S.TRUEMAN PhD THESIS 2016

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remote area nursing workplace’ (McCullough et al., 2012, p. 7). Violence in the workplace can also emanate from within (Mills et al., 2010). Mills, Francis and Bonner (2008) assert that horizontal violence forms ‘the cultural underbelly of rural [remote] health workplaces’ (p. 34). Exacerbating the issue, is remote nurses tend to down play and minimise the level and effect of being exposed to violence (Fisher et al., 1996). The remote nurse’s sometimes ‘missionary zeal’ to care for mental health patients, illustrates that such exposure can have a significant negative impact on their well ‑ being (Deans, 2004). Exposure increases developing post-traumatic stress disorder symptoms (Kelly, 1999) and, susceptibility to anxiety, impaired functioning and difficulties sleeping (Fisher et al., 1995; Rippon, 2000; Robbins, Bender & Finnis, 1997). While remote (and rural) nurses maintain this robust exterior, Albion et al. (2005) found significant elevated levels of distress in rural [remote] nurses. Obviously the four traits, resourcefulness, resilience, responsiveness, and robustness, vary between individual remote general nurses and groups. Much of which, relates to the resources available to deliver mental healthcare. For example it would be far harder to be resilient, by relying on colleagues after an adverse mental health event, if the nurse was working alone in a one person primary healthcare centre. Conversely, a community may have few mental health patients or may have key resources such as a resident GP, which lessens the need or degree for one or more of the traits. Variability between remote locations in relation to the four traits may also be transitory, fluid or rely on chance. A mental health crisis presentation may occur when a mental health nurse team or psychiatrist is visiting. In these situations obviously there is a lesser degree of reliance on any of the four traits or conditions.