Improving Recovery in Acute Mental Health Ward - Essay Example

Can Focussing On The Individual Service Users’ Needs And Personalising Their Care Plans Improve Recovery In Acute Mental Health Ward? Course Title Instructor Educational Institute Date Can focussing on the individual service users’ needs and personalising their care plans improve recovery on acute mental health ward? Nursing care plans are vital to the standards of nursing care service delivery and interventions that are undertaken by nurses in any health care setting (Bjorvell et al., 2003). Research suggests that nursing care plans are supposed to be specific to the service user (Tunmore et al., 2000). These plans should be developed in collaboration with the service user. Care plans should also contain details of intervention that are to be provided to help the individual service user during their recovery from their mental health issues (Tunmore et al., 2000; CQC, 2010). Hall et al. suggests that individualized and nursing care plans should be developed and these plans are ways of improving service user recovery (Hall et al., 2013). Despite care plans being an important tool in delivering health care services, the health care professionals often misunderstand them and the administration treats them as an extra task (Norman et al., 2009). According to Norman et al. (2009) during practice challenges occur during the implementation of care plan that is focused and personalized in compliance with individual service user needs. For example a service user may be acutely ill at the time of admission. During admission, it may be hard for the nurses to initiate individualized care because the service user may not be in the right mental state and may not be able to provide insight for the development of his/her care plan. Furthermore, the environment of acute mental health settings is very busy, there is lack of staff and unforeseen events might occur. This environment may negatively impact therapeutic engagement with service users and may even hamper individualized care planning with (Cleary et al., 2012). This essay examines the evidence that supports/reflects best practice in respect to care planning in acute setting and this essay focuses on devising a strategy for introducing best practice. The strategy will be developed while consideration factors those are likely to assist and hinder the implementation of evidence-based practice. According to a report published by Department of Health (2011) nursing care plans are central components of nursing services that are delivered to the service users. Research suggests that in developing and planning care plans for service users, nurses should adopt the provision of individualized care that is personalized to the needs of the user (Department of Health, 2011). According to Butterworth (2012), the focus of this approach is to involve service users and see things from their perspective rather than from the perspective of healthcare professional. Focus should even be on working with them instead of not involving them. This would make the service users as active participants instead of passive ones. In addition to person centred care planning, recovery approach is another model of working in the area of mental health. This model is widely accepted in the UK and worldwide. Recovery approach was introduced because there was a need of listening to service users regarding their experience while they cope with mental illness. This helped them in living a meaningful life despite the presence of symptoms (Slade, 2009). This approach is more of a philosophy for practice which should focuses on service user’s strength, it instils hope, promotes recovery, and lead to collaboration of service users in treatment for their illnesses. This model promotes the partnership between service users and carers during the development of effective care plans (Lloyd, 2012). Butterworth (2012) suggested that when developing care plans there should be written evidence of involvement of service users and explanation of how it was accomplished. The service users need to receive a copy of the care plans after they have participated in its development. The care plan should contain the service users views and what they would wish to receive as part of their care and should be encouraged to sign the plan (Norman et al., 2009; Mshultz et al., 2013; Tunmore et. al., 2000). When service users are encouraged to participate and are at the centre of developing nursing care and treatment, they feel empowered and this supports them through the recovery process (Department of Health, 2011). Morton and Morgan (2010) states that while supporting individual service users who have long term conditions, the collaborative approaches in goal setting, problem-solving, planning, negotiation and shared decision making is encouraged with the service user. Research suggests that individualizing nursing care using care plans empowers the service users and makes them feel that they are in control of their care and treatment. This promotes confidence in the recovery process and therefore becomes a vital point in delivering high-quality services (Department of Health, 2011; Practice Nurse Report, 2011). Furthermore, Practice Nurse Report (2012) suggested that the use of care plans allows service users in making decisions regarding how they should be treated in partnership with the health care professionals who offer support and care to them. A comprehensive care plan helps in early detection and identification of risk and problems that might develop. This helps in creating approaches and early interventions before the service user experience problems that would affect their recovery (CQC, 2010). Individualized nursing care helps the nurses in planning and evaluating service user outcomes basing on the individual needs of the service user. Different service users have different needs depending on their condition (Suhonen et al., 2010). Therefore, individualized service user care plans help the service user in being cared for in the right manner. Due to this, they receive the best care and treatment that aims at making the service user comfortable and recover well from an illness (Department of Health, 2011). Narco published a report that suggests that collaborative discussion between nurses and service users in regards to their care planning and jointly reviewing their care package is a principle that is strongly argued in mental health policy (Narco, 2008). The report suggested that it is also important for service users’ recovery. According to this report, involving service users in their care planning is particularly important for those that are detained as per the Mental Health Act. Service user involvement is even promoted for informal service users who are not under any legal obligation to comply with their care and treatment. Focussing on the individual service users’ needs and personalising their care plans is further supported by the Care Quality Commission’s Essential Standards for Quality and Safety (CQC, 2009). CQC strongly argued that service users should receive ‘personalised care treatment and support’ that would promote the health, happiness and safety of