RECOVERY MODEL. Utilisation in chronic conditions to reduce distress in the elderly. Janine Burton (CNS) MHSOP

Transcription

1 RECOVERY MODEL Utilisation in chronic conditions to reduce distress in the elderly Janine Burton (CNS) MHSOP

2 Contents The assault cycle Recovery model 101 WRAP plans Case studies

3 Assault cycle The pattern of someone in acute distress We will be focusing on the trigger phase and the importance of this in developing effective WRAP plans which will help identify triggers and how to deal with them and avoid escalation phase

4 Recovery model This is the guiding model for Waikato DHBs mental health and addictions service

5 Service User Movement Ultimately it is about the patient having primary control over the decision made about their own care. John Perceval dairies

6 Principals of Recovery Model Hope Personal Responsibility Education Self Advocacy Support

7 Hope People who experience mental health difficulties get well, stay well and go on to meet their life dreams and goals. Chronic conditions: "Hope to find a feeling of wellbeing and living the best they can with the health constraints they have Clinician Tips Reassurance that what they are experiencing is normal holding hope for those that are struggling to find it themselves Helping others to find their hope Acknowledging the little things

8 Personal Responsibility That the power sits with the individual to work toward recovery to self reflect and act when they notice changes in themselves and to utilise the tools they have identified to help when triggered. Clinician Tips Everyone has a different level of health literacy Be very careful to never take this as a literal quote NO BLAME CULTURE Your role is to help the individual in front of you find their personal resourcefulness

9 Education Learning all you can about what you are experiencing so you can make good decisions about all aspects of your life. Clinician Tips We have a responsibility to provide education about disease processes and medication Also we have a responsibility to be familiar with concepts of stigma and discrimination, we so often remove ourselves from what is going on for our clients but the reality is we all experience changes in our mental health Upskilling yourself about understanding the disease process they have and how their chronic disease might impact on them as an individual Concordance vs compliance

10 Self advocacy Effectively reaching out to others so that you can get what it is that you need and deserve to support your wellness and recovery. Clinician Tips Building respect and trust in the patient-nurse relationship so that they can feel able to reach out to you Feel Safe to express how they are feeling and what is effective for them You need to place all 'your' thought and 'your' ideas on the shelf This is about the patient NOT about you Therapeutic use of self

11 Support While working toward recovery that you allow yourself to receive support from others Clinician Tips Help the person identify what support they may need Helping the individual to understand that asking for help is not failing That you utilise the therapeutic use of self to support the individual communication, active listening, accepting, Walking beside NOT leading That the persons care-giver/support person has access to support and resources and can identify when they might be facing burnout themselves.

12 Recovery is Discovery

13 Dementia ALL of the recovery principals can be applied to patients with cognitive impairment and/or dementia. But that you will have a more active role in applying the principals. Hope Giving a sense of purpose through techniques such as validation Self advocacy Cognitive impairment means that while they self identify they may not remember their action plan and need assistance to do this walk beside them, talk them through it. Be patient. giving as much power back to the person as you possibly can to allow for self responsibility i.e. choice between tops Advanced care planning Supporting and educating family members

14 WRAP Wellness Recovery Action Plan

15 A WRAP includes: developing a Wellness Toolbox, and then 1. Evolving a daily maintenance plan 2. Understanding triggers and what I can do about them 3. Identifying early warning signs and an action plan 4. Signs that things are breaking down and an action plan 5. Crisis planning 6. Post crisis planning

16 A WRAP includes developing a Wellness Toolbox, and then 1. Evolving a daily maintenance plan 2. Understanding triggers and what I can do about them 3. Identifying early warning signs and an action plan 4. Signs that things are breaking down and an action plan 5. Crisis planning 6. Post crisis planning

17 Case study one Mrs R; 68 Year old woman with a psychotic depression. Anxiety & low mood When very unwell gets delusional thoughts which impact markedly on her ability to attend to her ADL s This illness has affected her personal relationships

18 Wellness toolbox What does it look like for the patient when they are well? When I am well I feel look do like this What do they find enjoyment in doing? What gives them a feeling of purpose?

19 Evolving a daily maintenance plan Developing achievable goals Exploring ways to build resilience Small steps Living document Strengths based - What are their strengths they can pull on Honesty can be very uncomfortable but highly important in the development of realistic and achievable plans You don t want to set someone up to fail

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21 Understanding triggers and what I can do about them What happened leading up to the episode? What situations or thoughts increase distress What situations or thoughts decrease distress make them feel better

22 Identifying early warning signs and an action plan out of control overwhelmed frustrated scared anxious Learning to identify how this looks and feels for them How did their body react? How do they feel this in their body? Increased respirations, churning stomach, foggy brain, shaky, weak what makes it better? What have they done in the past to help in situations Distraction - mindfulness, reading, praying, knitting, colouring, crosswords Or do they have to concentrate on what is going on in their body and talk it down

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24 Signs that things are breaking down and an action plan Exacerbation of illness and timely use of advanced care plan wishes

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26 Crisis and post crisis planning Advanced care planning

27 CASE STUDY TWO Mrs D; 78 year old woman Hx COPD, HT, anxiety New to your facility and refusing to shower becoming agitated with staff and snaps when they approached her and suggest a shower. You sit down and talk with her she tells you that she is claustrophobic. And that she is getting very SOBOE when she walks the distance to the bathroom. What do we do next?

28 You ASK her what does she think will help in this situation? Offer potential solutions a) if the person is unable to come to their own solutions or b) you think that you have an idea that might help.

29 Placing the Ethos of the Recovery Model into the Medical Model Concordance vs Compliance Crucial elements of concordance Sharing of power Decision making is a combination of patients and professionals viewpoints Values the patients expertise in his or her own body Recognises that their personal knowledge of self is different to a professionals knowledge but is just as relevant

30 Take home message Its not about you You are simply a tool for the patient to find their own answers Its about giving back as much control and power to patient as you can Its about the patient understanding themselves and figuring out ways to keep their wellbeing at an optimum in any given situation Utilising a tools such as a WRAP can be useful for some individuals Do not underestimate the simple plans and solutions they can make the biggest difference There is multiple ways you can adapt the recovery principals in the care we provide It will resonate with some of more than others I challenge you to start thinking concordance NOT compliance

31 Articles Mary O Hagan (2009) Health%20Today.pdf The Blueprint for Mental Health Services in New Zealand Recovery Competencies for New Zealand Mental Health Workers (2001) mental health commission, New Zealand. file:///c:/users/janine%20burton/appdata/local/microsoft/windows/inetcache/ie /KLNUDA13/recovery-competencies-for-new-zealand-mental-health-workersmarch-2001.pdf

32 Useful websites Mental Health addiction and disability up workforce development; Te Pou o Te Whakaaro Nui Mental Health Foundation of New Zealand