Ruth DeSouza » Mental Health

Nursing has been a significant part of my life, having been a student, clinician, educator and now a researcher, for the last twenty one years. My work has been primarily in mental health consumers/tangata whai ora with a particular interest in maternal mental health and culture and mental health. I believe that the relationship between the nurse and client should be based on enhancing the self-determination of the client and that nurses are privileged to work with people. Reflection, research and personal and professional development are vital to maintaining good practice. I am committed to consumer and community empowerment and social justice.I am also interested in clinical supervision and self-care. You can read more about supervision on my learning and development page.

Psychiatric/Mental Health Nursing

Horsfall (1997) argues that mental health nursing ways of knowing and their medical origins exclude human qualities such as soul, emotions and lived experience and that this has negative consequences for nurses and their clients. Horsfall argues that this Cartesian dualism has not improved the lives of consumers and have separated the person from their interpersonal, political and other life contexts. In addition the nursing trend toward increasing professionalism by way of scientisation (nursing as a body of scientific knowledge) poses a challenge for patient advocacy as these two strategies almost contradict each other (Lupton, 1995). Support workers are claiming a role nurse have had in the past as advocate for consumers because nurses are seen to be aligned with the medical model.

In contrast, support workers enter the daily lives of consumers and "come into my heart and my house" (Bird & Epstein, 1997) according to a consumer. Community support workers have a strong consumer-orientated philosophy, with a greater emphasis on consumer choice, empowerment in services and supports and recognition of self-help and self-advocacy. In addition, the relationship is more orientated toward collaborative relationships than prescriptive ones. The focus in support work is: "Help each client build a hopeful vision of a personal future, to negotiate personal preferences and to work in partnership with clients, family members and others to help the consumer to access or develop the skills, resources or supports necessary to realise their vision" (Curtis & Hodge, p15). You can read more about support workers on my culture and health page.

The creative tensions that multi-disciplinary teams have to offer is exciting.You'll find some of my favourite links to mental health nursing websites on this page. Followed by some general nursing links.

Mental Health Nurse Practitioner Prescribing

In the 1991 budget the health reforms began with the governments intention to reform the health sector in order to promote cost effective delivery of healthcare. In 1992 as part of the reforms a paper produced by groups including the Ministry of Health was reviewed and the issue of extending prescribing rights to nurses was raised. It was thought that this would provide the public with more choice and more efficiency. An issues paper was then developed which identified features that would need consideration before anything could be changed, such as education, registration, communication, monitoring and disciplinary procedures, legislative changes and medicines classification.

A discussion paper was then written in 1994 to debate whether prescribing rights should be extended to other health professionals and to identify issues to be resolved for that to happen. All the health professionals that were consulted agreed that this could only happen in an environment of co-operation between health professionals. The consensus was that this move should result in benefits for consumers and society. The next move by the Ministry of health was to decide to consider extending rights and addressing the issues profession by profession. Nurses were chosen for a number of reasons including their role in the delivery of health services and being supporters of extending limited prescribing rights. In 1997 a working group was formed to advise on the safety and quality issues associated with extending limited prescribing rights to nurses. The report of the Ministerial Taskforce on nursing strongly supports the first step towards prescribing rights for nurses which is working on the introduction of limited prescribing rights to nurses working in child/family health and aged care.

I am currently the Chair of the New Zealand Working Party for Mental Health and the New Zealand branch of ANZCMHN is developing the process with the New Zealand Nurses Organisation.

Nursing

Overseas Registered Nurses

One of my interests is in migrant nurses, Surveys by Pittman and Rogers (1990 found that nurses who had lived and worked in two or more countries and been migrants were more culturally sensitive The breadth of cultural experience of most minority nurses contributed to the awareness, empathy and insight that nurses brought to practise. The nurses in the survey identified that their ethnic background was an asset to the health system and benefited their practise. Their helpfulness in areas where many migrants present with issues of dislocation and grieving is not utilised. Alternatively, some skills are exploited like language skills, which may be used to suit the place of work, but no recognition of expertise is given in terms of being incorporated into the job specification or the clinical grade of a post.

Nurses can face racism or stereotyping from their clients, who can be surprised to meet a minority nurse, let alone engaging with the minority person as an expert of any kind. Furthermore, it is often the first time that a client has had an encounter with a minority person, but it is probable that the minority nurse has had both personal and professional relationships with white people. The ability of minority nurses to live in biculturally and develop skills for understanding the subtleties of both. Nurses' relationships with their own ethnic group can also be a source of tension and vulnerability(Tilki, Papadopoulos and Alleyne, 1994). This may manifest as a reluctance to identify with them or being intolerant and distant toward fellow people. This may be to avoid being drawn into potential conflicts from cultural misunderstandings or to avoid being called upon after hours. There may also be conflict between the nurses own cultural values and those to which he/she has been professionally socialised.Diana Grant Mackie has written about racism in New Zealand in the February 2006 Kai Tiaki.

Links
New Zealand Nurses Organisation
Nursing Council of New Zealand
College of Nurses Aotearoa (NZ)
Nursing in New Zealand (MOH website)
Nursing Education in New Zealand
Working as a Nurse in New Zealand
Trends In International Nurse Migration (by Linda H. Aiken, James Buchan, Julie Sochalski, Barbara Nichols and Mary Powell) was published in Health Affairs, Vol. 23, Number 3, June 2004
NZ Tops List of Countries Reliant on Overseas Nurses
Information to Register as a Nurse in New Zealand
Migrant health workers: Is one country's gain another's pain?

Nursing in New Zealand

Psychiatric/Mental Health Nursing

Mental Health Nurse Practitioner Prescribing

Nursing

Overseas Registered Nurses