REVIEW OF LITERATURE

The review of literature in a research report is a summary of current knowledge about a particular practice- problem. (Nancy & Burns 2002). A literature review is an organized writer’s presentation of what has been published on a topic by the scholars. The task of reviewing literature involves the identification, selection, critical analysis and reporting of existing information on topic of interest.

The literatures found relevant and useful for the present study have been organized under the following headings.

1. Literature related to prevalence of anxiety among patients receiving radiation therapy.
2. Literature related to interventions used to reduce anxiety of patient receiving radiation therapy.

Literature related to prevalence of anxiety among patients receiving radiation therapy.

Donna B. Jeffe (2010) conducted a study among women who received radiation therapy over a period of five years in United Kingdom. The results showed that 35% of women had significant levels of anxiety or depression prior to radiation therapy. 75% women with high levels of anxiety prior to treatment recorded further high scores over the time period of five years. Out of six women who received radiation therapy, one had high anxiety scores during every follow-up. Very few of the women’s with initial normal anxiety scores developed significant level of anxiety or depression over time. The study concluded that patients with little education showed higher levels of anxiety and depression over time and emphasized the need for education before radiation therapy.

Andersen BL,Tewfik HH (2006) conducted a study to find the psychological reactions towards radiation therapy. Totally 45 patients undergoing external radiation therapy were included in this study. Pre and post radiation assessments of the subject’s were done in the areas of state and trait anxiety, somatic complaints, and treatment side effects. Results showed increase in complaints and side effects reported by all patients at the treatment conclusion. Results also showed that (a) patients with an initial high level of anxiety reported a significant reduction, but they remained the most anxious subgroup; (b) patients with a moderate level of treatment anxiety before radiation therapy reported no change; and (c) patients with low levels of anxiety reported significant increase. The study concludes that patients who were either low or high in state anxiety were also characterized by more anger or hostility than patients with moderate level of treatment anxiety.

Hans Geinitz, FrankB (2003) conducted a study to evaluate fatigue 2.5 years after radiation treatment in patients with breast cancer and to assess its relation to pre- and immediate post-treatment fatigue values. Totally 41 patients were included in this study whose fatigue value was evaluated during the time of radiation therapy. Out of these 41 patients, 38 were alive and free of cancer 2.5 years after radiation therapies, received the Fatigue Assessment Questionnaire, a visual analog scale on fatigue intensity as well as on cancer-related distress scale, the Hospital Anxiety and Depression Scale, and Health Survey per mail. All 38 patients returned their questionnaires. The values were compared to pretreatment and immediate post-treatment levels. Cancer-related distress values correlated with the patient fatigue scores. Results showed that Patients with functional impairment had slightly higher fatigue values. Patients with pretreatment elevated fatigue, anxiety or depression levels were at high risk for chronic fatigue.

Barrie R. Cassileth Ph.D (2009) conducted a study to assess the effectiveness of experience on radiation therapy patients’ desire for information. Information giving and seeking were explored among 160 cancer patients who were receiving or about to receive radiation therapy. Eighty-two new patients and 78 experienced patients completed a questionnaire to find their knowledge of diagnosis and radiation therapy, expectations about treatment, self-assessment of the adequacy of their knowledge, and desire for additional information. Analysis showed that 92% of the patients reported detailed knowledge of diagnoses. Patients were optimistic about treatment: only one person thought that radiation might not be helpful; 50 percent of the patients had a thought that radiation therapy might cure their disease. Patients who had experience with radiation therapy shown with increased knowledge but they had diminished desire to seek information. Most experienced patients had accurate information, but many did not feel well informed. The desire among knowledgeable patients for more information might show the patients’ uncertainty about the radiation treatment.