individual service users (CQC, 2009). Personalised care planning in mental health care settings has been effective in relation to improving recovery and service user outcomes. Heavy emphasis has been made on personalise care plans and focus on individual needs. Still, the implementation can become quite difficult in acute mental health settings (Larson et al., 2011; Cleary et al., 1999). Care Quality Commission (2010) found that in psychiatric hospitals care planning was mostly carried out on a medical model. According to their report, there was not enough involvement of service users and carers in care planning. Lloyd (2012) argued that the traditional medical model assumes that doctors know best and this model recognizes as passive recipient of care. Department of Health (2011) stated “Successful personalised care planning needs to be developed with individuals, not done to them. It requires you to adopt a different role to the traditional “diagnose and treat” The healthcare professional’s role is to support individuals to acknowledge, understand and adapt to living with their condition” (Department Of Health, 2011, p3). Every service user needs care that is directed towards his or her needs, but this does not happen most of the times in acute mental health settings (Anthony et al., 2000). This could be because nurses have limited time to sit down together with the service users to plan for their care (Cleary et al., 1999). One of the main criticisms of mental health nurses in acute wards is that they are not spending enough time with service users to establish therapeutic relationship with them (Thibeault et al., 2006; Gijbels, 1995). Perhaps with the amount of work, which nurses are expected to accomplish by the end of every shift, the time they need to spend with the service user to develop individualized care plan becomes a challenge for them (Anthony et. al. 2000). The ratio of nurse to the service users is quite high and every nurse is expected to work harder in every shift so that every service user can be attended to (Tyson et al., 1995). This is a big challenge to nursing care plan development (Anthony et al., 2000). Furthermore, working in acute mental health wards is quite demanding because there is often lack of staffing and there are unforeseen events. For example nurses may have to deal with potentially aggressive as well as suicidal service users on a daily basis (Jenkins et al., 2004). All these factors can affect nurse-service user interaction (Cleary et al., 1999). Lloyd (2012) argued that very few healthcare professionals would suggest that there is no requirement for service users to be involved in care planning. In practice sometimes this involvement can be deemed as unsafe, unethical and unpractical. This is especially relevant to acute care where service users may be quite unwell and unable to make decision about their care. This is especially true for those who are detained in hospitals under the Mental Health Act. At times users’ involvement even does not take place because they are unwilling to be in hospital or lack insight into their mental state. Lloyd (2012) further suggested that it is very important for professionals to be familiar with the Mental Capacity Act 2005 guidance. This would be important “for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves” (Department for Constitutional Affairs 2007, p15). Even in circumstances where service users are considered to lack insight into their mental state, practitioners should work on building therapeutic relationship with them. They should not be denied with the opportunity to be involved in their care (Lloyd, 2012). Butterworth (2012) there should be documentation of instances when service users are either unable or unwilling to discuss their care plans with nurses. These challenges in acute settings can be addressed through several ways that are aimed at creating an environment that facilitates quick recovery of service users and promotes their participation in their care planning. As previously discussed, working in acute setting can be challenging but also rewarding. Nurses working in such busy settings come across quite unwell service users that are not necessarily willing or are unable to participate in care planning. This can be quite challenging and may require good communication as well as organisational skills on part of healthcare professionals (Lloyd, 2012). Lloyd (2012) suggested that it would require holistic view of the service user from both service user perspective as well as healthcare professionals’ perspective. According to Lloyd (2012) one way of overcoming difficulties in acute mental care settings is to have multidisciplinary (MDT) discussion regarding service user care as well as involving family members/carers and significant others in care planning. Good communication between MDT members would ensure that service user progress, needs and wants are taken into consideration when devising care plans. This will even lead to the reduction in pressure experienced by the service providers. Similarly, family member and carers are good source of information as they know service users well and can contribute to care planning. Mitchell et al., (2004) argued that family members should be included in care planning as their support can often help service user recovery. They could give their perspective in terms of service users’ recovery and management of mental illness. When devising a strategy for best practice in care planning a training package should be introduced in acute settings for nurses to appreciate the importance of the use of nursing care plans. This training package should include details regarding development of treatment plans and how to overcome barriers to best practices. It is through training that nurses will become equipped with knowledge on how the tools should be applied. The training package should also include information regarding its importance for nurse and the service user. This is in line with Nursing and Midwifery Advisory Committee (1994) recommendation. The committee recommends that more training should be provided for staff working in acute mental health settings to improve their skills and to promote evidence based health care and service user involvement. Nurses should be reminded of the importance of involving service users in care planning and the skills required. Skills include effective communication in identifying service user’s needs. They should also receive a training pack on how to complete care plans that should be developed with the involvement of service users (Butterworth, 2012). Various knowledge, skills and attitudes (KSAs) are required for the development of personalized care plans. These KSAs do not only help in the development of a care plan but also promotes best practice and even help in increasing involvement of service users as well as their family members/carers in planning and delivery of care and treatment (Cardwell et al., 2011). Research suggests that when service users cannot participate in care planning, family members can provide good information regarding their condition. Family members have a great role to play towards the recovery of the service user (Hall