Crowe, M., O'Malley, J., & Bigwood, S. (2002). Nursing mental health consumers in the community. Kai Tiaki: Nursing New Zealand, 8(8), 14–15.
Abstract: The purpose of this research was to describe the characteristics of community mental health nursing care in the community. Twenty six nurses were enrolled in a study consisting of semi-structured interviews about the nature of their care. Responses were analysed to identify categories of skills. These were characterised as: establishing connectedness; promoting individual and family resilience, promoting citizenship; and addressing structural issues. Responses from the nurses are used to illustrate these categories.
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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. (2002). Reflexivity and detachment: A discursive approach to women's depression. Nursing Inquiry, 9(2), 126–132.
Abstract: This paper explores a discursive approach to understanding women's depression by presenting the results of research into women's narratives of their experiences. The discursive approach taken acknowledges women's immersion in cultural practices that determine the subject positions available to them and places a value on attributes of reflexivity and detachment that are not usually associated with their performance. The social and cultural context of the individual's experience is significant because if the focus is simply on the individual this supposes that the problem lies solely with the individual. An understanding of cultural expectations and their relation to mental distress is important to mental health nursing practice. The psychotherapeutic relationship that is fundamental to mental health nursing practice requires an understanding of the meaning of individual's responses in their cultural context in order to provide facilitative and meaningful care for the women that they nurse.
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Haggerty, C. (2002). Preceptorship for entry into practice. Whitireia Nursing Journal, 9, 7–13.
Abstract: The author examines some of the issues affecting preceptorship in relation to a graduate diploma programme of psychiatric mental health nursing. Previous research by the author lead to recommendations on clarifying the roles and responsibilities of those involved in the programme, and improving preceptor selection, training, support and evaluation. By providing such clarity and support, the preceptor role in the clinical setting is given the best chance to succeed.
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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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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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Murphy, R. (2005). A day in the life of an acute hospital psychiatric nurse. Kai Tiaki: Nursing New Zealand, 11(9), 24–25.
Abstract: A nurse presents a personal account of a typical day at Middlemore Hospital's 50-bed acute inpatient mental health unit Tiaho Mai. The article covers aspects of shift handover, working with multidisciplinary teams, developing care plans, working with families, and responding to emergencies.
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Flint, V. (2005). The place of ECT in mental health care.11(9), 18–20.
Abstract: The author reviews the controversial treatment of electroconvulsive therapy (ECT) which has re-emerged as a safe and effective treatment for major depressive disorders. She first addresses the popular conceptions of ECT, which are based on early misuse of the treatment when it was delivered unmodified, or forcefully and without anaesthetic. She then uses a case study to illustrate the benefits of ECT for catatonia and catatonic states. Diagnostic criteria for catatonia include motoric immobility, excessive motor activity, extreme negativism or mutism, peculiarities of voluntary movement, and echolalia or echopraxia. The treatment of a patient is detailed, and the role of the ECT nurse is outlined. The ECT nurse is a co-ordinator, an educator, liaises with other services and families, and is a point of contact about ECT within the mental health service generally and in the ECT unit in particular. The case study showed successful use of ECT. A series of eight ECT treatments were administered to the catatonic patient, after which he was discharged home with minor depression and showing signs of enjoying life once again.
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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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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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McKenna, B., O'Brien, A. J., Dal Din, A., & Them, K. (2006). Responsible clinician role offers opportunities for nurses. Kai Tiaki: Nursing New Zealand, 12(11), 12–14.
Abstract: The authors report on a recent study investigating the statutory role of responsible clinician. Statutory roles under mental health legislation offer mental health nurses a means of having advanced practice skills recognised, as well as contributing to improved access to services. There is a proliferation of roles intended to develop nursing readership, but in most cases they are not primarily clinical roles. The concept of “advanced practice” has become a means of developing clinical leadership roles in nursing. Research on responsible clinician role is presented along with the results of a survey of the 11 Registered Nurses practicing as responsible clinicians, five senior nurses from each of the 21 district health boards, and the Auckland Regional Forensic Psychiatry Services (n = 121). Respondents were asked whether the responsible clinician role was a legitimate one for nurses and whether they were motivated to attain or maintain that role. They were also asked which competencies for the role they believed they met, their perceptions of credentialing processes and the educational requirements needed to achieve the role. A clear majority of the respondents felt the role of the responsible clinician was a legitimate advanced practice role for mental health nurses. Despite this, some respondents expressed ambivalence about taking on the role. The research highlighted deficits in knowledge and skills that could become a focus of education for advanced practitioners seeking appointment as responsible clinicians. Deficits included some assessment skills, knowledge of a range of interventions and knowledge of other legislation affecting mental health legislation.
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Crowe, M., & Luty, S. (2005). Recovery from depression: A discourse analysis of interpersonal psychotherapy. Nursing Inquiry, 12(1), 43–50.
Abstract: This paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression. It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression. The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recover from her depression. The process of recovery is underpinned by an understanding of women's depression as promoted by contemporary social and cultural expectations for detachment and reflexivity. This paper shows how IPT provides an opportunity for recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. The discourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information, exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alternative subject positions.
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Gaskin, C. J., O'Brien, A. P., & Hardy, D. J. (2003). The development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. International Journal of Mental Health Nursing, 12(4), 259–270.
Abstract: This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand district health board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.
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Bishop, D., & Ford-Bruins, I. (2003). Nurses' perceptions of mental health assessment in an acute inpatient setting in New Zealand: A qualitative study. International Journal of Mental Health Nursing, 12(3), 203–212.
Abstract: This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semi-structured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.
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Palmer, S. G. (2003). Application of the cognitive therapy model to initial crisis assessment. International Journal of Mental Health Nursing, 12(1), 30–38.
Abstract: This article provides a background to the development of cognitive therapy and cognitive therapeutic skills with a specific focus on the treatment of a depressive episode. It discusses the utility of cognitive therapeutic strategies to the model of crisis theory and initial crisis assessment currently used by the Community Assessment & Treatment Team of Waitemata District Health Board. A brief background to cognitive therapy is provided, followed by a comprehensive example of the use of the Socratic questioning method in guiding collaborative assessment and treatment of suicidality by nurses during the initial crisis assessment.
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