Abstract: This aim of this thesis was to explore and describe registered nurses' experiences of undertaking the statutory role of Responsible Clinician under the Mental Health (Compulsory Assessment and Treatment) Act 1992. The role of Responsible Clinician has been available to nurses since 1992 yet to date there has been little research into nurses' experiences of undertaking this role. An exploratory descriptive approach was therefore used in this study. A convenience sample of four nurses who had been undertaking the role of Responsible Clinician was recruited. Their experiences were elicited through in-depth interviews. Analysis of the interview material revealed the themes of legitimacy, relationships, expanding practice, responsibility and accountability, approaches to care, nurses' responsiveness to the role and support of the role. The author points to this research being important to nurses who are working in the psychiatric mental health area so that they can understand the role more fully. In this way, more nurses may choose to undertake the role of Responsible Clinician.

Abstract: Therapeutic relationships are central to mental health nursing. The nurse's role in maintaining professional yet therapeutic boundaries within this relationship can be challenging. When therapeutic boundaries are breeched within the nurse adolescent relationship the adolescent's safety within this relationship is compromised. There is currently limited literature on how nurses are managing professional boundaries in relationships with adolescents in this setting. The adolescent's nature is to push boundaries; therefore the nurse needs to be acutely aware of this boundary pushing in everyday practice settings. For the safety of the adolescent and the nurse it is vital the nurse understands her role in managing the professional boundary. This thesis explores, through the use of narrative inquiry, four adolescent mental health nurses' experiences of assessing, understanding and maintaining therapeutic boundaries with adolescents in a mental health setting in New Zealand. The unique and specific implications for adolescent mental health nursing are discussed. Three key themes emerged from the analysis and findings: the importance of the nurse clarifying his/her role; the learning that occurs throughout the practice journey; and the role of the nurse in keeping the adolescent and the nurse safe. These findings highlight the importance of clinical supervision and open communication with senior nurses and mentors, which assist the nurse in monitoring practice. When nurses do not have sufficient knowledge of the fundamental principles of adolescent mental health nursing; such as knowledge and skills in both adolescent development and psychodynamic nursing, they are at risk of boundary crossings. Recommendations from this research include more emphasis on psychodynamic nursing principles in nursing education and nursing practice. There is a need for specialised education for nurses in child and adolescent mental health nursing. Nursing entry to practice programmes for new graduate nurses working in mental health, could assist in providing this. There is a call for further research into therapeutic relationships and professional boundaries in this complex nursing specialty.

Abstract: Because nurses work in a wide range of settings they are well-placed to provide support for smokefree environments. The aim of this research was: to assess the knowledge of cessation, attitudes towards smoking, the provision of smoking cessation advice and treatment, and attitudes to and management of smokefree workplaces in a sample of nurses with practising certificates in New Zealand; and to describe the prevalence of smoking in nurses using the 2006 New Zealand census. One thousand questionnaires were posted to a random sample of 1000 nurses (500 community-based nurses, and 500 hospital-based) from the New Zealand Nursing Council register of nurses with current practising certificates. Statistics New Zealand provided results from the New Zealand Census of Population and Dwellings, 2006, for nurses by gender, practice area and cigarette smoking status. Responses were received from 371 (37%) of the nurses. They were enthusiastic about and committed to including smoking cessation in their practice, and to learning more about helping clients who smoke. Nine out of ten felt that it was part of their responsibility to advise clients to stop smoking. Nearly nine out of ten said they would be happy to spend an extra five minutes with each patient who smoked if they could effectively intervene. Over half had not received training for effective evidence-based smoking cessation interventions but three quarters were interested in learning more about how to help people stop smoking. The respondents' knowledge of the health effects of smoking was high, but there were gaps in knowledge of effective smoking treatments and a wide misunderstanding that nicotine causes cancer and heart disease. These gaps may limit nurses' ability to intervene effectively. Nurses supported their smokefree work policies although a fifth did not report support with enforcing these. Results from the 2006 census showed that smoking prevalence among nurses has declined from 18% in 1996 to 14% in 2006. Smoking rates in mental health nurses (29%) remain higher than the New Zealand general population (21%, census data).

Abstract: This thesis traces the journey of the author's inquiry into family members' experience of the relinquishment of the personhood of a loved one with a dementia; a journey in which she reports that her own prior understandings were significantly challenged. The study was prompted by her experience of working in the area of dementia care and hearing, in the course of the working day, comments such as 'there's nobody there' made in relation to someone suffering from severe dementia. Such comments appear to imply that the person of the dementia sufferer in some way is no longer present. They are comments which relate to the very nature of personhood. The study takes impetus from the fact that the ways in which nurses view the personhood of dementia sufferers has significant consequences for the ways in which they respond to dementia sufferers and their families. This thesis, which retells the stories of four family members who each have a loved one with a dementia illness, reveals that rather than there being a unified concept of personhood in dementia, and in spite of the fact that particular understandings of dementia and personhood dominate our cultural conversations, in their day to day lives these four family members managed and made sense of their experience through particular and different ways of looking at the impact dementia has on the personhood of dementia sufferers. Not all did, in fact, relinquish the personhood of their family member. In their lived lives, the four research participants had recourse, each in different ways, to multiple discourses of personhood. For some, in addition to loss, there was also unexpected gain. This finding necessitated and shaped further inquiry into discourse and the role of discourse in shaping, constraining and opening up possibilities for meaning, and into the two substantive areas of dementia and personhood. Nurses work closely alongside the family of dementia sufferers who are daily faced with the challenge of managing and making meaning of that situation. It is critically important that they are able to recognise, validate and support the variety of needs that family members have. Nurses, whose education is traditionally based on a biomedical framework, are nevertheless often required to mediate between different understandings. Not only do they need currency of knowledge in the rapidly changing biomedical field of dementia, but they need also an understanding of the role and the power of discursive constructions of both dementia and personhood. Such understanding will provide insight into alternate ways of understanding these concepts. However, although such understanding is critical for nurses working in this area, the author suggests that nursing literature has not brought these discussions to the fore.

Abstract: This thesis is a theoretical exploration of the concepts of 'Compulsive caregiving' and 'helping profession syndrome' in relation to the choice of nursing as a career. These concepts are derived from Bowlby's attachment theory and psychodynamic psychotherapy. Both have evolved from psychoanalytic theory. The thesis explains Bowlby's development of compulsive caregiving in health professionals. The author notes that her life history and experience as a nurse educator and as a nurse practicing psychotherapy support this theoretical explanation. An argument is developed that the propensity towards compulsive caregiving is a strength in nurses. Nursing places high value on caring and many of the traits exhibited by compulsive caregivers are desirable in nurses. Nursing as a caring interpersonal process is explored with reference to the literature. However, nursing has been identified as a stressful occupation. Support strategies such as professional supervision and reflective practice are discussed. Thesis concludes with a suggestion for further research on compulsive caregiving and helping profession syndrome.