Lynn kilbride (2007) conducted a study to assess the frequency, severity of anxiety and depression among brain tumor patients between the period of surgery and radiation therapy. Totally 51 patients were included in this study whose anxiety and depression were assessed at three time points; post surgery, three weeks post surgery and prior to radiation therapy. Hospital Anxiety and Depression scale was used. Results indicated a heightened level of anxiety prior to radiation therapy. Five patients had significant depression at the time period between surgery and radiation therapy. Four of the five patients with scores consistent with depression had past histories of depression. The study concluded that a past medical history of depression is a significant predictor of depression before radiation therapy.

Arthur peck, MD (2006) conducted a study to assess the emotional reactions of patients receiving radiation therapy. Totally 55 patients were included in this study. They were interviewed by a psychiatrist. The focus of initial interview was what they told when they were referred to have radiation therapy. Although 60% were informed by their doctors that they had cancer, all arrived at the treatment center without any preparation for the frequency, number, and the procedure of radiation treatment. Most of the patients believed that requiring radiation therapy was very bad news. They had the fear that radiation might cause further damage and possibly cancer. Few of them only expected it to be curative. Again the patients were interviewed after the completion of radiation treatment. The results showed that the incidence of depression and anxiety was even greater than their pretreatment interviews. More than one third of the patients judged the treatment to be ineffective; they were not realizing that their new distress resulted from the side effects of radiation treatment. In this study only one patient suffered damage due to radiation therapy and 60% were free of signs of cancer at follow up, 1 to 2 years later. This study concluded that patients before radiation therapy suffered from irrational fears of disability and death mainly due to their misconceptions about the radiation therapy.

Thomas w.decker (2006) conducted a study to assess the impact of stress, anxiety and depression on quality of life of cancer patients undergoing radiation therapy. Totally 82 outpatients who were undergoing radiation therapy were included in this study. The experimental group (34 patients) received some relaxation training and the control group (29 patients) received the standard education and counseling along with the radiation therapy. The results showed that there was significant (p < 0.01) reductions in tension, depression, anger, and fatigue of the experimental group. The study concluded that relaxation training significantly improves the quality of life of patients who are undergoing radiation therapy.

Yu P. Chen, Ngan M. Tsang (2002) conducted a study to find the causes of interruption of Radiation therapy in patients with Nasopharyngeal Carcinoma in Taiwan. A total of 3273 nasopharyngeal carcinoma patients were treated at the Radiation Oncology Department from 1979 to 1996 were included in this study. Among these patients, 276 did not complete the full course of radiation treatment. The medical records of these patients were reviewed to determine the factors contributing to treatment interruption. Results showed that the acute side effects and complications caused by radiation therapy were the major factors influencing patient’s decisions to discontinue the treatment. This study suggested that more attention should be paid to take care of acute side effects of radiation ­therapy and also reinforcing the patient with education is important.

Santhosh K.Chaturvedi (1998) conducted a study to assess the prevalence of anxiety and depression in patients receiving radiation therapy in India. A total of 100 patients referred to radiation therapy were included. All patients were administered the hospital anxiety and depression scale before starting the radiation therapy, after the completion of radiation therapy, and at 3-4 months follow-up. Anxiety and depression were detected frequently in patients receiving radiation therapy both prior to treatment and later during follow up. Frequency of anxiety significantly increased after initiating radiation therapy, but later reduced during follow up assessment.

Hoyle Leigh (1987) conducted a study to assess the psychological factors affecting survival in cancer patients receiving radiation therapy. Totally 101 patients receiving radiation therapy were evaluated for anxiety, depression, and perception of the seriousness of their condition. In 3 years, the survivors were compared to the non survivors. The survivors had significantly higher mean trait anxiety (p < 0.05) than the non survivors. State anxiety and depression scores also tended to be higher in the survivors. Results implied that anxiety may be adaptive in cancer patients, but it is not necessarily a good prognostic sign in cancer patients. However, if anxiety occurs in the context of massive defensive failure, it may be a predictor of poorer outcome.

Literature related to interventions used to reduce anxiety of patient receiving radiation therapy.

