The theories and approaches to treatment in mental health nursing are continuously evolving. One of the latest ideologies that are promoted in medical literature includes a recovery-oriented approach. This philosophy is based on the belief that people have a full capacity to engage in their planning of medical treatment, and their opinions should not be discarded but informed by healthcare providers (McKenna et al. 2014). This approach competes with the previously accepted biomedical one (Andresen, Caputi and Oades 2006; Lebowitz, Ahn and Oltman 2015). It is vital for a mental health nurse to recognize the different benefits and disadvantages of both philosophies and consider various aspects of recovery and patients’ decision-making process.
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Personal Recovery Philosophy
In order to discuss the elements of the recovery-oriented approach, one has to describe its predecessor and competitor first. The biomedical philosophy was popular before the introduction of the new psychosocial model that will be analyzed below. It is characterized by the idea that one’s mental illness is an abnormal experience that disrupts one’s life and requires treatment with the following rehabilitation (Trenoweth 2016). Furthermore, it states that all mental disorders are ‘brain diseases’, underlying their resemblance with some conditions affecting one’s physical health (Lebowitz, Ahn and Oltman 2015, p. 668). People, therefore, may be predisposed or susceptible to such illnesses (Trenoweth 2016). It is possible to support this view as one may see that mental health issues can interfere with their everyday activities. For instance, if a person with ‘auditory hallucinations’ feels as though this condition is harmful.
On the other hand, the focus on a biomedical model may undermine individuals’ experiences and limit their opportunities for recovery. According to Trenoweth (2016), some people may not feel as though their symptoms are not abnormal but a part of their identity. Here, the need for treatment to eliminate ‘a problem’ may not be in line with a person’s view of their own life. In this case, a recovery philosophy offers an answer that acknowledges personal experiences and shifts the focus from eliminating common problems to managing personal concerns. According to this ideology, personal experiences form one’s wellbeing and play a substantial role in mental health as well as recovery (Townsend and Morgan 2017). As a result, one’s individual story informs treatment instead of being regarded as non-influential.
The recognition of lived experiences opens up new possibilities for health care providers under the philosophy of recovery. People who receive care engage in co-production – the processes of planning and delivery of mental health services. They share their story and decide what aspects of healthcare providers are necessary for them to stay on the path of recovery (Slade et al. 2012). This structure of treatment leads to the differences between previous and new ways of patients interacting with clinicians. It also changes the way one view and understands the concept of recovery.
In the biomedical view, a person with a mental condition is not experiencing life in a normal way. Therefore, treatment is focused on eliminating the symptoms and signs of such abnormalities regardless of their value or significance (Stickley and Wright 2011b). Here, one can return to the example of auditory hallucinations. In this view, this is a sign f a mental illness, and a person is seen as recovered only if they do not hear any voices anymore. One’s recovery is a final destination that implies a lack of abnormal characteristics.
In a contrast, a recovery-oriented philosophy impacts clinicians’ approach to such situations. A person receiving care has an opportunity to share what aspects of their mental health interfere with their everyday activities (Olsson, Strand and Kristiansen 2014; Stickley and Wright 2011a). If they experience auditory hallucinations but do not want to receive treatment for this problem, it stops being an issue altogether. It is one of the principles of the recovery ideology. Another portrays recovery as a process and not just a concluding point of one’s treatment (Tew et al. 2012). People may consider themselves recovered if they are comfortable with their state of being. This opportunity to voice one’s opinion also bears political power – people cannot be deemed ‘abnormal’ by others based on their lived experiences since every person has encountered a unique set of events.
The mentioned above views can be summarised as clinical and personal recovery. Clinical recovery concerns the lack of symptoms, the end of pharmacological therapy, and the reintegration into society, particularly roles occupied by a person in a healthy state (Smith 2015). This type of closure is determined by a medical professional and is dictated by standards of treatment. On the other hand, personal recovery is closely tied to one’s experiences and feelings. It does not mean that a person is no longer taking medications or visiting therapy. It also does not imply the elimination of symptoms characterizing a particular condition. Personal recovery is the set of skills and attitudes that a person may develop during care in order to deal with arising concerns with or without additional support (Whitley and Drake 2010). People who underwent a personal recovery are self-aware of their abilities and strength and can understand how to approach stressors and other adverse events in their lives.
The differences between the biomedical and recovery ideas include some ethical considerations as well. Both philosophies address the mental capacity of a person to make decisions. According to the first ideology, an individual with a mental health condition may be unable to choose the best way of treatment. Therefore, such people should not participate in the planning process and should fully rely on medical professionals to determine what is the most suitable approach. As a result, there arises an issue of coercive care when medical professionals restrict one’s freedom and enroll them into a mental facility or prescribe mediation without a patient’s consent (Trenoweth 2016). Here, one can mention that coercive treatment may be seen as a violation of one’s human rights.
