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: This paper presents an exploration of a foundational goal of palliative care nursing which is to help patients die with dignity. The paper presents this practice exploration as a journey to gain understanding of the concept of dignity; the author notes that it does not avoid the difficulties encountered in practice situations because dying with dignity is unique and curiously also invisible and different for everyone. Much of human life is conducted through stories and much of nursing involves telling and listening to stories. Many of our social institutions are comprised almost entirely of opportunities for telling and retelling stories. Nurses are constantly listening to patients telling them what is going on in their lives and because of this the stories related here are written bold and raw. The three stories explore and reveal in-depth details of nursing practice that evolved and changed after reflection. The paper also reveals and explores the untold and often painful stories that challenge nurses' capacity to offer dignified care. To deepen the exploration towards discovering ways to articulate the complexity of dignity, the author reflected on the nature of the practice changes documented in the stories and then used a range of diverse literature and her love of the paintings and philosophy of a New Zealander, Ralph Hotere, to support her ideas that dignity is indeed a complex phenomenon.

Abstract: This dissertation came out of the author's wondering why there are still so few men going into nursing especially when the history of nursing reveals that men have been a part of nursing for a long time. In New Zealand it is only since the mid seventies that men have been able to gain the exact same nursing qualifications as their women colleagues. The author notes that men in nursing are still seen as unusual in that they work in a predominantly female occupation and have had their masculinity questioned by the myth that all men in nursing must be gay. There is also the notion that caring is a difficult task for men and is seen by society as a uniquely feminine ability. Both issues are related to dominant notions of masculinity. In addition to this there is currently a crisis in terms of a nursing shortage and it has been suggested that one way to resolve this crisis is to encourage more men into nursing. Thus this exploration as to why there are so few men in nursing is timely. Men who choose nursing as a career risk challenging the traditional roles of their gender stereotype. A comprehensive search of the literature from different disciplines reveals deeper issues than just the commonly held assumption that nursing is not masculine. Exploring the issues of gender with a particular focus on masculinity has uncovered the concept of hegemonic masculinity. This describes how gender is practiced in a way that legitimises patriarchy, reinforcing the dominant position of men over women as well as over other groups of men. It is these patriarchal attitudes that have seen men marginalised within nursing. On the one hand men in nursing could be seen as challenging the current dominant masculine ideal. However, on the other hand men in nursing may not challenge this hegemonic masculinity; instead often supporting the status quo in an effort to maintain their own masculinity. The author suggests that the implication for nursing, if it is to increase the numbers of men in the profession, is to challenge this notion of hegemonic masculinity. This needs to be done appropriately by critically examining this concept rather than by merely replacing one hegemony with another. He goes on to say that it is now time for nursing education to include a critical exploration of gender issues and how it relates to men as part of undergraduate nursing education for both men and women students.

Abstract: The function and implementation of clinical supervision in the practice setting presents a number of challenges for new graduate programmes for registered comprehensive nurses. There have been numerous reports and papers promoting its benefits as important and providing the impetus for change. Clinical supervision has been well established as part of social work, counselling, psychotherapy and psychoanalytic practice, and in mental health nursing and midwifery. Its utilisation for graduate nurses is clearly important and should be seen as integral to professional practice. This study evaluated a programme of clinical supervision as a component of a new graduate nurse programme in a secondary health care practice environment. The clinical supervision component aimed to support graduate registered nurses' transition from the role of student nurse to staff nurse in the context of professional clinical practice. This report is also intended to inform the ongoing provision of clinical supervision at Hutt Valley District Health Board. The evaluation process was guided by the work of Owen (1990) and used utilisation focussed evaluation as the framework on which to undertake the evaluation. A mix of quantitative and qualitative methodology was used to collect and analyse the data. Data were collected from nurse graduates of the new graduate programme using a postal questionnaire that covered three areas; clinical supervision, the Hutt Valley District Health Board new graduate programme and an evaluation of stakeholder roles. Twelve of the new graduates responded to the survey. Findings suggest clinical supervision provided professional support and assisted the new graduate in the identification of education needs. Difficulties associated with accessing the structured component of the new graduate programme and clinical supervision were highlighted. The recommendations made to Hutt Valley District Health Board to improve the programme include considering accessibility, consumer rights, acceptability, a comprehensive approach, the Treaty of Waitangi, efficiency and a coordinated approach.

Abstract: New Zealand statistics project that the aging population of people aged 65 years and over will more than double in the next decade. This has implications for palliative care providers including hospices and hospitals because long-term inpatient care is not generally provided by hospitals and hospices. When dying patients need long-term care, residential settings become an option. The level of palliative care in these facilities is dependent on staff training and numbers. In general, staff are not trained in palliative care, neither do they provide the multidisciplinary facets that define palliative care as undertaken by hospices. This paper describes a practice development initiative using storytelling as the vehicle for introducing the concept of the Liverpool Care Pathway (LCP) for the dying patient into residential aged care settings. With the emergence of a reflective paradigm in nursing the concept of storytelling as a teaching/learning tool has grown. Many staff in residential care settings come from diverse ethnic backgrounds where for some, English is their second language. Storytelling therefore can be a useful approach for learning because it can increase their communication skills. The author suggests that the Liverpool Care Pathway for the dying patient is a model that can be translated across care settings, hospice, hospital, and community. It can demonstrate a framework that facilitates multiprofessional communication and documentation and embraces local needs, culture and language to empower health care workers to deliver high quality care to dying patients and their family/whanau and carers. This paper also explores the role of a facilitator as an agent of change and discusses how the interplay of evidence, context and facilitation can result in the successful implementation of the LCP into residential aged care settings.

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: This paper explores the reaction of the author's colleagues when she returned to work disabled after recovering from an injury. In order to understand the new experience of disability and discrimination and to help answer what changed the behaviour of colleagues, the author considered evidence from the published literature. After considering many different models of disability, the social model of disability helped clarify and frame her own experience. Reflecting on this literature and personal experience, she suggests that there is acknowledgement that society's attitudes are changing slowly through governmental action and the activism of the disabled. However, she goes on to say, it is only through progressing education, experiencing disability, and continuing emancipatory research that progress will be made to release people with disabilities from their bonds of prejudice and oppression.