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Item Teaching coping behaviour to psychiatric patients : a thesis presented in partial fulfilment of the requirements for the Degree of Master of Arts in Nursing at Massey University(Massey University, 1978) Tangamonsiri, DaruneeA structured programme has been developed to teach aspects of the concept of "coping" to psychiatric patients. The teaching programme is based on the concepts of coping and adjustment developed by Lehner and Kube (1964); Coleman (1969); Lazarus (1969); Sawrey and Telford (1974); and Coelho, Hamburg and Adams (1974). In order to test the hypothesis that patients perceptions of nurses will affect their learning, the Massey - Patient -Nurse Projective Test (MPN) has been developed as a diagnostic tool. This is used to select patients for the two groups used in the teaching programme which is carried out by a registered general nurse who does not have a psychiatric qualification. The patients' coping behaviour is measured before and after the teaching programme by a coping behaviour test devised by the researcher for this study. The development of both groups has been analysed in the light of Whitaker and Lieberman's theory of group development. A content analysis has been used to define categories of patient and nurse behaviour during the teaching programme. In addition the behaviour of each patient has been studied using an idiographic case study approach. The teaching programme was first tested with eight psychiatric patients at a large psychiatric hospital. The same programme was then given to ten middle-aged psychiatric patients (two men and eight women) at the same hospital. The patients were selected into two groups on the basis of their results on the MPN test. Grouped results show that patients who initially saw the nurse as "helpful" (Group A) did not change their coping behaviour. This group viewed nurses as "less helpful" at the end of the programme. Also, the group shifted its dependency from the nurse to the group members and ended in an early formative phase. On the other hand, the group of patients who viewed nurses as "not helpful" (Group B) did show changes in their coping behaviour at the end of the programme. The group shifted their conflict with the nurse onto one of the group members and ended in a middle formative phase. The content analysis shows that patients in Group B had a higher degree of resistance to learning than patients in Group A and fewer attempts to gain insight. The nurse also showed more stimulation of Group A than Group B to gain insight. The case studies of the patients show a positive change in one Group A patient who developed self-confidence during the sessions, and improvements in two Group B patients who gained confidence in interacting with others, and in planning for future actions.Item 'On the path, off the trail' : the relational work of nurses in outreach health : a thesis presented in partial fulfilment of the degree of Masters of Philosophy in Nursing at Massey University, Wellington, Aotearoa New Zealand(Massey University, 2017) Martin, GarrickThis research study draws on the practice reflections of nurses working with people who are homeless and experiencing mental health problems to explore engagement as a core nursing practice in this setting. Therapeutic relationships and engagement are at the heart of nursing practice, and this is especially so in mental health nursing. Homeless and hard-‐ to-‐reach clients are an underserved population for mental health services. This research seeks to ‘make visible’ the ways in which mental health nurses uniquely and successfully engage with people experiencing homelessness and marginalisation, which in turn contributes to improved health and social outcomes for those people. Eight New Zealand registered nurses were interviewed and critical thematic analysis used to interpret the resulting data. The research findings were that nurses practicing in this specific homeless health context value relationships as a core nursing intervention. The work of engagement was described as uncertain. The research participants echoed the nursing theory and literature that argues nurses’ relational work is often unseen and undervalued within health systems. Relational work is described as a defining concept for mental health nursing yet the lack of visibility of this skilled work adds to nurses’ experience of uncertainty. The recommendations suggest ways to render visible and hold central the nursing work of engagement.Item Helplessness or self care? : a study of nursing practice with depressed patients in an in-care setting : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University(Massey University, 1982) Butterfield, ShonaThis study was conducted to investigate the practice of nurses when working with depressed patients in an in care setting. A survey of the literature shows that the role commonly prescribed for nurses who work in psychiatric settings is one that emphasises a one-to-one relationship based on models of psychotherapy and focusses on individual illness, pathology, symptoms and psycho-dynamics. It is suggested that this is not a role which most nurses working in New Zealand psychiatric settings would be able to implement in practice. Three perspectives of nursing practice were explored in the study: what nurses were seen to do in practice; what they thought they should do as evidenced in results of an exercise to rank different possible interventions; and what patients said were helpful nursing interventions. A framework was developed for the study which depicts the process of helplessness (depression) as the negative 'mirror-image' of the process of self care. Results were analysed within this framework to determine whether or not nurses tended to support behaviours which were indicative of movement towards helplessness or encourage those which indicated progress towards self care. Results suggest that nurses in this study sample did not encourage progress towards self care by their interventions. There was little evidence of positive reinforcement for independent or coping behaviours with patients in the study sample. Further, the nursing practice showed little relationship to the role prescribed in the literature. The nurses did demonstrate a warm, caring, friendly approach that seemed to stem from a more traditional 'succouring' or 'mothering' view of the nurse's role.Item Hearing voices : the gendered nature of mental health practices in New Zealand in the 1920s and 1940s : a thesis presented in partial fulfilment of the requirements