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This thesis presents findings from a New Zealand phenomenological study that investigated the lived experience of lecturers in nursing education. I decided that this was a relevant research topic as little was known about this area, and in New Zealand there were no previous studies. I also had an interest in the topic because of my own experience of being a lecturer. I was interested to find out how lecturers negotiate their work worlds in the intensifying political climate of nursing education today. The methodology and method for the study was guided by Heideggerian hermeneutics. Open-ended interviews were conducted with five participants, all lecturers with between two and five years teaching experience. Four themes emerged: 'politics as destabilising/politics as strength gathering', 'commitment amidst uncertainty', 'content and process in the pursuit of teaching security', and 'being an insider and an outsider as a shifting space'. Dynamic and shifting experience in the themes reveals that 'being' a lecturer includes the experience of 'becoming' one, in which lecturers are constantly required to renew themselves in the changing world that surrounds them. Their interpretation of their 'being' is always 'on the way', reflecting Gadamer's (1987) argument about the process of interpretation in understanding experience. I argue that because lecturers' interpretation of their 'being' is influenced by their surrounding context, it is important to include this surrounding context in determining the answer to my research question 'what does it mean to be a lecturer in the field of nursing education?' Issues in this surrounding context include an intensifying political climate where there is an increased risk of experiencing burnout Four recommendations are made in response to the challenging issues that exist: first, for lecturers to engage in curriculum development; second, establish learning communities; third, undertake professional supervision; and fourth, lobby poli

This thesis presents findings from a New Zealand phenomenological study that investigated the lived experience of lecturers in nursing education. I decided that this was a relevant research topic as little was known about this area, and in New Zealand there were no previous studies. I also had an interest in the topic because of my own experience of being a lecturer. I was interested to find out how lecturers negotiate their work worlds in the intensifying political climate of nursing education today. The methodology and method for the study was guided by Heideggerian hermeneutics. Open-ended interviews were conducted with five participants, all lecturers with between two and five years teaching experience. Four themes emerged: 'politics as destabilising/politics as strength gathering', 'commitment amidst uncertainty', 'content and process in the pursuit of teaching security', and 'being an insider and an outsider as a shifting space'. Dynamic and shifting experience in the themes reveals that 'being' a lecturer includes the experience of 'becoming' one, in which lecturers are constantly required to renew themselves in the changing world that surrounds them. Their interpretation of their 'being' is always 'on the way', reflecting Gadamer's (1987) argument about the process of interpretation in understanding experience. I argue that because lecturers' interpretation of their 'being' is influenced by their surrounding context, it is important to include this surrounding context in determining the answer to my research question 'what does it mean to be a lecturer in the field of nursing education?' Issues in this surrounding context include an intensifying political climate where there is an increased risk of experiencing burnout Four recommendations are made in response to the challenging issues that exist: first, for lecturers to engage in curriculum development; second, establish learning communities; third, undertake professional supervision; and fourth, lobby poli

Alcohol and other drug (AOD) use, abuse and addiction are destructive to Māori and are an urgent problem; wairuatanga, cultural identity and tino rangatiratanga (self determination) are key to successful recovery ffom AODs for Maori. Kaupapa Māori AOD services have better success rates because they provide what is essential for Māori such as tikanga, core beliefs, values and practices of Maori re health, illness, wairua, tapu, noa and life. There are strategies for addressing the problem of AOD addiction for Māori such as positive stories of recovery. This thesis explores the shared experiential journeys of four Pūkōrero (participants) who successfully completed detoxification and recovery programmes from AOD addiction. Three questions were used to guide the research process to enable the Pūkōrero to identify positive aspects of their individual detoxification and recovery programmes, surface any barriers and issues they experienced, and clarify the support they received throughout the process. Kaupapa Maori and Narrative Inquiry was adapted to undertake this study to capture the essence of Maori thinking and reality regarding AOD. Through the use of thematic analysis the data findings of the study reflect the views from each Pūkōrero of Wairua, Whakapapa and Whānau as key to their successful recovery. This supports the notion that a pathway of detoxification, recovery and hope exists to enable Maori and others to take the journey to reclaim their own health and well-being, and the health and well-being of Whānau, Hapū, Iwi, and Māori community. In honour of these Pūkōrero, Kāumatua, Tipuna, Whānau, Hapū, Iwi, Māori katoa, and to celebrate Kaupapa Maori and Narrative Inquiry [as the preferred methodological approach], the use of our tino ataahua reo integrated with English throughout the thesis demonstrates the interwoven connections between the two cultures enshrined in Te Tiriti o Waitangi that comprise the nation of Aotearoa me Te Waipounamu of New Zealand.

