Mental Health Nursing: Professional Development Plan - Essay Example

Professional Development Plan 2005 - Mental Health Nursing INTRODUCTION 1. Aim of the Professional Development Plan A Professional Development Plan (PDP) is outlined with regard to module learning outcome 1. The aim of the PDP is to reflect over past practices, experiences and learning, in order to set and achieve clear objectives for the coming year as well as for lifelong learning. These objectives will be linked with competency 2B2N, in order to demonstrate sound clinical judgment across a range of professional and care delivery context. The PDP will emphasize setting mutually agreed aims or goals appropriate for the client which are realistic, measurable and achievable. The goal is to identify possible areas or aspects of practice which may be improved by re-assessment and evaluation of current practice within a clearly focused plan, accelerating development in that area, making an impact on the lives of individuals, groups and organizations. 1.2. Mental Health Issues Mental Health issues occur as a wide diversity of conditions, ranging from the most common forms such as stress, anxiety and depression, to the less common problems including suicide. An equally wide range of treatments and therapies are available to alleviate or eradicate the symptoms of these conditions. 1 1.3 The Professional Development of the Mental Health Nurse The professional development of the Mental Health Nurse (MHN) is invariably linked to improvement of patient well-being and healthcare. In order to make an effective contribution towards enhancing patient care, the MHN should make use of development opportunities which occur on the job and via other avenues (e.g. training courses, conferences, colleagues, websites, publications and effective communication). The day to day actions and behaviour as well as the longer term career aspirations of the MHN can be enhanced and linked more efficiently to the desirable outcome. 2. PROFESSIONAL DEVELOPMENT PLAN Objective Action required Measurement Desirable Outcome On the job development Ÿ Identify and assess with patient potential and actual health problems., including thorough, accurate, ongoing risk assessment and management. Ÿ Plan nursing care, prioritize and set short, medium and long term goals. E.g. For a client who has lost weight due to depression, monitor ability to prepare food and eat in the short term, weight gain in the medium to longer term. Communicate effectively to promote healing2. Act on complaints received by client Ÿ Improve personal resilience Ÿ Respect patients and keep confidentiality Make decisive statement concerning client’s nursing needs which differs from medical needs in that it places emphasis on whole unique person who is interacting with the environment and whose health state- not just the illness or disease requires nursing intervention1. Periodically review with manager to evaluate and summarize how improvements have been demonstrated. Give specific examples of how a difficult situation was handled or how confidence, adaptability or flexibility was shown in meeting tight deadlines or/and in times of increased pressure. Take note of the perception of others reactions whilst carrying out a specific task or communicating certain issues3. (Reaction may be non verbal, e.g. facial expression, body language, anxiety), and taking the right corrective action if appropriate. Increased knowledge and understanding of subsequent similar situation. A sense of perspective, focus and direction for both client and nurse. Minimising risk to self and others . Improved quality of life of client. Client learns from knowledge imparted and as a result alters aspect of their behaviour. E.g. More responsive, more positive, more balanced perspective. I.e. Health empowerment and health promotion through clear, concise and effective communication. Facilitating restoration to independence and community-based living for client. If performance levels are not achieved, ask why and document specific points and put on plan for following year. Acquire new skills and new job assignments Ÿ Improve technical expertise. Ÿ Take exams. Ÿ Attend courses Ÿ Use websites4,5,6 to increase knowledge and understanding . Harness expertise, resources and partnerships across all sectors and disciplines Maximise inter-relationship between social, environmental and political influences, which result in positive effect on individual and community health . Pass tests and exams. Able to teach and train others. Observation of increased support from family, friends, schools, employers, faith communities and neighbourhoods, in enabling people with mental health problems to enjoy the same range of services and facilities within the community as everyone else. Wider needs of the whole person addressed. Client develops a healthy state of mind progressively . Increased evidence of creativity, intellect and spirituality of client is observed. More productive and efficient ways of working. E.g. Shorter time spent with clients but quality time. Better adapted to change. Can take on new challenges and have the freedom as