COMMUNITY PRACTICE ASSIGNMENT Essay Example
Community Practice Assignment
Community Practice Assignment
Growing research supports an integrated and multi-disciplinary approach to mental disorders. This is because, this from of approach promotes early intervention and the implementation of effective person-centered treatment and management plans. Consequently, it is associated with lower admission rates, compliance with treatment plans, and increased ease of reintegration into society. Community mental health teams (CMHT), promote a holistic approach to mental disorders at the acute/crisis, emergency, and rehabilitation episodes of care.
Describe the structure and role of the Community MH team involved in the episode of care
Community health teams consist of multidisciplinary health care providers. These professionals involved include nurses, social worker, psychiatrists, general practitioners, and psychologists. These teams at seek to reduce the rate of unnecessary admissions at the Acute and Emergency Department levels and allow for successful management of the condition during and after hospital stay at the rehabilitation level.
Acute mental health teams are responsible for the provision of intensive care to patients experiencing a crisis in their mental health. These teams usually provide short-term care with the goal of reducing unnecessary admissions and are available at all hours of the day. In some respects, they can be viewed as gatekeepers to psychiatric services. Patients under the care of these teams are usually referrals from General practitioners. In Jenny’s case her entry into the community based care was a result of her referral by Dr. Cook. These teams assess the patient and provide the appropriate treatment. Often this assessment is carried out by a nurse in conjunction with a trained psychiatrist.
At times, the provided medication may fail to alleviate the patient’s condition. In such instances, the patient needs to be moved into to the next episode of care. For Jenny transfer to the emergency department system was necessitated by her violent behavior and failure to comply with the care plan. At the time of her admission, she was a danger to both herself and her husband and in light of her worsening condition in need of supervised treatment. Although a number of patients are voluntarily admitted (Burton, 2011), Jenny’s violent behavior, which resulted from her delusion, necessitated police involvement.
Moreover, the severity of Jennny’s condition prompted her transition of care to the rehabilitation CMHT. Community rehabilitation teams provide biological, psychological, social, and legal interventions (Kalidindi, Killaspy, & Edwards, 2012). These interventions include prescription of medication for negative psychosis symptoms, formulation of strategies to increase drug adherence and treatment response, “low-intensity psychological interventions, and support to engage with family and friends. Strategies employed in Jenny’s case during her stay sought to create awareness and treatment adherence. Furthermore, in light of her limited social support network and strained relationship with her husband, the team needs to focus on strategies that support re-engagement with her friends and family.
Describe the key roles and responsibilities and areas of specialty possessed the CMHN’s working with this team
As identified by Huang et al. (2008), the roles of community mental health nurses include assessing, care provision, placement coordination, and provision of support. Furthermore, they are crisis workers, advocates, and case managers. Their performance in these roles allow for the promotion of mental health, management, and rehabilitation of patients with mental disorders. Furthermore, these roles and responsibilities are instrumental at each episode of care.
CMHNs are crisis workers. They provide a wide range of services to individuals, families and communities. These services include comprehensive and holistic biopsychosocial assessment of the patient to identify risk factors, current functioning state, and history of the condition(s) and outreach responses to allow for intensive home treatment during the acute/crisis episode of care. In addition, their services to the family focus on creating understanding of the patient’s conditions and available crisis and prevention measures. The nurse’s competence is also instrumental to community mental health emergency teams.
These nurses are also case managers. This role entails facilitating and coordinating complex patient care, teaching psychosocial rehabilitation, and linking patients with available and appropriate community services. These responsibilities recognize and appreciate that individuals, with the right intervention, are capable of living functional lives. Arguably this role is crucial during both episodes of rehabilitation and acute care.
Moreover, CMHNs are advocates. In this capacity they challenge formal and informal social institutions that promote the development of mental disorders and hinder effective rehabilitation. Some of the responsibilities under this role include protection of the clients’ rights, acting on behalf of patients whose life skills are compromised by their conditions, and creating awareness to dispel stigmatization. Notably, the role of acting on behalf of clients entails an understanding of the clients needs and respect to their preferences. The responsibilities associated with this role ease the process of reintegration for clients.
Describe the key professional and community stakeholders likely to be involved in collaboration with the community mental health team
CMHT are multidisciplinary teams that seek to promote and implement efficient treatment and management strategies that reduce the rate of admissions. Professionals in these teams are drawn from both health and social sciences and they work with individuals, families, and the community. Moreover, they are instrumental at each episode of care.
