HLST259 Mental Health Nursing : Principle Tenets
Question
1. Discusses the meaning of recovery in mental healthcare/ mental health nursing and identifies three (3) principle tenets. Supports answer by referencing literature and evidence, and writes in manner consistent with academic conventions.
Recovery in mental healthcare
The meaning of Recovery-oriented methods offers a transformative concrete framework for culture practice, and service delivery in mental health services. The lived experience and understandings of people living with mental health issues and their families are at the core of recovery-oriented culture. The notion of recovery was perceived by, and for, people with mental health issues to describe their experiences and journeys and to affirm personal identity beyond the constraints of their diagnoses. Recovery-oriented approaches recognise the value of this lived experience and bring it together with the expertise, knowledge and skills of mental health practitioners, many of whom have experienced mental health issues in their own lives or in their close relationships. Recovery approaches challenge traditional notions of professional power and expertise by helping to break down the conventional demarcation between consumers and staff. Within recovery paradigms all people are respected for the experience, expertise and strengths they contribute. Recovery-oriented approaches focus on the needs of the people who use services rather than on organisational priorities. Personal recovery—a definition there is no single definition or description of recovery. For the purposes of this framework, recovery is defined as ‘being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues’. Recovery-oriented mental health practice Recovery-oriented mental health practice refers to the application of sets of capabilities that support people to recognise and take responsibility for their own recovery and wellbeing and to define their goals, wishes and aspirations.
(The National framework for Recovery orientated mental health services 2013)
https://www.health.gov.au/internet/main/publishing.nsf/content/67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf
Recovery from mental illness is a process that involves personal decision-making in many areas. Nurses are in a unique position to assist individuals in assessing their personal health status and integrating health behaviours into their recovery plans. The use of assessment tools, motivational interviewing techniques, and recovery planning can help individuals make decisions about their health, try out new behaviours, and integrate healthy living behaviours into a recovery plan and activities. This role of the nurse in this process is outlined, strategies are described, and outcome examples are provided.
Issues in Mental Health Nursing
Volume 31, 2010 - Issue 8
https://www.tandfonline.com/doi/abs/10.3109/01612841003687316?journalCode=imhn20
Uniqueness of the individual
Recovery oriented mental health practice:
Recognises that recovery is not necessarily about cure but is about having opportunities for choices and living a meaningful, satisfying and purposeful life, and being a valued member of the community
Accepts that recovery outcomes are personal and unique for each individual and go beyond an exclusive health focus to include an emphasis on social inclusion and quality of life
Empowers individuals so they recognise that they are at the centre of the care they receive.
Real choices
Recovery oriented mental health practice:
Supports and empowers individuals to make their own choices about how they want to lead their lives and acknowledges choices need to be meaningful and creatively explored
Supports individuals to build on their strengths and take as much responsibility for their lives as they can
Ensures that there is a balance between duty of care and support for individuals to take positive risks and make the most of new opportunities.
Attitudes and rights
Recovery oriented mental health practice:
Involves listening to, learning from and acting upon communications from the individual and their carers about what is important to the individual
Promotes and protects an individual’s legal, citizenship and human rights
Supports individuals to maintain and develop social, recreational, occupational and vocational activities which are meaningful to them
Instils hope in an individual about their future and ability to live a meaningful life.
(Department of Health Principles of Recovery orientated mental health 2010)
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri
2. Discusses how recovery is applied in mental health nursing, and or mental healthcare in general
Promote collaborative relationships to foster understanding of each person’s strengths, wishes and opportunities.
- Respond to the strengths, preferences, concerns, needs, goals and values of individuals.
- Respond to the things, people, activities and roles that people identify as important to their wellbeing and recovery and minimise the impact of mental health care on these things.
- Promote decision making led by people with a mental illness, in accordance with each person’s values, needs, circumstances and resources.
- Demonstrate empathy and resourcefulness in communicating with and responding to people.
- Actively challenge stigmatising attitudes within the service and the broader community.
- Use people’s existing support networks.
- Use interventions that promote people’s personal agency, self-esteem and overall wellness.
- Use active listening and respond to people’s views, understandings of their experiences and advice on what they find helpful.
- Use person-centred and optimistic language that promotes hopefulness.
- Use practice that responds to gender, sexuality, culture, family and community.
