A Critical Evaluation of the Engagement and Psychosocial Asessment of a Client Living with Psychosis in the Health and Social Care Practitioners Work Setting.

INTRODUCTION This assignment is a critical evaluation of the mesh topology and psycho neighborly discernment of a client lifespan with psychosis in the community. It provides a critical and analytical account which encapsulates minds, psycho education, problem solving, implementation and evaluation of strategies use. I willing overly use Gibbs (1988) model of reflection to reflect on my sagacity process and how learning can be taken for shelter in terms of my own practice training and that of the service aspect.My client l shall call Emily a pseudo name used to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) 2002 Code of Professional Conduct that outlines guidelines of confidentiality. Emily was initially on the acute ward where l started the process of engagement with her out front she was discharged under our team in the community to facilitate other(a) discharge. Emily was suitable for psycho companionable based interventions ( poun ds per square inch) and this was identified as part of her care send off in articulate to provide support in adapting to the demands of community sustainment and managing her illness.PSI should be an indispensable part of treatment and options of treatment should be make available for clients and their families in an effort to promote reco very. Those with the best depict of effectiveness are cognitive behavioral Therapy (CBT) and family intervention. They should be used to restrain relapse, to thin symptoms, increase insight and promote adherence to medication, ( tight-laced 2005). Emily is 33 year old woman with a diagnosis of schizophrenia. She was referred to my team to facilitate earlier discharge from the ward as part of her discharge.She lives in supported ho development and had had several hospital admissions and around under the mental wellness act. Emily was organism maintained in the community on medication solely it was matte that there was still an amount o f injury in her life and that her accessible functioning was suffering as a result. Emily presented with both delusional and unreal symptoms and as part of her treatment cognitive approaches were considered to help alleviate the di melodic phrase and modify the symptoms. Emily was brought up in a soaringly dysfunctional family.both her parents had problems with drugs and the law. Emily had been introduced to drugs at an early age save due to her illness she had stop using them at the age of 30 when she went into supported accommodation. There was family account of schizophrenia as her grandad had it and he had killed himself. Emily identified that her problems started in 2007 when her grandfather passed a fashion as she was close to him and had lived most of her life with her grandparents. I holy a m line to look back at art object she talked about her life history (see vermiform appendix 1).It is vital that the client is allowed to key their story with the minimum interv ention from the practitioner and the timeline can be used to examine if there are approximately(prenominal) links to their relapses and psycho episodes (Grant et al 2004). In the community setting we catch a variety of patients with various diagnosis of mental health problems. The rationale for choosing this patient is that she had had various interventions frequently(prenominal) as medication changes and a lot of experience with the mental health professionals including compulsory treatment under the mental health act (1983). totally these factors are likely to welcome an impact on the individuals degree of willingness to engage in psychological interventions (Nathan et al, 2003). Hence initially it was a challenge to engage Emily and establish a relationship and build resonance. (Nelson 1997) states rapport is built by learning arouse and concern and be especially careful non to express any doubts about what the patient tells you. The bankruptment of a therapeutic re lationship is critically important in move with persons with schizophrenia, which maybe difficult with patients struggling with mistrust, suspicion and denial (Mhyr, 2004).Rapport took some time to develop and was established by core conditions of genuineness, respect and faultless empathy (Bradshaw 1995). I met with Emily to set the agenda and explained to her that she was free to terminate the session anytime should she thumb it necessary. It was likewise vital to ensure that the sessions were neither confrontational and totally pliant with Emilys view of the world ( Kingdom & Turkington, 1995) I encouraged Emily to name her current problems and to give a detailed description of the problems and concentrate on a more recent problem. l was directive, active, riendly and used constructive feedback, containment of smell outings to develop the relationship(Tarrier et al,1998). l used her interest in Christianity to engage her and because l showed an interest this became a regul ar point of conversation and strengthened the connection. I also demonstrated some flexibility in response to Emilys inevitably and requirements at different stages of the treatment and intervention. It is not possible to maintain a sound collaborative therapeutic relationship without constant attention to the ever-changing situation and requirements of a patient (Gamble and Brennan, 2006).Since the development of anti insane medication and restraint of biomedical models during the 1950s mental health care has changed and evolved. The dependency on the sole use of medication was order to have left patients with rest period symptoms and companionable disability, including difficulty with inter personalized skills and limitation with coping (Sanford&Gournay, 1986). This prompted the return of PSI to be used in conjunction with medication management.The aim was to slew residual disability and to include in the treatment process affectionate skills and training rehabilitation (Wy kes et al, 1998). As part of my sagacity process l carried out a comprehensive assessment using CPA 1, 2, and 4 in conjunction with the Trust Policy. This was to establish what her problems were and formulate a lightheaded intend. A process of structured, comprehensive assessment can be very useful in developing an in-depth understanding of issues surrounding resistance to service (Grant et al 2004).I carried out a Case Formulation (CS) using the 5Ws