Catherine Hungerford

Recovery as a Model of Care? Insights from an Australian Case Study

The terms “model of health care,” “service model.” and “nursing model of practice” are often used interchangeably in practice, policy, and research, despite differences in definitions. This article considers these terms in the context of consumer-centred recovery and its implementation into a publicly-funded health service organization in Australia. Findings of a case study analysis are used to inform the discussion, which considers the diverse models of health care employed by health professionals; together with the implications for organizations worldwide that are responsible for operationalizing recovery approaches to health care. As part of the discussion, it is suggested that the advent of recovery-oriented services, rather than recovery models of health care, presents challenges for the evaluation of the outcomes of these services. At the same time, this situation provides opportunities for mental health nurses to lead the way, by developing rigorous models of practice that support consumers who have acute, chronic, or severe mental illness on their recovery journey; and generate positive, measureable outcomes.

Mental Health Nursing in Australia: Resilience as a Means of Sustaining the Specialty

As a concept, resilience is continuing to attract considerable attention and its importance across various life domains is increasingly recognised. Few studies, however, have defined or considered the notion of the group or collective resilience of a profession, including the capacity of that profession to withstand adversity and continue to develop positively in the face of change. This article considers the notion of resilience from the perspective of the specialty of mental health nursing, including the ways the specialty has adapted— and continues to develop—to changes experienced since deinstitutionalisation. Insights are drawn from a national Delphi study undertaken in Australia to develop a Scope of Practice for Mental Health Nurses, with responses used as a springboard to consider the impact of the perceived loss of professional identity on the collective resilience of the profession. Recommendations for a way forward for the profession are considered, including the ways in which a collective professional resilience could be developed to sustain and strengthen the professional identity of mental health nursing in Australia and across the globe.

The perceptions of health professionals of the implementation of Recovery-oriented health services: a case study analysis

– Recovery approaches to healthcare are now an important feature of the mental health policies and plans of many western countries. However, there are continuing challenges to the operationalisation of these approaches. The purpose of this paper is to consider how to overcome these challenges, using insights gained from health managers and practitioners who have been involved in the process of implementation. , – The analysis is undertaken through a descriptive single-case embedded study of the implementation of Recovery into a public mental health service in Australia. The unit of analysis that features in this paper is the perceptions of the implementation of Recovery-oriented services, of health managers and practitioners. , – The analysis suggests that although health service managers followed many of the recommendations that can be found in the research literature to support achievement of Recovery-oriented services, there was a need to go further. For example, practitioners in the case study context were educated about the principles of Recovery and provided with new processes of clinical documentation to support their work, however these practitioners felt they were ill-equipped to address complex issues of practice, including the management of clinical risk and professional accountability issues. This raises questions about the content of the education and training provided, and also about the ongoing support provided to practitioners who work within a Recovery-oriented framework. , – The descriptive single-case embedded study of the implementation of Recovery is the first of its kind in Australia. Findings of the study provide insight for other health service organisations committed to effectively implementing Recovery-oriented services.

Nurse care coordinators: definitions and scope of practice.

Abstract The Nurse Care Coordinator role has emerged in recent years as an important means of achieving significant outcomes for patient, their families, and the larger health system. These outcomes include increased patient satisfaction with service provision, an increase in patient access to services, and a decrease in the hospital length of stay and unplanned readmission. Despite the potential benefits, confusion around role defi nition and scope of practice are evident. This paper examines findings of a literature review of studies involving Nurse Care Coordinators and provides preliminary definitions of their role and practice. The primacy of the therapeutic relationship is upheld, together with the importance of facilitating continuity of care. It is proposed that these preliminary definitions require testing and refi ning to ensure the nursing profession is more effectively positioned to continue to enable positive outcomes for patients and health systems generally.

Trauma-informed Care and the Research Literature: How Can the Mental Health Nurse Take the Lead to Support Women Who Have Survived Sexual Assault?

Many women who access mental health services have been subjected to violent acts, including childhood sexual abuse and adult sexual assault, often at the hands of family members and partners. The vulnerability of these women can be further complicated when health professionals lack sensitivity to the issues involved; and the treatment received by the women is insensitive, leading to experiences of re-traumatisation. This article considers the principles of trauma-informed care and practice, as represented in the literature; and explains how mental health nurses can lead the way in multidisciplinary environments to ensure that women who have experienced violence receive the most appropriate health care, and are thereby supported to attain the best possible outcome.

