Introduction

The aim of this assignment is to demonstrate a knowledge and understanding of a mental health nurse’s role in providing person centred care to service users and their holistic care needs. It will focus on how recovery orientated practices were utilised when working with individuals with long term mental health conditions, as well as assisting them with recovery and future planning. Coulter, Eccles, Entwistle, Perera, Ryan & Shepherd (2015) state that a long-standing mental illness can be defined as an illness which lasts for up to or above three months, or when the risk of relapse, or a reoccurrence of the mental disorder is deemed a high possibility. It will also discuss the importance of recovery being tailored towards service users as individuals as there is no single way to define recovery, and it is individual to each person’s journey (Bird, Leamy, Le Boutillier, Williams & Slade, 2011)

The assignment will be divided into sections, so each area is discussed thoroughly and clearly.

Throughout this assignment, a pseudonym will be used when referring to the patient and no specific locations will be disclosed; this is to ensure confidentiality is always maintained, in accordance with the Nursing & Midwifery Council Code (NMC, 2015).

The person in focus

Nigel is a 68 year old who lives in a rural area of Wales. Nigel is a widow, and has a daughter in her thirties that he speaks to daily on the phone, however she lives 3 hours away. Since Nigel lost his wife to cancer two years previously. Nigel has been struggling with

alcohol

dependence and has become social isolated – claiming he would sit at home by himself and drink. Nigel is not from this area, but his wife was and they moved here to retire. Nigel has no social life in the area, as he says his social life involved friends that he made through his late wife. Nigel is retired, and up until his wife passed away had been doing volunteer work locally to keep himself busy.

Since losing his wife, Nigel has become dependent on alcohol. Nigel states he has “always been a drinker” but since losing his wife, this has become a coping strategy for when he feels low. Nigel claims it used to just be late at night, however Nigel then began drinking when he woke up, as it’s when he would experience cravings and alcohol withdrawal symptoms (Umhau, 2019).

Nigel attended his GP to try and get help with his anxiety and alcohol dependence. Nigel saw his GP and was referred to the community drug and alcohol team.

Nigel has had a lot of input from his substance misuse worker, and recently completed a planned detox, under supervision and guidance from his substance misuse worker. The detox was a success and Nigel is determined to continue with his recovery.

Holistic assessment

A multidisciplinary team (MDT) is used frequently in the field of mental health in order to make sure the assessment takes into account the individuals holistic needs (Ascari, Guerzoni, Magistri, Marzi, Mereu & Vendelli, 2019). It is vital that the MDT maintain a high standard of collaborative working so that Nigel’s holistic needs are met (Dock, Griffiths & Heinkel, 2015). It should also be noted there can be difficulties to overcome when using a multidisciplinary approach (Bonney, Halcomb, McInnes & Peters, 2015). For example having several professionals involved with Nigel’s care could result in Nigel losing his person centred care approach (Roncaglia, 2016)  as well as decreasing the likelihood that he his say in the decision making (Cook, Miller & Petch, 2013), both of which are aspects that are required for a successful recovery (Grainge & West, 2012).

Nigel had tried several times to come off alcohol himself with no help from professionals. Nigel was only able to go 24 hours before he claimed withdrawal symptoms became too intolerable, which is incredibly common (Davis, 2018). People who struggle with substance misuse are more likely to successfully overcome their addictions and cravings with input from specialist services like a drug and alcohol worker (Cutcliffe, Green & Travale, 2018), the likelihood is also increased by having regular contact with your alcohol worker and building a therapeutic relationship (Crisafulli & DiClemente, 2017).

It was discussed that a planned detox for Nigel would be best, as detoxing without supervision and medication can be incredibly dangerous for an individual drinking the amount Nigel was drinking (Fernandez, 2019). When attempting to detox from any substance, having support around you is as important as having professional input (Barclay, Brett, Dawson, Ivers & Lawrence, 2017). Nigel had no one living near by he felt would be able to assist and support him through detox, and with his daughter living several hours away, Nigel felt a detox at a residential care setting would be beneficial as it would mean there would be someone to check on Nigel for a 48 hour stay. This is important as ones physical health can deteriorate quickly (even when they are sleeping) if they are going through an alcohol detox (Kouimtsidis, 2017). Working together in an MDT setting meant Nigel’s needs were able to be addressed in a timely manner (Evans, Haines, McCabe & Perkins, 2018), and the substance misuse worker and social worker were able to find suitable accommodation for the detox. Eriksson, Hanpatchaiyakul, Kijsomporn & Östlund (2016) state that tasks such as suitable accommodation and environments for detox are the biggest challenge when trying to successfully get over addiction. Knowing your strengths and weaknesses in the MDT means being able to complete tasks like this successfully so that the recovery process is not slowed down (Horan, Lambert & Wall, 2018).