well as the desire to carry out job rotations and career moves. Increased capability to keep team aligned, and /or flourish in a matrix environment. Break out of old ways of thinking and behaviour and embrace new ideas. Challenge and take action when issues arise and set an example and inspire others in order to generate both personal and business success. Client is able to engage in occupational or educational activity, independent living and effective decision making, sustain, satisfying personal relationships, resolve conflict and enjoying peace of mind and achieve other such milestones which were not possible previously. Work with experienced colleague/ mentor Watch and listen attentively, ask questions, write things down and read through at later date, clarify points that are misunderstood. Check procedures learnt by demonstrating to colleague, Improve communication and gain greater breadth of knowledge and deeper level of understanding. Form relationships and encourage teambuilding, eg. arrange socials. Feedback from colleague/ mentor. Suggestions for improvement. Learning from own mistakes and mistakes made by others, and making fewer mistakes as time goes on. Evaluating strengths and weaknesses. Consolidate learning into practice by contributing more to discussions and debates about patients. Develop respect for others and their ideas, sharing and influencing, without being overtly assertive or pushy. Develop greater career potential. Encourage creativity and new ideas. Improved teamwork. Understanding treatments for mental illness, e.g. depression Talk to doctors and pharmacists and other healthcare professionals. Read WHO report7 on antidepressants. Brush up counseling skills Ÿ In spare time, write an essay about the various treatments and therapies for certain mental disorder like depression. Ask doctors to give feedback and find answers to questions answered wrongly Better informed to talk to clients about their medication and alternate therapies such as counselling. 3. DISCUSSION The aspect of care analysed in this section is ‘Risk Assessment and Management’ with regard to identification of future learning needs. 3.1 The Issues of Risk assessment Maphosa et al 8, describe risk as the likelihood of an “untoward event happening"; a dynamic event depending on circumstances, that can alter over brief periods of time. Furthermore, The Royal College of Psychiatrists9 state that risk cannot be eliminated, but can be ‘rigorously assessed and managed’. Therefore, it is necessary that, risk assessment is subject to frequent reviews and not carried once only . Outcomes of risk assessment cannot be guaranteed but a plan to minimize the damage from the risk(s) posed is paramount. A report by the Standard Nursing and Midwifery Advisory Committee10 states that a quarter of the incidents that took place involving inpatients were as a result of inadequately trained and inexperienced staff. This raises the question ‘What is meant by adequate?’ Healthcare workers who have attended a number of courses on risk assessment, may not necessarily predict the outcome of the risk assessment. 3.2 Trends in risk Assessment There has been a shift in community care from networks of family and friends to that of professionals. However, it is unrealistic to assume that risk assessment is the responsibility of healthcare professionals alone. Published inquiry reports reveal that incidents of violence committed by people with a diagnosis of mental illness would have been less likely, had professionals listened to the family and others involved earlier. The Mental Health Foundation believes that effective risk management should not disempower people but should minimise risk through open discussion, standardised assessment and the use of up-to-date, jointly owned care plans. Increased collaboration and communication are key. 3.3 Politics of risk assessment Forster 11 warns that healthcare is “an increasingly politicized and publicly exposed arena” and the quality of risk assessments has become more open to scrutiny, fuelling the negative perception by the public that users of mental health services are a greater risk to themselves and others. This perception has been encouraged by high profile tragedies involving acutely ill individuals, for example, the David Bennett incident in 199912. Another example is the Victoria Climbie case12 , where the results of poor communication led to the death of the young girl. Such cases highlight the point that clear and effective communication is an integral part in providing a service and effectively managing risks13. Widespread media coverage portrays extremely negative publicity for mental health services. Each enquiry highlights specific deficits in the care and treatment provided, and often than not, pinpoint the failure by mental health service providers to assess risk adequately. This raises the question of how reliable and valid are the risk assessment tools currently used? Such incidences highlight the significance of accurate, thorough and ongoing assessment by healthcare professionals, as part of the process of working with individuals with severe mental illnesses. As a mental health professional, I realise that the assessment of ‘risk’ has become highly significant in recent years and is viewed as a core organizing concept of the western world14. This is echoed by Doyle15, stating that clinical risk assessment and management are high on the clinical, managerial and legal agendas and one of the major concerns in mental health. 