Operationalising recovery-oriented services: The challenges for carers

Abstract Purpose: Recovery approaches to healthcare now feature in the mental health policies and plans of many western countries. However, the operationalisation of these approaches has met with numerous challenges. This paper considers the reasons why, from the point of view of spousal or family carers of people with chronic and severe mental illness. Method: A single-case embedded study was used to analyse the process and outcomes of the implementation of Recovery-oriented services into a public health service organisation located in a major urban centre in south-eastern Australia. The unit of analysis considered in this paper is the experience of carers with the Recovery-oriented services. Findings: Seven of the ten carers who were interviewed had not heard of Recovery or the implementation of Recovery-oriented services. Nine out of the ten carers had noticed no recent improvements in the way services were delivered. Instead, most carers observed a trend to shift the responsibility for overseeing the consumer’s treatment and care from health professionals to carers. The carers went on to describe the limited support and training they receive to undertake their role; and the effects of health professionals with-holding the information required by the carer to provide effective care. Carers also identified solutions to the many service issues they identified, including the development of a designated clinical role, in which a health professional would be available to work with carers who are supporting consumers on their Recovery-journey. Conclusion: Inherent to Recovery approaches is collaboration and partnerships between all key stakeholders, including carers. It is important that mental health services focus on strengthening this aspect of service delivery to address ongoing issues with the operationalisation of Recovery-oriented services.

Recovery and the role of humility : insights from a case study analysis

When the individuals comprising a profession are focused more on competition rather than service to others, and when holding a significant place on the world stage is held in higher esteem than meaningful collaboration with the disempowered, is it possible to be truly consumer-centred? This article considers the notion of humility in the context of recovery and the challenges to the effective implementation of recovery-oriented services that have been identified. Insights are drawn from a case study analysis of the implementation of recovery approaches to health care into a publicly-funded mental health service located in Australia. While challenges to the operationalization of recovery are complex, we argue that the professional quality of humility provides an important means by which genuine and meaningful collaboration can be achieved among health professionals, consumers, carers, and other stakeholders.

Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation?

Recovery-oriented models of psychiatric rehabilitation, such as the Clubhouse model, are an important addendum to the clinical treatment modalities that assist people with chronic and severe mental illness. Several studies have described the subjective experiences of personal recovery of individuals in the clubhouse context, but limited research has been undertaken on how clubhouses have operationalized recovery in practice. The research question addressed in this paper is: How are recovery-oriented practices reflected in the documentation of a clubhouse? The documents examined included representative samples of key documents produced or utilized by a clubhouse, including public health-promotion materials and policy and membership documents. Data were subjected to content analysis, supported by the Recovery Promotion Fidelity Scale. The recovery categories identified in the documents included collaboration (27.7%), acceptance and participation (25.3%), quality improvement (18.0%), consumer and staff development (14.5%), and self-determination (14.5%). These categories show how the clubhouse constructs and represents personal recovery through its documentation. The findings are important in light of the role that documentation can play in influencing communication, relationships, and behaviour within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.

Addressing mental health nursing workforce issues in Australia: a case study analysis

Purpose – The purpose of this paper is to report findings of a review of a unique program that has helped to address workforce needs and support Registered Nurses (RNs) working in a public mental health service in Australia. RNs are employed, facilitated to gain clinical experience in diverse mental health settings, and funded to study a graduate diploma in mental health nursing. Upon completion, there is no obligation to continue working for the health service, but most RNs have chosen to do so.Design/methodology/approach – A case study approach was taken to review the Program, using the focus group method of data collection. Past and present Program participants, and also their mentors and managers, were interviewed about the Programs benefits and challenges.Findings – The findings highlight the many successes of the Program and also suggest areas for development. One of these is the need to examine the curriculum content of the graduate diploma and consider requirements around clinical experience. Ano...

Recovery outcome measures: Is there a place for culture, attitudes, and faith?

Purpose Utilization of the Recovery Knowledge Inventory (RKI) and Recovery Attitudes Questionnaire (RAQ) in southeastern Australia raised questions about the RAQ, including links between attitudes, faith, and culture in supporting the recovery journey. These questions are particularly important when considered in the context of people with mental illness who live in secular multicultural societies. Conclusions This paper discusses the cultural appropriateness of the RAQ in Australian settings, and identifies the need to develop rigorous, inclusive recovery outcome measures. Practice Implications It is important to identify what best motivates people in their recovery journey, and to find a way to harness these motivating factors to achieve the best possible outcomes.PURPOSE Utilization of the Recovery Knowledge Inventory (RKI) and Recovery Attitudes Questionnaire (RAQ) in southeastern Australia raised questions about the RAQ, including links between attitudes, faith, and culture in supporting the recovery journey. These questions are particularly important when considered in the context of people with mental illness who live in secular multicultural societies. CONCLUSIONS This paper discusses the cultural appropriateness of the RAQ in Australian settings, and identifies the need to develop rigorous, inclusive recovery outcome measures. PRACTICE IMPLICATIONS It is important to identify what best motivates people in their recovery journey, and to find a way to harness these motivating factors to achieve the best possible outcomes.