Alcohol and other drug (AOD) use, abuse and addiction are destructive to Māori and are an urgent problem; wairuatanga, cultural identity and tino rangatiratanga (self determination) are key to successful recovery ffom AODs for Maori. Kaupapa Māori AOD services have better success rates because they provide what is essential for Māori such as tikanga, core beliefs, values and practices of Maori re health, illness, wairua, tapu, noa and life. There are strategies for addressing the problem of AOD addiction for Māori such as positive stories of recovery. This thesis explores the shared experiential journeys of four Pūkōrero (participants) who successfully completed detoxification and recovery programmes from AOD addiction. Three questions were used to guide the research process to enable the Pūkōrero to identify positive aspects of their individual detoxification and recovery programmes, surface any barriers and issues they experienced, and clarify the support they received throughout the process. Kaupapa Maori and Narrative Inquiry was adapted to undertake this study to capture the essence of Maori thinking and reality regarding AOD. Through the use of thematic analysis the data findings of the study reflect the views from each Pūkōrero of Wairua, Whakapapa and Whānau as key to their successful recovery. This supports the notion that a pathway of detoxification, recovery and hope exists to enable Maori and others to take the journey to reclaim their own health and well-being, and the health and well-being of Whānau, Hapū, Iwi, and Māori community. In honour of these Pūkōrero, Kāumatua, Tipuna, Whānau, Hapū, Iwi, Māori katoa, and to celebrate Kaupapa Maori and Narrative Inquiry [as the preferred methodological approach], the use of our tino ataahua reo integrated with English throughout the thesis demonstrates the interwoven connections between the two cultures enshrined in Te Tiriti o Waitangi that comprise the nation of Aotearoa me Te Waipounamu of New Zealand.

Alcohol and other drug (AOD) use, abuse and addiction are destructive to Māori and are an urgent problem; wairuatanga, cultural identity and tino rangatiratanga (self determination) are key to successful recovery ffom AODs for Maori. Kaupapa Māori AOD services have better success rates because they provide what is essential for Māori such as tikanga, core beliefs, values and practices of Maori re health, illness, wairua, tapu, noa and life. There are strategies for addressing the problem of AOD addiction for Māori such as positive stories of recovery. This thesis explores the shared experiential journeys of four Pūkōrero (participants) who successfully completed detoxification and recovery programmes from AOD addiction. Three questions were used to guide the research process to enable the Pūkōrero to identify positive aspects of their individual detoxification and recovery programmes, surface any barriers and issues they experienced, and clarify the support they received throughout the process. Kaupapa Maori and Narrative Inquiry was adapted to undertake this study to capture the essence of Maori thinking and reality regarding AOD. Through the use of thematic analysis the data findings of the study reflect the views from each Pūkōrero of Wairua, Whakapapa and Whānau as key to their successful recovery. This supports the notion that a pathway of detoxification, recovery and hope exists to enable Maori and others to take the journey to reclaim their own health and well-being, and the health and well-being of Whānau, Hapū, Iwi, and Māori community. In honour of these Pūkōrero, Kāumatua, Tipuna, Whānau, Hapū, Iwi, Māori katoa, and to celebrate Kaupapa Maori and Narrative Inquiry [as the preferred methodological approach], the use of our tino ataahua reo integrated with English throughout the thesis demonstrates the interwoven connections between the two cultures enshrined in Te Tiriti o Waitangi that comprise the nation of Aotearoa me Te Waipounamu of New Zealand.

Trends in modern day mental health facilities have been towards the least restrictive environment with emphasis on patients’ rights, but these rights have to be balanced against the safety of both the patients themselves and anyone else in the immediate environment. One way of restricting a person’s movement is through the use of seclusion, a means of isolating a person in a locked room with minimal stimulus and from where that person cannot freely exit. This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. I also included some personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses’ way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person’s level of acuity and to their ability to engage in this approach in a real and tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. It is used when a person is so unwell that they cannot be managed in any other identified way. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.

