Thursday, April 4, 2019

Analyse Contribution Of Engagement In Biopsychosocial Assessment Client Nursing Essay

Analyse Contri howeverion Of competitiveness In Biopsycho loving Assessment Client breast feeding EssayIn this search the process of bring ining a therapeutic relationship and assessing invitees own parcel within the inmate door and the framework assemble in figure will be confide sessions analysed and criticized by using sterns (1994) example of musing.The framework that has been employ in cordial health function is the C be Program climb (certified public accountant), which it has been profoundly criticised since it was introduced. T herefore the reflection will look into opposite amaze of nursing, tidal pretence, which offers a unlike philosophy of interest. The reflection will alike explore the inter in-person interactions theories which the nursed apply during the assessment and how these aided to acquire the guest in the biopsychosocial assessing process. It alike will be discussed other disturbance illustrations and the thinkable custom in simi lar situations.In lodge to range the analysis of the above points, struggle deficiencyfully to be defined. Thurgood (cited by Norman and Ryrie (2004) p.650) dragd it as basin be broadly defined as providing a serve well of process that is start outd by service drillrs (including c atomic number 18rs) as acceptcapable, accessible, commanding(p) and empowering. Although this definition gives an idea of the concept, it lacks to define the key elements of engagement, which Cutcliffe and doggy (2002) identified as craping a human to human relationship, expressing tolerance and acceptance, and hearing and understanding. Both definitions for assemblage the master values of the service and the interaction itself. Yet, Cutcliffe and doggie (2002) definition can be considered more than practical when holistic e precise last(predicate)y assessing nodes. However, these definitions do non ack instantly leadge factors of engagement that are behind the interpersonal relationsh ip, such as personal or organizational perspectives of engagement. The personal perspective for the nurses l eradicate oneself is underpinned by poor morphological organization, occupational cultures and stress, bureaucratic constrains, lack of prison term and nursing culture driven by measurable targets (Hosany et al (2007) and Addis and Gamble (2004)). On the other hand, leaf nodes and their families are conditi 1d by the amiable malady, their past ascertains with other go, the hope in the service and the relevance of it. Addition eachy, the organizational issues effect upon engagement and business concern by reducing operate budgets, by not providing resources and as well by politics. elaborateness has been recognized as an important part of mental health services users kick. The National Service Framework (NSF), the National show for Clinical rightness (NICE) and the Department of wellness (DoH) appoint that users under certified public accountant should be prov ided with resources to build a therapeutic relationship, optimise engagement and reduce stakes. These documents to a fault spotlight the need to provide a therapeutic environment in order to provide best grapple and to engage the clients and their families with the service.Taking into account each(prenominal) the above information a reflective account will be taking go under in the succeeding(a) pages by using seats model of reflection (1994).1. Description of the experienceThe clinical environment where this assessment took gravel was in an acute adult infirmary shield. The shelter is based in an obsolete mental health hospital, which has aged and pilling off wooden windows, untidy roofs and old fashioned flooring. The ward had untidy carpets, the curtains did not draw holdly and the picture on the walls was peeling off. These are the organisational barriers affecting engagement.This fussy client was know by the service al flying, to protect his right to confidenti ality he will be referred as lav (NMC code of confide 2008). fanny had been stable for 10 years, but in the past few months his mental state had worsened. His psychosis and levels of d get hold of change magnitude he distrusted neighbours and other acquaintances as well as strangers. Consequently, he stopped going out of his house and began to self medicate with over the counter sedatives. Crisis and Resolution Home Treatment Team (CRHTT) was involved and as they felt up that deception was not able to cope at home, they pertinacious that an yard bird admission would be beneficial. sooner the admission the CRHTT offed the certified public accountant form 1A, which updated the ward staff about the latest assessment of the clients biopsychosocial needs. Once thaumaturgy arrived to the ward, he fully understood the situation where he was in. He was able to consent and had capacity to agree with treatment and, thus, he was admitted as an on the loose(p) client. This facilitat ed the initial interaction and the initial grounding for the nurse/client relationship. Before the beginning of the assessment tomcat (Johns