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Psychiatric nursing practice and the recovery model of care
Abstract
This article provides an overview of the national actions by key groups on recovery from psychiatric disability and how a shift is needed to transform health care service delivery in mental health. Fundamental components of recovery are outlined, and examples are provided from the literature in nursing and related disciplines that reflect similar research and evidence-based practice interventions. It is recommended that professional nursing include consumers as active participants in the design of evidence-based practices in all settings.
... More recently, multinational bodies have added voice to the need for mental health reform that includes recovery-oriented approaches to service delivery (Pan American Health Organization, 2023;European Health Union, 2023) while treatment gaps in understudied regions of the world including Eastern Europe and Central Asia are gaining attention (Hook and Bogdanov, 2021). Despite long-standing and emerging commitments to foster ROSC, inpatient mental health service providers continue to struggle in adopting recovery-oriented approaches in their day-to-day practice ( Caldwell et al., 2010;Hornick-Lurie et al., 2018;Matoba et al., 2023;McVanel-Viney et al., 2006;Nugent et al., 2017;Rickwood, 2004). Le Boutillier et al. (2011) point out that despite international calls for reform combined with a growing body of evidence within the research literature and first-person accounts espousing the need to transform mental health care delivery to include recovery-oriented approaches, the leap from ideology to practice remains an ongoing challenge in many health care organizations. ...
Patient care grounded in the principles of recovery is increasingly relevant in treating persons with mental illness. Although institutions embrace the concept, conveying recovery as an idea and its inherent principles into practice remains challenging in inpatient psychiatry. Through a pre and post-test, mixed methods design, this study explored staff understanding, perspectives, and attitudes toward recovery-oriented approaches before and after the implementation of a novel recovery program. Forty staff members from a tertiary-level psychiatric facility participated in the study over an eight- month intervention period. Relational security was used as an empirical proxy measure of therapeutic maturity indicative of recovery-oriented readiness. Self-report survey results indicated strong relational security practices in place prior to the intervention test phase, with reported improvements post-test. The qualitative assessment of staff understanding and attitudes toward strength-based care and positive risk-taking, two essential competencies of the recovery model, contradicted the survey findings, revealing a treatment model rooted in paternalism, risk-aversion, and deficit-driven care. The study highlights the entrenchment of the illness-based approach in institutional mental health care despite receptivity to recovery ideals. It also suggests that ordinal data from staff surveys, although informative, must be interpreted with caution. Institutions might benefit from a more fulsome qualitative exploration of culture, policy, and praxes when adopting recovery-oriented approaches into traditionally biomedical-driven care settings.
... Specifically, we were delighted to see that the findings of your study echoed that of our previous study (Lim et al., 2021), that mental health nurses are using recovery-focused care in acute inpatient units. While there seems to be a 'natural fit' for mental health nurses to use recovery-focused care given to their continuous presence in the consumers' recovery process (Caldwell et al., 2010;Santangelo et al., 2018), previous studies that have used traditional research methods and explored mental health nurses' beliefs, attitudes, knowledge and skills grappled with the evidence that they generated on how mental health nurses used recovery-focused care in acute mental health (Cleary et al., 2013;Hardy et al., 2022;Kidd et al., 2015;McKenna et al., 2014). This may be due to the uniqueness of every consumers' phases of mental illness when admitted to acute mental health units that required mental health nurses to use different approaches to contribute positively to the individual's recovery and to be actively engaged in the management of their illness (Lim et al., 2021). ...
... This research provides important insights into the uniqueness of each consumer's triggers for aggression many of which are not related to their presenting mental disorder. An increased understanding of the consumer's lived experience enables MHNs to implement therapeutic care to support the individual to cope with the negative feelings and thoughts, learn about their own strengths and weaknesses, and increase their ability to self-manage their personal triggers for aggression (Caldwell, Sclafani, Swarbrick, & Piren, 2010;Slade, 2013;Solomon, Sutton, & McKenna, 2021). ...
