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Some of the articles are available on-line
for free. Click on the picture of the journal to visit the publisher or the
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article directly.
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Lakeman, R. (2010). Maintaining
wellbeing when a service user dies. The British Journal of Wellbeing,
1(2), 28-33. |
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People who work with the homeless are
likely to be exposed to the trauma and death of services users. A theory
of how workers deal with sudden death was developed through grounded
theory analysis of in-depth interviews with people who had worked in the
sector. Maintaining well-being involves positively framing the life and
death of the service user and homeless sector work. This involves a
number of related processes and factors, such as the nature of the
encounter with death, responding to death emotionally and procedurally,
and being involved in the marking of death and memorials of the person’s
life. Being able to recognise and respond to the vulnerability of self,
peers and service users is also important. Successfully framing death
enables workers to stay in the sector while maintaining their own
wellbeing, enthusiasm for their work and compassion for users. |
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Lakeman, R. (2010). Epistemic
injustice and the mental health service user [Editorial]. International Journal of Mental Health Nursing, 19(3), 151-153. |
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This editorial explores particular
forms of epistemic injustice which mental health service users may be
exposed to. Mental health service provision throws up some particular
problems in relation to developing and sustaining just services. Like
the problems which people bring with them to mental health care, justice
is multifaceted and multidimensional. Whilst often it may seem that
addressing injustice is too big a problem for any but the most heroic of
individuals, much injustice is underpinned by testimonial injustice of
various kinds which we as health professionals are implicated in
perpetuating. Mental health professionals need to reflect on the way we
engage with service users, consider their testimony and construct
problems. To do so will have far reaching implications for creating just
institutions and ultimately just societies. |
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Lakeman, R. (2010). Mental health
recovery competencies for mental health workers: A Delphi study.
Journal of Mental Health, 19(1), 62-74. |
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Background: Mental health recovery is a concept that is now widely
promoted. Lengthy sets of competency statements have been published to
assist mental health workers become more recovery orientated in their
work. However, there continues to be a lack of clarity around what
constitutes recovery focused practice or which competencies are most
helpful to assist people towards recovery.
Aims:
To identify the most important or valued mental health worker
competencies/practices that are supportive of mental health recovery.
Method: Experts by experience participated in an online Delphi
survey to rate the importance of recovery competency statements, to
reach consensus on the most important competencies and provide examples
of specific practices that demonstrate competent practice.
Results: The top rated competencies emphasized mental health workers
listening to and respecting the person's view points, conveying a belief
that recovery is possible and recognizing, respecting and promoting the
person's resources and capacity for recovery.
Conclusions: These results serve to clarify some boundaries around
recovery-focused practices and demark these from other examples of good
mental health practice. |
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Cutcliffe, J., & Lakeman, R. (2010).
