What factors can impact upon working collaboratively.

Discuss the nature of collaborative working within the nurse client relationship

Discuss the nature of collaborative working within the nurse client relationship
Assignment plan

Part 1: Discuss the nature of collaborative working within the nurse client relationship. (300 words)

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Why is this important when delivering psychological interventions?

What factors can impact upon working collaboratively.

Nursing drivers, PHE, No decisions about me without me, policies and drivers – NMC etc re collaborative working.

Define collaborative working – does it happen, is choice given? Does it improve outcomes? How it involves patient and families – critique collaborative working, Arnstiens ladder. Participatory working – is this more effective?

Factors which may impact – therapeutic relationship, time and availability of the nurse nursing attitude to patient or diagnosis, effective communication, nurse’s physicality – how they present to the service user from the start. Instil hope and positivity.
Working collaboratively essential to engaging someone in psychological interventions
Be careful relationship is collaborative and not collusive, boundary setting, professional parameters. Managing expectations, Power where does this lie? Is your intervention client centred or economically dictated? How do you manage power dynamics? Peplau, assessment of levels of health literacy if client has to engage in independent work.

Part 2: Critically appraise the evidence base supporting the use of a particular psychological intervention in mental health. (1500 words)

Choose one psychological intervention and start to compile a list of credible sources – consider the quality/credibility of the research.

Also consider NICE guidance – does it have any flaws. What are its criticisms?

Look at the guidelines in relation to the therapy and its effectiveness for this diagnosis

Are there any flaws in the evidence? Link into the research module (year 2) when critiquing the research.

Appraise the efficacy of the therapy IN RELATION TO the patient’s diagnosis and presentation.
Look at systematic reviews on Cochrane database. NICE Guidelines – just guidelines, they are often old and outdated – check other evidence.

Part 3: Evaluate the knowledge, skills and values necessary to deliver psychological interventions. (1200 words)

Choose one psychological intervention to focus upon and identify the above.

Keep it relevant to the case study.

Training required – in house or formal. How are the sessions delivered? Does it vary from therapist to therapist.

Self-awareness – Bennar. Supervision from others.

Credibility of the intervention.

Engaging with the service user. Does the nurse value the therapy – how does this affect the success and quality of the intervention.Can someone deliver a therapy that they do not believe in.

Ethics of in house training – does this make the nurse qualified after a short time of training, no registered body, supervision to ensure the nurse is following the therapy as required. Link to financial outcomes and gains (clusters define what people are entitled to).

Students should consider lifelong learning, recovery model, Benner novice to expert, formal and informal training. Individual or group supervision. How the skills and knowledge link to the NMC code of conduct for example non maleficence/beneficence. This is in addition to any formal training required. What about clinical supervision individual or group when is clinical supervision effective? Is it always effective?

Deliver specific interventions within a legal and ethical framework.

Consider the ethics of delivering the intervention? Whose agenda?

Informed consent? Ability to consent? Coercion?

What other ethical issues should be considered?

MHA, MCA, DoL’s. How do these influence the delivery of therapy?

Coercion – removal of rights for ‘not complying’, does this affect the outcomes. Power balance involved in this. Look at the Model of change.

Is there a ‘best time’ for treatment?

Organisational constraints, time pressures, waiting lists – may be months after referral – look at transtheoretical model of change – may have been ready at the point of going to GP, may have waited 9 month – things change!

Has the intervention been explained properly, could the person make an informed choice and consent.

Manage expectations of self, team and service user. What is the service user’s presentation? Are they connected to the treatment?

How does motivational interviewing fit in? If the service user is not quite ready and perhaps needs some motivational interviewing to begin with, is there the time allowed? Ethics involved.

How did the nurse work with the service user in this case study? Person-centred? Collaborative?

Client? Psychiatrist? Practitioner? Family? Informed consent? Ability to consent? Coercion?