Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T17:52:04.999Z Has data issue: false hasContentIssue false
  • English
  • Français

Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units

Published online by Cambridge University Press:  19 December 2014

Karleen Gwinner  and
Louise Ward
Karleen Gwinner*
Affiliation:
Children and Youth Research Centre, Queensland University of Technology, Brisbane, Australia
Louise Ward
Affiliation:
School of Nursing, La Trobe University, Melbourne, Australia
*
Correspondence to: Dr Karleen Gwinner, Children and Youth Research Centre, Queensland University of Technology, Victoria Rd L139, Brisbane, Queensland 4059, Australia. E-mail: [email protected]
Get access

Abstract

Background and aim

In recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.

Method

Data gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.

Results

Four defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.

Conclusion

The four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

Keywords

Inpatientnursing practicepsychiatric intensive carerecoveryrecovery-oriented health services
Type
Review Articles
Information
Journal of Psychiatric Intensive Care , Volume 11 , Supplement 2 , August 2015 , pp. 105 - 118
Copyright
© NAPICU 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexander, J. (2006) Patients’ feelings about ward nursing regimes and involvement in rule construction. Journal of Psychiatric & Mental Health Nursing. 13(5): 543–553. doi:10.1111/j.1365-2850.2006.00977.x CrossRefGoogle ScholarPubMed
Amering, M. and Schmolke, M. (2009) Recovery in Mental Health: Reshaping scientific and clinical responsibilities. Wiley.CrossRefGoogle Scholar
Anthony, W.A. (1993) Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal. 16(4): 11–23. doi:10.1037/h0095655 CrossRefGoogle Scholar
Aston, V.V. and Coffey, M.M. (2012) Recovery: what mental health nurses and service users say about the concept of recovery. Journal of Psychiatric & Mental Health Nursing. 19(3): 257–263. doi:10.1111/j.1365-2850.2011.01776.x CrossRefGoogle ScholarPubMed
Australian Health Ministers (2003) Third National Mental Health Plan 2003–2008. Canberra: Australian Government. http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-plan03 Google Scholar
Barker, P. and Buchanan-Barker, P. (2010) The Tidal Model of Mental Health Recovery and Reclamation: application in acute care settings. Issues In Mental Health Nursing. 31(3): 171–180. doi:10.3109/01612840903276696 CrossRefGoogle ScholarPubMed
Bertelsen, M., Jeppesen, P., Petersen, L., Thorup, A., Øhlenschlæger, J., le Quach, P., Christensen, T.Ø., Krarup, T., Jørgensen, G. and Nordentoft, M. (2008) Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry. 65(7): 762–771. doi:10.1001/archpsyc.65.7.762 CrossRefGoogle ScholarPubMed
Bonney, S. and Stickley, T. (2008) Recovery and mental health: a review of the British Literature. Journal of Psychiatric & Mental Health Nursing. 15(2): 140–153. doi:10.1111/j.1365-2850.2007.01185.x CrossRefGoogle ScholarPubMed
Bowers, L., Simpson, A., Alexander, J., Hackney, D., Nijman, H., Grange, A. and Warren, J. (2005) The nature and purpose of acute psychiatric wards: the tompkins acute ward study. Journal of Mental Health. 14(6): 625–635. doi:10.1080/09638230500389105 CrossRefGoogle Scholar
Bowers, L., Chaplin, R., Quirk, A. and Lelliott, P. (2009a) A conceptual model of the aims and functions of acute inpatient psychiatry. Journal of Mental Health. 18(4): 316–325. doi:10.1080/09638230802053359 CrossRefGoogle Scholar
Bowers, L., Allan, T., Simpson, A., Jones, J., van der Merwe, M. and Jeffery, D. (2009b) Identifying key factors associated with aggression on acute inpatient psychiatric wards. Issues in Mental Health Nursing. 30(4): 260–271. doi:10.1080/01612840802710829 CrossRefGoogle ScholarPubMed