Answer
1. Meaning of recovery in mental healthcare or mental health nursing and three principle tenets
While there exists no particular definition for recovery in the context of mental healthcare or mental health nursing, recovery is to be perceived as the ability to establish and live a contributing and meaningful life in the absence or presence of noted mental health concerns. The notion of recovery, in context of mental health, had been developed for the people, and by the people suffering from mental health conditions. The aim was to describe the experiences and perceptions of these individuals for affirming personal identity crossing the limitations set by the mental health diagnosis (health.gov.au 2013). In continuation, it is mentioned that recovery approach to mental health puts focus on the potential for achieving recuperation and revitalization from mental health concerns. Recovery is perceived as the process through which the personal journey of the individual is made better as indicated through a strong sense of self and a secured base. Moreover, recovery considers symptoms of mental health issues as the ‘continuum of the norm’ instead of an abnormality. Some of the noted features of recovery are that it is a personal unique journey; it is a fundamental human process; the process is non-linear; and it is an ongoing procedure.
According to Fortinash and Worret (2014) recovery oriented mental healthcar
e approaches ensure that a transformative conceptual framework is enabled for care delivery within the provision of health service. For ensuring the individuals are to undergo the process of recovery, the insights and lived experiences of the individuals suffering from mental health illness are to be placed at the center of the care culture. Recovery-oriented approaches delivered through the professionals are to appreciate the lived experiences that individuals have and apply their skills and knowledge for establishing close relationship with them. Further, approaches targeting recovery must break the barriers of traditional concepts and conventional demarcation existing between staff and consumers. The recovery paradigm entails that all individuals being given care are shown dignity and their privacy is respected in relation to the strengths they exhibit.
Recovery, when studies from the standpoint of an individual experiencing mental illness, means receiving and preserving hope, personal autonomy, knowledge of the disabilities and abilities, and social indentify. A person therefore develops a positive sense of self. Recovery is linked to both external conditions facilitating recovery and internal conditions that the person experiences, such a healing, hope and empowerment (Le Boutillie et al. 2015). According to Camman (2010) recovery in context of mental health care is to be referred to as the process involving personal decision making in diverse areas. It is noted that mental health nurses are in a position to provide assistance to patients for developing mental health on the basis of a thorough assessment. Individuals can be guided to engage in effective decision making in relation to integration of healthy behaviours through the utilization of motivational interviewing processes, varied assessment tools and recovery planning techniques.
Figure: The concept of recovery (health.gov.au 2013)
The Department of Health, Australian government, has outlined the principles of recovery oriented mental health practice. These principles have relevancy to the national standards and the applicability is across the comprehensive mental health service system that encompasses the non-governmental community mental health service sector. The principles of recovery-oriented practice are outlined for ensuring that service projection is in such a manner that promotes the recovery in an adequate way. The three principle tenets are uniqueness of individuals, real choices, and attitudes and rights.
As per the principle of ‘uniqueness of the individual’, recovery oriented mental health practice must recognize that the process of recovery is not all about how care is delivered. Rather, it must involve ensuring opportunities for choices given to individuals so that one can live a satisfying, purposeful and meaningful life, and develop the sense of being a valued member of the society. Further, it is to be accepted that each individual has unique recovery outcomes that goes beyond the focus given exclusively on health. Quality of life and social inclusion are also to be given attention in this regard. In addition, individuals are to be empowered to make them recognized as the center of care delivered. The principle of ‘real choices’ entails that recovery oriented mental health practice empowers and supports individuals suffering from mental health issues so that they can make their own life choices that are creative and meaningful. Practice must also support the person to build up their key strengths and abilities so that they can take up social responsibilities. The principle of ‘attitudes and rights’ mention that mental health practice must promote and protect the legal and human rights of an individual. The individuals are to eb supported for maintaining and developing recreational, social, vocational and occupational activities that bring in much meaning of lie to them. Hope is to be instilled in the mind of the individual regarding the chances of leading a meaningful life in the future (health.gov.au 2010).
2. Application of recovery in mental health nursing, and or mental healthcare in general
Recovery oriented mental health services, in general, or as applied to mental health nursing focuses on delivery of evidence-based therapy, treatment, psychosocial and rehabilitation support aiming to achieve the required outcomes for individual in relation to physical and mental wellbeing. Recovery is achieved for people with mental health illness when services are considerate of the needs of the people and their aspirations. Further, recovery is successful when people are provided with a safe and secured environment. In mental health nursing, recovery is a commitment and visions that professional from all levels of the organization share. The vision must be sustained through resources and diverse workforce including people with greater expertise and skills (Gunasekara et al. 2014). Services targeting recovery considers the fact that individuals who suffer from unresolved and distinct trauma struggle are provided with a safe environment. Professionals are to acknowledge the main principles of stress and trauma such as choice, safety, empowerment and trustworthiness. In addition, services are to acknowledge and respond to the varying needs put forward by individuals of different beliefs, culture and values. Systems perspectives of identity are crucial for ensuring recovery in individuals. By advocating for the human rights and social inclusion, individuals with mental health issues are guided towards recovery. Services that challenge the prevailing stigmatizing attitudes also foster recovery (Townsend and Morgan 2017).