They include psychiatrists, psychologists, nurses, and social workers. Psychiatrists are medical doctors who have specialized in psychological/psychiatric disorders. They medical and psychological educational background allows them to provide medical and counseling services. In CMHT, psychiatrists’ responsibilities include diagnosis, prescriptions, and making treatment recommendations. Diagnosis entails identifying the client’s symptoms with already identified symptoms associated with certain conditions. The most commonly used manual is the DSM V. Medication prescriptions, on the other hand entails identification of appropriate medication to alleviate the disorder and making necessary modifications.
CMHNs, on the other hand, are trained registered nurses with mental health training and who work in the community setting. They are instrumental in the provision of services to not only individuals but also the whole community. These services include coordination of care, advocacy, creation of awareness about mental disorders to dispel stereotypes and stigma, and provision of long-term support. In addition, as part of the crisis team, they are crucial in the rapid assessment and intensive intervention for clients.
Unlike psychiatrists, psychologists do not prescribe medication. These individuals are scientifically trained to understand human behavior and mental processes and they use this knowledge to help clients with their problem situations. Their role in CMHT entails conducting therapy whose aim is to identify psychosocial factors that limit the effectiveness of treatment and resolve them. Moreover, this role also involves equipping clients with coping skills that facilitate their functionality in society.
Community mental health managers, in turn, are usually psychiatrists and their role in these teams is both challenging and demanding. On top of working with individuals with mental disorders in the community, these managers coordinate the efforts of the professionals in the CMHT and ensure that the strategies employed comply with existing mental health policies and frameworks. Arguably, their effectiveness is dependent on both their competencies and their relationship with other professionals in the team. In fact, research by McGuinness (2003), indicates that effective community mental health managers are committed to and have a positive working relationship with their teams.
Involvement of this multidisciplinary team promotes Jenny’s wellbeing. While psychiatrists deal with the medical aspect of her care through the prescription of drugs such as Mirtazapine and Olanzapine, the nurses’ support promote compliance. The psychologists, in turn, provide psychosocial therapy that promotes psychological wellbeing and allows for the identification and resolution of risk factors that undermine adherence to care.
Describe the main focus on the clinical nursing practice
The involvement of nurses in community mental health teams recognizes that the training and roles that nurses play in the society makes them an integral part of the health care and the community. Their role in promotion and maintenance of mental health issues is especially crucial in light of the rapid transition of patient from acute to hospital and finally home settings.
The community health approach recognizes and appreciates the fact that patients spend most of their time with nurses and that their contributions are instrumental in proactive measures. Also their involvement in CMHT is viewed as a means of improving care through the development of new, specialized, and expanded care that meet the community’s needs. Nurses in the community setting are at the forefront of implementing public health strategies that are in line with the community’s needs.
In light of their roles, the focus on their involvement in CMHT is on promotion of their access to evidence-based practice, expansion of scope of practice through relevant databases. In addition, this focus seeks to increase nurses involvement in leadership and improvement of nursing education at all levels. The implementation of these measures aim at increasing competence of the nurses and establishing their role in CMHT.
In addition, their integration in the team is at all episodes of care. At the acute/crisis episode, nurses are instrumental in providing intensive at home measures and monitoring the progress of the patient. At the emergency episode, they are instrumental in the coordination of care, while at the rehabilitation episode, they provide support to the patient and provide linkages to relevant community facilities and services.
Describe and discuss the main risk assessment considerations
Risk assessment is crucial in evaluation and management of mental health conditions. It is a process that seeks to identify possible harmful outcomes and inform the formulation of risk management plans to avoid these outcomes. These outcomes are a result of risk factors, which can be categorized using the 5Ps approach. They include, the problem, predisposing, precipitating, perpetuating, and protective factors (NHS Foundation Trust, 2016). They entail the risk under consideration, factors that increase vulnerability, trigger risk behavior, maintain the problem, and prevent deterioration respectively.
The risk management process involves information collation, risk identification, and risk assessment interviews. Information collation enables the CMHT to acquire information about the patient’s condition in the past. Useful sources include GP feedback, past professional results, and interviews with care givers and family members.
Risk identification, on the other hand, entails the creation of an individualized risk assessment and formulation process, which is regularly updated. It seeks to identify information related to specific events and the nature of their effect on mental health, responses to risk behavior, severity, frequency, and pattern of risk behavior. For example, in Jenny’s case, this information includes her reaction to her family member’s deaths.
Risk assessment interviews, in turn, allow for the identification of risk factors relevant to the domains of risk to self and risk to others. Furthermore, they are instrumental in collecting information about past triggers, current mental state and social circumstances. The information obtained at this stage, in part, focuses on current symptoms, level of impulsivity, thoughts of violence and self-injury and access to means to do so. This information is used to access mental status through suicide risk assessment, orientation, speech, general appearance, and thought content. This assessment allows the team at the acute stage determine the course of action. Moreover, it is at this stage that coping mechanisms are explored.