Georgia K.B Halkett (2010) conducted a study to assess the effective communication and provision in radiation therapy and role of the radiation therapists. Health professionals have a duty of care to radiotherapy patients in providing them with adequate information before treatment. The aim of the study was to (a) explore how radiation therapists communicate with breast cancer patients during a radiation therapy planning appointment (b) determine what information is provided during this appointment and (c) explore radiation therapists’ perspectives on their role in providing patient information and support. A total of 110 radiation therapists were participated in this survey. They simulated 2 radiotherapy planning appointments and held 2 forums. The study concluded that Radiation therapists play an important role in communicating with patients and providing information, especially if patients exhibit anxiety and distress.

Christie R. Eheman (2010) conducted a study to assess the information-seeking styles among cancer patients before and after treatment by demographics and use of information sources. Totally 731 cancer patients attending outpatient clinics for cancer treatments were surveyed during the pre treatment and post treatment period. The study evaluated the relationships between information-seeking style (active, moderately active, and passive styles) and demographics, cancer type, and health status for the pretreatment and post treatment periods and overall. The generalized estimating equations approach was used to model the log odds of more active to more passive information-seeking preferences taking into consideration both the pretreatment and post treatment periods. The results showed that prior to treatment, 17% reported an active information-seeking style, 69% were moderately active, and 14% were passive.

Raymond Chan (2009) conducted a study to assess the effectiveness of orientation program on levels of anxiety and self efficacy among newly registered cancer patients who were waiting for chemotherapy or radiation therapy in a cancer centre in Australia. A randomized control study was used and interventions given like a face-to-face program which includes introduction to the hospital facilities, introduction to the multi-disciplinary team and an overview of treatment side effects and self care strategies. The aim of the study was to orientate patients to the cancer centre and to meet the health care team. Results showed improvement in self-efficacy of patients and demonstrated potential improvement in health outcomes. The study also reported that there were only limited studies on orientation program for cancer patients particularly with respect to the use of multidisciplinary team members.

Yvonne Zissiadisa (2009) conducted a study to assess the impact of more intensive written information in patients receiving radiation therapy. Totally 194 patients were included in this study. The experimental group (102) received more intensive information and control group (92) received the standard consultation. State trait anxiety scale was completed prior to their first consultation at the time of simulation and at the completion of radiotherapy. Information satisfaction questionnaire to assess the patient’s satisfaction was also completed at the time of simulation prior to radiation therapy. The results showed that there was no significant difference between the groups with regard to mean satisfaction scores with the overall information given. Results showed that more intensive information did not significantly change the patient’s satisfaction, anxiety scores. But the patients were generally very satisfied with the information they received but they were less satisfied with the information on lifestyle issues.

Eva J.E. Christensen, B.Sc (2006) conducted a study to find the effectiveness of interventions to relieve pain and anxiety during radiation therapy. The main objective of this study was to assess the discomfort and anxiety during radiation therapy, which can increase patient motion leading to decreased treatment accuracy. Totally 2051 subjects were included in this study. They were given different interventions like placebo, hypnotherapy, aromatherapy, music therapy and guided imagery including pharmacological interventions. Results showed that guided imagery showed benefits in terms of pain. And the study concluded that relaxation therapies may decrease anxiety during radiation therapy, evidence supports the benefit of pharmacological interventions for pain and anxiety for specific radiological procedures and selection of common criteria for reporting pain and anxiety is valuable for further studies.

Cartledge Hoff A, Haaga DA(2005) conducted a study to find the effectiveness of an education program on radiation oncology patients and family. Information was presented in oral and in written form. After the intervention, orientation program participants did not differ significantly from control group members in state anxiety, general distress, treatment adherence, or knowledge of radiation therapy. Orientation group patients reported greater satisfaction with clinic care, and the orientation group had significant utilization of the psychological counseling services within the clinic, as well as outside support.