Challenging Normative Orthodoxies in Depression: Huxley's Utopia or
Dante's Inferno? Archives of Psychiatric Nursing, 24(2), 114-124. |
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Although there appears to be a widespread consensus that depression is a ubiquitous human experience, definitions of depression, its prevalence, and how mental health services respond to it have changed significantly over time, particularly during recent decades. Epistemological limitations notwithstanding, it is now estimated that approximately 121 million people experience depression. At the same time, it should be acknowledged that the last two decades have seen the widespread acceptance of depression as a chemical imbalance and a massive corresponding increase in the prescription of antidepressants, most notably of selective serotonin reuptake inhibitors (SSRIs). However, questions have been raised about the effectiveness and iatrogenic side effects of antidepressants; related questions have also been asked about whose interests are served by the marketing and sales of these drugs. Accordingly, this article attempts to problematize the normative orthodoxy concerning depression and creates a
"space" in which an alternative can be articulated and enacted. In so doing, the article finds that the search for a world where the automatic response to depression is a pharmacological intervention not only ignores the use of alternative efficacious treatment options but may also inhibit the persons' chance to explore the meaning of their experience and thus prevent people from individual growth and personal development. Interestingly, in worlds analogous to this pharmacologically induced depression-free state, such as utopias like that in Huxley's Brave New World, no
"properly conditioned citizen" is depressed or suicidal. Yet, in the same Brave New World, no one is free to suffer, to be different, or crucially, to be independent. |
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Lakeman, R. (2010). Mental health
nursing is not for sale: rethinking nursing's relationship with the
pharmaceutical industry. Journal of Psychiatric and Mental Health
Nursing, 17(2), 172-177. |
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The relationship between nursing and the pharmaceutical
industry is conflicted. The pharmaceutical industry holds commercial
interests which are incompatible with the interests of nursing and
service users. Nursing and nurses are courted by the industry, most
obviously to influence prescribing practices but also to promote a world
view that psychiatric drugs are essential, and to sanitise the image of
the industry (which has recently been rocked by fresh accusations of
unethical practice). Nursing’s image, the public trust it enjoys and
ultimately good relationships with service users stand to be tarnished
unless nursing rethinks its relationship with the industry. Nursing
ought to reposition (or restore its position) next to service users
rather than next to the pharmaceutical industry. |
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Lakeman, R., & Matthews, A.
(2010). The views and experiences of members of new communities
in Ireland: perspectives on mental health and well-being.
Translocations: Migration and Social Change, 6(1), http://www.translocations.ie/volume_6_issue_1/index.shtml.
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Ireland has a long history of outward migration but
in recent years Ireland has become a destination of choice for migrants
from the rest of the world. This has posed a challenge to Irish
institutions and Irish society. This paper reports on the findings from
a community development project undertaken in partnership between Cairde
(a non government resource and advocacy organisation for ethnic minority
groups) and Dublin City University. Members of new community groups in
Dublin who were affiliated with Cairde took part in focus groups
exploring their perceptions regarding mental health, mental ill-health
and their experiences of mental health care provision. Participants
focused more on their everyday experiences affecting their health and
well-being rather than presenting their difficulties from within an
illness paradigm. Whilst most participants had experience of accessing
health services they had little contact with specialist mental health
services. So while the study was designed to focus on conceptions of
mental health/ill-health and services, the findings highlight structural
inequalities that some migrants face in relation to legal status,
accessing educational, occupational opportunities, and social service
eligibility; all aspects of their everyday lives that cause them
distress and fear. |
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Lakeman, R., & Glasgow, C. (2009).
Introducing peer-group clinical supervision: An action research project. International Journal of Mental
Health Nursing, 18(3), 204-210. |
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Clinical supervision (CS) has been
found to be beneficial in the role development of nurses and can
contribute to increased job satisfaction and reduced burnout. However,
implementing CS can be resource intensive, and there are few accounts of
it being implemented in developing countries. Ten psychiatric nurses in
Trinidad engaged in an action research project over a 5-month period to
develop, implement, and undertake an initial evaluation of a model of
peer-group CS for use in routine practice. The participants were
involved in undertaking peer-group CS and contributing to monthly focus
groups to reflect on the practices and further refine the model. This
inexpensive form of CS was perceived by participants to have positive
effects on the way they viewed and practiced nursing. An outline of the
model and initial evaluation is presented, but further research is
necessary to establish the sustainability of the model in practice. |
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Lakeman, R., & Fitzgerald, M. (2009). Ethical suicide
research: A survey of researchers. International Journal of Mental
Health Nursing, 18(1), 10-17. |
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Research is needed to better
understand and respond effectively to people who are suicidal. Involving
people who are suicidal in research poses some ethical and pragmatic
problems. The ethical problems and difficulties in obtaining approval to
involve people who are suicidal in research has contributed to the
current paucity of research that explores the suicidal experience. To
explore some of these problems, a web-based survey of suicide
researchers was undertaken. Researchers identified from published
reports were contacted by email and invited to participate in a
web-based survey. Researchers were asked to describe any problems they
encountered, how ethical problems were negotiated or resolved, and any
advice received from human research ethics committees. The main problems
identified were accessing the population, maintaining confidentiality,
the extent of care owed by the researcher to participants, and the
facilitation of support to participants. As with clinical practice,
ethical research involving people who are suicidal involves a process of
sensitive engagement, and careful consideration and remediation of risk. |
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Lakeman, R., & Fitzgerald, M. (2009). The ethics of
suicide research: The views of ethics committee members. Crisis: The
Journal of Crisis Intervention and Suicide Prevention, 30(1), 13-19.