Available: http://hdl.handle.net/20.500.11937/88694
This hybrid thesis presents a two-phase sequential exploratory mixed methods research that explored mental health nurses’ and consumers’ beliefs of how recovery-focused care can be used to reduce aggression in the acute mental health settings. The thesis is comprised of traditional thesis chapters and five peer-reviewed publications. The findings of this research provide evidence-based knowledge for mental health nurses to understand how they can translate the use of recovery-focused care clinically to reduce aggression.
... These models operate on the premise that only consumers can understand the real experience and journey of being a consumer, therefore they are the key stakeholders in planning and discussions about care and so need to be active, valued and empowered throughout. Studies exploring strengths-based approaches have identified improvements in quality-of-life indicators, confidence, self-esteem, self-advocacy and self-care (Sclafani & Piren 2010). Strengths-based approaches focus unsurprisingly on strengths, abilities and empowerment-a shift from traditional problem-based care approaches, which largely ignore strengths and positive abilities that help fulfil wellbeing. ...
... There is initiative towards aligning mental health practitioners with peer workers using recovery-oriented frameworks to aid their working alliance (Caldwell, Sclafani, Swarbrick, & Piren, 2010). This alliance is supported by Australian Health Ministers' Advisory Council (2013). ...
Recovery-oriented practice (ROP) is being steadily adopted worldwide. The current research aimed to examine perspectives of clinicians about having people with lived experience of mental health working in service teams. The data was collected pre-implementation of ROP at a clinical mental health service. The method was a 14-item survey. The research design was mixed methods, and narrative and exploratory in nature. The present paper explores the quantitative and qualitative data from seven of the items in the survey. Participants were 203 multidisciplinary clinicians consisting of 142 females, 46 males. Fifteen did not specify their sex. Results showed that nearly 9 out of 10 clinicians were keen to have peer workers in their teams. Nine out of 10 believed peer workers’ add value to consumers’ mental health outcomes. There were mixed opinions about whether peer workers should have equal status in teams. Most clinicians did not think peer workers were a burden on the workforce. Around 3 in 10 clinicians did not believe peer workers would make their jobs easier. Most clinicians thought peer workers added value to their work. Qualitative responses reflected these data. This study concludes there is considerable hesitancy about the role of peer workers in the clinical mental health space. Clinicians do believe peer workers should be employed in their team but are not sure of the benefits and liabilities. The present paper is a second in a series presenting data from clinicians’ perspectives about ROP.
... Danışanın yaşam zorlukları ile mücadele etmesine, esnekliği inşa etmeye odaklanılmalıdır ve bakımın her aşamasındaki karar verme sürecinde hizmet alan kişiler ile işbirliği yapılması gerekmektedir. Sadece semptom yönetimine odaklanan bir bakım yetersiz olacaktır 5,15,16 . ...
İyileşme; bireylerin sağlık ve iyilik hallerini geliştirmek, kendi kendilerini idare edebilecekleri bir hayat yaşamak ve tam potansiyellerine ulaşmak için çabaladıkları bir değişim sürecidir. İyileşme kavramı için yapılan tanımlar; klinik iyileşme ve kişisel iyileşme üzerine bir ayırım yapılmasını zorunlu kılmıştır. Klinik iyileşme; ruh sağlığı çalışanları tarafından tanımı yapılan tıbbi modelin bir terimidir. Semptomların azalması ya da durması ve sosyal işlevselliğin düzeltilmesi, hastanın önceki sağlık durumuna geri dönmesi anlamına gelir ve biyomedikal görüşün bir yansımasıdır. Kişisel iyileşme ise bireyin
gelişim ve değişim sürecini ifade eden bir kavramdır. "İyileşme" kavramına duyulan ilgi giderek artmaktadır ve gelişmiş ülkeler kendi ruh sağlığı sistemlerini, iyileşme yönelimli uygulamaları ve hizmet yapılarını kapsayacak şekilde yeniden şekillendirmeye başlamışlardır. Bu makalede, biyomedikal görüşün benimsemiş olduğu klinik iyileşme yerine bir gelişim ve değişim sürecini ifade eden kişisel iyileşme kavramı üzerinde durulacaktır. Dünya alan yazın çalışmalarında iyileşme yönelimli yaklaşıma ilişkin sayısız yayın bulunmakla birlikte ülkemizde konu ile ilgili olarak gittikçe artmakta olan az sayıda yayına rastlanılmıştır. Bu makalede iyileşme odaklı yaklaşımın tarihsel sürecinden, iyileşme kavramının tanımından ve iyileşmeye rehberlik eden ilkelerden, iyileşme modellerinden, iyileşme yönelimli yaklaşımı temel alan bazı kılavuz ilkelerden, iyileşme odaklı yaklaşım ile ilgili dünyadan araştırma örneklerinden ve ülkemizdeki durumdan söz edilecektir. Derlemenin ülkemizde de bu hizmetlerin planlanması ve yürütülmesi açısından yol gösterici olmasına katkı sağlaması umulmaktadır. Anahtar kelimeler: Psikiyatrik iyileşme, iyileşme odaklı yaklaşım.
