The Nursing Process Seminar PDF

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Knowledge and activities about the nursing proccess...

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Week 8 Seminar Notes: The Nursing Process This session about the Nursing Process is designed to build on, and support you to progress your learning from, previous learning activities. The focus is on the first part of the Nursing Process (Assessment, Planning, Implementation and Evaluation: APIE) in the context of holistic mental health nursing. The Learning Objectives for this session are to:    

Build on previous learning and promote an understanding of the nursing process (APIE) in mental healthcare, with a focus on assessment Consider the philosophy which underpins contemporary mental health assessment Explore mental health care assessment Introduce the Care Programme Approach (CPA)

Assessment in mental health care Contemporary approaches to people’s assessment within mental health settings are collaborative and take a holistic approach. As you have been exploring in your Facilitating Health and Wellbeing module a biopsychosocial approach will involve gaining information to support the assessor to judge a person’s state of health and social factors: ‘determinants of health’ The purpose and intended outcome will guide the assessment and the ‘National Institute for Health and Care Excellence (NICE) provides clinical guidelines to support service users, carers and clinicians, in care and treatment planning for all diagnostic categories of mental disorder, such as depression, anxiety, bipolar disorder and schizophrenia’ (Evans and Hannigan 2016: 8). Activity One: Access the NICE website: https://www.nice.org.uk/ and search for evidence-based guidelines relevant to your mental health nursing practice. Identify the section of at least one guideline that focuses on carrying out an evidence-based assessment.

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Mental health problems in people with learning disabilities: prevention, assessment and management: NICE guideline [NG54] o

Mental Health assessment

Philosophies and frameworks which inform mental health assessment   

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Demonstration of NHS values (6 Cs) o Care, compassion, courage, commitment, competence and communication Collaboration with the person being assessed Holistic philosophy and bio-psychosocial approach to care o The biopsychosocial model is a modern humanistic and holistic view of the human being in health sciences o Humanistic approach o Does not consider the spiritual dimension Underpinning recovery philosophy with an emphasis on strengths and protective factors 1

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Effective self-management, self-awareness and understanding of professional boundaries Understanding of unconscious bias o Behaviours and attitudes that we are unaware of Unconditional Positive Regard o Carl Rogers: Humanistic psychology o The basic acceptance and support of a person regardless of what the person says or does, especially in the context of client-centred therapy. REG: Respect Empathy and Genuineness (Rogerian approach) o Counsellor attributes – learning how to be genuine – having 3 main attributes. These include empathetic understanding, genuineness, and congruence Models of Communication used in interviews/conversations e.g. Ideas Concerns Expectations approach The Care Programme Approach (CPA): a framework for mental health care delivery Different elements of assessment: history taking, needs and risk assessment

Activity Two: Choose two points from the previous list which grab your interest. Please look into these more and make some brief notes about what you find in the box below The philosophies and frameworks which underpinning mental health nursing assessment, initial thoughts: Recovery Philosophy

Unconditional Positive Regard

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Positive psychology

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Safety planning forms a significant part of everyday practice (Downes et al 2016: prevention and prediction of violent episodes

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Protective factors: Any characteristic of a person, their environment situation which reduces the risk of violence (De Vries Robbe et al 2012)

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Interesting knowing the impact that another person’s subtle behaviour can have

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Basic needs as a child to have positive regard and self worth: SW is a continuum and is influenced by positive regard.

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“Parents, significant others (and the humanist therapist) accepts and loves the person for what he or she is. Positive regard is not withdrawn if the person does something wrong or makes a mistake”

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Has no conditions of worth: doesn’t need to behave as a child to be loved

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A number of aspects to consider before commencing a mental health assessments include:        

What the purpose of the assessment is Equality and diversity How the nature of the person’s mental illness/mental health needs impact on the assessment process The stage of the life-course of the person How this assessment will link with other parts of the nursing process Whether expectations about the purpose of the assessment exist The service context/setting Boundaries

Would you add anything else to this list? Activity Three: in the box below list methods/approaches which you think that you might use to go about completing a nursing assessment, this may include the skills involved or any tools you think that you might use. These ideas might be new to you, or build on your previous experience and both are completely expected at this point in your learning on your programme. Methods of assessment

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Observations: taking physical and tangible data such as weight, height, HR, BP, pulse oximetry Head to toe assessment ABCE assessment tool Nutritional MUST tool Risk assessments Wellbeing: check for mood, habits and outcomes, medical history Therapeutic communication to establish rapport – ICE/APIE Neurological assessment: consciousness (Glasgow Coma Scale), pupil size and reaction to light

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Depression: family history, screening questionnaire

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Drug and alcohol: screening

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Bipolar: STABLE resources

You may have thought about observations, interpersonal skills, skills involved in keeping records, measurements, interview schedules, use of diaries, logs and personal records, questionnaires, rating scales and conversations. As mentioned before, these ideas might be new to you, or build on your previous experience and both are completely expected at this point in your learning on your programme. It can be useful to think about two stages of assessment: data collection and data interpretation Observation as an important part of mental health assessment: Your observations will include a person’s 3

Appearance and Behaviour Communication Disorder Environment A, B, C, D, E approach to the thinking through mental health nursing assessment Interviews: The scope of initial mental health assessment interview is likely to include:        

Presenting needs and the history of these Past mental health history Physical health/medical history Personal and family history Current and previous treatment including medication Substance use history (alcohol/Drugs) Forensic history Pre-morbid personality

Mental State Examination (MSE) involves consideration of a person’s           

Appearance and behaviour Speech Mood Anxiety Sleep Appetite Motivation Cognitions Thoughts Perceptions Insight

Activity Four What do you think might be the potential strengths and the potential limitations of using assessment methods including assessment tools. The box below is for your thoughts, there are no right or wrong answers this activity just sets out to start you thinking about assessment. Strengths

Limitations

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Various behaviours and various mental states

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Does this cover unpredictability?

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Sleep/Appetite/Perceptions may help to examine the circumstances in which a patient Is in

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Does it cover what the norm is for that patient

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Doesn’t consider that it might be a chronic 4

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Snapshot of current emotions, thoughts and feelings

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Holistic care: uses the biopsychosocial model as it considers many aspects of an individuals health and wellbeing

condition, as it is only considering behaviour at the time of observation: what is behaviour fluctuates? Mania for example

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No family/friends/significant other involvement in planning

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Does this account for cultural considerations: Wakandhe article

The Care Programme Approach The Care Programme Approach is a national strategic approach to mental healthcare delivery which involves: 1. Systematic arrangements (a framework) for assessing the health and social needs of people accepted into specialist mental health services. 2. The collaborative formation of a care plan which identifies the health and social care required from a variety of providers: • strengths, • goals, • support needs, and • difficulties. All care plans must include a crisis plan. 3. The appointment of a care co-ordinator to keep in close touch with the service user, and to monitor and co-ordinate care. 4. Regular reviews, and where necessary agreed changes to the care plan. (Rethink 2019) 5

Activity Five: Next make a list of what you consider to be the most important attitudes, skills and knowledge involved in carrying out a mental health care assessment? Attitudes

Skills

Knowledge

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Non judgemental

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Critical thinking

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About specific conditions

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Open minded

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Ability to implement person centred care

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Not easily offended

What can trigger certain behaviours: i.e what could trigger a panic attack

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Objective toward diagnosis

of Mental Health Nursing, London: Sage Publications

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