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Background. Good quality,
ethically sound research is needed in order to better understand,
appropriately respond to, and reduce the incidence of suicide. There is,
however, a lack of clarity around the nature of ethical problems
associated with suicide research and how to resolve them. This is a
formidable challenge for ethics committee members in approving and
monitoring research.
Aims. To describe the views that members of health research ethics
committee hold regarding ethical problems and ethical practice in
research involving people who are, or who have, been suicidal.
Methods. Ethics committee members were invited to complete an online
survey addressing the risks, benefits, and ethical problems associated
with suicide research. Findings were aggregated into themes using an
inductive form of content analysis.
Results. Concerns of ethics committees centered on accessing the
population, potential harm to participants or the researcher, researcher
competency, maintaining confidentiality, providing support to
participants, and responding sensitively to the needs of family.
Conclusions. Ethical research involving suicidal people requires
both procedures to protect participants, and consideration of ethics as
an ongoing negotiated process. The findings of this research provide a
snapshot of views held by a number of ethics committee members. |
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Lakeman, R., & Cutcliffe, J. (2009). Misplaced
epistemological certainty and pharmaco-centrism in mental health
nursing. Journal of Psychiatric and Mental Health Nursing, 16(2),
199-205. |
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This paper examines a trend and bias
in nursing to overstate the evidence in support of pharmacological
treatments. Examples of uncritical and emphatic statements of fact are
drawn from recently published literature. Treating theories of
biological causation of mental illness as fact and overstating the
efficacy of pharmacological treatment leads to a pharmaco-centric view
of mental distress and practice. This view is unscientific, and can be
potentially dangerous in that it may constrain nurses from seeking the
most appropriate responses to address the complex needs of those in need
of nursing care |
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Lakeman, R., & Fitzgerald, M. (2008). How people live
with or get over being suicidal: a review of qualitative studies.
Journal of Advanced Nursing, 64(2), 114-126 |
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Aim: This paper is a
report of a review of qualitative research to address how people live
with suicidality or recover a desire to live. Background. Suicide is a
pressing social and public health problem. Much emphasis in suicide
research has been on the epidemiology of suicide and the identification
of risk and protective factors. Relatively little emphasis has been
given to the subjective experiences of suicidal people but this is
necessary to inform the care and help provided to individuals.
Data sources: Electronic searches of CINAHL Plus with full
text, Medline and PsychArticles (included PsycINFO, Social Services
Abstracts and Sociological abstracts) were undertaken for the period
from 1997 to April 2007. In addition, the following journals were hand
searched (1997–2007): ‘Mortality’, ‘Death Studies’, ‘Archives of Suicide
Research’ and ‘Crisis: The Journal of Crisis Intervention and Suicide
Prevention’.
Method: A systematic review of the literature and thematic
content analysis of findings. The findings were extracted from selected
papers and synthesized by way of content analysis in narrative and
tabular form.
Findings: Twelve studies were identified. Analysis
revealed a number of interconnected themes: the experience of suffering,
struggle, connection, turning points and coping.