... The transformation to personal recovery accompanied the evolution of the role of registered nurses (RNs) working in mental health care. Their role developed from leading consumers in care through nurse-consumer therapeutic relationships (Peplau 1997) using illness-centred interventions to working in partnership with consumers in nurse-consumer therapeutic relationships using person-centred interventions (Caldwell et al. 2010). Nurses are required to work collaboratively in promoting consumers' autonomy and fostering hope and empowerment, which are favoured by consumers (Jubb- Santangelo et al. 2018). ...
Recovery‐focused educational programmes have been implemented in mental health services in an attempt to transform care from a purely biomedical orientation to a more recovery‐oriented approach. Mental health nurses have identified the need for enhancing their abilities and confidence in translating recovery knowledge into mental health nursing practice. However, recovery‐focused educational programmes have not fully address nurses’ learning needs. Therefore, this review synthesized the evidence of the effectiveness of recovery‐focused educational programmes for mental health nurses. A systematic search of electronic databases and hand‐searched references was conducted. It identified 35 programmes and 55 educational materials within 39 studies. Synthesizing the literature revealed three themes and nine subthemes. The first theme, a framework for understanding and supporting consumers’ recovery, had four subthemes: consumers’ involvement, multidisciplinary approach, profession‐specific training, and performance indicators. The second theme, contents of educational materials, included the subthemes: knowledge development and recovery‐focused care planning. The final theme, nurses’ learning experiences, included the subthemes: understanding recovery, the positive effects of recovery‐focused educational programmes, and implementation of recovery‐oriented practices. Based on these findings, a mental health nursing recovery‐focused educational programme framework is proposed. Further research should investigate the effectiveness of the framework, especially in relation to recovery‐focused care planning and consumer and carer involvement in the development, delivery, participation, and evaluation of these educational programmes.
... In the last few years, Recovery started to be considered by clinicians one of the main targets of treatment in mental health disorders. To reach this goal, a key role is represented by psychopharmacological compliance and community-based recovery services [31,43,44]. Several international studies have demonstrated the efficacy of those interventions, involving multiple treatment components and mental health specialists, individualized care plans and target outcomes [45,46]. ...
Rehabilitation is oriented to psychiatric patients’ recovery through specific techniques and structured projects, not yet fully standardized, carried out in territorial services. This study aims to apply an operational structured outcome indicator model (hospitalizations, continuity of care, LAI treatment adherence, working support) through a recovery-centered model in a rehabilitation community in Milan. This observational-retrospective study included 111 patients from a University High Assistance Rehabilitation Community (C.R.A.) based in Milan. Psychopathological and psychosocial functioning was evaluated with Kennedy Axis V, Brief Psychiatric Rating Scale (BPRS), Life Skills Profile (LSP), AR module of the VADO scale. Statistical analyses were performed using SPSS software version 19. Student t test and Wilcoxon Test were used to analyze quantitative variables, while McNemar test for qualitative variables. The minimum level of significance was set at 0.05 ( p <0.05). The results showed that CRA rehabilitation program led to significant improvement in global functioning in terms of hospitalization reduction; improved continuity of care; stable adherence to psychopharmacological treatment with Long Acting Injectable (LAI) antipsychotics; stable employment maintenance during the year following discharge from the CRA. This study confirmed the utility of a structured outcome indicator model and highlighted its feasibility in daily clinical context of a rehabilitative community. Our results supported the effectiveness of a community-based rehabilitation program to improve individual functioning and clinical stability. However, further studies are required to better achieve the development of a recovery-oriented rehabilitation model and rigorously define an outcomes evaluation model.
