being-professional-nurse Final Notes (1)

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Apr 3, 2024

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lOMoARcPSD|10182024 WEEK 2 MODULE 2 – MODELS OF CARE New care and mental health models have been developed over the last 30 years. They put the consumer at the centre of their journey of recovery. Sometimes as mental health professionals, we believe that we are central to the consumer’s treatment and care; however, so much happens outside of the health service that expects how a consumer will recover from their illness and continue to live rich and fulfilling lives as mental health professionals we act as support for the consumers and help facilitate the choices consumers may make in their recovery. This is a radical change from past mental health practices, which the biomedical model dominated. This was a deficit in the base model that based treatment decisions on symptoms observed in consumers by professionals, usually with pharmacological approaches. The professional was viewed as the expert, and the consumer was expected to do what the professional said without question. This created an unequal power balance where the consumer did not have control over their recovery because the professional knew what was best for them. The new models of care take a very different approach now; the consumer is at the centre of care and works in partnership with a professional the consumer is viewed as the expert in their illness. The professional takes a holistic approach to the needs of the consumer assessing all their needs, such as her physical, emotional financial and spiritual needs, and develops a plan of care with the consumer. The professional then supports the consumer to implement that plan by regularly reviewing the plan and reassessing the program as a consumer needs change. In this module, we will be discussing the recovery model of care that informs our current mental health practice in New South Wales Health. We will also be discussing how the Stress Vulnerability Model provides a theoretical framework for understanding how a person may be more vulnerable to the development of mental illness and the factors that may lead to the development of a mental illness, and finally we will look at trauma-informed care, which is a concept closely related to the recovery model that helps mental health and healthcare professionals understand how to respond if a person is experiencing trauma. Each of these concepts informs current care philosophies and needs to be taken into consideration when working with consumers to understand each of these models and how these models of care impact the consumer’s mental health journey. Each of these care philosophies informs how mental health nurses work with consumers. The first philosophy of engagement refers to the development of a relationship. In a therapeutic relationship, it is essential to consider many factors when assessing a person in a mental health setting. These include ensuring that the environment where the assessment 1

lOMoARcPSD|10182024 takes place is appropriate. The environment needs to be private promoting confidentiality and that the consumer understands how the assessment will occur and that the consumer in their family or their significant others in our present consent to the assessment taking place. The nurse needs to make sure that they use their verbal and nonverbal communication skills to ensure that the consumer feels listened to and understood. Client or consumer-centred care says that a consumer is an expert in their illness and should be at the centre of care. This effectively means that the consumer collaborates with the mental health professionals to develop their client’s care plan. The nurse needs to consider what the consumer judges most important in their recovery plan. Recovery is a model that is currently used in New South Wales health. It is a model that fosters hope empowerment inclusion recognising that the person is unique and therefore requires an individual care plan. There will be more on the recovery model later in this presentation family and carers are integral to the consumers’ recovery. They should be involved in the person's care plan as much as possible. Of course, this may require the consumer’s consent, and if the consumer becomes distressed when in the company of family or their carers, their involvement should be reconsidered. Early intervention is crucial as it promotes better health outcomes to ensure that consumers receive the best care as soon as possible any concerns a consumer may have should be taken seriously and assessed. Anyone experiencing a mental illness and their family and carers must be given appropriate psycho-education to understand what is happening to them. This will enable a person to receive culturally appropriate care. Many cultures see mental illness differently, and it is essential to assess the person from a cultural point of view; this includes anyone who identifies as an Aboriginal or Torres Strait Islander, coming from or living in a rural or remote location or someone who is culturally and linguistically diverse backgrounds. We also need to consider anyone coming from a refugee background, all these different cultural groups may have experienced trauma, and the effects of trauma are discussed later in this presentation. The final principle will also be discussed in Module 3 when we examine legal and ethical aspects of mental health. Still, this principle ensures that care that the care consumers receive is in the least restrictive environment that keeps them safe. This could be care in the community with family and carer support or in an inpatient unit mental unit or mental health unit. Sometimes, for the consumer’s well-being and safety, they must be admitted to a mental health facility under the Mental Health Act. In these circumstances, the consumer’s autonomy needs to be considered, and they should be only kept in a restrictive environment for as long as necessary. All these principles are integral to the recovery model that will be addressed in this presentation and are necessary to consider when any plan of care is being discussed with a person who is experiencing mental illness. Each of these philosophies needs to be considered when a health professional is responding to a person who has experienced trauma. Now we will examine the recovery model in more detail, and this slide should be considered in conjunction with your weekly reading about the recovery model in the current context of care in Australia, New Zealand and many other countries worldwide. This model has been 2