Bressi Nath, S., Alexander, L. and Solomon, P. (2012) Case managers’ perspectives on the therapeutic alliance: a qualitative study. Social Psychiatry & Psychiatric Epidemiology. 47(11): 1815–1826. doi:10.1007/s00127-012-0483-z CrossRefGoogle ScholarPubMed
Brimblecombe, N., Tingle, A. and Murrells, T. (2007) How mental health nursing can best improve service users’ experiences and outcomes in inpatient settings: responses to a national consultation. Journal of Psychiatric & Mental Health Nursing. 14(5): 503–509. doi:10.1111/j.1365-2850.2007.01119.x CrossRefGoogle ScholarPubMed
Browne, G.G., Cashin, A.A. and Graham, I.I. (2012) The therapeutic relationship and mental health nursing: it is time to articulate what we do! Journal of Psychiatric & Mental Health Nursing. 19(9): 839–843. doi:10.1111/j.1365-2850.2012.01944.x CrossRefGoogle Scholar
Chen, S.-P., Krupa, T., Lysaght, R., McCay, E. and Piat, M. (2013) The development of recovery competencies for in-patient mental health providers working with people with serious mental illness. Administration & Policy in Mental Health & Mental Health Services Research. 40(2): 96–116. doi:10.1007/s10488-011-0380-x CrossRefGoogle ScholarPubMed
Cleary, A. and Dowling, M. (2009) Knowledge and attitudes of mental health professionals in Ireland to the concept of recovery in mental health: a questionnaire survey. Journal of Psychiatric & Mental Health Nursing. 16(6): 539–545. doi:10.1111/j.1365-2850.2009.01411.x CrossRefGoogle Scholar
Cleary, M., Hunt, G.E. and Walter, G. (2010) Seclusion and its context in acute inpatient psychiatric care. Journal of Medical Ethics. 36(8): 459–462. doi:10.1136/jme.2010.035402 CrossRefGoogle ScholarPubMed
Cleary, M., Horsfall, J., O’Hara-Aarons, M. and Hunt, G.E. (2012a) Mental health nurses’ views of recovery within an acute setting. International Journal of Mental Health Nursing. 22(3): 205–212. doi:10.1111/j.1447-0349.2012.00867.x CrossRefGoogle ScholarPubMed
Cleary, M., Horsfall, J., O’Hara-Aarons, M., Jackson, D. and Hunt, G.E. (2012b) Mental health nurses’ perceptions of good work in an acute setting. International. Journal of Mental Health Nursing. 21: 471–479. doi:10.1111/j.1447-0349.2011.00810.x Google Scholar
Coatsworth-Puspoky, R., Forchuk, C. and Ward-Griffin, C. (2006) Nurse–client processes in mental health: recipients’ perspectives. Journal of Psychiatric & Mental Health Nursing. 13(3): 347–355. doi:10.1111/j.1365-2850.2006.00968.x CrossRefGoogle ScholarPubMed
Curtis, J., Baker, J.A. and Reid, A.R. (2007) Exploration of therapeutic interventions that accompany the administration of p.r.n. (‘as required’) psychotropic medication within acute mental health settings: a retrospective study. International Journal of Mental Health Nursing. 16(5): 318–326. doi:10.1111/j.1447-0349.2007.00487.x CrossRefGoogle ScholarPubMed
Deacon, M. and Fairhurst, E. (2008) The real-life practice of acute inpatient mental health nurses: an analysis of ‘eight interrelated bundles of activity’. Nursing Inquiry. 15(4): 330–340. doi:10.1111/j.1440-1800.2008.00426.x CrossRefGoogle ScholarPubMed
Dix, R. (2012) Responding to acute crisis: ways and means. Journal of Psychiatric Intensive Care. 8(2): 59–61. doi:10.1017/S1742646412000192 CrossRefGoogle Scholar
Gilburt, H., Slade, M., Rose, D., Lloyd-Evans, B., Johnson, S. and Osborn, D.P.J. (2010) Service users’ experiences of residential alternatives to standard acute wards: qualitative study of similarities and differences. The British Journal of Psychiatry. 197(Supplement 53): s26–s31. doi:10.1192/bjp.bp.110.081075 CrossRefGoogle Scholar
