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DEVELOPING AUTONOMOUS PRACTICE IN MENTAL HEALTH NURSING – PART 2 - RECOVERY

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DEVELOPING AUTONOMOUS PRACTICE IN MENTAL HEALTH NURSING – PART 2 - RECOVERY

Mon, 04/22/2019 - 20:47
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Mental Health Recovery Model

Recovery Model - Theoretical Perspective

The stress and vulnerability recovery model by Zubin and Spring (1977 ), emphasizes on the relationship between attending to clients stressing factors to minimizes being vulnerable or prone to being unwell. In other words, a client’s social distressing issues can be a trigger to their mental health illness. However, I have chosen the recovery model because Recovery emphasizes that while individuals may not be able to have full control over their symptoms, they can have full control over their lives. ‘Recovery asserts that persons with psychiatric disabilities can achieve not only affective stability and social rehabilitation, but transcend limits imposed by both mental illness and social barriers to achieve their highest goals and aspirations.’ (The Recovery Model, Contra Costa County, California).

 

This model looks at a holistic view of mental illness that focuses on the person, not just the symptoms. It also promotes that recovery can occur even though symptoms may reoccur. Within the recover framework, the client is responsible for the solution and not the problem. Finally, recovery requires a well-organized support system and collaboration for best result. 

 

Roberts & Wolfson (2004) have characterised this as a shift from staff who is presumed as remote, in a position of expertise and authority, to someone who behaves more like a personal coach or trainer: ‘They offer their professional skills and knowledge, while learning from and valuing the patient, who is an expert by experience.’

 

Demonstration of how the therapeutic theoretical approach provides a structure or guide towards the nursing care in the follow areas:

Assessment of needs:

The assessment of needs is done using a client centered approach by the multi-displinary team (MDT) and with a reliable and valid assessment tool that has a sound evidence base. The Stages of Recovery Instrument (STORI) is a self- report measure for the assessment of stage of recovery from mental illness. It is evident based to measure constructs that are more meaningful to the client than conventional outcome measures. In contrast, the STORI focuses on psychological recovery and personal growth. 

 

To ensure collaboration with the client and be systematic, using an interpersonal nursing skill is important because this assessment is conducted in a form of dialogue between the client and the MDT. Booth (1996) sums this concept as an interaction between the clinician and the client, with expectations, that the clinical practice will be based upon the systematic application of rigorous scientific methods to the evaluation of the effectiveness of health care interventions.

 

According to the five stages of recovery, the first stage is the moratorium stage. This is when the client feels hopeless and self protective withdrawal. The primanary propose for an assessment was to able to identify respectively James’ psychological, physical and social needs. Other important issues which were significant towards recovery — like his spiritual needs was also taken into count, to promote holistic care. The assessment also showed that James also needed to be assesses by other services such as a social worker, who will help him with his social and financial needs due to his disability. An occupational assessment team also had to assess the fitness and safety of his home.

 

Identification of aims and goals:

Following the assessment, the aims and goals were identified by the client's perspective. James was able to relate with the next stage of recovery, which is the realization that recovery and a fulfill life is possible. Together, we explored in James’ view where he was and where he wanted to get — since recovery is subjective. We also wrote and agreed on a step by step plan, which was realistic, specific, towards how he intended to achieve these goals.

 

Following the assessment, I't was evident both from nurse’s and the client’s perspective that James need to attend to his alcohol problem first. He will then need to have to deal with the bereavement of his brother and his mother as it appears he is still grieving over the loss of his family and not being able to contact any of his children. James is to try and have minimal or if possible no contact with his ex-girlfriend who also have alcohol problems, to enable him remain abstinence from alcohol.

 

Therapeutic nursing interventions:

 

The next stages of recovery are; preparation, rebuilding and growth were implemented using various therapeutic approach. They aimed at treating the client as an individual throughout by valuing their views and collaborating with other services and MDT.

 

The stage of preparation promotes the search for personal resources and external sources for help. James was being signposted to an alcohol treatment services to attend to his drink problem. As noted in the past, James had been through these services before. He was expected to be committed and be willing to work that team. Interventions such as psycho— education and medication management was carried by the nurse practitioner and James GP. This helped equip James with important knowledge about taking his medications for his physical health illness and the depression. He would also have an insight to his condition and treatment. Relapse prevention skills were also part of the psycho-education.