Nigel’s two needs that will be focused on are remaining abstinent from alcohol, and assistance with dealing with social isolation. These two specific needs coming together is a common thing, (Anderson, Bailey, Kenney & Stein, 2019) which is more likely following a loss of bereavement (Collins, Glowacka, Sherry, Stewart & Thompson, 2018). Nigel would require interventions to assist with remaining abstinent of alcohol (Bradberry, Coleman, Marsh, Pucci & Quelch, 2019), as well as to assist with his social inclusion within his local community (Boulze, Launay & Nalpas, 2016). There is the belief that general socialising within the community would give a service user empowerment and assist them to remain abstinent (Jacobson, Lord, Newman, 2017). Nigel had stopped driving as a result of his drinking. Nigel’s wishes are to recover and see his daughter and grandchildren whilst hoping he will regain his confidence to drive and visit them.

The Recovery Star framework (Mental Health Providers Forum (MHFP), 2009) will be the tool used to assist with the process and to monitor recovery. The Recovery star focuses on getting a service user to identify and note their needs in a visual way, so that their targets can be set based on the results. It has ten key areas which cover a person holistically, so that realistic goals can be made (Fazzari, Lucchi, Placentino & Scarsato, 2017). The ten steps are “physical health & self-care, social networks, living skills, work, addictive behaviour, identity & self-esteem, trust & hope, managing mental health, relationship & responsibilities.” (MHFP 2009). In Nigel’s case he could choose to select more relevant ones (for example) social networks, addictive behaviour, managing mental health & relationship and responsibilities. The service user can then set themselves a goal, which doesn’t have to be a goal from each step, but the ones they feel are relevant to them so that they do not feel overwhelmed (Lloyd, Machingura, Tse & Williams, 2016). The recovery star is a visual tool, meaning the service user is able to see their own progress (Lloyd, Machingura & Williams, 2016), furthermore demonstrating it’s ability to empower an individual to recognise which areas require further support or further intervention (Jacob, 2015). There is a stigma around mental health and substance misuse (Rust & Shim, 2013; ) and it’s been found that when service users face any kind of discrimination, they’re more likely to achieve their goals if there’s steady progress being made (Killaspy, King, Taylor & White, 2012). The fact it is holistic and shows progress in different areas can give people the empowerment needed to change (Rose, 2014). The recovery star has seen great success with not only mental health, but substance misuse services because you can visually measure and build on your successful changes in your recovery. (MacKeith, 2008).

Promoting recovery

Nigel has agreed to the administration of Pabrinex which is commonly used following an alcohol detox (Parsons 2018). Pabrinex is used with people who drink a large amount on a frequent basis and is seen as essential medication (Conlan, Kipping & McMullen ), as it can prevent irreversible alcohol related brain damages, nerve damage and death (Bault, Britton & Gilmore, 2018; Allard, Khan & Nevitt, 2014).

When providing opportunities for recovery, it is important that risk is managed in order to preserve the safety of the individual and others; balancing risk is an essential part of recovery, and professionals should be knowledgeable in when to avoid risk taking, and when to

take positive risks ().

Pabrinex

Councelling bereavement

ECS

It is important to remember, that recovery can only be achieved if the individual has

insight into their mental illness and is willing to engage with services in order to

receive the treatment they need to recover (Barker & Buchann-Barker, 2010).

Challenges

Overall discussion, summary and appraisal of nursing assessment of need

Conclusion

It is clean that recovery is a process that must be tailored and individualized to each service users needs and requirements (Bauer, Belanger, Ellison, Evans & Niles, 2018), and that it should be based on giving the service user hope and empowerment (Royal College of Psychiatry, 2010). Numerous recovery models can be followed; therefore it’s essential the nurse utilise a holistic and person centred approach when providing care, so that they can use the recovery model most effective to their needs in order to achieve their end goal (Slade, Stickley & Wright, 2018). When working with individuals with complex needs and co-occurring health needs there will always be barriers that can come in the way of recovery (Beeckman, Debyser, Joeri, Vandecasteele, Van Hecke & Vandewalle, 2016), however with the appropriate skills and knowledge including support from the MDT,  the recovery can be successful and these barriers would be overcome (Jarden, Oades & Slade, 2017).

This assignment has taught me that by utilising evidence-based practice and taking a holistic and person centred approach when caring for an individual, that a successful recovery is possible, and that a service user like Nigel could rebuild his life, and that despite his previous struggles with alcohol dependence and social isolation, Nigel could go on to have a fulfilling life.

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