Jeff Dunnab,(2004) conducted a study to assess the effectiveness of targeted treatment education for cancer patients to promote adjustment through assisting patients to participate in treatment decision making, comply with treatment regimens and cope more effectively with treatment side effects. Totally 92 patients included in this study, randomized into experimental and control groups. The experimental group patients were given video information about radiation therapy. Pre test post test and follow up design was used. Results showed that there were no significant difference between the control and experimental group. However, patients in the intervention group reported high levels of satisfaction with the video and all reported that they would recommend the video to other patients waiting for radiation therapy. In the experimental group 90% of patients reported that most of the information received through the video was new to them.

C.D.Linde, A.D.Stuart (2002) conducted a study to find the effectiveness of cognitive relaxation-visualization intervention in reducing the anxiety of patients receiving radiation therapy. Totally 88 female patients were taken for this study. The aim of the study was to find the effectiveness of the intervention in two groups. One group (N = 72) waiting for being pre-diagnosis and the other group (N = 16) before beginning radiation therapy treatment. Personal anxiety inventory was used to assess the anxiety. The results indicated that the intervention was effective in reducing anxiety for both the groups. It also concluded that patients had perceived the presence of an empathic individual during the time of diagnosis and before radiation treatment as being of greatest value. Taking interventions to reduce the anxiety before diagnosis and cancer treatment was very important.

Lundberg pranne C.PhD,RN (2001) conducted a study among Buddhist patients with cancer undergoing radiation therapy to assess their feelings, satisfaction and coping with nurse provided education and support before radiation therapy. In this study 90 males and 89 females participated. The results showed that the most common feelings about radiation therapy of both the genders were acceptance and women’s felt more anxiety compared to men. The most common ways of coping with the radiation therapy for both genders were rest, relaxation and communicate with their family or friends. The result showed that the satisfaction of patients with nurse provided education and support was higher among the men. The study concluded that when oncology nurses provide education to radiation therapy patients, it is very important that they should be well known about their patients’ characteristics including their cultural values and religious beliefs.

D’ Haese S, Vinh-Hung (2000) conducted a study to assess the timing of provision of information to reduce anxiety and to improve satisfaction of cancer patients receiving radiation treatment. Two sources of information’s were used (a) a booklet with a stepwise overall description of radiation treatment (b) teaching sheets with all the information about the radiation treatment site. Totally 68 patients were included in this study. They were randomly assigned to simultaneous information group and stepwise information group. Assessments were recorded before the simulation (p=0.02) and more satisfied (p=0.0001). Results showed that information given through a stepwise format leads to less anxiety towards the radiation treatment and patients were satisfied more before the simulation procedure.

D’ haese S, Vinh-Hung (2000) conducted a study to assess the timing of provision of information to reduce anxiety and to improve satisfaction of cancer patients receiving radiation treatment. Two sources of information’s were used (a) a booklet with a stepwise overall description of radiation procedure (b) teaching sheets with all the information about the radiation treatment site. Totally 68 patients were included in this study. They were randomly assigned to simultaneous information group and stepwise information group. Assessments were recorded before the simulation, 2nd week and at the end of radiation treatment. Results showed that information given through a stepwise format leads to less anxiety (p=0.002) and satisfaction (0.00001) towards the radiation treatment before the simulation procedure.

Conclusion

The review of literature enlightened the investigator to develop an insight into the radiation therapy anxiety, orientation program and its effects in the review of literature. Many studies were conducted to reduce the level of pre radiation therapy anxiety, particularly the education before radiation therapy have shown more significant results throughout the entire course of treatment. These reviews helped the investigator to gain a deeper knowledge of the research problem and guided in designing the study.

The Issue

“An eighteen-year-old male was found unresponsive with apparent gunshot wounds today…”. This announcement is a news opener we hear way too often. Areas with large urban populations such as Washington, DC, Chicago, and Los Angeles are hit the hardest with these types of disparities, which is why Healthy People 2020 named it one of the Leading Health Indicators (LHI) with a goal of setting a lower percentage of deaths by violence in each respective city. The District of Columbia had 100 homicides in 2019, a six percent increase from last year (

https://mpdc.gov/page/district-crime-data-glance

). For too long, this epidemic has been overlooked, brushed aside as if it will go away on its own. That certainly has not happened yet. Now, it is time to take action. Finding the root and cause of this type of violence will be critical in implementing a strategy that can be utilized for saving more lives. There is much to be discussed when it comes to the why, how and how comes of this topic. Blame has been placed on the lower income areas as well as the higher income areas. Some believe it is a systematic destruction of specific races. In the end, it is a National issue that must be addressed not in part, but by the whole of the human population. It starts… one person at a time.