lOMoARcPSD|10182024 driven by mental health consumers and is essentially about protecting their human rights. Its goal is to ensure that everyone experiencing a mental illness can live a fulfilling and rewarding life. This slide shows the basic principles of recovery. The first principle is that recovery is a journey of healing that is personal to each individual. This means that the consumer is the expert in their experience of mental ill-health as mental health or health care professionals, we act as facilitators who support and promote the person's self-directed recovery journey; therefore, decisions about what the consumer needs are made in collaboration with a professional working in partnership with the consumer the professional is there to promote the individual's self-growth. The second principle is that the individual is a valued participant in the community. This socially inclusive principle means that an individual is no longer defined by the illness but by their role within the community, including being a worker, a parent, a student or a citizen. You can include any description the individual decides that demonstrates their contribution to the community this has. This directly impacts the length of the language we use as professionals, as discussed in the first module. We must ensure our language does not find consumers by their illness. The third principle of recovery is that the individual has the autonomy for their own lives and can make their own decisions as professionals; we need to respect that the individual is an expert in the illness and that we will report their findings. Finally, the fourth principle is always to ensure that the individual has hope and knows that they will recover from this experience of illness and live a satisfying life, although there are times when we need to make decisions that will keep an individual safe. The next model will examine how that is done ethically and legally. 3

lOMoARcPSD|10182024 These are the ten components of recovery that guide mental health and health care professionals when caring for an individual with a mental illness. These components support professionals in creating a partnership with the consumer. The professional is a facilitator who empowers consumers to develop their person-centred plans based on their own holistic needs. The components demonstrate there is no one way to recover from mental illness and that a consumer begins their journey, they find that it is nonlinear, that is, there will be occasional setbacks, but they should be reviewed as learning experiences. From these points of view, recovery can be seen as strength-based. Focusing on what an individual can do rather than their symptoms of illness. It helps individuals explore their capabilities, talents and coping skills because they are seen as worthwhile people. This enables the individual to take responsibility for their recovery and self-care. However, individuals need to be supported on this journey by being shown respect by professionals protecting their human rights and eliminating discrimination and stigma. They can find crucial support from those around them who have also experienced a mental illness and who may work in mental health services as a peer support worker. Perhaps the most crucial message of recovery is a message of hope that a person can live a better life and learn to overcome barriers that may confront them during their recovery journey. So these are the important nursing roles in the recovery model of care nurses empower individuals and their families or significant others by building positive therapeutic relationships with consumers. This involves developing a trusting relationship by using the 4

lOMoARcPSD|10182024 language of recovery as discussed in Module 1 for this therapeutic relationship, the nurse can assess the individual strengths, needs and goals and can also assess any risks to the safety of the individual once this assessment is completed an individualised plan of care can be developed that will include psycho-education support for carers and family members and significant others safety and crisis management, as well as medication management. It is also essential to ensure that the consumer is cared for in the right environment. The Stress Vulnerability Model is a theoretical framework that assists us in understanding the development of mental illness from a holistic point of view. This framework was developed in 1977 in reaction to prevailing thoughts that saw mental illness as a disease or a biomedical model. The biomedical model of mental illness concentrates on the person's condition examining signs and symptoms. The goal of care was to eradicate those signs and symptoms, usually via pharmaceutical methods. However, the Stress Vulnerability model attempted to look beyond these signs and symptoms and examine what was happening in a person's life and how their life events affected them and made them vulnerable to mental illness. Doing so enables health professionals to look beyond the signs and symptoms of the biomedical model to the stresses in a person's life. One example of a stressful life might be homelessness, and really no point in treating a person’s signs and symptoms of mental illness if you're not going to help them find accommodation. Therefore, care plans could now be developed that look beyond these life events considering what was happening to the person. The Stress Vulnerability Model is shown in this diagram. It is a theory that examines how an individual's vulnerability to mental illness can be triggered by stress everyone has at a particular point where they become vulnerable to the development of mental 5

lOMoARcPSD|10182024 illness is shown by the horizontal axis on this graph by the broken line labelled as a natural vulnerability level. This is a fixed line but varies in all individuals because some people are more vulnerable to mental illness than others. The vertical axis represents a person's level of strength throughout their lives. We experience low and high levels of stress. This is represented on the graph with the wavy line and shows how our stress levels change depending on what's happening in our lives. If the events in our lives cause us to feel a level of stress that passes through the vulnerability line, we become vulnerable to the development of mental illness. Such priorities in our lives include daily activities, such as getting to university or work and ensuring our children are at daycare. All those assessments have been completed on time. Such events may cause an increase in our levels of stress, and these may include the loss of someone close to us or suddenly feeling financially insecure, divorce, separation from family or immigration. Anytime a person experiences change can be stressful. You may wish to reflect on your stress levels when you started studying at university, and we need to remember that happy events can also be stressful. Getting married or having a child can be one of the most stressful events in a person's life other factors protect an individual from developing a mental illness. These include having a supportive family networking supportive family network and being able to understand their experience of mental illness so that they can identify symptoms if they return in the future, not taking drugs and alcohol not taking alcohol or other substance in a harmful manner and taking any medication that has been prescribed for their illness and finally being employed or having a daily life purpose such as volunteering or caring for children or others can be a protective factor anything that gives an individual's life a meaning. Not having these protective factors can make a person more vulnerable to mental illness, including an individual who has experienced abuse as a child or is now isolated from family and friends. Someone who understands their mental illness or the symptoms may also experience some people who use alcohol or other substances in a harmful manner or 6

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