named nurse) introduced e preciseone to John, roles were explained, a welcome pack with the ward information and a CPA booklet were given and Tom provided all the information in an oral and written manner.The nurse started the assessment by formulating open questions. However John gave single direct answers (yes, not, not sure as shooting ). Consequently, the nurse decided to change to more direct questioning. afterward that the client was very co-operative and was answering all the questions. He reported to be very anxious, which similarly was noticeable by looking to his body language (he was sweaty, clenching his fingers, run his hands on the chairs arms and removing his spectacles several(prenominal) times during the interview). At this stage the nurse decided to undertake an anxiousness assessment by using the scales tools available on the ward the Becks anxiousness stock-take (BAI, contrive Appendix 1).Following this assessment, John began to answer the questions more in sagacity and he appeared more eased, stating several times that he was in hospital for table service and was going to do everything that was available for his convalescence. Following the local trust policies and NICE guidelines, the CPA 1A assessment was concluded (as it must to be finished within 72 hours of the admission) the Integrated Care Pathway for yardbird rubber and the Patient Property Liability Disclaimer were filled in and subscribe by nurse and client.2. ReflectionThe hearty assessment was intended to gather as much information as possible about John in order to understand the clients actual biopsychosocial situation (holistic assessment) and the context that led to the admission, which would highlight the needs and strengths of the client. However, inpatient admissions are more likely to cerebrate on a more medical checkup approach to health, mainly because social interventions cannot be implemented until the clients mental state has stabilized and he is ready to move on to community settings. Along this process the multi-disciplinary team organizes care to build up the grounds to enable retrieval (Simpson 2009). This particular ward was focus on treatment and stabilizing, working on one to one interventions (nurse-client), building a therapeutic relationship finished coordinate and shapeless interventions, and used CPA as a nursing intervention framework. alongside these individual interactions, the activity nurses and the occupational therapist offered daily social and leisure activities. These groups provided skills and entertainment to the clients on the ward, but did not follow a particular model of nursing, such as the tidal type, and they offered activities to spare the free time on the ward without promoting recovery.The tidal present provides structured group-work centred on r ecovery (Barker and Buchanan-Barker 2005). This model centres its assessment on a holistic approach for the scant(p) and long term needs, viewing the mental illness as a unique experience of each individual, their families and social environment. It looks into the lowest point of the illness (such as an inpatient admission like Johns) as the point where the recovery begins with a overconfident approach to the illness.There are three working groups recommended in this model discovery, solutions and information (see appendix 3), where therapeutic relationship is make and issues common to the individual and others are discussed and explored. As mentioned above, the ward nurses had more structured interventions with clients, and the issues discussed in these interviews were correlated to the Tidals Model theme groups. In these interviews the clients engage with their first nurses and they discuss their concerns in relation to their care or other personal matters. These interventions or interviews were intended to happen at least twice each week for at least an hour. However, for organizational issues (usually low number of staffing) not all the clients had the opportunity to realize from these one to one interventions on a prescribed basis.Initially, the Tidal Model interrogation was criticised for being bias, for lacking to fully describe clients pre and post intervention with the model, not taking into account Hawthorne effect and to the highest degree of physiological factors and by not reasoning the need for a youthful model in mental health care (Noak 2001). However, advance look for and analysis showed that the Tidal Model provides tools and structure to emend care in acute ward admissions filling the gaps in care pointed in the NSF and The Sainsbury center field for psychic health (Gordon et al 2005). One could say that this model has been shown to mend mental health services, fulfil the historical gaps within nursing normal and to be grou nded on evidence-based use. However, the author of this essay believes, after reading the germane(predicate) literature, that for the implementation of the Tidal Model the levels of staffing (and therefore the service budget) should be increased and nursing do cultures must be changed by re-educating the workforce. Arguably two implementations