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Discuss about the Foundations of Psychiatric Mental Health Nursing.

Empowerment in Recovery

Recovery in healthcare is either clinical or social (Mizock and Russinova, 2016). Clinical recovery focusses on the diminution of symptoms while social recovery work with an ultimate goal of ensuring that the subjects lead self-fulfilling and contributing lives as normal citizens (Tew, 2013). It has been proved that at international population level, social and cultural factors lead to a great impact in ensuring that patients recover fully from chief mental health problems. There are three classes of descriptions of recovery which are clinical, research as well as consumer (Marton, 2016). These three are the policy contexts from which recovery from mental disorders is evaluated. It is again from one of the three that three other positive-based aspects or rather the principles of recovery (hope, respect and empowerment) are formulated.

In many mental health systems, recovery has been understood as an individual and biased experience. It cannot be the return to a condition free from symptoms of mental illness as this definition has many weaknesses that even people suffering from mental illnesses detest by all means (Slade et al, 2014). It is a complex process involving complex and unique procedures of changing one’s attitude, objectives, skills, values, beliefs, feelings and duties. Recovery is a mode of bringing satisfaction, hope and impacting life positive beyond restrictions caused by the mental infirmity (Marton, 2016).

Slade et al (2014) say that the definition of recovery in mental health as a subjective experience for individual patients has been hijacked by professionals. Recovery has diverse subjective definitions since a patient’s understanding of recovery is not static but changes with time. This has rendered it difficult to formulate a recovery orientation in healthcare that considers a personal understanding of recovery.

At a population level, social interventions are preferred to medical interventions when working out a recovery framework in a healthcare facility. However, according to Tew (2013) social work processes have always been subjugated by biomedical viewpoints and attention to risk management. That makes the study to bring up a new paradigm that develops mental health social work particularly focused on the advancement of discrete efficiency as well as social capacity.

The way people perceive recovering from a physical health problem is not the way mental health conceives recovery (Tew, 2013). Many people view recovery as being in control of one’s life despite of the mental health challenge. Enforcing a culture of resilience on the ailing under care is what recovery means. The recovery process is comprised of so many aspects such as a holistic view of mental infirmity and not just symptoms, a belief that despite the severity of the illness, recovery is still possible, a confirmation that to recover is not to get back to your original state, a consent that so many challenges come along the process, and that, it is a journey and not a destination and thus requires total commitment. Some other guiding values towards recovery is that the expectation of the people involved are very is a determining factor towards success, family support has a great impact towards recovery and that it requires services to take into consideration innovative and groundbreaking ways of working.

Hope in Recovery

The first principle of the recovery model is empowerment. It is basically the provision of a space for a patient to express concerns, wishes and needs, plus focusing on the patient in the social context and eliminating barriers to gaining a positive position in the world (Slade et al., 2014). The principles work together with capability and social engagement to reach to that goal. Empowerment leads to fearless expression of feelings. The principle encompasses even the other two principles of hope and respect. Under empowerment the management team is not to be judgmental following concerns of the patient which are sometimes unreasonable.  Empowerment also entails eliminating the feeling of insufficiency by promoting full acceptance of the patient (Vansiea, 2016). The patient is always the driving force of the care plan and the paradigm should allow safe care for self. The patient has a say over what he think is the right care for him through an interaction with mixed services for the best psychosocial care (Australian Government Department of Health1, 2018).

Hope is another important principle within the recovery model (Moxham et al., 2018). It comprises being optimistic about the future (Slade et al., 2014). Hopelessness is among the major causes for poor recovery outcomes. It is sad that there are still present mental healthcare facilities that do not involve a culture of emotional and mental supportiveness like hope, and instead depending on the assumption that professional experts make people better (Varcarolis, Carson and Shoemaker, 2006). Vansiea (2016) describes a circle of hope as the most basic and necessary mental recovery exercise considering that mental illness comes with desperation. A desperate patient is not collaborative or rather lacks the motive and personal will to the recovery processes. Giving hope should be in a humorous way that expresses love and pride in order for the patients to perceive life from a different angle (Mizock & Russinova, 2016).

Respect is also a vital positive based aspect to recovery. The individual should be respected as a citizen in the society (Varcarolis, et al., 2006). The right to privacy for all patient s should also be exercised (Weller, 2013). Language is a major tool in the social recovery paradigm. The quality is manifested by actions such as attending, suspension of value judgments, and assisting clients develop own resources. The use of language has an attitude of respect in it. And since social recovery requires frequent oral engagement, language as a tool of communication should be very appropriate. Respecting the decision of the patient is also very important as it helps a patient develop a positive attitude towards the carers as well as the whole recovery process. A mentally unhealthy person is always a delicate person to deal with. They often get offended quickly if mishandled (shown disrespect). Courteousness and honesty are values of respect that inform effective interactions between carers and their patients (Australian Government Department of Health2, 2018).