DMV Metro and other major cities

In 2018, Washington, D.C. had over four thousand violent crimes with 160 resulting in a homicide. (

https://mpdc.gov/page/district-crime-data-glance

). Almost two thousand firearms were recovered the same year. Cities in close proximity such as Baltimore, had alarmingly high numbers as well. Most of these crimes affect racial and ethnic minorities. People in low income housing had a higher crime rate of two times higher than high income households. Adolescents ages 12 to 17 held the highest rate for violence in these areas. (

https://www.americashealthrankings.org/explore/annual/measure/Crime/state/MD

) The Healthy People 2020’s overarching goal is to create social and physical environments that promote good health for all. This will include implementing these strategies in the public-school system as well as creating afterschool and summer programs. Lower income housing individuals have less financial freedom to enroll children in extracurricular activities that builds their skill level. They are often left to fend for themselves as parents are working all day and sometimes even second jobs. The new strategies will give children and young adults alternative and positive actions to circumvent the chance of violence.

Article One: “I’m scared to die”

This article showcases an eight-year-old from Langston Lane Apartments in Washington D.C., one of the areas known for physical and gun violence, who says this everyday while he waits for his grandmother to walk him home from his afterschool program. This is one of many kids who all speak of the same fear. The fear of dying while coming home from school, going to the store for their parents, or simply playing outside. The article goes on to talk about the TraRon program that promotes art and therapy as a way to deal with the inner-city violence. It helps kids consisting of mostly middle school and elementary handle the trauma of “generational gun violence” This program, like many others, are spearheaded by Healthy People 2020 as a way to lower the percentage of injury and violence.

Article Two: Mass shootings

Albeit this second article is primarily about people being killed in the U.S from mass shootings, which is contrast to my focus on the inner city of the D.C. metro area, It is imperative to show you because it shows that as a nation, we are ALL responsible for protecting each other and unilaterally finding ways to end the violence. This article speaks about a specific three mass-shootings in the U.S., killing over fourteen hundred people combined. It does speak of Baltimore with 11 people (all teens or under 25 years of age) being shot and killed in one weekend. It also hints on the new kind of normalcy that comes with the fact that we are becoming used to shootings and killings that we almost expect it. This is also another area that we can capitalize on for promotion of self-awareness, and love for humanity in general. (

https://www.thetrace.org/2015/08/gun-deaths-charleston-chattanooga-lafayette/

)

Article Three: Firearm suicide among youth in the United States

Another area we need to address is teen and young adult suicide with 37% of these coming by way of firearms. There are programs in place and more being created every year that will help to give teens a better way to deal with the disparities that come from growing up in less than ideal environments, abusive parents, lack of educational resources, etc. The article relates to them as “Greater Risk” because of all of the pitfalls and obstacles they face over children in more affluent areas. It goes on to educate on more statistical data such as the study population done for children who died by firearms between January 2004 and December 2015 all between the ages of 10 to 18. All of these deaths were ruled a suicide. As you delve deeper into the article it gives you some alarmingly high percentage numbers of children susceptible to this ill fate. It is a must read for everyone. This is another piece of the puzzle that quickly needs to be addressed if we are to save the future generations. (

https://link.springer.com/article/10.1007%2Fs10865-019-00037-0

)

Health Promotion: Where do we start?