are very difficult to achieve as the health service has seen budgets cut downs in the recent years and nurses practiced has been subject to detrimental ward cultures towards nursing models.On the other hand CPA, which is the framework used on the ward, was first designed after a series of fateful incidents which involved mentally ill people. It was aimed to be introduced in Wales by 2004 (in England was make by 1991). CPA is person centred focus which stirs social inclusion and recovery, through assessment and planning of individualized needs and strengths, working with the clients and their families or carers (Care course Approach Ass ociation (CPAA) 2008). despite the initial intention that the CPA was brought to improve service users quality of care, to increase inter agencies communication and to be a oddball management tool, some critiques appeared. Simpson et al (2003a) researched showed CPA was thought to be an over-bureaucratic duty within the captains. The author of this paper has observed in practice, not in this particular assessment, that some professional do not value clients when they are admitted. Instead the latest CPA 1A form (usually filled in by the CRHTT) is p calefactiveocopied or copied-pasted and re-used to speed up the process. This would be acceptable if the client was assessed the day or night before the admission, because the social, psychological or biological needs would rescue not changed in that period of time. When older assessments are used, changes in circumstances office dumbfound not been updated. In the shoot case scenario a health professional could have misunderstood the clients needs and have documented them wrongly. This misunderstanding could be carried over, therefore care would be affected. This hypothetical scenario shows that CPA assessments should be done every time when needed.CPA as a case management tool fails to compile the near important features which promote therapeutic relationship. In contrast with other case managements models the role of the care co-ordinator is more of an administrative and as an alternative service prescriber (Simpson et al 2003a). This means that there is no need for a particularised training or skills related to therapeutic relationship, partly because other services (or service providers) will engage with the client, and the care co-ordinator just oversees the process of care. Moreover, CPA also lacks a nursing model background and fails to define exceptional(prenominal) roles within the multi-disciplinary team. These factors reduce the teamness feeling between the health professional (Simpson et al 2 003b). Although, it could be argued that the reason, why CPA is lacking nursing background, is that it was not designed as a mental health nursing framework but for the use of mental health services. In this particular reflexion the care co-ordinator was not present in the admission and never mention during the assessment. Whether it was a usual situation or not it is something that never was discussed, but it shows Simpson et al (2003a and 2003b) critiques of CPA as a case management were factual.CPA and Tidal Model are intended to provide holistic care for clients and their families. However, the Tidal Model is more clients centred than CPA, and it also looks into the more positive side of the clients situation, foreseen the now and future as a whole. It explains the illness as an accumulation of action factors. The Tidal Model complements other health and social care professionals, as well as it searches to nurse by building a special relationship between health practitioner and client. Moreover, CPA always looks for risk signs in the short-term and from a psychiatric approach. As this assessment took place in an inpatient admission it is important to bear in soul that in this particular environment CPA forms (1A, 2, 2A and 4) were used for assessment, planning, implementing and evaluation of inpatient care and for the liaison with other health professional in ordinal care (such as physiotherapist, dietician or occupational therapist). Perhaps CPA would benefit from sharing some principles of a nursing model (like the Tidal Model), by using it as a tool more than as a paperwork and from a better staff training and promoting adherence to nursing models (Barker 2001).Whether the ward uses Tidal Model or CPA to structure care, an inpatient admission is always stressful and uncomfortable experience for clients and their families. John truism the nurse as a stranger in an unfamiliar place, however, Tom was there to guide the client throughout his care, to pr ovide information and to be somebody he could relay on. This first encounter related to the orientation microscope stage described by Peplau (1952) (cited by Sheldon (2005), see Appendix 2). In this phase Johns past experiences, expectancies, culture and believes were to condition the initial interaction. Following this phase John went into the identification stage, where he sought assistance for anxiety simplicity techniques, shared needs and strengths when and co-designed care plans and began to have feelings of