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    Investigating decision-regret and distress among psychologists impacted by client suicide : a thesis submitted in partial fulfilment of the requirement for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2022) Marshall-Edwards, Shoni
    Background: Mental health professionals are tasked with making critical decisions about their client’s care. It is thus unsurprising that client suicide has been described as a distressing experience among professionals. Significant emotional, cognitive, and professional impacts have been reported which include psychological distress, shock, self-blame, guilt, and absenteeism. Due to the variability of impacts reported across the literature, a novel theoretical approach to understanding the impact of client suicide on psychologists was implemented using two decision-regret theories. Methods: A quantitative cross-sectional survey design was used to measure the impact of client suicide on psychologists. By using structural equation modelling, the following factors were investigated: regret, distress, self-blame, supervisory support, and beliefs about suicide preventability. Additionally, two regret theories were tested which included the following variables as predictors on regret: decision-regret, decision justification, decision-process quality, and intention-behaviour consistency. Control models were tested to control for carefully selected confounding variables, and a supplementary qualitative analysis was included investigating the factors related to coping following client suicide. A sample of 248 psychologists from New Zealand, Australia, Canada, United Kingdom, and the United States of America was included in this study. Results: The results identified statistically significant relationships between the following predictor variables on regret: decision-justification, decision-process quality, and beliefs about suicide preventability. Additionally, a significant moderate positive relationship was evidenced between regret (as the predictor) and distress. The qualitative analysis indicated that high-quality supervisory support and understanding the predictive limitations in assessing suicide risk were important factors in coping with client suicide. Additionally, factors identified that were related to poor coping included judgement, counter-factual thinking and blame, and confidentiality limitations preventing seeking support from loved ones. Conclusions: The present study demonstrates support for two factors which appear to influence regret levels: decision-justification and decision-process quality. Additionally, this study also evidenced regret as a significant moderate predictor of distress, highlighting the role that regret may play in influencing a range of affective states among psychologists following client suicide. The findings of the present study highlight the need for the development of robust support structures that acknowledge the impact of client suicide.
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    '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, Garrick
    This 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.