NURSING 3004 Mental Health Nursing

Introduction

The role of nurse in providing care to the patients in hospitals as well as in the community setting is very important. The role of mental health nurse is equally important and significant in the present world. Mental health nurses (MHN) have an important role to play in improving the physical as well as mental health of such people.  Psychiatric nurse play a very effective therapeutic role, which is acknowledged by the consumers with serious ongoing mental health problems. The nurses require to be provided with the credit for rendering an exceptional role in providing mental health services. For providing the effective psychological treatment in mental health care, it is important to employ the evidence based practice, which is appropriately done by the mental health nurse.

The purpose of this paper is to discuss the importance of the role of mental health nurse and to prepare a nursing plan according to the given case study. The case study is related to George, a 27 years old single man, who has been diagnosed with schizoaffective disorder and sexual abuse. He is an unemployed man and receives the Disability Support Pension. He is also a compulsory patient under the Victorian Mental Health Act [2014] and lives with his very supportive brother. Due to a recent relapse, he is admitted to hospital. Therefore, paper will discuss the role of mental health nurse and will provide an interventional framework with evidence based nursing care plan for George.

What is Recovery Oriented Mental Health Nursing?

The goal of recovery oriented approach is to improve the patient outcomes and patient’s experience at the health care setting. According to the study of Fisher (2011) “the role of mental health nurse could be very crucial and instrumental in moving mental health care delivery forward with a focus on improving patient outcomes and recovery”(p. 3). Recovery oriented approach can be considered as the transformational and conceptual framework in the mental health service provision. The main focus of the approach is to consider the experience and insights of the client and their families. This concept was mainly conceived to understand the perception and experience of the people suffering with mental health illness. It provides an opportunity to the patient s to explain their own experiences and their journey of recovery is affirmed with their identity.

The recovery oriented care principles are applied in the psychiatric in-patient units and community setting to help people and involve them in their own recovery process. The aim of this approach is not just to bring positive outcomes, but it is to provide a positive and effective recovery process for overall mental and physical health. The key focus of the acute psychiatric inpatient unit is the patient safety. According to Seed & Torkelson (2012), in the traditional acute psychiatric care the major focus was given to medical model of care, which was not based on therapeutic and recovery model. The recovery model is embraced by providing the therapeutic care environment and it comprises of the following components, “self-directed, individualized and patient-centered care, empowering, holistic, non-linear, strength-based, peer supported, respectful, and hopeful” (Seed & Torkelson, 2012, p. 395).

The recovery oriented practice when provided in the metal health services, greatly depends on the relation between the care receiver and the care provider. The most important care provider is the mental health nurse. Under this approach nurses are required to display the set of capabilities through which they can support patients to take the responsibilities of their own recovery through setting goals.    

What is Schizoaffective disorder?

Patient George suffers from schizoaffective disorder and has been diagnosed with sexual abuse. Schizoaffective disorder is the mental health illness that can be divided in two parts. The first part is the ‘schizo’ which refers to the psychotic symptoms found in the patient, which are psychosis, hallucinations, delusions and mania. The second part is ‘affective’, which refers to the mood symptoms associated with mental health. The psychotic symptoms found are similar to the schizophrenia and mood symptoms are similar to bipolar disorder, which are depression and mood fluctuation.

Schizophrenia is a mental health condition that affects the way a person thinks. The patient may suffer to cope with the activities of the daily life. George suffers from the mixed type of condition. That includes symptoms of both mania and schizophrenia. Such condition occurs due to various factors. The factors could be genetic, chemical or environmental. In the case of George he suffers from schizoaffective disorder because of the environmental factors. Environmental factors are considered as the things or incidents that happen in the life of patient, such as stressful childhood, job related stress, life style choices, and sexual abuse or relationship problems. Environmental factor affecting the mental health of George is the incident of sexual abuse that he has faced. The treatment of the mental disorder is done through combination of medication or therapies. George is being treated with the help of antipsychotic medicines, mood stabilizers and Electroconvulsive therapy (ECT). This therapy is a non-pharmacological treatment, which is found to be effective for the patients suffering with bipolar disorder and schizophrenia.