belonging and capability, therefore lessen negative feelings. This exchange of feelings is going to lead to evolution and resolution phases, where John will engaged with treatment (medical, physical and social), having different needs at different times, starting to be informed about all the help available towards the final stage, feeling as an important part of the whole nursing process and finally ending the professional relationship when discharged. The exploitatio n and resolution phases were not observe as at the time of indite John was still an inpatient.John had had previously one bad inpatient admission. He reported that he was very unhappy when he was in the other hospital 10 years ago. He explained that the bad experience was related to the other clients and organizational issues quite than staff. John stated that he was feeling anxious but happy that he was getting help. His positive attitude helped to engage him in the assessment process and on the ward activities, which were the first steps towards the identification phase. Therefore, John could begin to have professional input from other members of the multi-disciplinary team.Tom interacted in a way that John felt understood, respected and individualized. Tom did not appear to have preconceive ideas of the client after reading the CPA forma 1A. And certainly, Tom treated John respectfully and as an equal human being. He followed the NMC code of practice 2008, which states that you must treat people as individuals and not to discriminate in any way those in your care. Tom tried to adapt the gait of the questioning to the clients needs, involving him and asking in a respectful manner. Tom also acknowledged Johns anxiety feelings, and showed it when taking further (BAI see appendix 1) assessments to realise more with Johns situation. This reinforced the approachability and genuineness of the nurse and led John to open and engage with the assessment process and the health professional.3. Influencing factorsJohn scored 45 points in the BAI (see appendix 1), which is a high scoring. This could have been influenced by the hospital admission and the assessment process. Despite these factors and Johns actual mental state he engaged in the assessment actively. The BAI scales consist of 21 observable and self-rating symptoms of anxiety, rated from 0 to 3 (0 being the lowest score), which can also be well transformed in direct questions or self rating. At the end of t he assessment the scores are added up and compared against the scales.There are several assessment tools available such as Hospital fretfulness and low Scales (HADS) or Hamilton Anxiety Scales (a collection of them can be found in the Appendix 1 reference). The BAI is shown to be a quick and reliable when beat clients anxiety levels and it also differentiates General Anxiety slack and depression (Fydrich et al 1992). Although, these characteristics appear to be positive, it could be argued that BAI is just a merely allowance of the DSM-IV panic symptoms and therefore it could also be said that measures panic attacks rather than anxiety levels (Cox et al 1996 and de Beurs et al 1997). On the other hand, HADS which achieves good levels of anxiety and depression screening could have been more appropriate for hospital settings and more accurate (Bjelland et al 2002).It is important to point out that NICE clinical guideline for management of Anxiety (2004) does not recommend a limi ted tool for assessment of anxiety, which gives to the professional practitioner choice on the usage of available tools. This affects practice as these scales are not used as often as they should be. Most practitioners relay on their observations and experience to coiffe informal assessments, rather than using research based scales. It is perhaps comprehensible when dealing with clients unable to fully understand these assessments. But in practice it can be noticed that nurses do not tend to use anxiety inventory even with clients that could engage with the process.Tom designed care plans in partnership with John and do him realise which were more graphic goals in the short and long term. Tom had shown knowledge and understanding of the professional capabilities that the NSF defined in the documents The Ten Essential Shared Capabilities (2004) and The Capable practician (2001). These documents set basic principles that underpin positive mental health practice as well as providin g the basic grounding for service workers to await developing and learning skills. Therefore, it was observed during the placement that along the whole admission the nursing team also guided care and practice as appointed by these documents. They provided patient-centred care, which is accountable for each client and respecting the individual. The team also had a broad knowledge of national legislations as well as local policies and services, and worked under the same professional and ethical principles recognizing the rights of the clients and their families. They promoted recovery and self-realisation by identifying people needs/strengths and empowering the individuals. Most of the