This has been a topic for quite a while. There has been a lot of finger pointing, and race blaming to the point that the real issue has been overlooked time and time again. Sure, there are systematic obstacles in place that can often hinder or bind people from lower income households, or inner city, urban areas from achieving the same goals as those from more affluent ones. There is no denying that. However, we as a people, the humans of this planet, must rise above that and aim to teach the entire next generation the importance of humanity. If you see someone hurting, reach out a hand. If you see your neighbor struggling, offer assistance of any level, and if you see someone lost without guidance, then by all means try and guide them.

Healthy People 2020 has realized the aforementioned issues and are taking great strides to assist with overcoming these obstacles. They are organizing more focus and educational groups to assist with this challenge. Adding more afterschool and summer camp programs, creating male role model mentors for mother only homes, more seminars on how to deescalate possible violent situations, and moreover teaching young boys and girls the value of their worth, are some of the key areas that can be utilized to see a significant drop in injury and/or death by gun or dangerous weapon .

Conclusion

As we have heard before, on many topics… This is easier said than done. There is no overnight fix. Healthy People 2020 are satisfied with a 10% increase as a win. This places the expectation and realization in perspective. It is not easy trying to change programming of people who have lived a certain lifestyle for their entire lives. Whereas we do not want to give up on the older generation, we must choose our battles wisely. The children are the future and can bring in a new era of thinking and pave a way of human betterment for the generations to come. We hold a responsibility to the next generation to pave the way for the next generation after that. As a person who has awoken from the blindfolds of society, I am proud to say that becoming a Nurse will enable me to help teach and educate people of all ages in many areas, especially health to allow them to pass ion to others. When we see the high percentages of young deaths as I spoke of earlier, we know it is our duty to not stand idly by. Healthy People 2020 is a great initiative, but it takes all of us to make a real difference. I say this with love and I hope you all receive it with open minds.

References

• Schnitzer, P.G., Dykstra, H.K., Trigylidas, T.E. et al. J Behav Med (2019) 42: 584. https://doi.org/10.1007/s10865-019-00037-0
• 
  https://www.healthypeople.gov/2020/About-Healthy-People
  
• 
  https://mpdc.dc.gov/page/district-crime-data-glance
  

• ‘I’m Scared To Die:’ Children In D.C. Cope With Gun Violence Trauma

• https://www.ncbi.nlm.nih.gov/pubmed/31367924
• https://www.thetrace.org/2015/08/gun-deaths-charleston-chattanooga-lafayette/

Introduction

The aim of this assignment is to demonstrate a knowledge and understanding of a mental health nurse’s role in providing person centred care to service users and their holistic care needs. It will focus on how recovery orientated practices were utilised when working with individuals with long term mental health conditions, as well as assisting them with recovery and future planning. Coulter, Eccles, Entwistle, Perera, Ryan & Shepherd (2015) state that a long-standing mental illness can be defined as an illness which lasts for up to or above three months, or when the risk of relapse, or a reoccurrence of the mental disorder is deemed a high possibility. It will also discuss the importance of recovery being tailored towards service users as individuals as there is no single way to define recovery, and it is individual to each person’s journey (Bird, Leamy, Le Boutillier, Williams & Slade, 2011)

The assignment will be divided into sections, so each area is discussed thoroughly and clearly.

Throughout this assignment, a pseudonym will be used when referring to the patient and no specific locations will be disclosed; this is to ensure confidentiality is always maintained, in accordance with the Nursing & Midwifery Council Code (NMC, 2015).

The person in focus

Nigel is a 68 year old who lives in a rural area of Wales. Nigel is a widow, and has a daughter in her thirties that he speaks to daily on the phone, however she lives 3 hours away. Since Nigel lost his wife to cancer two years previously. Nigel has been struggling with

alcohol

dependence and has become social isolated – claiming he would sit at home by himself and drink. Nigel is not from this area, but his wife was and they moved here to retire. Nigel has no social life in the area, as he says his social life involved friends that he made through his late wife. Nigel is retired, and up until his wife passed away had been doing volunteer work locally to keep himself busy.