3.4 The Importance of Effective Communication The SNaMAC10 raised concerns about the documentation and communication of risk assessments. It was concluded that poor standards were a result of a lack of experience by acute inpatient mental health services’ staff. It was stated in the Sainsbury’s Center for Mental Health manual16 that risk assessment should be accurate and well communicated to all directly involved in patients’ care, in order to form a valid basis of effective care and future treatment planning. Good communication and observation skills are equally important as they compliment the risk assessment tools and enable effective exploration of issues identified within the assessment, for example when working with a suicidal service user. The Royal College of Psychiatrists9 support the idea that interventions and relationships play a crucial role in the assessment and management of risk as they can increase or decrease the risk. The report also states that forming relationships have been proven to make the assessment easier and more accurate as the patient may be more forthcoming with information and this could help in reducing the risk. As a nurse, identifying the risks posed by a patient automatically gives me the responsibility to take action with a view to reducing the risk and ensuring that it is effectively managed. I have come to appreciate the complexity of acquiring a valid and reliable assessment that enables me to identify the factors likely to increase or decrease risk. 3.5 A Framework for Effective Risk Assessment and Management To address the widespread negative beliefs about mismanagement of risk in psychiatric hospitals, valid and reliable risk assessment frameworks have been formulated by mental health professionals. Examples are the ‘Brief Psychiatric Rating Scale (BPRS)17’ which is a scoring system and the enhanced ‘CPA checklist, WLMHT18. These frameworks are based on the patient’s history and mental state, specifying the factors likely to increase or decrease the risk. However the BPRS17, is a ‘tick-box tool’ which is rated numerically using a scoring system. It does not have room for additional comments on it. I found the Worthing’s Risk Assessment tool (WLMHT18), more comprehensive and detailed as it covers past and present incidents of violence and aggression, and has a different section covering self neglect and suicide ideation. The information and form filling for risk assessment ought to be validated and easily accessible. All staff should be properly trained to use the tools effectively. Doyle15 maintains that assessment scales differ in their usefulness depending on what they are being used for. It is important to ensure that structured guidelines or rating scales are used in clinical practice to allow informed clinical judgment and to determine which risk management measures are required. The Association of Psychological Therapies19 state that, to some, risk assessment and management has come to mean ‘covering your back’ and ensuring that the organization and the individual do not get blamed if things go wrong. The multidisciplinary team engage in defensive- nursing- practice -mode whenever they are faced with difficult situations. The focus is taken away from helping patients but ensuring that if anything happened, the paper-work would be state that all efforts were made to minimise its occurrence. This highlights that even though there is a need to minimize the likelihood of adverse events happening, there is also a worry about not doing things right, so much that time is lost doing paper work than observations. All staff must receive adequately risk assessment training, be conversant with risk management plans in place and should be sent for refresher courses yearly to improve their assessment, interviewing, communication and documentation skills. Even though there are risk assessment tools in place, it should be re-enforced that these should not replace the clinician’s ability to make their own judgment. Risk management strategies should contain systems for incident reporting and learning from the complaints. 