Abstract: Home Based Treatment in acute mental health care is a relatively new phenomenon in New Zealand, although it has been utilised successfully overseas for many years. This paper considers factors that are integral elements of its successful implementation, specifically considering the relationship of nursing care to crisis intervention methodology. It describes how Home Based Treatment fits with contemporary crisis services and how the adherence to crisis intervention models can enable nurses to create a clearly defined recovery perspective in their practice. The author notes that service users in New Zealand and overseas have openly voiced their concerns around the discrepancies between how services have traditionally been delivered and how they wish services to be. He suggests that, as an alternative to inpatient care, Home Based Treatment is an option that promotes recovery and self determination. It is also an arena in which nurses can deconstruct the traditional power relationships between themselves and clients to create a new and invigorating way of practicing.

Abstract: The author describes the purpose of her writing as exploring the journeys that Maori have experienced within the nursing profession of Aotearoa/New Zealand. It presents the reader with insight into these journeys by examining a broad range of events and experiences from pre European contact up to contemporary times. The intention of providing these insights is for the reader to be made aware of not only the “uniqueness” that Maori nurses bring to the profession in New Zealand but to give voice to the many untold experiences of Maori nurses. The Nursing Council of New Zealand (NCNZ), numerous Maori and non- Maori academics have long acknowledged the uniqueness of Maori health perspectives and needs. However, the author notes there is limited literature which specifically discusses experiences of Maori consumers of health services and until recently, exploration of the experiences of Maori nurses has been limited. The Ministerial Taskforce of Nursing (1998) identified the paucity of research related to Maori nursing and acknowledges the need for Maori nurses to develop a body of knowledge specifically focused in this area. To this end, the author intended that this work would contribute to the increasing body of knowledge regarding this unique group within the nursing profession of Aotearoa/New Zealand.The discussion includes revisiting the history of nursing in Aotearoa/New Zealand and critiquing the participation of Maori nurses. The experiences of Maori nurses and students from within the education sector is detailed with a particular focus on their experiences of Kawa Whakaruruhau / Cultural safety. Contemporary issues for Maori nurses are critiqued and possible solutions offered along with details of the writer's vision for the future direction of Maori within the wider nursing profession in Aotearoa/New Zealand.

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: Psychiatric consultation liaison (PCL) nursing is an evolving specialist area of mental health nursing in the USA, UK, Australia and New Zealand. The aim of this dissertation is to explore models of PCL nursing practice in order to develop and discuss a PCL nursing model applicable to the New Zealand context. The role of the PCL nurse was of particular interest to the author as a new practitioner in this specialist area. While there have been PCL nurses in practice for over 50 years, the literature does not offer much clarity about models of PCL nursing. From a review of the literature, four themes were recurrent in the work of PCL nurses. These themes represent four functions which are vital to the role of the PCL nurse: partnership, expertise of the PCL nurse, therapeutic relationship and organisational consultation. The needs of the patient are the core of this model and the primary objective is to improve the quality of care of patients in the general hospital with co-existing physical and psychological problems. It is imperative that PCL nurses evaluate their practice and embark on research to investigate clinical outcomes, cost effectiveness and the impact of PCL nurse practice on patients and staff. This PCL nursing model provides a beginning for this process. It also clarifies and articulates the role of the PCL nurse which enables the service to be promoted to colleagues. This PCL nursing model represents a critique of the author's understanding of the role of the PCL nurse. As expertise develops, the model will continue to be tested and refined.

Abstract: The author argues that the involvement of nurses in the decision-making of health organisations is essential to maximise the contribution of nurses and promote positive outcomes for patients. She suggests that development of leadership skills will make nurses aware of power structures in the health system and allow them to become interdependent health professionals in primary health organisations (PHO). The particular competencies discussed are those proposed by Van Maurik (1997), namely ability to understand and manage organisational politics, work facilitatively with people and circumstances, and build a feeling of purpose.

Abstract: This paper describes the Kidz First paediatric community homecare nursing team in South Auckland. While the service was not initially planned as an integrated approach to child health, its evolution reflects the move to more community based care delivery and the expansion of nurse-led initiatives in New Zealand. The components of a community paediatric home nursing team as described by Eaton (2000) are used to provide the framework with which to describe the service. A focus group held with the Kidz First paediatric community homecare nurses has enabled definition of the key nursing components provided to children and their families living in South Auckland.

Abstract: This paper traces the emergence of categories of nurse over the last hundred years from the time that the Nurses Registration Act became law in 1901. Insights from the work of Michel Foucault are utilised to show how nurses and nursing have been historically shaped and positioned. It is suggested that the recent endorsement by the Nursing Council of New Zealand of the concept and title of 'nurse practitioner' represents an opportunity for nurses to imagine what might be constructed for their roles.