Objective:
The present study aims to translate into Turkish and investigate the validity and reliability of the Mental Health Recovery Measure (MHRM).
Method:
The sample consisted of 343 outpatients - and in-patients under treatment for a variety of psychiatric diagnoses at a state hospital and a university research hospital. The MHRM along with the Subjective Recovery Assessment Scale (SRAS), Psychological Well Being Scale (PWBS), Emotional Eating Scale (EES), and The Internalized Stigma of Mental Illness Scale (ISMI).
Results:
The mean MHRM total score was estimated at 31.66 (sd=10.02). Exploratory factor analysis revealed one single robust factor explaining 64% of the variance of the total scores. Alpha internal consistency coefficient was calculated as 0.94 and corrected item-total correlation coefficients were entirely above 0.60. The MHRM scores showed positive and strong correlations with the PWBS (r=0.695; p<0.001) and SRAS (r=0.732; p<0.001), negative and strong correlation with the ISMI (r=-0.696; p<0.001) and no correlation with the EES scores (r=-0.021; p=0.703).
Conclusion:
Our data provides initial evidence supporting the validity and reliability of the Turkish MHRM in evaluating the tendency for recovery of mental health consumers for clinical and research purposes. Further studies addressing psychometric properties of the scale are warranted.
The recent opioid overdose crisis has created an opportunity to reconsider best practices for treatment of opioid use disorder as well as other substance use disorders. Increasingly peers who are in recovery from substance use disorders are being included in care teams, based on experience from other mental health and chronic disease treatment models. Those with lived experience of the disease offer a unique perspective and valuable skill set to enhance effective, patient-centered care for this chronic disease. While these are early days and more research is needed, the role of peers in recovery offers much promise for supporting effective interventions for persons with substance use disorder.
he implementation of deinstitutional- ization in the 1960s and 1970s, and the increasing ascendance of the com- munity support system concept and the practice of psychiatric rehabilitation in the 1980s, have laid the foundation for a new 1990s vision of service delivery for people who have men- tal illness. Recovery from mental illness is the vision that will guide the mental health system in this decade. This article outlines the fundamental services and assumptions of a recov- ery-oriented mental health system. As the recovery concept becomes better understood, it could have major implications for how future mental health systems are designed. The seeds of the recovery vision were sown in the aftermath of the era of deinstitutionalization. The failures in the imple- mentation of the policy of deinstitutionalization confronted us with the fact that a person with severe mental illness wants and needs more than just symptom relief. People with severe
This article describes a popular and effective self monitoring and response system that was developed in 1997 by 30 people who attended an eight day mental health recovery skills seminar in Vermont. They developed the system in response to their need for a structured way to use their wellness tools to relieve and eliminate their symptoms, and to stay well. While it was developed by and for people who are dealing with troubling emotional symptoms, the Wellness Recovery Action Plan can be used by anyone to deal with any kind of physical or emotional illness or issue. People who use the plan develop it by identifying tools or responses that will help them to relieve symptoms and/or enhance their wellness. They then use these tools to develop a Wellness Recovery Action Plan that includes: (1) a daily maintenance list, (2) identifying and responding to triggers, (3) identifying and responding to early warning signs, (4) recognizing when things are getting much worse and responding in ways that will help them feel better and (5) a crisis plan or advanced directive. The people who developed this plan emphasize that the plan must be developed by the person who will use it, although they can reach out to their supporters for assistance.
