Abstract: This study using action research involving twelve registered nurses worked toward improving nursing care in an acute mental health in-patient service. Following focus groups with consumers, families, nurses, doctors, and allied health professionals, the action research group developed projects over eighteen months to improve continuity and consistency of nursing care. There was a subsequent restructuring of nursing service to better define leadership, accountability and to strengthen care delivery. The second half of the thesis involves a critical social analysis of the research data and produces a theory of mental health nursing which, the author suggests, has wide application in practice.

Abstract: Nursing in New Zealand has been a recognised profession for one hundred years. Throughout this time the profession has made a significant contribution to the health of communities, nationally and internationally. Despite the obvious effort and achievement, the author suggests that the evidence of this contribution is not well known. She goes on to say that nurses, now as never before, are challenged to show how they 'add value' and to explain why nursing expertise is essential to safe service delivery. Finding a way to communicate this contribution has been identified as one of the most important issues facing the profession. This thesis explores the concept of contribution and presents a model, the 'Contribution Model', to show how nursing can articulate the action and achievements that show how nursing professionals have and will continue to contribute to health gain in New Zealand. Through the application of the 'Contribution Model' and framework presented in this thesis, nursing is shown to have made a contribution to health gain by using the broad range of knowledge, skills and experiences in a wide range of settings, to provide care wherever and whenever required. Case studies and scenarios from history, observation and prediction are used to show how the actions and achievements of nursing meet the expectations of individuals, the community and society: past, present and future.

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: Health reforms, reviews and restructuring are not new to New Zealand nursing. The author notes that changes in the environment have created many pressures on nursing as a profession. The profession is trying to deal with this turmoil in a responsible fashion. It is also trying to grow and develop at the same time. This research is focused on finding the relationship between job and professional development. It also highlights the factors that affect job satisfaction and professional development.

Abstract: This study, which is methodologically grounded in qualitative research and philosophically informed by critical social science, explores aspects of the socio-political context in which practice nurses and general practitioners (core primary health care team) work within a team environment. It is indicated in the literature that there are benefits for improved health care through the development of collaborative teamwork. However, there have been many barriers identified which prevent collaborative teamwork. Amongst the many barriers, is the lack of role clarity and attitudinal differences. This thesis explored and highlighted whether the lack of role clarity and attitudinal differences do indeed impede the team's success, and are barriers to teamwork. The views and opinions of practice nurses and general practitioners and the understanding of their own and each other's current roles within the general practice setting were explored. The participants had the opportunity to discuss together, in focus group meetings, their thoughts on the topic. This raised their awareness of their taken for granted ideas on role and teamwork. Focus groups offered the participants the added opportunity to question each other which allowed for a deeper and more fulfilling understanding of role. New understandings that emerged could lead to alternative models of health care and influence the future delivery and planning of general practice. The thesis concludes by offering a potentially suitable model/framework which has been developed to further the understanding of teamwork in the future.