Finally there will be identification of the relevant skills and knowledge that was gained as a result of the series of this encounter. I will identify CASH model, for further knowledge and skills in my training. I will adhere to confidentiality issue in line with the Nursing and Midwifery Code of professional conduct (The Code, 2008) therefore pseudonyms will be used throughout in the commentary.
“Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness”. (Boardman, 2010)
“The journey of recovery may have ups and downs but a period of illness does not necessarily mean that recovery stops it may in fact be part of the longer-term process of growth and development”(Repper & Perkins, 2003)
Sainsbury Centre for Mental Health (2008) states that the principles of recovery is about building a meaningful and satisfying life as defined by the person whether or not there is reoccurring symptoms or problems, recovery is a movement away from pathology illnesses and symptoms of health strength and wellness. Rethink (2008) also suggested four important component of recovery as finding, maintaining hope i.e. believing in one’s self, optimistic about the future, re-establishing of a positive identity, building a meaningful life, taking responsibility and control .
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Fredrick, a 41 year old gentleman of African origin who struggles with drug addiction, came into contact with the drug and alcohol services for treatment informally. Fredrick was living in a hostel and was well known to the service. At the initial interview Fredrick stated that his childhood was bad and his parents separated when he was still a little child. His grandmother was responsible for his upbringing. Fredrick declined to give information regarding his parents. He further confirmed that his drug addiction started when he separated from his partner, the mother of his three children. He became anxious when he became unemployed and was unable to get back to work. Fredrick said he has a prison record for shop lifting, he said he did this to sustain his drug addiction.
At the assessment, the nurse asked Fredrick why he was just coming into treatment now, what has he been doing for the past two months and what does he want from the services? because he was informal.
I felt that the question was aggressive due to the way the nurse was asking him. Positive reinforcement and rewards such as praise from others have been suggested as improving self-esteem (Logan 1985).
Huberman and O’Brien (1999) found that positive reinforcement was one of the factors that resulted in improvements in the work of therapists and in the progress of patients in mental health. Positive reinforcement can be used here to reward Fredrick for coming in that was what the nurse should have asked him, how he has been coping and what has kept him going for the last two months, this can be his strength and which can use to plan and work collaboratively with him. Shepherd (2007) states that we should encourage self-management of mental health issues by providing information, reinforcing existing coping strategies. Perkins, (2007) also stated that clients may be encouraged to write down their symptoms and coping strategies, by focusing on small steps for change, increase their sense of self control over distressing events (Scips 5.4.3).
The nurse discussed with Fredrick various options which was recommended by NICE, (2005) guidelines (SCiP 5.3.1) valuing the need for evidenced based practice such as abstinence based treatment, those that can help him to stop taking drugs, harm reduction; those that reduce the risk involved in using drugs and maintenance treatment, that is taking opioid substitute. The nurse reflected on the issue of pharmacology intervention for detoxification. NICE, (2007a) and the D.O.H 2007 guidelines recommend that methadone or Buprenorphine should be offered as the first choice of treatment. The nurse also reflected on the key ingredient of recovery-oriented practice, provide by Borg and Kristiansen (2004). The nurse discussed what he hopes to achieve through treatment and giving him information and various options (SCiP5.4.2) providing good meaningful choice and collaboration, the nurse was also able to give Fredrick information which enables him to make informed choice and also manage his risk appropriately, treat him with respect regardless of his problem. The NMC of professional conduct (2002) explains that you must respect the patients as an individual. This means that you look at all the diverse elements that make up a patient. This provides the basis of holism. Siviter (2004) outlines that holism and holistic care look at the patient as a whole person, with distinctive and individual needs and condition. Holism ensures the nurse to see more than just the situation the patients are in care. It encourages them to look at the way the patients feel, what is paramount to them and their families, their living condition and their beliefs. It focuses on their spiritual, emotional, physiological, psychological and cultural needs. This ensures the care given meets all patients needs in a respectful and dignified way.
Fredrick was prescribed Methadone since that was his choice he was titrated for three days, and he comes in for observation for possible side effect or withdrawals symptoms daily. The nurse gave him information and leaflets on the medication (SCiP 5.4.2). The nurse also reflected on the key ingredient of recovery-oriented practice, provided by Borg and Kristiansen (2004).
I felt this was a good example of empowering him to take responsibility of his treatment. Tunmore and Thomas states that care plan can be used as a therapeutic tool, and also as a means of engaging clients and family in care.
My skills has improved by using the tenets of recovery as stated by various authors and the chief nursing officer’s review of mental health putting values into practice, improving outcomes for service users and working as a positive modern professional.
I also learnt that recovery does not necessarily mean cure but it is when someone is able to leave a normal life despite an illness or disability. I will continue to update myself with available evidence in order to deliver a patient centre care and improve my skills and practice.
My working with the nurse and Fredrick, I was able to apply recovery approach in according to the Chief Nursing Officer review (D.O.H.. 2007), using best based available evidence by NICE and the D.O.H drug and substance misuse and I was able to establish and sustain a trusting, meaningful, therapeutic and collaborative relationship with the nurse and Fredrick by involving him in planning his care, these according to (NIHME 2005) needs to be the core to all relationships. I was also able to give Fredrick information which enables him to make informed choice and also manage his risk appropriately like. I have being able to treat him with respect regardless of his problem and my interventions have been evidenced based.
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I was not too confident in working with Fredrick since I was still training so I have to work under supervision of the nurse and I also lacked the knowledge of Motivational interviewing (MI) such as not cohering the client into taking decision but after discussion with the psychologist, reading researches, I now feel confident in using MI in my practice when I qualify.
It will comprise of reading literatures and journals on how to build a therapeutic relationship. To read more on motivational interviews techniques and relapse prevention management, enhance my skills and practice.
In conclusion this reflection has discussed my therapeutic encounter with a client I worked with who is drug dependant. It highlighted how I was able to build a therapeutic relationship by collaboration with Fredrick to address his drug use using the best based evidence supported by NICE guidelines and UK clinical guidelines for drug misuse, the NTA model to stabilize and maintain him. The reflection also discussed how the professionals (nurses) were able to enable and support recovery from drug use and able to live a meaningful life. These were achieved by using the tenets of recovery as stated by various authors and the chief nursing officer’s review of mental health putting values into practice, improving outcomes for service users and working as a positive modern professional. Recovery does not necessarily mean cure but it is when someone is able to leave a normal life despite an illness or disability.
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