Fortinas and Worret (2014) opined that mental health nurses can ensure that patients recover from the their present situation by helping the individuals recognize the needful combination of treatments, services and supports for removing barriers and challenges to participation in community life. Encouragement for taking part in education and work underpins the process through which a mental health nurse achieves recovery for the person cared for. In this regard Parker et al. (2017) mentioned that mental health nurses promote collaborative relationships with clients for fostering a healthy and collaborative relationship. Such a relationship is also elementary for understanding the opportunities, and wishes of the individuals. While delivering care, mental health nurses provide an appropriate response to the concerns, needs, preferences, strengths and values of the clients.
From the paper of Kidd, Kenny and McKinstry (2015) it is understood that mental health nurses caring for individuals with mental health issues are to aim at achieving recovery while responding to the activities and things people perceive to be as significant in their lives. Further, nurses are to promote effective decision making as per the needs and values of the individuals. Demonstrating resourcefulness and empathy also go a long way in establishing an effective therapeutic communication between the care provider and the patient that is crucial for recovery of the person. In this regard it is to be mentioned that using the support networks patients have, service providers can integrate maximal care provision. Mental health nurses and other professionals are entailed to use intervention promoting the self-esteem, wellness and personal agency of the individuals.
A person centered approach also goes a long way in promoting hopefulness and instilling a sense of hope in the individual, two most important elements of recovery. For example, when a nurse acknowledges the sexuality, gender, culture and ethnicity of the person, a strong therapeutic relationship is build that is supportive of recovery. A therapeutic relationship between the patient and the professional is to be perceived as the helping relationship that is based primarily on respect and mutual trust. Such a relationship nurtures hope and faith while being sensitive to the requirements of the patient. Assistance provided with gratification to the spiritual, emotional and physical needs through skills is crucial. The caring relationship is effective when both the patient and the professional give their best efforts, leading to healing and remedy. Further, effective forms of communication are needed as a component of care delivered with the prime motto of recovery. These are both verbal and non verbal modes of communication. On the whole, recovery is applied in mental healthcare context when the service delivery embraces the possibility of wellbeing indicated by the capacity and strength of those experiencing mental health issues (Pullen and Mathias 2014).
References
Camann, M.A., 2010. The psychiatric nurse's role in application of recovery and decision-making models to integrate health behaviors in the recovery process. Issues in Mental Health Nursing, 31(8), pp.532-536.
Fortinash, K.M. and Worret, P.A.H., 2014. Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.
Gunasekara, I., Pentland, T., Rodgers, T. and Patterson, S., 2014. What makes an excellent mental health nurse? A pragmatic inquiry initiated and conducted by people with lived experience of service use. International Journal of Mental Health Nursing, 23(2), pp.101-109.
Health.gov.au. 2018. A national framework for recovery-oriented mental health services. [online] Available at: https://www.health.gov.au/internet/main/publishing.nsf/content/67D17065514CF8E8CA257C1D00017A90/$File/recovgde.pdf [Accessed 29 Aug. 2018].
Health.gov.au. 2018. Principles of recovery oriented mental health practice. [online] Available at: https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri [Accessed 29 Aug. 2018].
Kidd, S., Kenny, A. and McKinstry, C., 2015. The meaning of recovery in a regional mental health service: an action research study. Journal of Advanced Nursing, 71(1), pp.181-192.
Le Boutillier, C., Chevalier, A., Lawrence, V., Leamy, M., Bird, V.J., Macpherson, R., Williams, J. and Slade, M., 2015. Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implementation Science, 10(1), p.87.
Parker, S., Dark, F., Newman, E., Korman, N., Rasmussen, Z. and Meurk, C., 2017. Reality of working in a community?based, recovery?oriented mental health rehabilitation unit: A pragmatic grounded theory analysis. International journal of mental health nursing, 26(4), pp.355-365.
Pullen Jr, R.L. and Mathias, T., 2010. Fostering therapeutic nurse-patient relationships. Nursing made easy, 3(4), p.4.
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