Implementing Person-Centred Care in Mental Health

The Person-centred care is referred to the approach where the individuals involved in utilising healthcare services are kept in the centre while making care plan and healthcare decision by the nurses and health professionals. The person-centred care is essential as it helps to provide service to the patient in compassionate, dignified and respectful manner that ensures patient’s proper improvement in health (Moore et al. 2017). According to the person-centred framework developed by McCance and McCormack, there are four key elements to be followed which are perquisites that focus on the nursing attributes, care environment indicating the surrounding in which the patient was provided care, person-centred processes that are focused care delivery through different activities and expected outcomes that are the final results of the care (McCormack and McCance, 2016). In this assignment, the case-study of Jack is to be followed who has been admitted to the mental health ward under section 1 of the Mental Health Act 1983. The Barker-Tidal Model for Mental Health Recovery is to be used for discussing the way the model allows the person-centred care approach to care delivery as well as

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The NMC Code mentions that the confidentiality of the patients is to be maintained to avoid any harm or abuse towards them (NMC, 2015). Thus, to maintain confidentiality pseudonym Jack is used to name the patient to protect the person’s real identity. Jack is a 20-year-old British individual who lives with 3 of his family members (mother, father and sister). Jack was admitted to the hospital on the context that when his professor entered the classroom he suddenly accused the person of taking his tuition fees and expressed refusal to sit down until the fee is returned. It was mentioned that the professor never took any money from Jack. It was also reported by Jack’s father, mother and sister that they saw him many times in the past 3 months talking to self and others in the room though there was no one else present. This led to the assessment that Jack may be suffering from delusion and hallucination which is controlling his action and require immediate medical intervention. On admission, Jack was found to be wearing dirty clothes and mentioned that he is still listening to voices in the room and do not wish his family to be around as they do not support him. It was revealed that Jack was previously bullied at the school for remaining isolated.

The parents reported that there was no previous history of any mental illness in the family. According to section 1 of the Mental Health Act 1983, the person is to be detailed within the hospital if the individual is identified to be suffering from mental illness (legislation.gov.uk, 1983). Thus, under the Act, Jack was admitted and detained within the hospital. The symptoms of Schizophrenia include delusional thoughts, hallucinations, disorganised speech and thinking along with disorganised behaviour (Marder and Galderisi, 2017). The health assessment for Jack done by using DSM-5 where it is revealed that according to the symptoms Jack is suffering from schizophrenia. The DSM-5 is referred to the Diagnostic and Statistical Manual of Mental Health Disorder developed by the American Psychiatric Association to be used as taxonomic and diagnostic tool for assessment of schizophrenia and various other mental disorders (Viher et al. 2016). It is planned that Jack is to be provided chlorpromazine as medication and for long-term care is to be put under Cognitive Behavioural Therapy to help him treat the psychotic symptoms related to the illness and develop organised thoughts, feeling and behaviour.

The Barker-Tidal Mental Health Recovery Model has the key intention to determine the meaning of the experiences of the patients by putting emphasis on the wisdom and voice of the patient to understand their speech. The 10 commitments to be followed as per the model are valuing patient’s voice, respecting language, developing genuine curiosity, be apprentice, reveal wisdom, de transparent, use toolkit available, frame steps, offer time and understand that change is constant (Teixeira et al. 2018). The patient’s voice is to be valued to show them respect and dignity. Moreover, it allows health professionals to take care decisions that do not overlook the essential needs mentioned by the patient (Adamson et al. 2017). Thus, it was identified that Jack needs to be allowed to share his entire story so that his voice can be valued to show him respect.

The respecting language as per the model leads the nurse to consider the need for Jack that he is to be allowed to reveal his experiences in his own words and sentences. The development of genuine curiosity is required so that the patient narrating the needs and story feels being respected and develops trust over the health professional in accepting care (Andersson et al. 2015). Thus, the need identified is that nurses are to hear Jack’s story with interest to determine his experiences that led to his condition to identify the cause of the illness. On following the experiences shared by Jack, the nurses analysed that lack of emotional support from family and previous bully at school may have contributed to his deteriorated mental state. This is because the experiences may have affected his mind to develop a make belief world and think absurd to soothe his mind. The "becoming an apprentice" is required by the nurses so that they are able to learn the specific needs and demands of the patients to be fulfilled (Borg and Karlsson, 2016). This leads the nurses to understand that Jack needs care to treat his delusion and hallucinations as well as require care where his family is not involved. The revelation of wisdom is required to allow Jack to sustain through the process of recovery.

