Three discharge factors cause disruption:
DISCHARGE PLANNING
Purpose of hospital or community admission is to be discharged in a state of
health that enables the person to sustain himself/herself as independently as
possible.
Work of care team is to deliver care designed to promote this,
If the discharge begins with admission then surely the atient has to be actively
participating in clinical decision making from the very beginning, not at the point
of dischsrge when all descions have already been made.
Nurses have a key role to play in the provision of appropriate discharge and
aftercare.
This is an important safety measure, showing the link between inpatient and
community teams, as the immediate period after discharge is a time of significant
suicide and self harm risk. (NHS Choices, 2016)
FAMILY WORK/AUDREY Audreys entitled
to a formal carers assessment.
Safeguarding Sandras accessible to abuse
due to being in abusive relationship
Family intervention should: - NICE 2009
include the person with psychosis or schizophrenia if
practical
be carried out for between 3 months and 1 year
include at least 10 planned sessions
take account of the whole family's preference for either
single-family intervention or multi-family group intervention
take account of the relationship between the main carer
and
the person with psychosis or schizophrenia have a specific
supportive, educational or treatment function and include
negotiated problem solving or crisis management work.
DOMESTIC ABUSE
Therapeutic communication forms the basis of a comprehensive holistic
assessment. (Wallace, 2013)
Domestic violence has a higher rate of repeat victimisation than any other crime
(Home Office, July 2002)
2 women are killed every week in England and Wales by a current or
former partner (Office of National Statistics, 2015) 1 woman killed every 3
day
PHYSICAL HEALTH/MEDICATION
RESPIRDONE: SIDE EFFECTS & NURSING
INTERVENTIONS
The choice of antipsychotic medication should be made by the
service user and healthcare professional together, taking into
account the views of the carer if the service user agrees.
Provide information and discuss the likely benefits and possible
side effects of each drug, including:
metabolic (including weight gain and diabetes)
extrapyramidal (including akathisia, dyskinesia and dystonia)
cardiovascular (including prolonging the QT interval)
hormonal (including increasing plasma prolactin)
other (including unpleasant subjective experiences). NICE, 2009 AMENDED
2014
inadequate patient assessment by health professionals resulting in
problems such as poor knowledge of the patient's social circumstances,
poor organisation of post-discharge health and social care; the late booking
of transport services to take a patient home which prevents timely
discharge from hospital; and poor communication between the hospital,
follow-up care and community service providers. (Shepperd et al, 2014)
DISCHARGE meeting need has to be taken palce/care co-ordinstion
review
AUDREY Aware of discharge plans/ advocate informed
NEW FACE risk is done/cluster reviewed/Form H23 (NTW) is completed
Sandra has been given a discharge care-plan
Medication has been checked against kardex
Make sure that an email has been sent to me the CPN
7 Day Follow Up Appt/ Make sure that the CMHT consultant has been fully
informed
1. THERAPEUTIC COMMUNICATION (VERBAL)
o The process in which the nurse consciously utilizes the principles o
communication in a goal-directed professional framework.
o Best responses should focus on the general guidelines
Open-ended questioning is best used
Here and now rather than the past *
What rather than why
Orientation and presentation of reality
Offer carers of people with psychosis or schizophrenia an
assessment (provided by mental health services) of their own
needs and discuss with them their strengths and views. Develop
a care plan to address any identified needs, give a copy to the
carer and their GP and ensure it is reviewed annually.
Advise carers about their statutory right to a formalcarers
assessment provided by social care services and explain how to
access this.
Give carers written and verbal information in an accessible
format about:
diagnosis and management of psychosis and schizophrenia
positive outcomes and recovery
types of support for carers
role of teams and services
getting help in a crisis.
When providing information, offer the carer support if
As early as possible negotiate with service users and carers
about how information about the service user will be shared.
When discussing rights to confidentiality, emphasise the
importance of sharing information about risks and the need for
carers to understand the serviceusers perspective. Foster a
collaborative approach that supports both service users and
carers, and respects their individual needs and
interdependence.
Review regularly how information is shared, especially if there
are communication and collaboration difficulties between the
service user and carer.
Include carers in decision-making if the service user agrees.