According to the study of Benzoni et al (2015), ECT has been found to be very effective in treating the patients with mixed condition, as in the case of George. The study also explains that patients suffering with schizoaffective disorder are resistant to many pharmacological treatments, such patients are effectively treated with Electroconvulsive therapy (ECT). Self care and management of the disorder can be done by patient himself. Therefore, recovery oriented approach is the correct approach for George. Some of the risk factors associated with this condition are ineffective coping, suicidal thoughts, depression and hopelessness. Such complications can be diminished by treating the patient with recovery oriented practice in in-patient unit or in community setting.

 Community setting is considered to be most appropriate setting for the George. According to Assessment and treatment order under Mental Health Act (2014), patient can be referred to in-patient or community setting according to the assessment made by registered mental health practitioner. Community setting will be appropriate for George to manage his problems and promoting recovery oriented well-being.  

Community setting is often understood as an important setting for the purpose of health promotion. Communities can be differentiated or divided in many ways. Community could be the people living in a specific geographical boundary, community could also be the administrative area of the service or it could be also understood as the group of people with shared characteristics. Such setting is not a home, but community based facilities that are operated publically or privately and provides the in-patient treatment and care facilities. Such facility is very significant for the people suffering with mental health problems, because it helps people to build positive connection with their neighbors or other people from the community. In building such connection nursing staff play a significant role.

Role of Mental Health Nurse in Recovery-Oriented Approach

The recovery oriented approach is a framework that encourages the collaborative partnership between the care receiver and the care providers, and it also involves meaningful engagement between the two. Nurse focuses on the strength of the consumers and helps them to walk on the positive path of recovery. The cultural hope is promoted through community based service and in healthcare settings; this strengthens the positive aspects of the mental health treatment (Australian College of Mental Health Nursing, 2017). The collaborative decision making is also encouraged for goal setting and understanding the feelings and aspirations of the consumers. Nurse’s role is also important because they provide specific programs and services according to the cultural needs, interest and experiences of consumers.

The people involved in the recovery are provided with the access to their care plans and treatment plans. The significance of the role of nurse in recovery oriented approach can be acknowledged through their actions of educating people and developing recovery hopes in them (Australian College of Mental Health Nursing, 2017). The efforts of recovery also involve the family members, friends and other natural supports to increase patient’s confidence. Nurses provide the natural environment according to the needs of the consumers. Recovery oriented approach is a kind of social movement, which focuses on empowering people and making them hopeful in life.

Nursing Care Plan

Recovery based nursing care plan for George will include the nursing interventions for the mood disorder as well as schizophrenia. George suffers from mixed condition and requires the nursing care plan for promoting his recovery and helping him to live a normal life.