3.6 Developing an Assessment Strategy for risk assessment One aspect of care that I shall improve in my future role is the development of an assessment strategy that comprehensively explores the physio-social factors that underpin risk. Mental health service providers need to work with commissioners to enable high quality service provision, ensuring existing ‘resources are used efficiently and potential gaps identified’ 23. Good team working and valuing each member’s contribution, good communication channels are an important aspect as it helps to manage risks. Managers should ensure that junior or inexperienced staff are not expected to undertake assessments of new referrals or patients with histories of risky behaviour without supervision because of the complexities presented by different scenarios. Mental health providers must implement protocols to regularly review multidisciplinary team staffing levels and skill mix on inpatient units. This would ensure that a safe and therapeutic environment is provided for all. 3.7 Developing a Personal Practice for Risk Assessment I realize that the ability to undertake risk assessment completely and confidently will come with training, practice and experience, therefore, I will make use of the preceptorship program and clinical supervision to discuss my weaknesses and strengths in this field. This will allow me to reflect on my current practice. I will work with other colleagues on the ward to get guidance and support on how to improve my nursing and other assessment skills necessary to facilitate the assessment process particularly in relation to risk assessment. In line with the Agenda for Change expectations, I will enrol for refresher courses, subscribe to mental health journals and make use of data bases to keep updated on current evidence based research. Miller (1999) states that risk assessment and management have become the heart of effective mental health practice, As a future mental health nurse, a necessary aspect of my work is to becoming skilled at the principle and practice of risk assessment and management. 4. CONCLUSION Mental Health Nurses play a vital role in recognising and alleviating the symptoms of stress and more severe forms of mental illness. They identify coping strategies, encourage restoration of self esteem and assist in promoting changes in lifestyle and perception to enhance the client’s prospects. The first hurdle to be crossed is for the affected person to admit they are ill and that they need help. This confession leads to an open door through which the well-equipped, highly educated and well-informed MHN can make an entrance and introduce a world of possibilities gradually and realistically to the affected individual. By arming themselves with a goal-orientated plan such as the one introduced in section 2 above, the MHN is able to slowly but surely turn an upside down world the right way up and with a clearer view for the patient. A multi-disciplinary approach to care must be established to ensure thorough risk assessment and management in order to facilitate the clients restoration towards independence delivered in a non biased manner and from a widely evaluated perspective. Good Mental health promotion has a wide range of health and social benefits -improved physical health, increased emotional resilience, greater social inclusion and participation and higher productivity. It can also contributes to health improvement for people living with mental health problems and to challenging discrimination and increasing understanding of mental health issues. I shall play a vital role in promoting good health issues such as increasing awareness of the mission of the MHN must be to equip themselves with maximum knowledge and expertise and to respond to any foreseeable situation. I’ll take advantage of opportunities that allow me to achieve high educational status and improve my capabilities, which will improve the lives of mental health patients and their families. In order to achieve these objectives, I intend to remain focussed on my developmental plan over the next twelve months, in order to achieve my goals and enhance my career prospects so that I can increase my influence in the longer term. I have found it both challenging and inspiring to write the development plan. I feel confident that I have captured my thoughts as well as my true feelings on the subject and I hope that I can at least encourage all who read this, whether they are healthcare workers or clients to have a more positive view on the Health System and to embrace the possibility of what each of us can achieve if we open our minds to fresh thinking and ideas, and open our eyes to new paths. Passion and enthusiasm will soon follow and make way for miracles to happen. (Word count - 3000). REFERENCES 1) George, J. (1995) Nursing Theories: The Base for Professional Nursing Practice. Norwalk, CT, Appleton &Lange. 2) Ruben, B. (1990) the health caregiver-patient relationship; pathology, aetiology, treatment. In E. Ray and L. Donahue 9eds), Communication and Health: Systems and Applications. Hillsdale, NJ:Lawrence Erlbaum. 3) Christenson, P. and Kenney, J. (1990) Nursing Process: Application of Conceptual Models. 4th ed. St Louis, C.V. Mosby. 4) www.cebmh.com 23 May 2005 5) www.clinicalevidence.com 23 May 2005 6) www.icn.ch 23 May 2005 7) World Health Organisation (WHO) report 2001. Mental Health. New Understanding, New Hope. 8) Maphosa et al (2000). 9) Royal college of Psychiatrists (1996) p4. 10) SNMAC (1999). 11) Forster (2000). 12) DOH (2000). 13) RCN (2003) p.34 14) Gray et al, (2002). 15) Doyle (2001). 16) Sainsbury Center for Mental Health Manual (2000). 17) Brief Psychiatric Rating Scale 18) CPA checklist WLMHT (2000) 19) Association of Psychological Therapies (ATP, 2004). 20) Donaldson (2000), p. 243. Read More