Conclusions: Living with or overcoming suicidality
involves various struggles, often existential in nature. Suicide may be
seen as both a failure and a means of coping. People may turn away from
suicide quite abruptly through experiencing, gaining or regaining the
right kind of connection with others. Nurses working with suicidal
individuals should aspire to be identified as people who can turn
people’s lives around. |
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Lakeman, R. (2008). The medium, the message,
and evidence based practice. Issues in Mental Health Nursing, 29(3),
319–327. |
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Marshal McLuhan, the media
guru of the 1960s, famously observed “we shape our tools, and thereafter
our tools shape us” (McLuhan, 1994, p. ix).Tools influence the way we
think and behave, “we become what we behold” (McLuhan, 1994, p. 19).We
extend ourselves through the tools we use but inevitably we also lose
something in the process. For example, the invention of the automobile
has greatly extended our mobility but it has also changed village life
and led to pollution. In medicine, an over-reliance on diagnostic tests
has been blamed for a loss of basic clinical skills (Bordage, 1995) and
in nursing, an overextension of the scientific may lead to a
diminishment of the humanistic. This paper considers McLuhan’s
proposition that our tools shape us in relation to mental health care
and the tools derived from evidence based practice (EBP). |
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Lakeman, R. (2008). Family and carer
participation in mental health care: perspectives of consumers and
carers in hospital and home care settings. Journal of Psychiatric and
Mental Health Nursing, 15(3), 203-211. |
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It is widely accepted that
family and carer participation in adult mental health care is desirable.
However, rarely is service development informed by representative
opinions of both carers and service users. This study took place in the
context of a larger project to introduce and evaluate practice standards
relating to family participation. The aim of this paper is to explore
the perceptions of service users and carers to carer participation in
adult mental health services. One hundred and twenty-nine service users
and 86 family members recruited via hospital and community settings
completed a survey which addressed obstacles to family participation,
perceived benefits of participation and areas for improvement. Many
service users and family were entirely satisfied with existing levels of
family participation. Different needs for information, support and the
nature of participation in mental health care are highlighted in acute
hospital and community settings. Across settings, the provision of
support and accessing services were identified as the most useful
aspects of family participation. Meaningful carer and family
participation in mental health care should proceed from respectful
connection with carers and be informed by need which will vary depending
on setting and circumstances. |
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Lakeman, R. (2008). Practice standards to
improve the quality of family and carer participation in adult mental
health care: An overview and evaluation. International Journal of Mental
Health Nursing, 17(1), 44-56. |
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Mental health services are
required to involve family, carers, and service users in the delivery
and development of mental health services but how this can be done in
routine practice is challenging. One potential solution is to prescribe
practice standards or clear expectation relating to family involvement.
This paper describes practice standards introduced to an adult mental
health service and a study that aimed to evaluate the impact of the
standards on practice. Hospital and community files were audited before
and after the introduction of standards for evidence of participation
and surveys of carers and consumers relating to the quality of
participation were undertaken. Increases in documented carer
participation were found, particularly in relation to treatment or care
planning. The expressed needs relating to participation varied in
hospital and community settings. The majority of carers and service
users were satisfied with their level of participation. The introduction
of practice standards is an acceptable, inexpensive, and feasible way of
improving the quality of family and carer participation, but gains may
be modest. |
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Lakeman, R., Walsh, J.,
& McGowan, P. (2007). Service users, authority, power and protest: A
call for renewed activism. Mental Health Practice, 11(4), 12-16.