The transparency is care is required so that the patient has detailed knowledge regarding the reason and way of care intervention as well as nurses has understanding regarding the essentiality of care to be delivered (Cusack et al. 2017). Thus, it led to identify the need that the nurses are to provide error free care and access informed consent from Jack regarding the way care is to be provided. The present toolkit means that information present in the patient’s story is to be used to understand what may work and what not (Hunter et al. 2015). This informed that Jack’s story is to be analysed and since he does not wish the family to be around the Cognitive Behaviour Therapy (CBT) is to be chosen over Family Therapy so that satisfied care is provided to the patient. This is because, in Family therapy, the family members are to be involved which is not wished to be accepted by Jack as per his story. Moreover, chlorpromazine as medication is to be provided to control his hallucinations and delusional symptoms. The framing of the steps indicates that the nurse is to discuss with Jack what care is to be done next to offer the person satisfactory healthcare. Thus, the nurse needs to share information regarding further care process with Jack. The model further indicates that timely care is to be provided to Jack and nurses require understanding that they have to change the care plan continuously as the needs of Jack may change with time.

The advantage of using Barker-Tidal Model is that it informed the way the patient’s wishes and demands are to be respected (O’Keeffe et al. 2018). This is evident as the model indicated that nurses are to allow Jack to voice his opinion and framed the care plan through informed consent received by analysing the information mentioned by Jack to respect him. The Barker-Tidal Model is beneficial as it acts to promote the mental health of the person by acknowledging their demands and empowering them to recover by focussing that all the care goals are related to the individual (Fisher, 2016). However, the limitation of the model is that it does not consider the mental efficiency or physical ability of the person to direct their care. In addition, the Barker-Tidal Model does not identify the physical needs of the patients (Teixeira et al. 2018). This indicates that the personal hygiene of Jack was not able to be focused through the model and his mental ability to direct his care is also not considered while taking informed consent from him regarding care support.

The holistic care is referred to providing care services to the patient that heals their body, mind as well as soul. It indicates that love and support is the key healer and the patient is to be allowed to take responsibility for their own well-being (Zamanzadeh et al. 2015). The Barker-Tidal Model is able to provide holistic care to Jack by letting the nurses have clarified information about the reason behind Jack’s current mental condition and the way they as well as Jack can participate to treat the problems being raised. As mentioned by Jasemi et al. (2017), holistic care principle indicates that patients are thought to have innate healing power. The principle is supported by Barker-Tidal Model where it indicated the nurses to include the patient in deciding and participating in care support instead of following direction of the health professionals only. Thus, it leads the nurses to decide the nature of therapy to be provided to Jack as per his wish to help him show better emotional health. It leads Jack to feel valued and empowered as he was not a burden of care and his decisions were respected as well as valued. As argued by Wilson (2017), holistic care principle mentions that healing the person requires a team approach. The fact is also supported through Barker-Tidal Model where equal involvement of the nurses and patient is required in framing and executing the care plan. It impacts Jack to receive love and support from the nurses as well as allowed him to participate in arranging his own care.

The holistic care considers the aspects of physical, emotional, social and spiritual effect on the patient (Mathisen et al. 2015). The identified needs through the Barker-Tidal Model impact Jack psychologically by making him feel dignified and valued as well as express better emotional health and behaviour. This is because Barker-Tidal Model informs that value to the opinion and language of the patient is to be provided by developing proper curiosity as well as information from the patient is to be gathered to decide care plan which is also to be done through informed consent of the patient (Townsend and Morgan, 2017). Thus, valuing the opinion of Jack and able to make the individual decide his care plan makes him feel dignified and respected as well as psychologically empowered in taking his own care. The identified needs by the Barker-Tidal Model impact Jack physically by showing contented and normal behaviour. This is evident as the model informed that chlorpromazine is to be used to control his improper behaviour and physical discontentment in the public.

The Barker-Tidal Model identified that psychological therapy is required by Jack to improve his emotional health which would impact on improving his social life. Thus, the model suggested using CBT for Jack to improve his mental health help him act normally in society. As mentioned by Green et al. (2015), schizophrenic individuals to have improved social life require undergoing counselling. This is required so that they can control their symptoms which lead them to show improper behaviour in public in turn leading them to be isolated by the public in the society. The Cognitive Behavioural Therapy (CBT) is referred to the psychotherapy with the goal to change the thinking pattern and behaviour of people affected by mental disorder (Jauhar et al. 2019). Thus, the model was able to enhance the social life of Jack by making him understand and improve his behaviour to act normally in society to be accepted by others.

The chosen model that is Barker-Tidal Model has been able to support Jack’s care planning by making the nurses understand the way they are to participate in analysing and collecting information of needs and demands of the patients to ensure the person’s care satisfaction. This is evident as the model mentioned nurses to value the voice of the patient, be apprentice where the patient mentions their own care needs and show genuine curiosity in understanding the facts to develop care support (Gabrielsson et al. 2015). The Barker-Tidal Model has also supported Jack’s care planning by mentioning the nurses about his care preferences. This is evident as in using present toolkit elements the nurses are asked to draw conclusion of preferences of care to be delivered from story shared by the patient (Ramage et al. 2018). On drawing information, the nurses understood that one-to-one therapeutic care is to be provided to jack as he wishes the family intervention to be avoided.