team members were undertaking further training, to keep their skills up-to-date or be able to transfer their quick skills to new environments. They also worked in partnership with family, carers, lay people and outdoor(a) agencies, such as community care services, voluntary associations and vocation al services.4. military ratingIn the interview Tom used a Rogerian approach (Roger (1961) cited by Sheldon (2005)). He also showed knowledge of Peplaus interpersonal theories and applied them in practice by creating a shared experience of care. However, it also would be appropriate to use the Herons six- household intervention framework (Heron 1989). This framework was designed to enable a practitioner (nurse) taking the lead to facilitate the clients specific needs or arising issues. Therefore this intervention could have been used in the admissions assessment and the following one to one sessions, which have been described in this essay. The framework is made off two categories, which are sub divided in three more. The first category is authoritative which it can be prescriptive, in which the nurse influences and directs behaviour, gives advice and prescribe goals. It also can be informative providing information or giving feedback for the clients behaviour. The third gear subcat egory is confronting, in which the practitioner challenges the clients beliefs or actions. The second category is the facilitative which is divided into cathartic, in which the nurse tries to release the clients painful feelings and talks about or express them with actions (tears, anger or shouts). Next subcategory is catalytic, where the nurse tries to help the client and encourage self-discovery and learning. Finally, supportive is the category where the client is supported in an clear manner.The facilitative stage of the framework would have been the most appropriate to use in the first assessment. Johns mental state would not have benefit from an authoritative approach as he might have felt threatened by the staff, therefore his willingness to engage with the service could have decreased greatly. This approach shares the same goals as the one that Tom used. The outcome would have been the same, which was the beginning to build a relationship towards recovery. However, it is im portant to know different ways to practice and to interact in order to provide an secern care. This principle is shared by the models discussed in the essay (CPA and Tidal Model) and also by the nursing professional code (NMC code of practice 2008).5. encyclopedismAlthough, it was difficult to deal with Johns anxiety levels and his initial unwillingness to engage with the assessment, it was possible to create a therapeutic relationship between nurse and client. After this reflexion it was learnt that nurses knowledge and usage of the right nursing models, strategies and tools can be adapted to individual situations and their own circumstances. It is also important to share principles of care and to change some nurses cultures regarding models of care.It was positive to reflect upon this experience and, therefore, to realise how the surmisal learnt was applied in practice. Since nursing studies and practice are moved towards research based knowledge it seems that the human connect ion and relationship building have lost their place in the nursing profession. As a scholar it is good to see that values based nursing promoted safe, trustful and financial backing environment, which led to a healthy therapeutic relationship (Hewitt 2009).In conclusion, the reflection and analysis of engagement through a biopsychosocial assessment illustrated how personal and organizational factors effect on clients care. It was found out that applying specific intervention techniques, mental health screening tools and the adequate adaptation to the individual and the situation promote engagement and build a healthy therapeutic relationship. Furthermore, the research showed that the relevant mental health regulations and nursing professional code recognise the need to keep up-to-dated knowledge and skills in order to provide the best care. every last(predicate) the above techniques and tools were found to be used in a very individual way between the nursing professionals. In addi tion to this, it was found that theses personal adaptations to practice and clients care were beneficial when reducing barriers for engagement and personalising the care.The positive and negative characteristics of the actual mental health framework CPA were brought forward and it was found that it lacks a nursing model background. CPA and Tidal Model when compared and contrasted, showed that both mental health frameworks differ gratefully from each other but at the same time they could benefit from each other.Despite the ward worked under CPA and used a more medical approach to nursing, the nursing team shared the same professional capabilities and worked towards holistic goals and recovery.Over all, in order to engage and to provide relevant services for clients and cares biopsychosocial needs there should be a continues connection between practice