Evidence Based Mental Health Nursing

Introduction

This report will focus on the assessment and care planning for an individual using the mental health services. Evidence based approach will be deploy in order to be able to record, review and monitor the progress of the service user. Evidence-based practice is a structured and systematic approach to using research based knowledge of effectiveness to inform practice (Olfson, 2009). Knowledge includes formal information derived from research, for example from published trials and reviews. It also encompasses the informal knowledge and wisdom of practitioners, sometimes called tacit knowledge. This informal knowledge can include, in addition, the expertise of those who receive an intervention, whether that is medication, talking therapies or attending a parenting skills group.

Care Programme Approach(CPA)provides the framework for assessing and care planning for a person with mental illness. CPA was introduced in 1991 by Department of Health as a systematic arrangement for assessing the health and social needs of people accepted into specialist mental health services (Kingdon, 1998). The formation of the plan will detail the health and social care required from a variety of provider as well as the appointment of a key worker to keep in close touch with the service user and to monitor and co-ordinate care. In addition, regular reviews will be conducted where necessary, agreed changes to the care plan. Hence, in this report, I will outline the main principles of CPA and deploy the use of Tidal Model and principles throughout the report by Tidal model’s principles to clinical practice and assessment and care planning.

A detailed background and information about the individual receiving care in the clinical section of where I work will be provided.  And to make it clearer for the audience of this report, I will highlight the purpose of conducting this assessment as well as the process of the assessment. The discussion will centre on care planning and the strategies or issues that may impact the process. In order to keep the identity of the person under care anonymous in in accordance with confidentiality and the NMC code, only the initial of the individual will be used through the discussion in this report. As a nurse, I owe a duty of confidentiality to all those who are receiving care under me and that includes making sure that they are informed about their care and that information about them is shared appropriately (Maloney, 2016).

Care Programme Approach Framework and The Tidal Model

The Care Programme Approach (CPA) is a way that services are assessed, planned, co-ordinated and reviewed for someone with mental health problems or a range of related complex needs (Nhs.uk, 2017). CPA are generally offered to individual that have been diagnosed for having a severe mental disorder, someone who is at risk of suicide, self-harm, or harm to others and people with history of violence or self-harm. In addition, the service is available for people that vulnerable, this could be for different reasons such as physical or emotional abuse, financial difficulties because of mental illness or cognitive impairment.

The three main core principles of CPA according to Rowland (2013) are the assessments of the needs of the individual, allocation of a care coordinator and plan how to meet the needs of the person. The coordinator will ensure that the plan include the fully assess of the service user needs, it will also show how the NHS and other organisations will meet the needs of the person, including the family in some cases. It has to be regularly reviewed by the coordinator to monitor progress.  In addition, the coordinator will have to think about all the mental health needs of the service user, medication and side effects, employment, training or education and personal circumstances including family and carers. The assessment will include the risk of the service user to themselves or other, either there is a problem with drugs or alcohol. The CPA is a model for good practice which remains applicable today.

However, the CPA is a care for those of working age in contact with specialist mental health and social care services (Donohue, 2014). It is crucial to work have an integrated approach across health and social care to minimise the distress and confusion sometimes experienced by people referred to the mental health system and their carers. In addition, professionals have found some aspects of the CPA over-bureaucratic, managers and service users alike have found the lack of consistency confusing (Donohue, 2014). It is they who have been working and living with the CPA for some years now and it is important to take account of their views. In the nutrshell, Bree-Aslan and Hampton (2009) indicated that CPA is not a model of care but a tool and process to guide nurses on how to provide effective service for people with mental illness. By embracing an integrated approach where by a seamless service can be achieved through an integrated approach to care co-ordination which provides for a single point of referral and a unified health and social care assessment process (Koopmans, 2013).

Tidal model will be deployed through the care planning and assessment in this report. This principles and philosophies of this model will help to give an in depth understanding to the process of assessment and care-planning. Tidal model is a mental health recovery model which may be used as the basis for interdisciplinary mental health care. It was developed by Dr Phil Barker and Poppy Buchanan-Barker as a philosophical approach to the discovery of mental health (Barker and Buchanan-Barker, 2010). The Tidal Model accentuates helping people reclaim the personal story of mental distress, by recovering their voice. With service user, own language, metaphors and personal stories, people can begin to reclaim the meaning of their personal experiences. Helping someone to a problem in living is rarely easy because everyone is unique and each person’s reaction to any problem in living also is unique. Hence, what works one person may not always ‘work’ for another.

In Tidal model. The first step towards someone with mental illness recovering control over their lives. The model enable mental health nursing to be used as the basis for interdisciplinary mental health care and the focus begin with begin with the recovery journey when the person is at their lowest ebb experiencing the most serious problems in living (Barker and Buchanan-Barker, 2010). The Tidal Model provides a practice framework for the exploration of the patient’s need for nursing and the provision of individually tailored care. (Barker P, 2001) and it is considered as a mid-range theory of nursing, hence the main focus of the model is on helping individual people, make their own voyage of discovery. From the research, already been conducted by different scholars, the combination of CPA framework and Tidal model with the collaboration with the service user will enable them to recognise areas and needs that will be most suitable for their recovery as well as promoting a culture of person-centred care that is not associated with CPA framework.