In recovery-oriented approaches, a service user is considered to be capable of making decisions related to treatment. People who have some problems with making choices or coming to logical conclusions are not fully devoid of the mental capacity to participate in the process (Waldemar et al. 2016). They, however, may require advice or guidance from a qualified professional. As a result, this sphere prioritizes collaborative care, centering on the relationship between a client and a clinician. For example, nurses may suggest some types of therapy or treatment to patients, and service users may refuse the advice or ask for different strategies. Moreover, they can talk about their personal experiences and highlight their unique capabilities or limitations that a health practitioner should include in the plan. Collaborative care is the foundation of recovery philosophy since service users’ lived experiences and opinions are at the center.
Application to the Area of Choice
In the area of treatment of working-age adults, the collaborative philosophy has its drawbacks and benefits. On the one hand, adults are among the group of people with the most lived experience. The working-age population includes people between 16 and 64, although one can further limit the category to include only adults from 18 to 64 years old. The main advantage of this category is the development of independence which happens for the majority of adults. These people have informed decisions about their life and their health. Therefore, it may be easy for them to describe their health issues and determine the causes of concern.
This is a broad category, but it has some similarities. Most of the individuals from this group have family, loved ones, or friends which means that they have supporting people. Furthermore, as people of these ages may easily socialize in various ways (both online and in real life), they can create a network of support. (Schrank et al. 2012) Here, the benefit of collaborative care can be identified since personal recovery often requires people to reach out to others in order to find comfort in them or communicate their issues (Sebergsen, Norberg, and Talseth 2016). Another positive feature is the possibility of a nurse connecting with an adult. Collaborative care with children is often led by the service user’s parents or caretakers who, while being responsible for the child, do not always share their opinions with the patient. Similarly, older people may also have a lowered capacity to participate in a discussion due to age-related limitations such as mobility issues, speaking problems, and comorbidities. It should be recognized, however, that adults can have these problems as well.
The mentioned above benefits also present disadvantages of using collaborative care. Adults with lived experience may feel apprehensive about reaching out to medical services in the first place. In some cases, their refusal of treatment may be explained by previous negative encounters (Wagstaff 2011). Other reasons include the stigma of mental illnesses, fear of medicalization, and desire to resolve the problem independently. Adult clients may also be hesitant to discuss some symptoms or concerns out of fear to be considered abnormal (Slade et al. 2014). Moreover, they may want to focus on pharmacological treatment and dismiss any plans for personal (not clinical) recovery.
Adults can engage in various activities proposed during the planning process of collaborative care. However, they are also burdened by responsibilities and work which limits their attention to mental health, Hutcheson (2011) states that working adults can focus on symptoms but fail to recognize the underlying issues, thus remaining in a state of limited functioning. Socioeconomic aspects play a significant role in adults’ access to care. Some people work long hours or multiple jobs and cannot afford to visit specialists or take time off work to rest and think about their health (Gilburt et al. 2013). This is a problem since collaborative care implies an interaction between nurses and clients as well as a variety of interactive activities.
Clinicians working with adult patients often encounter hesitation and unresponsiveness. A mental health nurse working with adults should be able to communicate with clients and deliver the information efficiently (Bowers et al. 2009; Le Boutillier et al. 2015). Thus, the role of a professional as an effective communicator is highlighted. It is vital to provide patients with information that is helpful. For instance, busy adults may not find an idea of inpatient treatment useful even if their condition seems to seriously interfere with their daily activities. For them, such treatment may be replaced by meetings, group therapy sessions, and active communication (Rinaldi and Watkeys 2014). These initiatives may keep the interest high and engage service users in dialogue.
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In treating adults, mental health nurses should recognize that experienced people have their own perceptions about clinical and psychological assistance. According to Lebowitz, Ahn, and Oltman (2015), they may view recovery-oriented providers as less competent. Moreover, the issue of hope arises with many adults – Herrestad et al. (2014) find that patients may struggle to view hope as a valuable addition to treatment. A nurse’s role is to find an approach to each client and make sure that their experience is not devalued but incorporated into the planning process (Kidd, Kenny, and McKinstry 2015). The balance between sincerity, positivity, and confidence is necessary to help clients understand that collaborative care can bring many benefits and support recovery.
Development as a Mental Health Nurse
The last three years have given me an opportunity to advance as a mental health nurse. My professional practice provided me with various experiences, including work in an Acute Care Unit and Dementia Assessment Unit. Therefore, I was able to establish contacts with various clients and professionals. The first competency that I engaged in developing was linked to professional values. I revised my personal understanding of mental health and created a Wellness Recovery Action Plan (WRAP) which is presented in reflection 1a (Copeland n.d.). I analyzed my behaviors and stressors and created a system for dealing with them either by myself or with the help of others. I also implemented similar tools during my work at NP4 and NP5 placements.