Offer a carer-focused education and support programme, which
may be part of a family intervention for psychosis and
schizophrenia, as early as possible to all carers. The
intervention should:
be available as needed
have a positive message about recovery.
NICE 2014
ASSESSMENT TOOLS
Nursing Considerations
Monitor patient for tardive dyskinesia, which may occur after prolonged use. It
may not appear until months or years later and may disappear spontaneously or
persist for life, despite stopping drug. Life-threatening hyperglycemia may occur
in patients taking atypical antipsychotics. Monitor patients with diabetes
regularly. Periodically reevaluate drugs risks and benefits, especially during
prolonged use.
Monitor patient for weight gain.
Side Effects
CNS: akathisia, somnolence, dystonia, headache, insomnia, agitation, anxiety,
pain, parkinsonism, neuroleptic malignant syndrome, suicide attempt, dizziness,
fever, hallucination, mania, impaired concentration.
CV: tachycardia, chest pain, orthostatic hypotension, peripheral edema, syncope,
hypertension.
EENT: rhinitis, sinusitis, pharyngitis, abnormal vision, ear disorder.
GI: constipation, nausea, vomiting, dyspepsia, abdominal pain.

PSYCHO-SOCIAL INTERVENTIONS
Copeland, 2012
Recovery Star was designed with users to reflect their experience of
recovery and not to adhere to a predetermined statistical factor structure.
(Dickens et al, 2012)
One of the criticisms of the recovery star is that it is subjective and relies
completely on the patients internal opinion of themselves instead of addressing
the external environment alongside her inequalities. (Gadsby, 2015).
MH LEGISLATION COMMUNITY
RESILIENCE
TRANSTHEORETICAL MODEL OF CHANGE
Beattie Model
There are many different models of health promotion but the most commonly
used is Beattie (1991). Beattie sets out 4 main strategies for health promotion:
Health Persuasion
Health Persuasion will involve interventions that are directed at individuals and
led by in the mental health setting a Community Psychiatric Nurse (CPN), Support
Worker or another a healthcare professional. This is the technique I would
ultimately work on first with John.
Personal Counselling
Interventions that are client led and encourage individuals to make their own
choices. (Beattie, 1991). Personal counselling in this instance would help John to
gain confidence, increase his internal control (Ogden, 2004) surrounding alcohol
and ultimately empower him.
Community Development
Interventions that take place within a defined community to identify local health
issues and working with local people to take action on those concerns. As Johns
nurse, I advocate for him to make the most of support groups and weekly
meetings. (Warwick-Booth, 2012)
Legislative Action
CBT approaches Recovery Star Solution Based Approaches
Wellness Recovery Box Creative influences utilizing John Herons six
interventions
Holistic patient assessment is used in nursing to inform the nursing process and
provide the foundations of patient care. (Wallace, 2013).
Person-centred care is about seeing all people as valued. (Brooker, 2011)
NICE RECOMMENDATIONS 2014: Advise people who want to try psychological
interventions alone
that these are more effective when delivered in conjunction with
antipsychotic medication. If the person still wants to try
psychological interventions alone:
offer family intervention and CBT
agree a time (1 month or less) to review treatment options,
including introducing antipsychotic medication
continue to monitor symptoms, distress, impairment and level
of functioning (including education, training and employment)
regularly.
Creation of advanced statements
Installation of hope
Altruism
Positive coping strategies de-esclation careplan
Motivational interviewing
CORRECTIVE RECAPITULATION OF PRIMARY FAMILY GROUP.
Patients renew previous dysfunctional family patterns and learn that these
patterns can be changed to meet their present needs effectively.
DEVELOPMENT OF SOCIALIZING TECHNIQUES. Patients are taught appropriate
social skills.
IMITATIVE BEHAVIOUR. Patients selectively model healthy behaviors of the
leader and other group members.
CATHARSIS. Patients are not only allowed to express them appropriately.
EXISTENTIAL FACTORS. Patients share feelings about ultimate concerns of
existence, such as death or isolation, and learn to accept that
there is a limit to their control of these issues.
COHESIVENESS. Patients experience feelings of being accepted, valued,
and part of a group experience
INTERPERSONAL LEARNING. Patients learn how their behaviours affect
others and more appropriate ways of relating in the supportive atmosphere