Since losing his wife, Nigel has become dependent on alcohol. Nigel states he has “always been a drinker” but since losing his wife, this has become a coping strategy for when he feels low. Nigel claims it used to just be late at night, however Nigel then began drinking when he woke up, as it’s when he would experience cravings and alcohol withdrawal symptoms (Umhau, 2019).

Nigel attended his GP to try and get help with his anxiety and alcohol dependence. Nigel saw his GP and was referred to the community drug and alcohol team.

Nigel has had a lot of input from his substance misuse worker, and recently completed a planned detox, under supervision and guidance from his substance misuse worker. The detox was a success and Nigel is determined to continue with his recovery.

Holistic assessment

A multidisciplinary team (MDT) is used frequently in the field of mental health in order to make sure the assessment takes into account the individuals holistic needs (Ascari, Guerzoni, Magistri, Marzi, Mereu & Vendelli, 2019). It is vital that the MDT maintain a high standard of collaborative working so that Nigel’s holistic needs are met (Dock, Griffiths & Heinkel, 2015). It should also be noted there can be difficulties to overcome when using a multidisciplinary approach (Bonney, Halcomb, McInnes & Peters, 2015). For example having several professionals involved with Nigel’s care could result in Nigel losing his person centred care approach (Roncaglia, 2016)  as well as decreasing the likelihood that he his say in the decision making (Cook, Miller & Petch, 2013), both of which are aspects that are required for a successful recovery (Grainge & West, 2012).

Nigel had tried several times to come off alcohol himself with no help from professionals. Nigel was only able to go 24 hours before he claimed withdrawal symptoms became too intolerable, which is incredibly common (Davis, 2018). People who struggle with substance misuse are more likely to successfully overcome their addictions and cravings with input from specialist services like a drug and alcohol worker (Cutcliffe, Green & Travale, 2018), the likelihood is also increased by having regular contact with your alcohol worker and building a therapeutic relationship (Crisafulli & DiClemente, 2017).

It was discussed that a planned detox for Nigel would be best, as detoxing without supervision and medication can be incredibly dangerous for an individual drinking the amount Nigel was drinking (Fernandez, 2019). When attempting to detox from any substance, having support around you is as important as having professional input (Barclay, Brett, Dawson, Ivers & Lawrence, 2017). Nigel had no one living near by he felt would be able to assist and support him through detox, and with his daughter living several hours away, Nigel felt a detox at a residential care setting would be beneficial as it would mean there would be someone to check on Nigel for a 48 hour stay. This is important as ones physical health can deteriorate quickly (even when they are sleeping) if they are going through an alcohol detox (Kouimtsidis, 2017). Working together in an MDT setting meant Nigel’s needs were able to be addressed in a timely manner (Evans, Haines, McCabe & Perkins, 2018), and the substance misuse worker and social worker were able to find suitable accommodation for the detox. Eriksson, Hanpatchaiyakul, Kijsomporn & Östlund (2016) state that tasks such as suitable accommodation and environments for detox are the biggest challenge when trying to successfully get over addiction. Knowing your strengths and weaknesses in the MDT means being able to complete tasks like this successfully so that the recovery process is not slowed down (Horan, Lambert & Wall, 2018).

Nigel’s two needs that will be focused on are remaining abstinent from alcohol, and assistance with dealing with social isolation. These two specific needs coming together is a common thing, (Anderson, Bailey, Kenney & Stein, 2019) which is more likely following a loss of bereavement (Collins, Glowacka, Sherry, Stewart & Thompson, 2018). Nigel would require interventions to assist with remaining abstinent of alcohol (Bradberry, Coleman, Marsh, Pucci & Quelch, 2019), as well as to assist with his social inclusion within his local community (Boulze, Launay & Nalpas, 2016). There is the belief that general socialising within the community would give a service user empowerment and assist them to remain abstinent (Jacobson, Lord, Newman, 2017). Nigel had stopped driving as a result of his drinking. Nigel’s wishes are to recover and see his daughter and grandchildren whilst hoping he will regain his confidence to drive and visit them.