I investigated the differences that the notions of clinical and personal recovery possess. When working in a Dementia Assessment Unit, I collaborated with older service users who entered the facility for supportive care. The main purpose of the organization was based on personal recovery since it was interested in finding the causes of dementia instead of dealing with its symptoms. Therefore, I observed as other professionals presented a different approach to treatment that was not as centered on medications. Moreover, the facility adhered to the latest NICE guideline and proposed non-pharmacological strategies to its clients, such as group reminiscence therapy (National Institute for Health and Care Excellence 2018). All patients, regardless of their cognitive abilities, were included in the decision-making process as much as possible.
These activities can be linked to Domain 3 and my reflections 3a and 3b. As the clinicians did not use medications frequently, the procedures in the unit were different from those of other departments. Service users and nurses interacted closely, having a collaborative experience. Relying on the findings of Benner (1982), I could see the expertise of some nurses who seamlessly blended their professional knowledge with clients’ lived experience. My personal reflection shows that I was competent enough, but I still need practice in dealing with personal recovery. Nonetheless, I feel as though I have reached the point where I can establish contact with clients and use my knowledge to guide them on the way to recovery.
While this process may be challenging for nurses working with older people diagnosed with dementia, the results of this collaboration could be seen in a short period of time. I also followed the same rules and focused on explaining to service users and their carers the value of personal recovery (Mental Health Policy and Service Development, Department of Mental Health and Substance Abuse and World Health Organization 2017). I implemented my skills of collaboration and improved my use of person-first language as discussed in reflections 2a and 2b. The philosophy of recovery is vital in such conditions, as both people with dementia and their loved ones often lose hope for living their usual lives again (Gunasekara et al. 2014; Mental Health Coordinating Council [MHCC] 2013; Raeburn et al. 2015). As a result, my competence in this domain increased as I was feeling confident about my knowledge and experience.
I also worked on my leadership skills, although I did not have as many opportunities to practice them with colleagues as other domains. Nevertheless, my leadership style, as described in reflection 4b, has developed into a transformational one, introducing many aspects of collaborative work and compassion (NHS England 2014; NHS Leadership Academy n.d.). During the three years, I addressed four sides of compassionate leadership, starting with myself. The mentioned above WRAP is a part of this practice since I examined my strengths and weaknesses as well as my personality in stressful situations. Then, I learned what attitudes I should have to maintain the position of a leader as a manager in a group. In this case, I have learned that leadership is highly dependent on communication and listening – feedback from others can enrich one’s experience and create strong bonds of trust. The knowledge of the personal experiences of both patients and co-workers also allows one to make connections and see both sides of the dialogue.
Clinical supervision and reflection played a prominent role in my training and will continue to be important in the future. First of all, supervisors at my placement sites offered me advice and needed support. Clinical supervision differs from counseling and mentoring activities in many ways, although it is also a tool for positive reinforcement and education. It maintains professional boundaries and is not focused on monitoring one’s performance. Instead, as noted in reflection 1b, a supervisor is a person who reviews one’s issues that cannot be solved alone. In mental health nursing, collaboration is vital not only for patient-nurse but also for interprofessional relations. It is a challenging sphere of health care, and its problems often require group thinking and the insight of other specialists. Thus, group supervision was extremely useful in cases where I felt that my competence has not yet been developed fully.
Reflection was another tool that I used to gain knowledge about myself. Reflections open the doors to one’s beliefs and attitudes (Barksby, Butcher, and Whysall 2015). By engaging in self-reflection, I was able to move away from practices that stagnated my professional growth. For instance, I understood that I forgot to use person-first language because I centered on its importance for service users but not their carers who sometimes utilized older phrasing.
- S – I will focus on helpful activities to deal with stress (watching TV, reading books, talking to my friends) and stray away from engaging in less beneficial behaviors (taking on more responsibilities, ignoring the signs of burnout).
- M – I will continue to adhere to a sleeping schedule and take time to rest when not at work.
- A – I will use my usual hobbies and ask my loved ones for support when it is needed.
- R – I will remember that stress is a problem that leads to other issues and will not dismiss my concerns.
- T – I will meet with my supervisor regularly and discuss my performance and progress (Doran 1981).
Mental health nursing is a field that requires not only substantial clinical knowledge, developed communicational skills, and leadership qualities, but also the ability to self-reflect. Nurses have to continuously examine their beliefs and attitudes to move forward in their performance and care quality. Recovery-oriented care attracts attention to patients’ individual needs and encourages collaboration between service users and providers. It can be implemented in many areas, including mental health nursing for adults. Older patients have enough experience to share their perceptions of life with nurses and contribute to the decision-making process. However, their knowledge may also interfere with treatment if they have any prejudices. The role of the mental health nurse is to explain the concept of personal recovery and offer the most suitable solutions for one’s treatment plan. It requires many competencies, including compassion, experience, confidence, and self-awareness.
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