Recovery has emerged as a dynamic and effective model for community services for people with serious mental illness. As the efficacy of the model is demonstrated and the reality of recovery is experienced by many consumers, some state hospital systems are expressing an interest in how a recovery model might influence prevailing institutional practices. The challenge in the hospitals may be to recognize at what point in the treatment process the recovery model informs the medical model. Issues to be considered in implementation of the recovery model in state hospitals include the relative dominance of symptom-focused treatment models, hierarchical institutional structures and employee attitudes that tend to resist change, and the effects of chronic institutionalization on patient and staff attitudes toward recovery and autonomy. State hospitals may need to focus on consumer-identified themes such as hope, self-identity, responsibility, and meaning as they attempt to incorporate the recovery model into the hospital culture. These themes are not incongruent with exemplary medical practice. Practical application of the model should consider these dimensions with respect to the key hospital domains of treatment team function, patient role, hospital environment, administrative leadership, and intervention strategies.
Customer satisfaction represents the outcome of patients' expectations of nursing care and the care actually received.
This paper describes an implementation project to incorporate an evidence-based, structured model of relapse prevention into routine clinical practice at the Community Mental Health Team in Reading, Berkshire. This project has currently reached the end of the pilot stage, which this paper reports in details. It is proposed that clinicians will adopt Smith's Self-Management Training Manual for individuals with psychosis as a clinical tool for working with patients who have schizophrenic-form disorders or bipolar affective disorders with psychosis. Effects of the proposed change are considered from the viewpoint of the clients and families/carers, the clinicians and the service. The process of transition and its impact on members of the multidisciplinary team is examined. It includes an audit of Care Programme Approach (CPA) forms and a staff survey, which give background information on the needs for improvement and staff development initiatives. A pilot study incorporating the structured relapse prevention work into the local community mental health team is also underway. The method of evaluation and dissemination to the wider team and service settings across the organizational boundaries is reviewed with implications for practice drawn. This paper aims to describe the background and development of this ongoing development project whilst focusing on the current pilot stage. Ongoing work will be carried out in addressing and reporting the outcomes of the full project in future papers.
Antidepressants have proven efficacy in the treatment of acute depressive episodes and the prevention of relapse over the long-term. However, whether due to ignorance about the chronicity of depression, intolerable adverse effects, or an inappropriate fear of dependence, antidepressants are often discontinued after remission or recovery from an acute episode, which frequently leads to relapse or recurrence. This, in turn, increases the risk of subsequent poor treatment response and lifelong depressive chronicity. Clinicians should focus on preventing depressive relapse with long-term antidepressant pharmacotherapy, thereby improving patients' overall outcomes, particularly with patients at high risk for relapse. When patients with depression have comorbid anxiety, benzodiazepines may be useful but should be used only as short-term augmentation during the beginning phase of antidepressant treatment; long-term treatment of comorbid anxiety is better managed by antidepressants that also treat anxiety disorders.
To clarify the concept of early recognition for the field of forensic nursing. The concept is based on the proposition that patient behavior deteriorating toward aggression is idiosyncratic but nevertheless reconstructable like a "signature." Once reconstructed, this signature can be used to detect "early signs" of deterioration and thus prevent violent behavior.
Early recognition is approached from the perspective of deteriorating behavior. Special attention is paid to the social and interpersonal factors related to the individual behaving violently. From this perspective, the thoughts, feelings, and behavior of the patient can indicate the onset of aggression, and early recognition of these warning signs can help thwart such deterioration. The aviation metaphor of a "black box" is used to emphasize the importance of attention to early warning signs. Patients in forensic care must draw upon their previous experiences (i.e., their own black boxes) to gain insight into their violent behavior and the warning signals for this. The emphasis is on the cooperation between the patient and the nurse in the application of risk management strategies. The Early Recognition Method provides an approach in which patients and nurses also gradually attune their perspectives on aggressive behavior.
The concept of early recognition is important because it extends the idea of early intervention to include enabling patients to control their own behavior. Early recognition has strong practical implications for forensic nurses as it allows them to attenuate aggression by assisting patients with the detection of early warning signs.