The Recovery Star framework (Mental Health Providers Forum (MHFP), 2009) will be the tool used to assist with the process and to monitor recovery. The Recovery star focuses on getting a service user to identify and note their needs in a visual way, so that their targets can be set based on the results. It has ten key areas which cover a person holistically, so that realistic goals can be made (Fazzari, Lucchi, Placentino & Scarsato, 2017). The ten steps are “physical health & self-care, social networks, living skills, work, addictive behaviour, identity & self-esteem, trust & hope, managing mental health, relationship & responsibilities.” (MHFP 2009). In Nigel’s case he could choose to select more relevant ones (for example) social networks, addictive behaviour, managing mental health & relationship and responsibilities. The service user can then set themselves a goal, which doesn’t have to be a goal from each step, but the ones they feel are relevant to them so that they do not feel overwhelmed (Lloyd, Machingura, Tse & Williams, 2016). The recovery star is a visual tool, meaning the service user is able to see their own progress (Lloyd, Machingura & Williams, 2016), furthermore demonstrating it’s ability to empower an individual to recognise which areas require further support or further intervention (Jacob, 2015). There is a stigma around mental health and substance misuse (Rust & Shim, 2013; ) and it’s been found that when service users face any kind of discrimination, they’re more likely to achieve their goals if there’s steady progress being made (Killaspy, King, Taylor & White, 2012). The fact it is holistic and shows progress in different areas can give people the empowerment needed to change (Rose, 2014). The recovery star has seen great success with not only mental health, but substance misuse services because you can visually measure and build on your successful changes in your recovery. (MacKeith, 2008).

Promoting recovery

Nigel has agreed to the administration of Pabrinex which is commonly used following an alcohol detox (Parsons 2018). Pabrinex is used with people who drink a large amount on a frequent basis and is seen as essential medication (Conlan, Kipping & McMullen ), as it can prevent irreversible alcohol related brain damages, nerve damage and death (Bault, Britton & Gilmore, 2018; Allard, Khan & Nevitt, 2014).

When providing opportunities for recovery, it is important that risk is managed in order to preserve the safety of the individual and others; balancing risk is an essential part of recovery, and professionals should be knowledgeable in when to avoid risk taking, and when to

take positive risks ().

Pabrinex

Councelling bereavement

ECS

It is important to remember, that recovery can only be achieved if the individual has

insight into their mental illness and is willing to engage with services in order to

receive the treatment they need to recover (Barker & Buchann-Barker, 2010).

Challenges

Overall discussion, summary and appraisal of nursing assessment of need

Conclusion

It is clean that recovery is a process that must be tailored and individualized to each service users needs and requirements (Bauer, Belanger, Ellison, Evans & Niles, 2018), and that it should be based on giving the service user hope and empowerment (Royal College of Psychiatry, 2010). Numerous recovery models can be followed; therefore it’s essential the nurse utilise a holistic and person centred approach when providing care, so that they can use the recovery model most effective to their needs in order to achieve their end goal (Slade, Stickley & Wright, 2018). When working with individuals with complex needs and co-occurring health needs there will always be barriers that can come in the way of recovery (Beeckman, Debyser, Joeri, Vandecasteele, Van Hecke & Vandewalle, 2016), however with the appropriate skills and knowledge including support from the MDT,  the recovery can be successful and these barriers would be overcome (Jarden, Oades & Slade, 2017).

This assignment has taught me that by utilising evidence-based practice and taking a holistic and person centred approach when caring for an individual, that a successful recovery is possible, and that a service user like Nigel could rebuild his life, and that despite his previous struggles with alcohol dependence and social isolation, Nigel could go on to have a fulfilling life.

References

• Allard, R., Nevitt, S., & Khan, G. (2014). Screening And Management Of Alcohol Dependence In A District General Hospital.
  
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• Boulze, I., Launay, M., & Nalpas, B. (2016). Variation of Interpersonal Values Following Alcohol Withdrawal in Alcoholics Seeking Treatment: 12-Month Longitudinal Study.
  
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