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Recent years have seen an
explosion of roles for service users within public mental health
services and an elevation of some people to celebrity status, based in
part on claims of having used mental health services. This paper
proposes that there has come to be a hierarchy of service users in
relation to perceived insight, power, authority and wealth that
parallels and in part perpetuates the power hierarchy within psychiatry
and the helping fields. This has not helped many people who use public
mental health services. Service users and indeed all people with an
interest in promoting mental health should be activists and continue to
challenge authority, biomedical hegemony, coercion in mental health
services and seek improvements and alternatives for those that use
mental health services. |
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Lakeman, R. (2006) An
anxious profession in an age of fear. Journal of Psychiatric & mental
Health Nursing, 13(4), 395-400 |
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This paper proposes that
some practices and trends in mental health care may be considered as
defensive responses to collective anxiety and fear. On a larger scale
similar dynamics occur around fear of terrorism. Collectively and
individually we are pulled by the defensive forces and dynamics
associated with anxiety. This can in part explain the polarization that
occurs around issues of definition and response to mental illness. Fear
and anxiety push services towards simplistic viewpoints and futile
practices. Pluralism, humility and the capacity to view things from the
perspective of others may help in channelling anxiety productively. |
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The tradition in many
schools of psychotherapy has been the exclusion of people experiencing
psychosis or the suspension of psychotherapy when psychosis emerges. In
this paper it is argued that those who experience psychosis have a need
for psychotherapeutic assistance. Health professionals involved in the
care of people with psychosis ought to interact in a psychotherapeutic
manner and develop psychotherapeutic skills. The purposes and some
selected techniques of psychotherapy along the supportive-exploratory
continuum are reviewed and pragmatic considerations when selecting
psychotherapeutic interventions are discussed. |
| Lakeman, R. (2004). Standardized routine outcome measurement: Pot
holes in the road to recovery. International Journal of Mental Health
Nursing, 13(4), 210-215. |
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Routine ‘outcome measurement’
is currently being introduced across Australian mental health services. This
paper asserts that routine standardized outcome measurement in its current form
can only provide a crude and narrow lens through which to witness recovery. It
has only a limited capacity to capture the richness of people’s recovery
journeys or provide information that can usefully inform care. Indeed, in its
implementation nurses may be required to collude in practices or account for
practice in ways which run counter to the personal recovery paradigm. Nurses
should view a focus on outcomes as an opportunity for critical reflection as
well as to seek ways to account for recovery stories in meaningful ways. |
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Hearing voices is a common
occurrence, and an experience of many people in psychiatric/mental health care.
Nurses are challenged to provide care, which is empowering and helps people who
hear voices. Nursing practice undertaken in partnership with the voice hearer
and informed by a working explanatory model of hallucinations offers greater
helping potential. This paper uses Slade's (1976. The British Journal of Social
and Clinical Psychology 15, 415-423.) explanatory model as a framework for
exploring interventions which may assist people in exerting some control over
the experience and which might be used alongside pharmacological interventions.
Principles and practical ideas for how nurses might assist people to cope with
and make sense of the experience are explored. |
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Lakeman, R. (2000).
Advanced nursing practice: experience, education and something else.
Journal of Psychiatric and Mental Health
Nursing, 7(1), 89-94. Reprinted in amended form from:
| Lakeman, R. (1999). Advanced nursing practice: Experience, education and something else.
Nursing Praxis in New Zealand, 14(2), 4-12. |
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This paper provides some critical
reflection on the development of the concept of 'advanced practice'. Whilst
defining, credentialing and regulating advanced practice promises rich fruits
for nursing, advancing nursing practice will be a consequence only if the right
conditions are fostered for the development and provision of nursing expertise
in practice. A conscious and collective effort must be made to ensure that
nursing expertise of all nurses is recognised and developed. One process which
has shown promise in psychiatric and mental health nursing is 'clinical
supervision. Evolving nursing leadership roles and more education can only
provide a partial solution to the problem of advancing practice. |
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The development of the Internet
is happening at a staggering pace and promises to have a dramatic impact on
human relations. If nursing is to adapt to and benefit from these changes,
consideration ought to be given to the experiences and opinions of nurses who
have adapted to and use the technology. This paper provides an outline of the
findings of an Email survey of psychiatric and mental health nurses who are
experienced in using the Internet. Questions focused on what psychiatric and
mental health nurses use the Internet for, how their use has changed,
work-related benefits, and what impact they see the Internet having in the
future. |
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Lakeman, R. (2000).