Glick, I.D., Sharfstein, S.S. and Schwartz, H.I. (2011) Inpatient psychiatric care in the 21st century: the need for reform. Psychiatric Services. 62(2): 206–209. doi:10.1176/appi.ps.62.2.206 CrossRefGoogle ScholarPubMed
Green, C.A., Polen, M.R., Janoff, S.L., Castleton, D.K., Wisdom, J.P., Vuckovic, N. and Oken, S.L. (2008) Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatric Rehabilitation Journal. 32(1): 9–22. doi:10.2975/32.1.2008.9.22 CrossRefGoogle ScholarPubMed
Gwinner, K. and Ward, L. (2013) P.I.C.U., H.D.U., A.O.A. What treatment do we provide? Current descriptions of the function of intensive care for inpatient psychiatric health care. The Mental Health Review. 18(3): 128–143. doi:10.1108/MHRJ-02-2013-0008 CrossRefGoogle Scholar
Gwinner, K., Knox, M. and Brough, M. (2013) Making sense of mental illness as a full human experience: perspective of illness and recovery held by people with a mental illness living in the community. Social Work in Mental Health. 11(2): 99–117. doi:10.1080/15332985.2012.717063 CrossRefGoogle Scholar
Hamrin, V., Iennaco, J. and Olsen, D. (2009) A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements. Issues in Mental Health Nursing. 30(4): 214–226. doi:10.1080/01612840802701083 CrossRefGoogle ScholarPubMed
Hilton, M.F. and Whiteford, H.A. (2008) Pro re nata medication for psychiatric inpatients: time to act. Australian & New Zealand Journal of Psychiatry. 42(7): 555–564. doi:10.1080/00048670802119804 CrossRefGoogle ScholarPubMed
Huang, D.T., Clermont, G., Kong, L., Weissfeld, L.A., Sexton, J.B., Rowan, K.M. and Angus, D.C. (2010) Intensive care unit safety culture and outcomes: a US multicenter study. International Journal for Quality in Health Care. 22(3): 151–161. doi:10.1093/intqhc/mzq017 CrossRefGoogle ScholarPubMed
Janner, M. (2007) From the inside out: Star Wards’ – lessons from within acute in-patient wards. Journal of Psychiatric Intensive Care. 3(2): 75–78. doi:10.1017/S1742646407001136 CrossRefGoogle Scholar
Kartalova-O’Doherty, Y., Stevenson, C. and Higgins, A. (2012) Reconnecting with life: a grounded theory study of mental health recovery in Ireland. Journal of Mental Health. 21(2): 135–143. doi:10.3109/09638237.2011.621467 CrossRefGoogle ScholarPubMed
Lakeman, R. (2011) Leave your dignity, identity, and day clothes at the door: the persistence of pyjama therapy in an age of recovery and evidence-based practice. Issues in Mental Health Nursing. 32(7): 479–482. doi:10.3109/01612840.2011.579690 CrossRefGoogle Scholar
Long, C.G., Knight, C., Bradley, L. and Thomas, M. (2012) Effective therapeutic milieus in secure services for women: the service user perspective. Journal of Mental Health. 21(6): 567–578. doi:10.3109/09638237.2012.734649 CrossRefGoogle ScholarPubMed
Lorem, G.F. and Hem, M.H. (2012) Attuned understanding and psychotic suffering: a qualitative study of health-care professionals’ experiences in communicating and interacting with patients. International Journal of Mental Health Nursing. 21(2): 114–122. doi:10.1111/j.1447-0349.2011.00773.x CrossRefGoogle ScholarPubMed
Mayers, P., Keet, N., Winkler, G. and Flisher, A.J. (2010) Mental health service users’ perceptions and experiences of sedation, seclusion and restraint. International Journal of Social Psychiatry. 56(1): 60–73. doi:10.1177/0020764008098293 CrossRefGoogle ScholarPubMed
Mezey, G.C., Kavuma, M., Turton, P., Demetriou, A. and Wright, C. (2010) Perceptions, experiences and meanings of recovery in forensic psychiatric patients. The Journal of Forensic Psychiatry & Psychology. 21(5): 683–696. doi:10.1080/14789949.2010.489953 CrossRefGoogle Scholar
