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: In this study a qualitative descriptive methodology with focus group interviews was used to explore with users of mental health services, the attitudes, knowledge and skills that they need in mental health nurses. Users of mental health services valued the therapeutic work of mental health nurses, and identified positive attitudes towards users of mental health services as essential in mental health nurses. However, they did not consistently experience a therapeutic approach in their interactions with mental health nurses. In a sociopolitical climate where the views of users of mental health services are increasingly incorporated into education and the planning and delivery of services, there is a need for more research that reflects the perspective of users.

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: The author describes his experience of five years as a nurse practitioner in mental health at Waikato District Health Board. A recent review of the role gave him the opportunity to reflect on the learning associated with assuming the nurse practitioner role. A key area of learning has been in negotiating the shifting responsibilities and changing relationships associated with his role as an nurse practitioner and also as a Responsible Clinician, a role traditionally held by psychiatrists. The Responsible Clinician role is a statutory one under the Mental Health Act (1992), generally performed by psychiatrists but open to other suitably qualified professionals. He reports the results of a review based on feedback from fellow professionals, clients and their families, along with quantitative data from basic statistics connected to the role, such as a time and motion study. The review asked fellow professionals to rate the performance of the nurse practitioner against the Nursing Council competencies. These results indicate the nurse practitioner role is of some value and that other professionals and clients seem satisfied with the role. There is some evidence it is delivering outcomes acceptable to clients and other professionals. The study has many limitations which are discussed, such as a poor response rate and short time frame. Further research is planned to evaluate this role.

Abstract: This paper provides an overview of the evolving meaning of 'culture' in New Zealand nursing. Then, drawing upon the findings of research that used hermeneutic phenomenology to explore the experience of nursing people from cultures other than one's own, a description of the constituent parts is of this phenomenon is briefly outlined and followed by an exemplar that describes the coalescent and contradictory nature of the phenomenon as a whole. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, interplay of the notions of prejudice, paradox and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses.

Abstract: As has been the case internationally, deinstitutionalisation of dual diagnosis (intellectual disability and mental illness) services has also occurred in New Zealand. Inpatient services have been redefined to respond to the more acute focus that has arisen out of this deinstitutionalisation process and nurses are having to redefine their roles in response. This study was undertaken to explore and describe the culture of nursing practice in a dual diagnosis inpatient unit in one psychiatric hospital. A focused ethnographic approach was used to triangulate data gathered from fieldwork observations, review of documents and semi-structured interviews. Schein's (1985) levels of culture model, was used to identify and explore the artifacts, values and assumptions evident in this nursing practice. Analysis presents three key themes categorised as 'communication', 'assessment' and 'safety'. While these key themes are shown to be evident in the everyday practice of the nurses, how these relate to the notion of 'dual diagnosis nursing' is not clear. Therefore, the author describes the major finding of this study as revealing a nursing culture holding tight to traditional psychiatric and psychopaedic nursing practices and struggling to develop a distinctive culture in the absence of a defined dual diagnosis knowledge base. The author concludes that these findings suggest an urgent need to provide nurses with support in gaining contemporary knowledge regarding dual diagnosis nursing. Support for nurses in advancing these areas then impacts on support for the patients. It is suggested that additional research is undertaken to assess the learning needs of the nurses in order to develop clinical practice guidelines for this area. Further recommendations are made to address system issues which are contributing to the gap in knowledge.

Abstract: This research project explored nurses' perceptions of clinical leadership in mental health nursing practice. Within New Zealand no research exists that evaluates the role and impact the clinical leadership has in mental health nursing practice. From personal experience and discussion with colleagues the author argues that clinical leadership in terms of support and guidance for nurses is often minimal and that there is a relationship between qualities of clinical leadership and poor retention rates of mental health nurses. The prime objective of this study was to increase knowledge about clinical leadership in mental health nursing practice. This research used a quantitative descriptive methodology, utilising survey design. A questionnaire was used to rank the attributes of the person the respondents identified as a clinical leader. The data was collected from 30 registered nurses working in mental health settings within the central region of New Zealand. Findings indicate that there is room for improvement with regard to clinical leadership in mental health nursing practice. Clinical leadership is perceived to be more effective by nurses in their second year of practice and in community settings. A statistically significant difference was indicated between nurses in their second year of practice and nurses in their third year of practice in terms of their ranking of clinical leadership abilities. Overall the respondents perceived poor communication and poor attitude as the biggest barriers to effective leadership. Support and good role models were said to influence nursing practice positively and the skills that were identified as being helpful in assisting and retaining nurses were mentorship and good communication. The results of the study are discussed in relation to the literature on transformational leadership skills. Finally, the general limitations of the study are outlined and implications for future research are discussed.

Abstract: This research paper reports on an exploration of the key elements nurses need to be aware of to effectively nurse adolescents in an adult inpatient unit. It describes the developmental needs and significant influences that affect this age-group, that when incorporated into nursing care, nurses can gain a therapeutic relationship with the adolescent. By means of a literature review, sharing the author's experience in nursing adolescents, and through vignettes of practice, an illustration of some common situations that may occur during the adolescent's inpatient stay are described. These situations are explored and a perspective is offered on how nurses may be effective in their nursing of an adolescent patient from the point of admission through to discharge. More research is needed on adolescent mental health nursing, however the author anticipates that nurses will be able to use this report as a helpful resource in their current practice.