 

The next stage which is rebuilding involves taking positive steps towards meaningful goals. James involvement with a bereavement services, as part of his care plan, encourage taking positive and meaningful steps towards his life and over all recovery. Therapeutic interventions such as social inclusion and signposting to structured programs which will keep James pre-occupied, by volunteering to work and also meet socialize other people. 

 

Growth, the final stage of the recovery is when the client eventually has a sense of control over their life and looking forward to the future.By agreeing to meet with James every fortnight for a chat and to review how he was coping, we were able to identify when it was time to move into the next step of James recovery. Growth was observed when James expressed feeling better than before and was actively going in and out of his home. He was also involved with various activities at his local day centre.

 

Clinical review:

James was started on his anti-depressants. This medication will normally take up to 4 weeks before it takes effect. His mood improved and he was motivated to engage with other services as per his care plan. He was also signposted to an organization known as the Beresford project. They work with clients who want to be alcohol free like James. They asses and provide services such as one to one counseling, community detoxification and home detoxification from counseling as part of their services. James was assigned a key worker which James found very helpful as he received a lot of support in person and also part of a group. The alcohol team also worked with collaboration with the our team, to monitor and minimize risk of relapsing . James also benefited from other talking therapy once his stopped drinking and was sober for six months. He was able to come to terms with his illness and losses, and even tried building a relationship with his family.

The therapeutic efficacy of the current clinical environment where care is being provided.

The efficacy of the current clinical environment for James can be considered as appropriate and vital towards his overall road to recovery. This clinical setting is designed to help James by helping him maintain his mental health wellbeing by encouraging independence. He is also provided with information and contact details for rapid response teams, if/when in crises. James is referred and signposted to various relevant services to help and encourage recovery. 

 

Although James lives alone in his home, there is an allocated nurse practitioner who is monitoring James’ progress very closely via telephone and door visits. The team also follows up his progress with other relevant services. The nurse is able to liaise with James’ GP and other services involved like the occupational therapist, who are also monitoring and help James by facilitating mobility in and around his home. 

 

Possible alternative service provision options and discuss whether they may or may not be more beneficial for the individual.

 

A possible alternative service for James could be with a service that would provide a care coordinator for the client. This is because, our team would be able to work with James for up to four months. However, if he was allocated a coordinator, the team will be able to mediate with and for James for up to two year. Thus, promoting a longer time for recovery and help the client manage their holistic care and work as an advocate. Service provision such as a community recovery team, would be also suitable. Together with the professional, James will be able to attend to every stage of his recovery with a lot of support. Also, James will be able to slowly engage with other services who will help him attend to finding his family and mending their relationship via counseling. He would also be able to get help towards looking after himself and home.

 

References

Beck AT (1991) Cognitive Therapy and the Emotional Disorder. Penguin

Beck, A.T., Depression: Causes and Treatment. University of Pennsylvania Press, 1972.

Booth A (1996) In Search of Evidence: informing effective practice.

Dryden W. (2005) Getting Started with REBT; Routledge

Ellis A & Dryden W. (2007), The Practice of Rational Emotive Behaviour Therapy 2.ed.; Springer Publishing

Http://tiny.cc/alcoholmentalhealth Http://www.mentalhealth.org.uk/information/mental-health-overview

Http://www.m hrecovery.com

John Heron (5th edition) A Creative Practical Guide :Helping the Client. Sage

Publication.

Journal of Clinical Effectiveness 1(1):25-9

Knight, Robert G, Neurological Consequences of Alcohol Use, Chapter 7,

International Handbook of Alcohol Dependence, 2001, ed. Heather N, Peters T J, Stockwell

Morgan S (2000) Clinical Risk Management: a Clinical Tool and Practitioner Manual. Pavilion.

Nursing and Midwifery Council — code of conduct 2009

Rogers C (2003) Client Centered Therapy: its current practice implications and theory. Constable & Robinson.

 

Recovery Mental Health

 


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