Middelboe, T., Schjødt, T., Byrsting, K. and Gjerris, A. (2001) Ward atmosphere in acute psychiatric in-patient care: patients’ perceptions, ideals and satisfaction. Acta Psychiatrica Scandinavica. 103(3): 212.CrossRefGoogle ScholarPubMed
Mullen, A. (2009) Mental health nurses establishing psychosocial interventions within acute inpatient settings. International Journal of Mental Health Nursing. 18(2): 83–90. doi:10.1111/j.1447-0349.2008.00578.x CrossRefGoogle ScholarPubMed
Nolan, P., Bradley, E. and Brimblecombe, N. (2011) Service users’ beliefs about acute in-patient admission. The Journal of Mental Health Training, Education & Practice. 6(3): 142–149. doi:10.1108/17556221111171748 CrossRefGoogle Scholar
O’Donovan, A. (2007) Patient-centred care in acute psychiatric admission units: reality or rhetoric? Journal of Psychiatric & Mental Health Nursing. 14(6): 542–548. doi:10.1111/j.1365-2850.2007.01125.x CrossRefGoogle ScholarPubMed
O’Hagan, M.A. (2006) The Acute Crisis: Towards a recovery plan for acute mental health services in New Zealand. Mental Health Commission Wellington, New Zealand. ISBN: 0478292104; 0478292090 (Internet). 25 pp.Google Scholar
Olmos-Gallo, P., Starks, R., Lusczakoski, K.D., Huff, S. and Mock, K. (2012) Seven key strategies that work together to create recovery based transformation. Community Mental Health Journal. 48(3): 294–301. doi:10.1007/s10597-011-9441-6 CrossRefGoogle ScholarPubMed
Papadopoulos, C., Ross, J., Stewart, D., Dack, C., James, K. and Bowers, L. (2012) The antecedents of violence and aggression within psychiatric in-patient settings. Acta Psychiatrica Scandinavica. 125(6): 425–439. doi:10.1111/j.1600-0447.2012.01827.x CrossRefGoogle ScholarPubMed
Pereira, S., Dawson, P. and Sarsam, M. (2006) The national survey of PICU and low secure services: 1. patient characteristics. Journal of Psychiatric Intensive Care. 2(1): 7–12. doi:10.1017/S1742646406000227 CrossRefGoogle Scholar
Priebe, S. and McCabe, R. (2008) Therapeutic relationships in psychiatry: the basis of therapy or therapy in itself? International Review of Psychiatry. 20(6): 521–526. doi:10.1080/09540260802565257 CrossRefGoogle ScholarPubMed
Radcliffe, J. and Smith, R. (2007) Acute in-patient psychiatry: how patients spend their time on acute psychiatric wards. Psychiatric Bulletin. 31(5): 167–170. doi:10.1192/pb.bp.105.009290 CrossRefGoogle Scholar
Roberts, G. and Boardman, J. (2013) Understanding “recovery”. Advances in Psychiatric Treatment. 19(6): 400–409. doi:10.1192/apt.bp.112.010355 CrossRefGoogle Scholar
Roy, L., Rousseau, J., Fortier, P. and Mottard, J.-P. (2009) Perception of community functioning in young adults with recent-onset psychosis: implications for practice. The British Journal of Occupational Therapy. 72(10): 424–433.CrossRefGoogle Scholar
Schoubroeck, L. van (2013) Decision to lock adult mental health facilities in Queensland’s public hospitals. Statement from the Commissioner. Queensland Mental Health Commission. http://www.qmhc.qld.gov.au/wp-content/uploads/2013/12/QMHC-statement-201213.pdf [accessed 20/2/2014].Google Scholar
Sjöstedt, E., Dahlstrand, A., Severinsson, E. and Lützén, K. (2001) The first nurse-patient encounter in a psychiatric setting: discovering a moral commitment in nursing. Nursing Ethics. 8(4): 313–327. doi:10.1177/096973300100800404 CrossRefGoogle Scholar
Slade, M. (2009) 100 ways to support recovery: a guide for mental health professionals. London: Rethink. 32 pp. http://www.rethink.org/about-us/commissioning-us/100-ways-to-support-recovery [accessed 12/12/2014]CrossRefGoogle Scholar
Slade, M. (2010) Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Services Research. 10: 26. doi:10.1186/1472-6963-10-26 CrossRefGoogle ScholarPubMed