The person-centred care is seen to be concentrated on eight key values which are individuality, rights, choice, privacy, dignity independence, partnership and respect (Sjögren et al. 2017). The Barker-Tidal Model values the rights, respect and dignity of Jack by offering him ability to voice his opinion and nurses acting according to his preferences. The individuality and independence are valued through Barker-Tidal Model by arranging the care as per the health condition of the particular patient and preferred way of care delivery. The Barker-Tidal Model values partnership by asking the nurses and patient to work with each other in framing the care plan. Thus, the fulfilment of most of the values of person-centred care indicates that a person-centred approach is been take to support Jack. The care goals were set with the patient by considering their choices and preferences regarding ways and nature of care. This is because respecting the preferences and choices of patients related to care leads nurses to effectively meet the needs and demands of the patient to offer them satisfactory care support (Ross et al. 2015).

The long-term goal of care for Jack is to treat his delusion and hallucinations thoughts through medication and CBT so that he is able to properly interact with society and avoid being isolated due to improper behaviour. The current care goal is to make Jack realise that he is suffering from mental illness and need to participate in accepting care to differentiate between normal and delusional perceptions. The short-term goal is to make Jack comply with the treatment and develop belief that he can be cured. The patient’s choice is required for planning care because it assists in valuing their thoughts and perception (Kelly et al. 2015). Thus, Jack’s choice was considered by listening to his entire story and identifying his preferences of care which impacted in framing the long-term care goal. This is evident as from the story it was found that Jack expresses the choice to not include the family members in his care may be due to some reason that has not been mentioned by him and thus the CBT instead of Family therapy is arranged. The rights and consent of the patient are to be valued so that they feel dignified and respected as well as nurses avoid facing legal action for violating human rights (Jernberg et al. 2015). This has influenced the current care goals and care to be framed by including the decision of the patients in offering them determined support.

The SMART stands for specific, measurable, attainable, realistic and time period and the SMART goal allows all these criteria to be included to assist in improving chances of achieving the care goals (Revello and Fields, 2015). The concept of SMART goal is incorporated in the goal-setting by identifying whether each of the selected goals fulfils the criteria of being specific, measurable, attainable, realistic and can be accomplished within the determined time period of care for the patient. The care provided was perfectly tailored to Jack by setting the care plan as per his identified needs developed through the implementation of Barker-Tidal Model. Further, the care provided is tailored by considering if holistic support has been able to be provided by using the model. The choice and preferences of Jack were also considered in arranging the care making the care support to the tailored with the health needs and demands of the individual.

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The personal beliefs as a nurse are that involvement of the family is essential in offering care to the mentally-ill patients as it helps the family members become educated regarding the way to communicate with the patients. Moreover, it enhances psychological support to the patients to cope with the illness resulting in improved health of the individual (Rigol-Cuadr et al. 2015). This personal belief may have impacted to include Jack in Family Therapy to treat schizophrenia. However, it would have led to violate the rights and disrespect choice of Jack as he did not wish the family to be around which would result in him to get dissatisfied care. The personal values such as commitment impacts to provide error-free medical care (Parandeh et al. 2015). This is because nurses with effective commitment wish to identify new ways in which better care can be offered to patients. Thus, commitment could have been able to deliver better quality care to Jack compared to the present nature of care being delivered.

The impact of care delivery which is arranged for Jack after following the Barker-Tidal Model to identify his needs and arrange the care plan is to be evaluated by comparing his current psychological health and physical condition with the previous condition from when he was admitted to the hospital. This is because comparing health condition before and after therapy helps the health practitioners to understand the extent of effective care has made on the health improvement of the patient (Ali et al. 2016). Jack is to be monitored continuously to assess his progress in the delivery of care after identification of needs through Barker-Tidal Model. The feedback from Jack is to be received aftercare is being delivered to assess the extent of progress in health has been made by him after receiving the care. The intended outcome for Jack is achieved through patient-centred approach because the care has been framed by using the Barker-Tidal Model which offers all the persona-centred values such as individuality, independence, choice, rights, respects and others to be achievable.

The discussion informs that Jack is a 20-year-old individual who is suffering from schizophrenia is admitted to the mental health ward of the hospital. The Barker-Tidal Mental Health Recovery Model is being used to identify the care needs of Jack. The needs identified through the model are that Jack is to be offered voice to related his story, his language is to be respected, he is to be included in the care decision, care delivery and arrangement is to be made in partnership with the patient by the nurses, changes in care is to be made accordingly and others. The needs identified through the model is able to impact Jack physically by improving his behaviour to normal, psychologically by making him avoid delusion and socially by making him able to understand way to interact in the society by controlling his mental health symptoms. The Barker-Tidal Model was able to deliver person-centred care to Jack as it met all the values and principles related to the person-centred approach. It is recommended that in future Roper-Logan-Tierney model is to be used along with Barker-Tidal Model so that holistic care, as well as mental health recovery, is more effectively achieved in the patients like Jack. Further, apart from arranging one-to-one therapy like CBT for Jack the reason behind his disapproval to include the family is to be identified so that Family therapy can also be included to ensure better treatment and improved living condition of the patient for long-term basis.

References

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