Negotiating the ethical minefield of psychiatric nursing practice. Nursing
Praxis in New Zealand, 16(3), 38-48. |
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Psychiatric nursing practice can
be likened to an ethical minefield. Nurses are often in the middle of the
minefield and are pushed and pulled by forces, which are sometimes beyond their
control. This paper signposts some of the more problematic areas of practice so
that nurses may be equipped with at least a broad over-view of the ethical
terrain. |
| Lakeman, R. (1999). 'Growing old' versus declining miserably: Some facts about depression and the older adult.
Vision, 5(9), 6-12. |
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The
twentieth century has been described as the "age of melancholy"
(Barker, 1992, p.24). Whilst first world countries such as New Zealand have
enjoyed great improvements in life expectancy we have also become increasingly
miserable. Epidemiological studies suggest a ten-fold increase in the prevalence
of depression since the Second World War (Barker, 1992). The notion of 'growing'
older, has for many people been replaced with a reality of hopelessness and
despair. What is particularly frightening is that depression is perceived by
many people (including health professionals), as a normal and expected part of
ageing. This article aims to explore some of the myths and realities of
depression so that health professionals might better recognise and assist the
older person experiencing depression and facilitate "growth" in
ageing. |
| Lakeman, R. (1999). Remembering Hildegard Peplau.
Vision, 5(8), 29-31. |
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On the 17th of March 1999,
Hildegard Peplau died at the age of 89, ending a nursing career, which spanned
over fifty years. Peplau is often recognised as the 'mother of psychiatric
nursing' but her ideas have influenced all fields of nursing. |
| Lakeman, R. (1998). Removing the toll bridge to compulsory treatment.
Kai Tiaki: Nursing New Zealand, 4(8), 17-19. |
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This paper suggests that one need
look no further than New Zealand mental health legislation and the medical
hegemony over the compulsory assessment and treatment process to uncover
barriers to nursing actualising it's potential |
| Lakeman, R. (1998). Beyond glass houses in the desert: a case for a mental health 'care' system.
Journal of Psychiatric and Mental Health Nursing, 5(4), 319-328. |
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A system of mental health care is
not an unattainable goal, but it is a challenging one.. one which is necessary
to pursue if we are serious about mental health. |
| Lakeman, R. (1997). Using the internet for data collection in nursing research.
Computers in Nursing, 15(5), 269-275. |
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This article examines how the
Internet may be used as a tool for data collection in nursing research. An
overview of the demographic composition of the Internet population is
outlined and discussed as a constraint on the type of research that can be
undertaken using the Internet. Methods of data collection such as e-mail and
WWW questionnaires are discussed as well as the possibility of virtual focus
groups. Some of the difficulties and advantages that may confront the
researcher wishing to undertake research using the Internet are outlined. |
| Lakeman, R. (1997). Dangerousness & mental illness: The implications for nursing practice.
Vision, 3(4), 10-14. |
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Lakeman, R. (1996). Psychiatric nursing. The Internet: facilitating an international nursing culture for psychiatric nurses.
Computers in Nursing, 16(2), 87-9. |
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The Internet
consists of some ten million computers networked together. It provides a means
of human communication which transcends boundaries of language, race and sex, as
well as providing people with access to an unimaginable quantity of information.
This paper reports on a qualitative study undertaken to explore how psychiatric
nurses experienced in the use of the Internet currently use and benefit from it,
how they have learned to communicate on the Internet and how they see the
Internet affecting psychiatric nursing culture. The research was undertaken
using electronic mail to several nursing discussion groups. The responses were
analysed and are discussed according to themes that were identified from the
data in response to the questions posed. Selected responses are used to
illustrate the themes. The Internet may be a useful tool in facilitating a
global psychiatric nursing culture based on egalitarian principles and
characterised by a sense of belonging and a shared vision. The realisation of
this potential is contingent on psychiatric nurses being pro-active in the use
of technology and will be constrained or empowered by the creativity and vision
of those who use it. |
| Lakeman, R. (1996). The ethics of bathing. Kai Tiaki: Nursing New Zealand, 2(2), 13-15. |
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This paper discusses the
ethics of bathing someone against their expressed will. |
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