Biography

Janet Bonet is a 58-year-old female living with her daughter who is one of her three children. Janet has never been married and also has no partner at the moment, although she said to have been in different relationships in the past but which seem to lead nowhere. My mentor and I have been asked to assess Janet during her inpatient appointment at the centre. Janet has been known to mental health services over the years and has a history of disengagement. She has had a diagnosis of severe depression in the past and also suffers from back problem which impacts on her mental health.

Janet has never been able to keep a job due to her physical health and so she has been in benefits most of her life. Due to financial stress in the past, she has self-neglected and now depend on her carer who is also her daughter for support in daily activities. Also, she was asked by the council to downsize her four-bedroom house to a two-bedroom house which she has done but still waiting on the housing list to be moved closer to her family and she finds this waiting period stressful as she has been waiting for over a year so housing is also her concern.

Recently, she has been experiencing a lot of fluctuations in her mood as she reports that she lost her Dad, Mum,Nan,and Grandad within two weeks of each other and found this extremely distressing  and also has been having thoughts of harming herself. Her daughter is her carer and she also claims that her other children along with her grandchildren do visit sometimes which makes her think less about self-harming herself. She says “My children and grandchildren are my protective factors”. She went further to say that she has been experiencing feelings of emptiness and anger due to the fact that she does not feel safe in her neighbourhood as she feels some people are out to get her.

Janet admits that in the past she has not been compliant with her medication due to side effects but is willing to be compliant with treatment now that she feels she is in crisis in order to promote her recovery. Janet has also reported suicidal thoughts in the past and has had two attempts at committing suicide.

Assessment

The assessment of service user with mental illness include collections of different range of information. The information may include mental health symptoms and experiences of the service user, feelings, thoughts and actions physical health and wellbeing, culture and ethnic background, use of drugs or alcohol, social and family relationships and past experiences, especially of similar problems. The whole essence of conducting assessment is for the coordinator to be familiar with the life history of the service user. However, I prefer deploy Barker (2008, p.66) procedures of assessment by trying to answer the question who the service user is. The procedure will enable the coordinator to focus on the individual as a whole by considering their needs instead on focusing on diagnosis. The second question like “what is wrong”? will prompt the service user to give information about their state of mind and wellbeing. For a nurse, the concept is to show empathy for the service user to be at ease and feel unthreatened to give more information about the state of the health and their experience. The correlate with Tidal model of Barker and Buchanan-Barker (2010) that indicated that coordinator can deploy a “holistic assessment whereby the service user is allowed to tell their story and world of experience. Through holistic assessment, therapeutic communication, and the ongoing collection of objective and subjective data, nurses are able to provide improved person-centred care to patients. A holistic assessment approach acknowledges and addresses the physiological, psychological, sociological, developmental, spiritual and cultural needs of the patient (Kreys, 2014).

However, finding out who the person is and what is wrong with them, is just one part of the assessment. It is essential to form a collaborative and empowering relationship with the service user in order for them to be comfortable around the coordinator. Hence, service user should be treated with respect and dignity no matter the state of their health.

References

Barker, P. (2008). What are psychiatrists for?. Mental Health Practice, 12(1), pp.11-11.

Barker, P. and Buchanan-Barker, P. (2010). The Tidal Model of Mental Health Recovery and Reclamation: Application in Acute Care Settings. Issues in Mental Health Nursing, 31(3), pp.171-180.

Bree-Aslan, C. and Hampton, S. (2009). Pressure care, part two: the importance of assessment. Nursing and Residential Care, 11(1), pp.12-17.

Donohue, P. (2014). Involving families in planning and assessment of community services. Nursing and Residential Care, 16(3), pp.175-176.

Kingdon, D. (1998). Reclaiming the care programme approach. Psychiatric Bulletin, 22(6), pp.341-341.

Koopmans, R. (2013). Mental health in long-term care settings: The Dutch approach. Geriatric Mental Health Care, 1(1), pp.3-6.

Kreys, T. (2014). A holistic approach to patient care in psychiatry. Mental Health Clinician, 4(3), pp.98-99.

Maloney, P. (2016). Nursing Professional Development. Journal for Nurses in Professional Development, 32(6), pp.327-330.

Nhs.uk. (2017). Mental health services: Care Programme Approach – NHS Choices. [online] Available at: http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/care-programme-approach.aspx [Accessed 28 Feb. 2017].

Olfson, M. (2009). Review: limited evidence to support specialist mental health services as alternatives to inpatient care for young people with severe mental health disorders. Evidence-Based Mental Health, 12(4), pp.117-117.

Rowland, P. (2013). Core principles and values of effective team-based health care. Journal of Interprofessional Care, 28(1), pp.79-80.