both their working conditions and their patients' welfare. To achieve these ends, they employed working-class means of industrial action. By accepting the notion that psychiatric nurses' identity was socially constructed, this thesis provides an interpretation that goes beyond the assumption that nursing is a woman's profession. Instead, it presents psychiatric nursing as a changing phenomenon shaped by contested discourses of gender, class and professionalisation. Nursing in public mental hospitals attracted ordinary men and uncommon women whose collective identity was forged from the experience of working in a stigmatised role.

Abstract: Postnatal depression is a term used loosely to describe disorders of mood and distressing symptoms for women in the postpartum, yet it has its own distinct symptoms. It is thought to affect between 10 and 20 percent of new mothers in New Zealand. In order to deliver effective nursing care that has a positive impact on the health of women who experience postnatal depression, nurses need knowledge and theory to underpin practice. This study explores the experience of four women who experienced postnatal depression and the care they received from a nurse. A postmodern feminist position informed the research project. Women became actively involved in a focus group to explore their experiences. A thematic analysis of the focus group transcripts revealed the women's experiences of care from nurses and health professionals as not always helpful. The themes that arose from the analysis were knowledge, perception, care and self. Knowledge examined the women's and significant others' knowledge of postnatal depression as well as women's own knowledge of themselves. Perception identified the women's beliefs of and views on mental illness, as well as their expectations of motherhood. Care as a concept was examined as to how it was provided by nurses. This encompassed a lack of care and, in contrast, supportive care as impacting on the women's individual experiences. Self described the experiences of a loss of self as women experienced their distress in the postpartum, and that a regaining of self was identified by women as difficult, and this is where they required support. The themes are discussed and critiqued with literature that identifies the nursing role with women who experience postnatal depression. There are recommendations for ongoing research and development of the nursing role in order to promote the health and wellbeing of women in the postpartum.

Abstract: This paper is a literature review of the psychogeriatric specialty and describes the clinical role, practice and knowledge of the psychogeriatric nurse. Literature reviews provide a useful means for evaluating what is currently known and understood in a particular area of interest to help nurses' build current opinion into practice. Psychogeriatric nursing is a specialised field of practice that focuses on the mental health needs of people over the age of 65 (including younger people who have acquired needs that are similar in 'like' and age and 'interest'). The literature asserts the urgent need to develop the role and practice of the psychogeriatric nurse in order to address the complex needs of our ageing population in areas such as home care, hospitals, primary health, and long term care institutions. The findings highlight aspects of nursing care that are essential to the role and practice of the psychogeriatric nurse. Knowledge that is necessary for best practice in psychogeriatric nursing care is drawn mainly from the field of general psychiatry and gerontology but also from general medicine, psychology, neurology, and disability. Nurses' working with older adults affected by psychogeriatric conditions must possess a broad knowledge of physical and mental health issues that affect the elderly, including also knowledge and understanding of psychosocial risk factors that can also have an impact on the health and behaviour of older people and their carers. Despite these literal assertions however there appears to be a dearth of literature available to support the requirements for developing the psychogeriatric nursing specialty in clinical practice, research, and education. The author notes that authorities in this specialised field of practice generally agree that with an increasing aging population looming in the future more research in the field of “old age psychiatry” will be critical.

Abstract: This article discusses the disconnection between mental health nurses and policy, and the importance of reconnecting such relationships. It is suggested this will benefit consumers, provide influence in health care policies and, ultimately, contribute to strategies to improve the health of our nation. In this article, the author draws on her own experiences and applies these to a discussion of how mental health nurses can influence and strengthen their relationships with nursing policy.