The New Zealand Emergency Department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, as this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the Emergency Department. In addition to this education deficit are the challenges of providing care in an overcrowded ED environment. Such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

Trends in modern day mental health facilities have been towards the least restrictive environment with emphasis on patients’ rights, but these rights have to be balanced against the safety of both the patients themselves and anyone else in the immediate environment. One way of restricting a person’s movement is through the use of seclusion, a means of isolating a person in a locked room with minimal stimulus and from where that person cannot freely exit. This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. I also included some personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses’ way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person’s level of acuity and to their ability to engage in this approach in a real and tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. It is used when a person is so unwell that they cannot be managed in any other identified way. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.

The New Zealand Emergency Department (ED) nurse is faced daily with the challenge of caring for patients of all ages with a wide variety of presenting complaints. Courses are available for ED specialty work such as trauma and paediatric assessment. However, as this thesis argues, it is difficult to access updated and ongoing education in relation to caring for people with mental health problems who present to the Emergency Department. In addition to this education deficit are the challenges of providing care in an overcrowded ED environment. Such factors contribute to a perceived lack of confidence and sometimes ambivalence or frustration on the part of nursing staff in caring for this group. This may result in an inconsistent standard of care for the the person with a mental health problem unless such issues are addressed. The aim of this research paper was to explore the education needs of ED nurses when caring for people with mental health problems. A literature review was undertaken to investigate the broad education strategies available to overcome these challenges. Diverse approaches were identified such as workshops, clinical guidelines, and mental health consultation-liaison roles. Research was also identified that examined ED nursing attitudes and their learning needs in relation to mental health. This paper concludes with a discussion of recommendations for the New Zealand setting with the intention of developing a more confident and competent nursing workforce, who are better prepared to care for the person with a mental health problem.

This research paper aims to explore the contribution of the Strengths Perspective (hereafter known as S P) to mental health nursing practice. The S P emerged from the area of social work and is primarily concerned with emphasising the strengths and resources of the person, as they define them. The premise is that if a person is able to identify and call on those strengths then he or she is able to improve the quality of their life. The paper outlines the historical, philosophical and moral foundations of the Strengths Perspective and discusses the humanistic approach to mental health nursing. The aim is to demonstrate that the S P and mental health nursing have a strong alignment, particularly with regard to a person-centred approach to care. The influence and constraints of the biomedical model on both mental health nursing and strengths based practice is a theme of the paper. The contention is that the biomedical or pathological approach to care can often disable, not enable consumers of health care, whereas an approach that centres on a person and their strengths is more likely to empower and liberate. The paper concludes with a discussion of themes that emerged from reflection on the literature and propositions are then made about how mental health nurses might orientate their thinking and practice to utilise the S P to augment their clinical work.

This research paper aims to explore the contribution of the Strengths Perspective (hereafter known as S P) to mental health nursing practice. The S P emerged from the area of social work and is primarily concerned with emphasising the strengths and resources of the person, as they define them. The premise is that if a person is able to identify and call on those strengths then he or she is able to improve the quality of their life. The paper outlines the historical, philosophical and moral foundations of the Strengths Perspective and discusses the humanistic approach to mental health nursing. The aim is to demonstrate that the S P and mental health nursing have a strong alignment, particularly with regard to a person-centred approach to care. The influence and constraints of the biomedical model on both mental health nursing and strengths based practice is a theme of the paper. The contention is that the biomedical or pathological approach to care can often disable, not enable consumers of health care, whereas an approach that centres on a person and their strengths is more likely to empower and liberate. The paper concludes with a discussion of themes that emerged from reflection on the literature and propositions are then made about how mental health nurses might orientate their thinking and practice to utilise the S P to augment their clinical work.

This research paper aims to explore the contribution of the Strengths Perspective (hereafter known as S P) to mental health nursing practice. The S P emerged from the area of social work and is primarily concerned with emphasising the strengths and resources of the person, as they define them. The premise is that if a person is able to identify and call on those strengths then he or she is able to improve the quality of their life. The paper outlines the historical, philosophical and moral foundations of the Strengths Perspective and discusses the humanistic approach to mental health nursing. The aim is to demonstrate that the S P and mental health nursing have a strong alignment, particularly with regard to a person-centred approach to care. The influence and constraints of the biomedical model on both mental health nursing and strengths based practice is a theme of the paper. The contention is that the biomedical or pathological approach to care can often disable, not enable consumers of health care, whereas an approach that centres on a person and their strengths is more likely to empower and liberate. The paper concludes with a discussion of themes that emerged from reflection on the literature and propositions are then made about how mental health nurses might orientate their thinking and practice to utilise the S P to augment their clinical work.