Arguably, in spite of the fact that it is an ongoing process, it is especially crucial during the acute/crisis episode of care. Its use allowed the CHMT involved in Jenny’s case to obtain information about her current status, development and social history, and her mental status. Apart from identifying risk factors, the information obtained also informed her diagnosis. In fact, her sleeping pattern disturbance, altered thought process, and anxiety are some of the symptoms used to arrive at her Major Depressive Disorder (severe) recurrent with psychotic features.
Describe and discuss the practical impact and implications of the recovery method upon practice
This approach to mental disorders treatment and management affects professionals who work in these teams. The establishment of CMHT in organizations is associated with role confusion and the modernization of mental health services (Hanley, Scott, & Priest, 2017). Role ambiguity and confusion often results from overlapping of duties. For example, both psychologists and nurses function as counselors in the team. This confusion often lead to increased defensiveness among professionals and consequently increased adherence to professional identities. Since the effectiveness of the team is dependent of coordinated teamwork at all episodes of care, increased individualization and defectiveness results in decreased response time to crises and the formulation of ineffective strategies.
In addition, organizational change associated with the implementation of CMHT is associated with increased morale. This is because, professionals view it as a means of modernizing mental health services (Hanley et al., 2017). CMHTs appreciate that communities are sources of illness and wellbeing and that long institutionalized stays in various institutions fail to consider the clients’ preferences and hinder successful reintegration into society. Therefore, increased community involvement and the identification and resolution of risk factors is lauded by many in the sector as a progressive move in the treatment and management of mental disorders.
Additionally, integrated approach promotes the effectiveness of transitions of care. Often the efficiency of these transitions is undermined by communication, accountability, and patient-education breakdowns (Joint Commission, 2012). Coordinated involvement of a multidisciplinary team that adheres to set frameworks and policies, has eased the the provision of care at all stages. For example, this system allowed for the provision of adequate and appropriate treatment for Jenny. Comprehensive assessment allowed for her diagnosis at the crisis episode of care. Regular check-up by the CMHT, in turn, fostered early identification of condition progression and rapid intervention.
However, the strategy is associated with poor communication between professionals. Poor communication contributes to neglect of clients’ physical and mental health (Blythe, & White, 2012). This neglect is further promoted by CMHT staff who believe that the promotion and maintenance of physical health of their patients is not their responsibility. Inefficient communication also undermines the intended purpose of CMHT, which is to provide integrated, holistic, and person-centered treatment and management options. For example, neglect in physical health makes it difficult to manage Jenny’s blood pressure, which since initial entry into the system has remained high. Her case illustrates the need for GP involvement and increased consideration of the patient’s psychological as well as physical wellbeing.
In light of the benefits associated with the approach and its challenges, there is need for training. This exercise would foster role differentiation and allow the staff to appreciate the importance of each member in the provision of holistic interventions. Moreover, it would foster effective communication that facilitates physical and psychological care of the patient.
Blythe, J., & White, J. (2012). Role of the mental health nurse towards physical health care in serious mental illness: An integrative review of 10 years of UK literature. International Journal of Mental Health Nursing, 21(3), 193-201. doi: 10.1111/j.1447-0349.2011.00792.x
Burton, N. (2011). Psychiatry. John and Wiley Sons
Clinical care policy. (2016). Lincolnshire Partnership: NHS Foundation Trust. Retrieved from http://www.lpft.nhs.uk/assets/files/Accessing%20our%20information/Policies%20and%20Procedures/Clinical_Care_Policy_V2.8_Dec_2016.pdf
McGuinness, M. (2003). Exploring the role of community mental health team managers. Nursing times, 100(32), 40-43. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15373160
Hanley, B., Scott, H., & Priest, H. (2017). The impact of organisational change on professionals working within a Community Mental Health Team (CMHT): a psychodynamic perspective. Psychoanalytic Psychotherapy, 1-19.
Huang, X. Y., Ma, W. F., Shih, H. H., & Li, H. F. (2008). Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan. Journal of clinical nursing, 17(22), 3030-3040. doi: 10.1111/j.1365-2702.2008.02426.x.
Joint Commission. (2012). Transitions of care: the need for a more effective approach to continuing patient care. Oakbrook Terrace, IL: Author.
Kalidindi, S., Killaspy, H., & Edwards, T. (2012). Community psychosis services: the role of community mental health rehabilitation teams. Faculty Report, FR/RS.
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