1. Communicating Hope: First intervention of the recovery oriented approach is communicating hope in people. Hope helps the patient to cope with their present illness and past situations that have negative impact on their mental health. Due to depression and mood disorder patient often suffers from the subjective state of hopelessness. Such patients are often unable to mobilize their energy on the correct path and feel hopeless.  Recovery oriented approach is the alternative of the medical model. Recovery from the mental disorder can be a struggle for the patient. The dysfunctional attitude of the patient will be assessed and goal setting approach will be used to communicate hope. The relationship between the nurse and consumer is based on compassion and understanding. The high expectations of recovery will be communicated by encouraging hope in the case of George. Nurse will communicate with George to help him believing in himself and become optimistic about future. His focus will shift from being hopelessness to hope towards future. Therapeutic communication will be done by respecting the dignity and rights of patients and establishing trustful relationship.  
2. Strength based approach: Strength based approach is the next intervention for treating George. According to the study of Xie (2013) “the strength-based approach allows practitioners to acknowledge that every individual has a unique set of strengths and abilities so that he/she can rely on to overcome problems” (p. 3). The recovery oriented approach states that mental health improvement is achieved through a journey, which also a personal journey towards gaining a meaningful life. Nurse will focus on the strength of the patient and help him to develop coping skills. Recognizing the patient’s ability by monitoring his daily routine and activities will help the nurse to focus on George’s abilities and will encourage confidence in him. The hopes, interests, aspirations and feelings of the consumer will be elicited and cultivated by the nurse. Recivery oriented approach focuses on understanding the dreams, desires and goals of consumers, and promoting them.
3. Self Care Management: Providing education and promoting self-care management in the patient will be the next intervention. Self-care and self management helps people in increasing their capabilities of connecting with self and understanding the importance of self management. Nurse will educate George about his medication, importance of taking medication and adherence to medication. Nurse will also help him to learn self care strategies and coping strategies (Bradshaw & Pedley, 2012). All the information about treatment and care will be discussed with patient to make him involved in his personal care. Recovery oriented approach is meant to provide holistic care to patient; therefore it will focus on all aspects of care and illness management. Involving the patient in personal care, care plans and necessary medications will encourage trust and self-determination in the patient (Seed & Torkelson, 2012). Transparency is very important to form positive relations with George.
4. Family Centered and Culturally Sensitive Care: In addition to exploring interest, expectations, desires and aspirations of the patient for improving and promoting self-care, family centered approach is equally important. With the person centered interventions, it is also important to promote family centered interventions. Recovery oriented approach help families to understand their family member’s experience and journey of recovery (Davidson et al, 2016). Nurse will help George’s brother to understand George’s recovery process and how his brother can help him in counseling sessions, education sessions, therapies, support services and different trainings. Patients often feel safe with their family members and loved ones. Since, George’s brother is very supportive, he will feel more support and enthusiastic to cope with his condition. George’s brother will also provided with psychological support and counseling, as he might be feeling depressed with his brother’s condition.
5. Community Integration:Community integration could be understood as the central focus of the recovery oriented approach. The physical environment provided to the patient is more home like environment and very less institutional. Patient’s choices in terms of food, treatment plans and activities are respected and accepted. The community integration helps the patient to feel more homely and comfortable. In community integration George will be supported and encourage to take part in meaningful activities, making meaningful connections with other people,  and taking part in social and recreational activities. Under such intervention, less emphasis is given on the mental health programs, and more emphasis is given on encouraging meaningful work for patient. Community setting also helps in “combating discrimination and promoting empowerment, self determination, respect, and the intrinsic equality of individuals in recovery” (Davidson et al, 2016, p. 46). Community integration will also help patient in learning and gaining knowledge.
6. Positive Risk Taking and Positive Learning: In order to help the person to gain control over their choices, decision making and life and to gain self determination, nurse plays a major role. The role of nurse is very challenging, as they have to reduce the potential risks and increasing more opportunities for positive learning and positive risk taking. Therapeutic relationship will be maintained with the patient, so that he may trust the nurse and maintain safety (Fisher, 2011). Initiating trustful relationships and participatory relationship between the nurse and patient will help to develop secure and successful relationship between patient and nurse. Nurse will encourage supportive decision making related to risk management, as the risk of environmental stressors will be avoided by making collaborative decisions. Intervention will include sensory modulation therapies for managing distress in the George. He will also be involved in making recovery workbooks and well being plans. Trauma assessment plan will also be included for risk management. Nurse will identify the signs of triggers that can escalate relapses. Nurse will also make the collaborative strategies for preventing such triggers and arousals.

Conclusion

This paper is based on discussing the role of mental health nurse in providing recovery oriented care to the patient suffering with mental health problems. Recovery oriented approach is a revolutionary approach towards encouraging patients on the path of recovery and gaining a meaningful life. Recovery oriented  mental health practice refers to the set of goals, skills and capabilities  that help in supporting people to recognize their strengths and taking the responsibility of their well being and recovery. Mental health problems have become the major concern for the policy makers and Government in Australia. This problem is significantly addressed by the skills, knowledge and capabilities of the mental health nurses, working in in-patient setting and community settings.

Paper discussed the case study of George, who is suffering from schizoaffective disorder and has been the victim of sexual abuse. Recovery Oriented Approach in mental health nursing is very significant and this approach is supported with focusing on the recovery period. Recovery is not just the health outcomes that are desired, but recovery is the journey through which patients goes and regains physical, mental and psychological well-being. Paper provides the evidence based interventions for promoting recovery in the case of George. The interventions assimilated in the care plan promote recovery oriented approach in mental health service.

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