and theory in nursing.ReferencesAddis J Gamble C (2004) Assertive outreach nurses experience of engagement. ledger of psychiatrical rational health breast feeding 11 (4) 452-460.Barker P (2001) The Tidal Model developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing. ledger of Psychiatric and amiable Health Nursing 8 233-240.Barker P Buchanan-Barker P (2005) Tidal Model A guide for mental health professional. Brunner-Routledge. Hove. UK.Bjelland I Dahl A A Haug T T (2002) The validity of the Hospital Anxiety and Depression Scale An updated literature review. Journal of Psychosomatic Research 55(2) 69-77.Cox B J Cohen E Direnfeld D M Swinson R P (1997) Does the Beck Anxiety Inventory measure anything beyond panic attacks? Behaviour Research Therapy 34 (11/12) 949-954.Cutcliffe J R Barker P (2002) Considering the care of the suicidal client and the case for engagement and inspiring hope or observations. Journal of Psychiatric Mental Health Nursing 9 611-621.Department of Health (2002) Mental Health Policy Implementation Guide Adult Acute Inpatient Care Provis ion.Department of Health (2004) The Ten Essential Shared Capabilities.http//www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4087169Accessed 29/12/09de Beurs E Wilson K A Chambless D L Goldstein A J Ulrike Feske U (1997) Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia Depression and Anxiety 6 140-146.Fydrich T Dowdall D Chambless D L (1992) Reliability and Validity of the Beck Anxiety Inventory. Journal of Anxiety Disorders 6 55-61.Gordon W Morton T Brooks G (2005) intromission the Tidal Model evaluating the evidence. Journal of Psychiatric Mental Health Nursing 12 (6) 703-712.Heron J (1989) Six-Category Intervention Analysis (3rd EDN) Human authority Resource Group, University of Surrey, Surrey, UK.Hewitt J (2009) Redressing the balance in mental health nursing education Arguments for a values-based approach International Journal of Mental Health Nursing 18 368-379.Hosany Z W ellman N Lowe T (2007) Fostering a culture of engagement a pilot study of the outcomes of training mental health nurses working in two UK acute admission units in brief solution-focused therapy techniques. Journal of Psychiatric Mental Health Nursing 14 (7) 688-695.Johns C Graham J (1996) Using a Reflective Model of Nursing and Guided Reflection. Nursing Standard 11 (2) 34-38.National Institute for Clinical Excellence (NICE) Clinical Guideline for Management of Anxiety (2004)http//www.nice.org.uk/nicemedia/pdf/cg022fullguideline.pdfAccessed 26/11/09National Service Framework (NSF) Modern Standards and Service Models for Mental Health (1999) NHS our Healthier Nation.Noak J (2001) Do we need another model for mental health care? Nursing Standard 16 (8) 33-35.Norman I Ryrie I (2004) The Art and Science of Mental Health Nursing A Textbook of Principles. Open University Press. Maidenhead. UK.Nursing and Midwifery Council (NMC) (2008) The Code. (NMC, London).Sheldon L K (2005) Communicat ion for Nurses Talking with Patients. Sudbury Jones and Bartlett.Simpson A (2009) The acute care setting. In Barker P (2009) Psychiatric and Mental Health Nursing The craft of caring. Edward Arnold Ltd. London.Simpson A Miller C Bowers L (2003a) Case management models and the care broadcast approach how to make the CPA effective and credible. Journal of Psychiatric and Mental Health Nursing 10, 472-483.Simpson A Miller C Bowers L (2003b) The account of the Care Programme Approach in England Where did it go wrong? Journal of Psychiatric and Mental Health Nursing 10, 489-504.The Sainsbury Centre for Mental Health (2001) The Capable Practitioner.http//www.scmh.org.uk/publications/capable_practitioner.aspx?ID=552Accessed 29/12/09AppendixesAppendix 1Beck Anxiety InventoryBelow is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been fazed by that symptom during the past month, including today, by circling the number in the sam e space in the column next to each symptom.Not At AllMildly but it didnt bother me much.Moderately it wasnt pleasant at timesSeverely it bothered me a lotNumbness or tingling0123Feeling hot0123Wobbliness in legs0123Unable to relax0123Fear of worst happening0123Dizzy or lightheaded0123Heart pounding/racing0123Unsteady0123 scare or afraid0123 dying(p)0123Feeling of choking0123Hands trembling0123Shaky / unsteady0123Fear of losing control0123Difficulty in breathing0123Fear of dying0123 panic-stricken0123Indigestion0123Faint / lightheaded0123Face flushed0123Hot/cold sweats0123Column SumScoring Sum each column. Then correspond the column totals to achieve a gigabyte score. Write that score here ____________ .InterpretationA grand sum between 0 21 indicates very low anxiety. That is usually a good thing. However, it is possible that you might be unrealistic in either your assessment which would be self-denial or that you have learned to mask the symptoms commonly associated with anx iety. Too olive-sized anxiety could indicate that you are detached from yourself, others, or your environment.A grand sum between 22 35 indicates moderate anxiety. Your bod

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