of Master of Arts in Women's Studies at Massey University(Massey University, 2007) Adams, Glennys ElaineThis thesis asks what insights can be gained from the oral histories of mental nurses and attendants about the gendered nature of mental health practices in New Zealand in the 1920s - 1940s. Previously recorded interviews provided the primary texts for analysis. In considering both their oral accounts and memories as constructions, feminist poststructuralist models are used to study the nurses' and attendants' experiences. Utilising gender as an analytical tool meant that the narrators' memories were understood as the gendered products of the interconnections between the practices and discourses of culture and individual subjectivity, and that gender was implicated in the practices and production of power in mental institutions. Discourse theory and practices provided the conceptual framework and methodology for an analysis that regarded knowledge as residing in and produced by discourses. By studying the different constructions of female nurses and male attendants in discourses of mental nursing it was possible to recognise how these representations legitimised and privileged particular kinds of knowledge and power. Contextualising the narratives socially and culturally enabled consideration of how the nurses and attendants reproduced dominant discourses of femininity and masculinity in circulation at the time they were working. The findings point to the way in which powerful discourses of gender predicated on the separation of women and men respectively into private and public spheres, intersected with gendered assumptions of mental illness and mental nursing. The oral testimonies show that the female nurses were situated between the paradigms of these discourses, but because subjectivities are not fixed and immutable, they adopted different and changing positions in relation to them at different times. Although it is argued that discourses of gender did shape the subjectivities of the nurses and attendants and were employed to support gendered institutional practices this was more complex than first appears. The voices of the female nurses can be heard sometimes embracing, sometimes resisting and sometimes transgressing gender norms.Item An evaluation of nursing documentation as it relates to pro re nata (prn) medication administration : a research report presented in partial fulfilment of the requirements for the degree of Master of Nursing in Mental Health at Massey University(Massey University, 2003) Jenkinson, Frances HeatherAims of the project: l. To investigate if documentation related to pro re nata (Latin, prn) medication administration by mental health nurses, in a particular Forensic Psychiatry Clinic, in a metropolitan city in New Zealand, complies with the requirements of the National Mental Health Sector Standards (Ministry of Health, 1997), the specific District Health Board's policies, the local policies of the Forensic Psychiatry Clinic, the Code of Conduct for Nurses and Midwives (Nursing Council of New Zealand, 1999) and follows the nursing process. 2. To investigate whether there are any variations in the documentation practices between nursing shifts. Methods: A retrospective file audit was conducted at a forensic psychiatry clinic in a city in New Zealand. Non-random sampling was used. Data was collected from all admissions in 2002 that had prn medication administered during the first four weeks. A document questionnaire was designed to capture the required data to answer the research questions Results: From the sample of 27 files data was collected from up to 170 nursing entries. This was primarily a descriptive and exploratory study. None of the nursing entries met all the requirements of the National Mental Health Sector Standards (Ministry of Health, 1997), company policies, local area policies and/or the Code of Conduct for Nurses and Midwives (Nursing Council of New Zealand, 1999) in relation to nursing documentation. Nearly 47% of the prn medication administered had no documentation, apart from that in the medication-recording chart, to indicate it had been given. Approximately 85% of prn administrations had no evidence of an assessment prior to administration. Where it was documented that a client had requested medication. nearly 82% had no evidence of assessment. A large number of prn medications were administered from prescriptions that did not meet legal or policy requirements. Evidence of planning was lacking in the documentation with nearly 98% of the notes not indicating the rationale for a choice of route of administration where this was permitted on the prescription. No nursing entry offered a rationale for the choice of dose where this was allowed. The name of the medication, dose, route and/or time administered was frequently missing. Of the prn administrations considered for an outcome, nearly 60% had no documented outcome. Little difference was found in the nursing documentation between the shifts. However it was noted that for day and aftenoon shift, the earlier in the shift the medication was administered the less likely there was to be any mention of the medication being administered. Conclusion: The findings established extremely poor documentation practices. The lack of evidence of patient assessment, prior to administration of the medication in the documentation, raises the issue of whether this is being done prior to prn medication administration or simply not being documented. The documentation left questions about decision making in the planning of administration. The large number of medication administrations lacking a documented outcome raises uncertainty about nurses' knowledge of evaluating care, or even whether they are actually evaluating the care given. As a result of these findings, it is recommended that further research in this area be undertaken in New Zealand.Item The therapeutic relationship : perceptions of mental health nurses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University(Massey University, 2000) O'Brien, Anthony JohnThe therapeutic relationship is a concept that has become central to the identity and practice of mental health nurses since it was formulated by nursing theorists in the 1930s. Most commonly associated with the work of the late Hildegard Peplau, the therapeutic relationship has been considered both fundamental to nursing generally and to capture the unique focus of mental health nursing: interpersonal engagement with consumers of mental health services. However this dual role, and the absorption of specialist