Respect in Recovery

Therapeutic alliance concept is a significant one in psychiatric nursing treatment. Focusing on a consumer guided recovery, there is promotion and development of collaborative relationships between the carers and the patients. Therapeutic alliance focusses on personal notions of health in line with the understanding of mental health recovery that has been adopted by this study. It primary works towards achieving shared partnerships amid nurses and consumers (Varcarolis, et al., 2006). Factors that enhance growth in clients include genuineness, empathy and positive regard. It is good to note that a therapeutic relationship is not a social relationship despite working in a social recovery framework.

The initial step towards therapeutic alliance is establishing an understanding between the consumer and the nurse. The client should be made to understand the role of the nurse in the plan of care as a safe and confidential one that can be relied on as it is unswerving and it sets unblemished boundaries. Therapeutic relationships are not curative to complex disorders like schizophrenia, but they prove a great deal when combating emotional challenges and poor self-image in restoring self-esteem to a consumer who has lost it. Most successful outcomes are from a strong positive therapeutic alliance (Varcarolis, et al, 2006).

After the consumer has been made to understand the nurse’s role, great nursing skills need to apply in this time consuming exercise. Nurses are required to keep borrowing skills from more experienced personnel. The reason for in the activity with great skills and caution is that without the good nurse-client association, the whole process of care will be all in vain or with very minimal positive outcomes. The results of that is mutual withdrawal and frustration. The Therapeutic alliance is not like the common day to day nurse-consumer relationships which are loosely defined (Varcarolis, et al., 2006). This one includes principles of mental health like hope, respect and empowerment and is more distinctly defined plus it diverges from other nursing associations. The alliance works towards achieving goals of efficient communication, assistance in handling activities of day today life, empowering clients to evaluate behaviors of self-defeat and indorsing self-care and independence.

How the therapeutical relationship is developed in a mental health recovery model is in two ways; attitude and action.

Attitude is the passion of the nurse towards the client. For a warm therapeutic alliance to be formed, the nurse must show willingness to work with the consumer. The relationship between them is that taken seriously from the first day. Therapeutic alliance requires that the relationship be viewed as part of a course and not a job (Varcarolis, et al., 2006). It is not spending time talking but a chance for the consumer to advance individual resources and objectify more of his prospective living.

Therapeutic Alliance in Psychiatric Nursing Treatment

The nurse is to develop an attending behavior especially while guiding interviews (Varcarolis, et al, 2006). This involves a culture of giving the client full attention both culturally and individually. It incorporates aspects of the correct body posture that is leaning forward, marinating high degree eye contact as well as the appropriate body language. These last factors are culturally affiliated to mean that the carer must be aware of the culture of the patient to avoid actions or postures that would mean to the client as disrespect to his or her culture. That is the principle of respect that is confirmed by the therapeutic alliance. “Disrespect” destroys the client-patient relationship and leads to poor recovery outcomes at the end. Therapeutic alliance involve another specific that is, establishing boundaries between the client and nurse (Varcarolis, et al, 2006).

References

Australian Government Department of Health1 (2018). Department of Health | Principles of recovery oriented mental health practice. [online] Health.gov.au. Available at: https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-servst10-toc~mental-pubs-n-servst10-pri#4 [Accessed 1 Sep. 2018].

Australian Government Department of Health2 (2018). Department of Health | Empowering consumers and their families and carers through participation and partnerships. [online] Health.gov.au. Available at: https://health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-p-mono-toc~mental-pubs-p-mono-inc~mental-pubs-p-mono-inc-emp [Accessed 1 Sep. 2018].

Marton, K. (2016). Measuring recovery from substance use or mental disorders; National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Sciences Policy, Division of Behavioral and Social Sciences and Education, Board on Behavioral, Cognitive, and Sensory Sciences, Committee on National Statistics. National Academies Press, p.13.

Mizock, L. and Russinova, Z., 2016. Acceptance of Mental Illness: Promoting Recovery Among Culturally Diverse Groups. Oxford University Press. Pp (ix-143)

Mizock, L. and Russinova, Z., 2016. Acceptance of Mental Illness: Promoting Recovery Among Culturally Diverse Groups. Oxford University Press. Pp 18-75

Moxham, L., Hazelton, M., Muir-Cochrane, E., Heffernan, T., Kneisl, C. and Trigoboff, E. (2018). Contemporary psychiatric-mental health nursing; Partnerships in Care. 3rd ed. Pearson Australia (a division of Pearson Australia Group Pty Ltd), pp.552-586.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S. and Whitley, R. (2014). Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1), pp.12-20.

Tew, J. (2013). Recovery capital: what enables a sustainable recovery from mental health difficulties?.European Journal of Social Work, [online] 16(3), pp.360-374. Available at: https://10.1080/13691457.2012.687713 [Accessed 1 Sep. 2018].

Vansiea, J. (2016). Judy E. Vansiea's circle of care and hope. [Parker, Colorado]: Outskirts Press, pp.13-128.

Varcarolis, E., Carson, V. and Shoemaker, N. (2006). Foundations of psychiatric mental health nursing; CHAPTER 10 Developing Therapeutic Relationships. St. Louis: Saunders/Elsevier, pp.155-170.

Weller, P., 2012. New law and ethics in mental health advance directives: The convention on the rights of persons with disabilities and the right to choose. Routledge. Pp 32-128

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