The background to this research report is my personal and professional belief that more can be done in caring for people who experience psychosis. Psychosis can be a life-threatening illness; about one in ten young men with psychosis will take their own lives. It ravages individuals and robs families and societies of what may have been. Over the last 25 years there has been great progress in the treatment and nursing approach to psychosis, however much of this progress has been predicated on a biological explanation of psychosis. The late 1990s have seen increasing interest in psychological approaches in the treatment of psychosis; not withstanding that this treatment does not work for all people. This has caused me to examine critically what else might work and why. My intuition is, that Cognitive Behavioural Therapy (CBT) may offer a way forward. It seems that as I have come to a greater understanding of CBT, its theory and its process, it has become increasingly clear that much of what mental health nurses do is, in fact, CBT. The first aim of this research report is to understand a little about CBT, through exploration of the origins of CBT and examining the theoretical basis and reviewing the evidence that may support its use The second aim is to explore the evidence around mental health nurses' training and use of CBT, by critically examining some of the major UK and Australian reports. I believe that for New Zealand mental health nurses, CBT will be the next major mental health movement in which they are involved. I consider CBT is theoretically and pragmatically compatible with contemporary nursing practice. It seems on the evidence I have found, that potentially, this approach offers the way forward for nurses and a way back for clients.

The background to this research report is my personal and professional belief that more can be done in caring for people who experience psychosis. Psychosis can be a life-threatening illness; about one in ten young men with psychosis will take their own lives. It ravages individuals and robs families and societies of what may have been. Over the last 25 years there has been great progress in the treatment and nursing approach to psychosis, however much of this progress has been predicated on a biological explanation of psychosis. The late 1990s have seen increasing interest in psychological approaches in the treatment of psychosis; not withstanding that this treatment does not work for all people. This has caused me to examine critically what else might work and why. My intuition is, that Cognitive Behavioural Therapy (CBT) may offer a way forward. It seems that as I have come to a greater understanding of CBT, its theory and its process, it has become increasingly clear that much of what mental health nurses do is, in fact, CBT. The first aim of this research report is to understand a little about CBT, through exploration of the origins of CBT and examining the theoretical basis and reviewing the evidence that may support its use The second aim is to explore the evidence around mental health nurses' training and use of CBT, by critically examining some of the major UK and Australian reports. I believe that for New Zealand mental health nurses, CBT will be the next major mental health movement in which they are involved. I consider CBT is theoretically and pragmatically compatible with contemporary nursing practice. It seems on the evidence I have found, that potentially, this approach offers the way forward for nurses and a way back for clients.

The background to this research report is my personal and professional belief that more can be done in caring for people who experience psychosis. Psychosis can be a life-threatening illness; about one in ten young men with psychosis will take their own lives. It ravages individuals and robs families and societies of what may have been. Over the last 25 years there has been great progress in the treatment and nursing approach to psychosis, however much of this progress has been predicated on a biological explanation of psychosis. The late 1990s have seen increasing interest in psychological approaches in the treatment of psychosis; not withstanding that this treatment does not work for all people. This has caused me to examine critically what else might work and why. My intuition is, that Cognitive Behavioural Therapy (CBT) may offer a way forward. It seems that as I have come to a greater understanding of CBT, its theory and its process, it has become increasingly clear that much of what mental health nurses do is, in fact, CBT. The first aim of this research report is to understand a little about CBT, through exploration of the origins of CBT and examining the theoretical basis and reviewing the evidence that may support its use The second aim is to explore the evidence around mental health nurses' training and use of CBT, by critically examining some of the major UK and Australian reports. I believe that for New Zealand mental health nurses, CBT will be the next major mental health movement in which they are involved. I consider CBT is theoretically and pragmatically compatible with contemporary nursing practice. It seems on the evidence I have found, that potentially, this approach offers the way forward for nurses and a way back for clients.