mental health nursing education into generalist nursing education, has left the specialty in a problematic situation in identifying and articulating its unique contribution to mental health care. This problem is at its most acute in inpatient settings where, ironically, mental health nursing has its strongest historical roots. In this study I have sought to describe mental health nurses' perceptions of the therapeutic relationship. Rather than ask, as many previous studies have done, whether mental health nurses interact therapeutically with consumers I have sought the views of mental health nurses themselves. A constructionist research paradigm has been used to develop the research. From within a constructionist paradigm, phenomena are seen as socially constructed rather than objectively available for observation. Language is regarded not as a transparent medium of description, but as theory-laden. Focus groups were used to gather data from experienced nurses in three different practice settings; inpatient care, community care and from nurse-therapists. By attending to the group as the focus of analysis it was possible to develop a broad view of the therapeutic relationship. The themes reported here describe the therapeutic relationship as fundamental to mental health nursing, independent of theoretical accounts of mental health nursing and mental health care, and with a wide scope, from facilitative listening to involvement in coercive interventions. The therapeutic relationship in mental health nursing has emerged as a phenomenon socially constructed by its development as part of a therapeutic discourse in mental health care in the middle of the last century, and through the influence of current practice contexts. From the description developed in this study it has been possible to make recommendations for mental health nursing education, research and practice.Item An ethnography of caring and control in an acute psychiatric unit : a dissertation presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing Studies at Massey University(Massey University, 1992) Boddy, Julienne MaryThe setting for this study was a 19 bed general hospital psychiatric ward serving a heterogeneous population. The objective of the study was to generate thick description of the cultural knowledge patients and nurses used to organise their behaviour and interpret their experience in an acute psychiatric unit. Further aims were to describe the nature of the service provided, and more specifically to identify relationships between caring and controlling in this social context, and the outcomes for patients of caring and controlling interventions by nurses. Over a 10 month period primary data were obtained through participant observation and ethnographic interviews, with analysis of documentation providing secondary data. Thirty patients and 20 nursing staff acted as informants. They were selected on the basis that they had experienced the event being studied, and that they were both willing and able to share the experience. A cyclic research process was adopted, in which initial data analysis followed early data collection resulting in more focussed questions for subsequent data collection. Content analysis was undertaken to inductively derive patterns or themes from the data. Validity of data was achieved through triangulation of multiple data sources. Interpretations of the findings were verified and clarified in collegial dialogue with other psychiatric nurses, and with academic colleagues. The central thesis which emerged from the data is that the nature of caring and controlling acts by nurses is shaped by the social organisation of care, and by the dominant belief system of that setting. A view of mental illness as a life long event for the majority of inpatients, coupled with beliefs about the "outside world" as tough, contributed to nurses' feelings of powerlessness to change situations for, or with patients, and so diminished expectations for change. Caring as a moral obligation was often interpreted by nurses as a moral obligation to provide a safe haven, with nurturance and acceptance of patients viewed as chronically psychiatrically disabled. Additionally, features of the organisational context including nurses' lack of autonomy in their practice, the absence of both appropriate environmental controls and a clearly articulated rule structure, and the competing demands on nurses arising from the provision of the after hours crisis service from the ward, contributed to an organisational context which was not supportive of sustained therapeutic interaction between nurses and patients. There was a culture of chronicity in the ward. Implications of these findings for psychiatric nursing education and practice, and for service development are discussed.Item A qualitative study of the ethical practice of newly graduated nurses working in mental health : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University(Massey University, 2008) Butters, Katheryn JanineDespite nurses having legitimate ethical rights and responsibilities, they are often constrained in practice from acting in ways they believe to be morally correct. This thesis presents a qualitative exploration of factors that influenced eight newly graduated nurses as they endeavoured to practice ethical mental health nursing in New Zealand. Data was gathered from in depth interviews with the participants and analysed using a thematic analysis method. A critical lens was employed to view the data so as to make visible aspects of the social and political context within which the participants were situated. The participants? moral practice was profoundly influenced by a number of relational experiences they had. These relationships were then determinants in their moral development, professional socialization and their ability to practice in accordance to their moral beliefs. Key aspects of these relationships were their experiences with nursing education and the influence of the organisations where they worked. Recommendations are made to both areas to enable and support moral nursing practice for new graduate mental health nurses. New graduate nurses inherently desire to practice in a way that honours the client and is therefore inherently ethical. Moral nursing practice is an everyday occurrence that must be situated in a culture of respect and regard for both clients and nurses. New graduate nurses have much to offer the profession and the tangata whaiora of the mental health services. They must be valued and supported to act in accordance to their moral ideals.