Presentation Notes

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Oak House Introduction

Oak House focussed on Personal Recovery through the use of medication and psychological intervention with an onsite psychologist and psychiatrist. Here (on the slide) you can see the difference between clinical and personal recovery and hopefully I will be able to explain to you how Oak house attempts to incorporate personal recovery through the use of the Recovery Star assessment tool.

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Oak House: What assessment is used?

As I said, Oak House uses the recovery Star assessment tool. The recovery star is a model that enables the RMN to capture evidence whilst engaging with service users and carers in discussion over important issues concerning where the patient believes they are, where they want to be, and how they plan on getting there, in ten key areas of their life.

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How is the Recovery star Implemented at Oak House?

Each Patient at Oak house has a care plan. This Care Plan is influenced by the answers the patient gives during a recovery star plan review. A patients recovery star is reviewed every 3months at Oak House. Care Plans are reviewed monthly. Patients are taken aside with their Key worker (HCA or named nurse) where they will work through the recovery star together. This can be a lengthy process depending on the capabilities of each patient, e.g. the patient may be uncomfortable with one to one situations,  easily agitated, has learning disabilities, frequently goes out for cigarettes.

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How is the Recovery star Implemented at Oak House?

Slide 6: Patients will rate themselves out of ten in 10 keys aspects (shown on the picture). If a patient gives a certain area a particularly low score this area will have more impact in the care plan. As you can see from the slide, if we say the red line was session 1: managing mental health, relationships, social networks and living skills would have had a heavier focus in the care plan. We can see from session 2 (the green line) that these areas have improved for the majority, however the patient feels as though their social networking skills have got worse. This would be more heavily focused on in the next care plan review, which would take place in the weekly multi-disciplinary meeting to incorporate a holistic perspective.

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How is the Recovery star Implemented at Oak House?

Slide 7:. The Recovery Star assessment is usually followed up by a WRAP ; a wellness and recovery action plan, in which the patient sets goals and say how they are going to achieve those goals, which is also incorporated into the care plan.

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The recovery star and relapse prevention

Slide 8:

The recovery Star: engages patients and enables them to see the holistic approach to their care through a fairly simple tool. However, aside from perhaps a noticeably rapid or exaggerated score on the patient’s part to “speed up” their recovery there is little in the way of relapse prevention from this tool. Arguably this tool does allow for the patient to see a progression, e.g. last time they scored noticeably lower on the star

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Criticisms of the recovery star as an assessment

The recovery star is reviewed every 3 months whereas the care plan is reviewed every month. As the recovery star supposedly influences the care plan 2 out of three care plans reviewed could be seen as inaccurate or not person-centred as the care plan cannot accurately depict where the patient feels they are in their recovery and where they need to work on the most. It could be argued however that working on each point of the star may actually take three months to see any progression.

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Criticisms of the recovery star as an assessment

A patient suffering from a low self-esteem or even a form of depression for example, may rate themselves much lower on the star than their key worker might rate them. As the recovery star is a subjective assessment tool, and the key worker cannot actively enforce their views on the patient’s progress/recovery too much so as to influence the scoring during the assessment as the assessment itself is based on how the patient feels they are doing in the 10 key areas, the process off recovery itself can take much longer than the multidisciplinary team originally thought/planned. Although this promotes patient-centred care, limited resources across the field cannot facilitate this. The recovery star is perhaps not the most efficient and cost effective assessment tool.

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Criticisms of the recovery star as an assessment

This is also true nearing the end of a patient’s treatment. In Oak house in particular a patient’s confidence in their independence often affected the scoring of the star. Again the lower score would often slow down or at least influence their discharge from the unit. This can manifest itself in a fear of being on their own, fear of not having as much support, being totally in charge of self-medication.

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Issues with my involvement.

Often Patients found one to one situations difficult, so two to one situations are understandably even more difficult. Even my role as an observer in the beginning often made patients more uncomfortable than necessary. This highlighted to me a difficulty with my personal professional development. Without attending the assessment I would not gain any practical experience of doing an assessment; by attending the assessment I was initially unable to gain a realistic insight into the patients assessment, as the were distracted by my presence (student nurse; extra person in the room)

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Issues with my involvement.

This leads into another issue with my involvement towards the beginning of the placement. I was what Peplau describes as the orientation phase in my involvement into their recovery. This is where the parameters of the relationship with the patient is established. This includes the client trusting me as a student nurse, being able to effectively communicate with the patient (which is adapted when working with patients with learning disabilities, which I came across), and comforting any anxiety that the patient may have regarding my presence during the assessment. Due to the nature of the placement, it was understandable that for some patients trust was an issue for them, especially as I would be entering their lives essentially, gain insight into their history, how they feel, what medication they are on, to drop right back out of it at the end of the placement. This I personally felt was unfair on the patients especially those with relationship difficulties, however necessary from a professional point of view.

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Issues with my involvement.

There is difficulty engaging with patients who have different cultural views; e.g. one patient had been smoking cannabis most of his adult life and was being encouraged to stop as it is seen as an inappropriate coping strategy for his mental health problems, however if he were to score highly on the recovery star in the “managing mental health” section of the model this would reflective of his culture. However my culture, and the culture of health care professionals disagrees with his “culture” (smoking cannabis) as a coping strategy as it is incongruous. I feel like this is a barrier of the recovery star and most assessment tools, with or without my involvement.

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