et. al. 2013). Care plan is not only designed to address individual needs but it is also a legal document that makes people accountable for the care plans and this is one more reason why improvements in care planning is needed (NMC, 2008). According to Stark (1992), the use of primary nurse system in mental health is effective way of delivering care as well as care planning. In settings where primary nurses are allocated to service users, the system would ensure continuity of care and will facilitate development of good therapeutic relationship with service users. Stark (1992) argued that regular meetings to discuss care plans will be a good way of receiving feedback and support from other healthcare professionals. When providing training to nurses it is important to inform primary nurses about the role they play in service user recovery. Their engagement should be reinforced and used as a forum to make improvements in care planning. Furthermore, nurses should use multidisciplinary meetings and team members should discuss their service user care plans and progress made in hospital to ensure consistency and collaboration with other team members. In circumstances where nurses lack motivation due to barriers identified in acute settings, team working and collaboration becomes especially important (Lloyd, 2012). Support from senior nursing staff is crucial especially taking into consideration that there are many obstacles in acute mental health wards when it comes to care planning. These issues include limited time to spend with service users, heavy workloads as well as shortage in staffing and all these issues are to be managed by (Anthony et. al., 2000). According to Anthony et al., (2000), it would be useful if the senior management acknowledges that involving patients in their care planning requires time as well as commitment from nursing staff. For nurses to provide information to their service users and to identify their needs and ways to support them appropriately requires organisational support and commitment. It is very important that commitment from organisation is reflected through adequate staffing levels and sharing of appropriate resources that would help to improve care planning in acute settings. For example, Patterson (2011) suggested that reducing nurse service-user ratio would help nurses taking care of the service users and will not feel overburdened with work. This will ensure that they have time to discuss with the service users regarding their care and treatment. This would make nurses realise that working in collaboration with service users will enhance their service delivery. The nurses will have time to engage with their service users and discuss their care and treatment (Cleary et. al. 1999). Linton and Prasun (2013) argued for the need of educational/training intervention for nurses in clinical settings in order to implement evidence-based practice in their work. According to these researchers, nurses increasing knowledge and encouragement to obtain and implement best practice would improve service user outcome as well as nurses recovery. The aim of training for nurses should be to provide them with necessary knowledge and skills to use best practice when planning care for their service users. Providing information and training to staff is a good way of promoting good practice. Role modelling can also be a helpful way to train nursing staff (Linton et al., 2013). Linton et al., (2013) suggested that role modelling can be powerful as it helps nurses adopt the practice which is being modelled and valued in settings in which they work. Focussing on service user individual needs and personalizing their care plans seems straightforward and represents best practice that can improve recovery. But, in practice nurses working in acute wards face many difficulties as stated in this writing. At times, it might be difficult for service users to participate in care planning due to their current mental state and similarly busy nature of acute wards. Other factors can prevent involvement of service users in development of their care plan. It is through training and role modelling nurses could be better equipped do address this obstacles (Norman et al., 2009, Cleary et al., 1999). This writing examined the evidence base that supports best practice in care planning in acute wards taking into consideration factors that might support as well as hinder implementation of best practice in such settings. Focussing on individual service user needs and personalizing their care plans can increase the pace of the process of recovery in case of mental illness. Service user’s involvement in care plans empowers them to take active role and puts them in the centre of service delivery. By encouraging service users to participate in care planning and developing care plans with them improves their treatment outcome and recovery. Research has shown that this would instil hope, promote happiness and safety of individual service users (Kings Fund, 2010). More and more emphasis has been put on individual needs in the development of personalized care for service users in the case of mental health care by NHS. However, this behaviour is still not being fully implemented in some settings where nurses encounter many barriers in their everyday practice. Therefore in order to introduce best practice and improve care planning in acute wards training should be introduced in such settings to inform nurses regarding the importance of improving their care planning skills and knowledge. Trainings will also educate them regarding the need for personalized care plans and the importance of such care plans for the achievement of best results. Care plans are equally important to service user as well as the organisation as a whole because it helps promote best practice and ensure delivery of high quality of care (Lloyd, 2012). Apart from training nurses and providing them with practical support, it is also important to emphasise the need for establishing a good relationship with their service user in order to develop trust and make them feel safe (Schultz et al., 2009). Service users that have good relationship with their health care professionals are more likely to achieve better results and engage in care planning with them. Furthermore, writing care plans in collaboration with the aim of focusing on individual needs is a very good way of assessing services users’ need as well as evaluating effectiveness of care and treatment provided to them. This essay depicts evidence that although implementation of best practice in acute wards can be challenging, it is not impossible as there a ways of overcoming these challenges. The best way to ensure an effective process of implementing personalized care plans is to identify areas of challenges in particular acute setting and inform the nurses about how challenges can be eradicated. Acute wards should show commitment and assign time to train the nurses on how to use the nursing care tool to achieve best results. Doing this will ensure maximum input from service user and will improve the quality of health as well as their recovery from mental illness. 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