What? , Where? , When? , With Whom and wherefore, and Frequency, Intensity, Duration and Onset ( FIDO) model to explore and get a detailed ex platformation of the problem and explore the Five aspects of your life experiences (Greenberger and Padesky 1995) (see Appendix 3). CS maps out the relationship on how the environment impacts on your thoughts, emotion, behaviour, tangible reactions (Greenberger and Padesky,1995).While the assessment helped to form a picture of Emilys suitability for PSI it also provided a scope for further r un away on her coping skills. Given the assumption that a person may feel reluctant to give a particular way of coping as this maybe the only means of control (Gamble & Brennan, 2006), the exploration was collaborative. From the assessment and example formulation Emilys goal was to go out more and sicken the frequency and intensity of her voices or even have them disappear. l explained to Emily that we had to be realistic about her set goals and having voices disappear was unlikely.Kingdom (2002) states that though patients hold to make voices disappear are unlikely since voices are, as far as reasonably established, attributions of thoughts as if they were external perceptions. Goals are positive, based in the next and specific (Morrison et al 2004) and the golden rule in goal setting is to be SMART, Specific, Measurable, Achievable, Realistic and Time Limited. Emily then rephrased her goal statement to that she precious to reduce the intensity of her voices in the next few we eks by using distraction techniques that she had not tried before.I used the KGVM Symptom scurf version 7. 0 (Krawieka, Goldberg and Vaughn,1977) to assess Emilys symptoms which focuses on six areas including anxiety, effect, suicidal thoughts and behaviour, elevated mood, hallucinations and delusions. A KGV assessment provides a global measure of roughhewn psychiatric symptoms (feelings and thoughts) experienced with psychosis. The frame prevail ensures that important questions are asked and a consonant measure of symptoms is provided. The KGV is a valid tool with a considered level of high reliability (Gamble and Brennan, 2006).Assessment is a process that elicits the presence of disease or exposure and a level of severity in symptoms (Birchwood & Tarrier, 1996). This gathering of randomness provides the bases to develop a plan of suitability of treatment, identifies problems and strengths and agree upon priorities and goals (Gamble & Brennan,2006). l also used the Social F unctioning Scale (SFS appendix 6) (Birchwood et al,1990) which examined Emilys social capability and highlighted any areas of concern.Emily was a loner and though living in supported accommodation she was hardly askd with the other residents or join in with community activities. She uttered that she was afraid pile could hear her voices and were judging her at all time and used avoidance as a coping strategy. On using the KGV assessment and from the results (see Appendix 2) Emily scored highly in four sections hallucinations, delusions, depression and anxiety. It appeared during assessment that her affective symptoms were econdary to her delusions and hallucinations, which were initiated and exacerbated by mostly disagreeable events in her life. Her hallucinations were noted to be evident at certain times and were followed by sleep want. Emily expressed fleeting suicidal thoughts but denied having any plans or intentions. She also experienced sporadic moments of elation which appeared to be joined to stress. It was important for Emily to understand how life events had an impact on her difficulties and the use of the tune Vulnerability Model SVM (Zubin and Spring 1977) demonstrated this (see Appendix 4).Practical measures arising from an assessment of stress and vulnerability factors seek to reduce individual vulnerability, decrease surplus life stressors and increase personal resistance to the effects of stress. One of Emilys highlighted problems was a lack of sleep and this could be linked to the stress vulnerability and her psychotic symptoms. Normalisation was used to illustrate this to Emily. Her increase in psychotic symptoms could then be normalised through discussing about the effects of sleep deprivation on her mental state and reduction of the associated anxiety.Emily was able to recognise how stress impacted on her psychosis. Emily identified the voices as a problem from the initial assessment. She was keen to talk about them but listened to suggestions l made to play the voices. The assumption of continuity between normality and psychosis has important clinical implications. It opens the way for a group of therapeutic techniques that focus on reducing the fault and anxiety often associated with the experience of psychotic symptoms and with diagnostic labelling.Kingdom and Turkington(2002) have described such approaches as normalising strategies, which involve explaining and demystifying the psychotic experience. They may involve suggesting to patients that their experiences are not strange and no one can understand, but are common to many people and even found amongst people who are relatively normal and healthy. Normalising strategies can help instil hope and decrease the stigma and anxiety which can be associated with the experience of psychotic symptoms.This rationale emphasises the biological vulnerability to stress of individuals with schizophrenia and the importance of identifying stresses and amend methods o f coping with stress in order to minimise disabilities associated with schizophrenia (Yusupuff & Tarrier, 1996). (Grant et al 2004). The problem l encountered when applying and using this model with Emily was that she realised and understood that she was not the only one experiencing voices but she precious to find out wherefore she experienced the voices.I used the belief about voices questionnaire (BAVQ-R appendix 5) which assesses vicious and benevolent beliefs about voices, and emotional and behavioural responses to voices such as engagement and resistance (Morrison et al 2004). We identified the common triggers of her voices such as anxiety, depression and social isolation. During my engagement with Emily l emphasized enhancing existing coping strategies (Birchwood& Tarrier, 1994) (Romme &Escher 2000). The imagination was to build on Emilys existing coping methods and introduce an alternative. We concur upon distraction as a coping strategy.The plan was for Emily to listen to medical specialty or carryout breathing