Abstract: This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. It also includes the author's personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses' way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person's level of acuity and to their ability to engage in this approach in a tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.

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: 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: 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: The author suggests that the thesis as a production of disciplined work presented in a creative style is congruent with performance and presentation best practice in community arts. As a practising nurse artist the author describes creating spaces of alternate ordering within the mental health field environment. “I also inhabit the marginal space of the artist working in hospital environments. This Other Place neither condones nor denies the existence of the mental health field environment as it is revealed. Yet, it seeks to find an alternative to the power and subjectivity of the [social] control of people with an experience of mental illness that inhabit this place both voluntarily and involuntarily. I have used a variety of texts to explore the experience and concept of Otherness. The poems are intended to take you, as a reader where you could not perhaps emotionally and physically go, or might have never envisaged going. They also allow me as the author to more fully describe the Otherness of place that is neither the consumer story nor the nurse's notation, but somewhere alternately ordered to these two spaces. Drawing on the heuristic research approaches of Moustakas and literary psychogeography , particularly the work of Guy Debord, this thesis creates the space to explore the possibilities of resistance and change and the emergence of the identity of the nurse artist within the mental health field environment”.

Abstract: There is limited nursing research as to how mental health nurses work with client stories. Furthermore mental health nurses have not been asked how they would define a client story within their practice. Client's stories allow promotion of the storyteller's experience leading to increased self awareness by supporting growth, and personal development of the individual through exploration of their experience. While listening and working with these stories, mental health nurses are able to interpret, reframe and validate the experiences and meanings disclosed over time. Three community mental health nurses were interviewed about how they identified client stories within their clinical practice. They explained how they created an environment for stories to be told, and worked to enhance meanings, and view alternative possibilities by 'carrying' the story until the client was ready to explore it. By working and understanding stories, mental health nurses were able to work collaboratively with the client to provide humanistic care. Themes of therapeutic relationship, purposeful use of self, and narrative as therapy were identified within the nurse's stories, providing an understanding of how mental health nurses practice. This study was framed by narrative inquiry and influenced by Riessman and Polkinghorne. Core stories are presented from the analysis of the nurses stories about how they defined 'story' and worked with the client stories.