Slade, M., Amering, M. and Oades, L. (2008) Recovery: an international perspective. Epidemiologia e Psichiatria Sociale. 17(2): 128–137. doi:10.1017/S1121189X00002827 CrossRefGoogle ScholarPubMed
Stenhouse, R.C. (2011) ‘They all said you could come and speak to us’: patients’ expectations and experiences of help on an acute psychiatric inpatient ward. Journal of Psychiatric & Mental Health Nursing. 18(1): 74–80. doi:10.1111/j.1365-2850.2010.01645.x CrossRefGoogle Scholar
Stylianos, S. and Kehyayan, V. (2012) Advocacy: critical component in a comprehensive mental health system. American Journal of Orthopsychiatry. 82(1): 115–120. doi:10.1111/j.1939-0025.2011.01143.x CrossRefGoogle Scholar
Summers, R.F. and Barber, J.P. (2012) Psychodynamic Therapy: A guide to evidence-based practice. Guilford Press.Google Scholar
Thibeault, C.A., Trudeau, K., d’Entremont, M. and Brown, T. (2010) Understanding the milieu experiences of patients on an acute inpatient psychiatric unit. Archives of Psychiatric Nursing. 24(4): 216–226. doi:10.1016/j.apnu.2009.07.002 CrossRefGoogle Scholar
Turton, P., Demetriou, A., Boland, W., Gillard, S., Kavuma, M., Mezey, G. and Wright, C. (2011) One size fits all: or horses for courses? Recovery-based care in specialist mental health services. Social Psychiatry & Psychiatric Epidemiology. 46(2): 127–136. doi:10.1007/s00127-009-0174-6 CrossRefGoogle ScholarPubMed
Usher, K., Baker, J.A. and Holmes, C.A. (2010) Understanding clinical decision making for PRN medication in mental health inpatient facilities. Journal of Psychiatric & Mental Health Nursing. 17(6): 558–564. doi:10.1111/j.1365-2850.2010.01565.x CrossRefGoogle ScholarPubMed
Wallcraft, J. (2012) Involvement of service users in adult safeguarding. Journal of Adult Protection. 14(3): 142–150. doi:10.1108/14668201211236340 CrossRefGoogle Scholar
Wallcraft, J., Amering, M., Freidin, J., Davar, B., Froggatt, D., Jafri, H., Javed, A., Katontoka, S., Raja, S., Rataemane, S., Steffen, S., Tyano, S., Underhill, C., Wahlberg, H., Warner, R. and Herrman, H. (2011) Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers. World Psychiatry. 10(3): 229–236.CrossRefGoogle ScholarPubMed
Walsh, J. and Boyle, J. (2009) Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment. Issues In Mental Health Nursing. 30(1): 31–38. doi:10.1080/01612840802500733 CrossRefGoogle ScholarPubMed
Ward, T. and Syversen, K. (2009) Human dignity and vulnerable agency: an ethical framework for forensic practice. Aggression & Violent Behavior. 14(2): 94–105. doi:10.1016/j.avb.2008.12.002 CrossRefGoogle Scholar
Weisser, J., Morrow, M. and Jamer, B. (2011) A Critical Exploration of Social Inequities in the Mental Health Recovery Literature. Centre for the Study of Gender, Social Inequities and Mental Health (CGSM). http://www.socialinequities.ca/publications/ Google Scholar
Whitelock, A. (2009) Safeguarding in mental health: towards a rights-based approach. The Journal of Adult Protection. 11(4): 30–42. doi:10.1108/14668203200900026 CrossRefGoogle Scholar
Whittemore, R. and Knafl, K. (2005) The integrative review: updated methodology. Journal of Advanced Nursing. 52(5): 546–553. doi:10.1111/j.1365-2648.2005.03621.x CrossRefGoogle ScholarPubMed
Winkler, D., Naderi-Heiden, A., Strnad, A., Pjrek, E., Scharfetter, J., Kasper, S. and Frey, R. (2011) Intensive care in psychiatry. European Psychiatry. 26(4): 260–264. doi:10.1016/j.eurpsy.2010.10.008 CrossRefGoogle ScholarPubMed
Wykes, T., Steel, C., Everitt, B. and Tarrier, N. (2008) Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin. 34(3): 523–537. doi:10.1093/schbul/sbm114 CrossRefGoogle ScholarPubMed
Supplementary material: File

Gwinner and Ward Supplementary Material

Table S1

Download Gwinner and Ward Supplementary Material(File)
File 37 KB