exercises when the disturbing voices appear and to start interacting with them by relation them to go away rather than shout at them. Emily used this plan with good effect at most times as it appeared to reduce the psychological arousal and helped her gain maximum usage of these strategies in arbitrary the symptom (Tarrier et al, 1990). To tackle Emilys social functioning we identified activities that she enjoyed doing and she enjoyed discharge to church but had stopped due to her fears that people could hear her thoughts and found her weird.I suggested that she could start with small exposure, like sitting in the mill with her fellow residence and going on group outings in the hearth as these were people she felt comfortable with as she knew them. This would then hopefully lead to Emily change magnitude her social functioning and enable her to attend church. Emily expressed that she felt more in control of her voices REFLECTION My mold with Emily was made easy as she agreed to work with me although l did face some reluctance initially. As my intervention and engagement with Emily started while she was on the ward this made it easier for me to engage her in the community.We developed good rapport and she felt she could trust me, which made the process of engagement easier. Through my engagement and assessment process l improved on my questioning and listening skills. Emily was distinctly delusional at times and working with the voices present proved a challenge at times, but l realised that l had to work collaboratively with her and gain her trust and not question her beliefs. At times though l felt l was interrogating her and did not follow a data formatting and also because of the constraints on time l did not allow a good deal time to recap and reflect and could never properly agree the time of next merging.I also worked at her existing strengths and coping strategies that she had adapted throughout he r life and this empowered her and made her feel like she was contributing. At times though l felt we deviated from the set goals and l woolly-headed control of sessions. On reflection this is an area that l will get hold of to develop and improve on and be able to deviate but bring back the focus to the agreed plan. My interventions were aimed at Emilys voices and increasing her social functioning. This l discovered was my target areas and not necessarily Emilys. n in store(predicate) l will aim at concentrating more on what the client perceives as their major problem as this will show client involvement in their care. This will also help me have a clear and rational judgement and appreciate every advantage the client makes no matter how small. I did not focus much on Emilys family which l realised was a topic that she wanted to explore but l felt l was not fit out in exploring this part of her life in relation to her illness. The other difficulties l faced was because of my wo rking pattern l had to cancel some of our meeting appointments.As part of the set agenda l had to reintroduce myself and the plan and goals that we had set out in the initial stages and this constantly proved to bridgework the gap. It was also difficult for continuity in the team that l work in as one did not carry a personal caseload so delivering interventions was not always easy and there was not always continuity as some of my colleagues were not familiar with some applications of PSI. This highlighted as a service that there was a need for us as nurses in the team to have PSI training in order to continue with the work if the main practitioner was away and also as a team we hardly ever sed assessment tools and were therefore not confident and competent in their use. l also had difficulties in end assessment in time due to constricted time frames. l could not always spend as much time with Emily because l had other clients to see in a space of time. In future l will have to n egotiate my time and improve on my time management. In this assignment l had to carry out a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis and carry out a critical self reflection on the assessment process and how this could be improved on.From my case larn l deduced that use of some applications of PSI remains highly experimental and requires capacious research and more theoretical models. Furthermore discussion is also deficient on the details as to ways in which symptoms improved or social functioning enhanced in behavioural terms in relation to social context. However the interventions used in this case study highlighted considerable strength in supporting claims that PSI can work and does help reduce symptoms of psychosis. 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Krawieka, M, Goldberg,D, Vughn,M (1977) A Standardised Psychiatric Assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica 197755 299-308. Kingdom , D and Turkington,D (1994) Cognitive Behaviour Therapy of Schizophrenia.Hove Lawrenc e Erlbaum. Kingdom, D and Turkington (2002) The Case Study Guide to Cognitive Behaviour Therapy of Psychosis. Wiley. Mhyr, G(2004) Reasoning with Psychosis patients Why should a general psychiatrist care about Cognitive Behavioural Therapy for Schizophrenia. Morrison,AP, Renton, JC, Dunn, H, Williams, S, Bentall, RP (2004) Cognitive Therapy for Psychosis, Brunner- Routledge. Nathan, P, Smith, L, Juniper, U, Kingsep, P, Lim, L (2003) Cognitive Behavioural Therapy for Psychotic Symptoms, A healer Manual, Centre for Clinical Interventions.Nelson H (1997) Cognitive Behavioural Therapy with Schizophrenia. A exert Manual. Stanley Thornes. National Institute for Clinical Excellence (2003) Schizophrenia core interventions in the treatment and management of schizophrenia in primary and secondary care, NICE publications. Nursing & Midwifery Council, Code of Professional Conduct (2002). Romme M and Escher A Eds (1993) Accepting Voices. MIND Publications Sanford T and Gournay K (1996) Perspec tives in Mental Health Nursing. Bailliere Tindall.Tarrier, N, Yusupoff, L, Kinney C, McCarthy E, Gledhill A, Haddock G and Morris J (1998) Randomised controlled trial of intensifier cognitive behaviour therapy for patients with chronic schizophrenia. British Medical Journal 317,303-307. Zubin, J, & Spring, B (1997) Vulnerability A new view on schizophrenia. Journal of subnormal Psychology, 86, Topic Students will carry out a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis in the health and social care practitioners work setting. Word deliberate 2826