Abstract: The aim of this research was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present at emergency departments with intentional self-harm.

Abstract: The question explored in this research project is: What are inpatient registered nurses' perceptions of the factors which influence therapeutic relationship development? The literature reviewed for this project includes the history of interpersonal relationships in nursing; therapeutic relationships; what constitutes these relationships. Also discussed is literature about phenomenology as the underlying theoretical and philosophical position that informs the research method. To answer the research question a single focus group was used to gather data from a group of registered nurses practising in inpatient mental health units. Focus groups as a data collection method produce data and insights that would not be accessible without the group interaction. The key themes to emerge from the data analysis were; time, environment, knowing / self-awareness, compassion and power imbalance / empowerment. These key themes are discussed in relation to the literature and the wider context of the mental health care environment. The contribution this research makes to nursing includes a list of recommendations to nurses, nurse leaders and managers who aim to provide therapeutic mental health unit environments.

Abstract: The New Zealand emergency department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the emergency department. In addition to this education deficit, are the challenges of providing care in an overcrowded ED environment. The author goes on to say that such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

Abstract: Accountability has been described by nurses as an elusive concept or myth. The author suggests that this elusive concept or myth can partly be attributed to accountability becoming visible usually following a critical incident. The overall goal of this project is to provide nurses working within mental health with the incentive to raise their awareness and explore what their roles and responsibilities are within the accountability process in a more positive scenario. This research paper reports on an exploration of the key components of accountability within the New Zealand mental health environment. It describes significant influences that affect accountability. This is achieved by the means of a literature review, sharing of the author's experience of being involved in a national inquiry, and the adaptation of a who what and how framework, in conjunction with a diagram displaying accountability levels and lines for mental health nurses. The author points out that the domains of accountability for nurses will continue to evolve and expand but what remains important is that consumers have access to good quality mental health care.

Abstract: Evidence within the literature highlights that staff within the general hospital wards are not necessarily equipped to assess and meet the needs of patients with mental health or behavioural problems. The author notes that this is cause for concern as a number of people requiring admission to the general wards often have a complex, interrelated combination of physical and mental health problems. Within New Zealand there have also been a number of changes to health care policies that have increased general nurses contact with mental health patients over the last decade. The Mental Health Consultation Liaison Nurse is an advanced nurse specialist who can meet this need. Having reviewed the literature and communicated with Mental Health Consultation Liaison Nurses in New Zealand and Australia, the author says it is clear that the availability of a mental health nurse within the district health board general wards would be advantageous to all. The role has been shown to positively influence the care of patients and benefit other health care professionals. It provides an improved system of care that is co-ordinated, integrated and responsive to the needs of patients and health care staff. The implementation of the Mental Health Consultation Liaison Nurse role has the potential to cut costs in relation to decreasing length of stay with untreated mental health issues, and reduce the cost of continued use of 'specialling' unnecessarily. Also of importance is the fact that such a position would assist the district health board to comply with the standards of health care provision as directed by the Mental Health Commission and the Ministry of Health. The author suggests that the introduction of the Mental Health Consultation Liaison Nurse role represents a change in traditional ways of providing general nursing and consequently there are a number of issues that may hinder its success. This dissertation aims to increase the visibility of mental health nursing and provide a resource for others debating the development and implementation of the Mental Health Consultation Liaison Nurse role.

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: This report reviews relevant literature pertaining to clinical career pathways and associated core competencies for nursing in New Zealand. The review identifies and analyses existing clinical career pathways for nurses and mental health workers in New Zealand, paying particular attention to the content, structure, strengths, criticisms and applicability to the development of a clinical career pathway for Maori registered nurses to work in Maori mental health (NGO organisations). This report is part of Te Rau Matatini's current work on the development of a career pathway for Maori registered nurses with mental health work experience to work in NGO, community settings. It is a preliminary report, based on existing literature. A subsequent report was planned detailing the career pathway developed by Te Rau Matatini, with strong guidance and input from Maori mental health nurses and the wider Maori mental health sector.

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.