Use Of Counselling Skills When Assessing Needs Of Carers Nursing Essay

practice Of Counselling Skills When Assessing Needs Of C bers Nursing EssayWelsh Assembly governing (WAG) policies emphasises the con bunsmentr to agree fretfulnessrs (2000 Strategy for C atomic number 18rs in Wales). However more(prenominal) recently, the subject Institute for Health and Clinical Excellence (NICE) emphasizes the shoot to project support to pack with dementia and their c bers in health and social c atomic number 18 in the NICE clinical guideline 42 on dementia care (National Institute for Health and Clinical Excellence, 2006). In response to English command the Welsh Assembly Government (WAG) produced the Carers strategy for Wales Action fancy (2007) it highlighted that in Wales 70% of care in the fraternity is provided by unpaid carers. The memorandum sets come on WAGs strategic path for carers it delivers specific action points that bequeath incline the modal value forward over the next few years that willing alleviate achieve the objectives. Re cently the Welsh Minister for Health and accessible Services (WAG 2010) consulted on a draft hallucination Action Plan for Wales paper produced by a Task Finish Group, which highlighted four antecedency areas that would improve the lives of people with dementia and their families in Wales. As a egress of these specifyings WAG has allocated funding of 1.573m to support the development of Dementia action plans in the years between 2010 2012. WAG has besides made available a nonpareil off funding of 400,000 in 2010/12 to extend serve provided by Older Peoples Community Mental Health Teams to develop new Young Onset Dementia Services across Wales (WAG 2010). These services would admit appropriate support and assessment of carers.PrevalenceThe Care Standards Act (2000) provides principle and national minimum standards. These standards are based on service drug user take aimfully. The purpose of which is to provide a minimum standard, below which no provider may operate . One much(prenominal) provider is(Adult Social Services) (ASS), currently supports 100,000 braggys in Wales. The main provision of ASS is to support and protect those people who would be worse off financially in their absence, by offering community care services and to work in federal agencynership with other providers (ASS no date). ASS provides services to many adult groups. For the purpose of this assignment integrity group that ASS supports is older people with mental health issues such as dementia and their carers. The Community Mental Health Nurse (CMHN) is part of the Community Mental Health Team that works in confederation with ASS. CMHNs provide specialist skills in Caring for people with dementia and their carers. Dementia has been described by many as universe a chronic decline in mental functioning that equates to having complex unavoidably colony and morbidity ( NICE 2006, NICE-SCIE 2007). Having such complex needs the older adult with dementia is assessed. Th is assessment military operation too involves offering an assessment of needs for the carer. There are mental Health Policy Guidance issued by (WAG 2003) that recommends using an assessment tool called the Care Programme Approach (certified public accountant) the certified public accountant assist will be discussed later in the assignment as this.The CarerThe fibre and needs of the carer is often overlooked, despite government policies. The carer looks disappointed at the deficiency of reading of support that is available and is non easily accessed. on with lack of employer support in having m off to take their cared ones to appointments (Carmichael et al 2008). There is evidence to suggest from a carers view that it is an emotional rollercoaster of challenges that stretch forth the carer to the edge of normal reasoning determine Appendix 1(HCWPC 2008). These challenges cigarette redress a wide spectrum. This could include and non be limited to divergence of psychea l space, hiding, and choices due to not having the sentence. This as well as disables the carers major power to think case-by-casely as a person as they have very elfin time to themselves. This can lead to having to deal with the emotional effects of liner the lack of having a meaningful relationship, ego love and loss of the ability to know joy. Further emotional challenges can be evoked as friends, family and the wider community withdraw as often they can pick up on the carers feelings of despair and greater or lesser depressive symptoms. To avoid people catching a glimpse the carer will often put on an act to outsiders take aim off though they are slowly emotionally demise on the inside, through and through lack of laughter and loss of control of ones self (HCWPC 2008). thusly it is essential for the CMHN to utilise the skills they have in recognising the individual needs of the carer.CMHN have their agencyCurrently in England there are full admiral Nurses who are specialist practitioners in dementia and work in coalition with family carers and people with dementia. In Wales the first Admiral Nurses started working in one county only. Three years later in April 2010 (An anonymous University Health Board) failed to wedge funding for the service to continue (Dementia UK 2010). Currently the gap in Wales is organism met by Community Mental Health Nurse medical specialist Practitioners (CMHNSP) whose role is that of team leader. Leading specialist teams that, pick up these unhurrieds and carers with complex needs. specialist Practitioner courses are available through designated universities in Wales. These courses follow Standards for Specialist Education and Practice as set by the Nursing and tocology Central Council (NMC 2001). Identifying the needs of the patient with dementia and carer through the CPA draws on the skill of the CMHNSP. These skills will draw on effective communication, listening, pleader and contemplative practice skil ls. (Casement 1985), a psychoanalyst, cited in Johns (2004) Offers a more satisfactory belief of jobion as the ability to talks with self whilst dialoguing with a client. He calls this dialogue with self the Internal Supervisor paying attention to the way the self interprets what the other is saying, and weighing up how best to respond. During the assessment process the CMHNSP will be taking everything into account some(prenominal) as an national supervisor, and combat-ready listener. The CMHNSP should feel imperious in using these skills, but should also be awake(predicate) that negative forces could also be in force. As using both skills could influence the CMHNSP to miss what actually was being verbalize. Rowlinson (2010) warns that whilst actively listening, it is outstanding that a counsellor stops any other grade of distraction. This includes the natural dialogue that everyone has running through their mind constantly. Forming judgments, considering what is being s aid, is also a block to actively listening, as is the urge to provide information at, what may be, an inappropriate pause in the conversation.The assessment and any bechance with the patient and carer should also lead the CMHNSP to draw on their knowledge of counselling theory skills, and cognitive behavioural therapy (CBT) interventions and as an informal doer, this forms part of the CMHNSPs day- subsequently-day interventions with both patients, and carers. CBT is a short-term talking treatment that has a exceedingly practical approach to problem-solving. It aims to change patterns of thinking or behaviour that are behind both patient and carers difficulties, and so change the way they feel. Mind(2010). ( reference point CBT)Collins (2003) In response to a questionnaire, nurses responded that CBT enabled them to offer clients unconditional positive regard. The relationship that developed between the client and nurse wait oned the nurse to come out and respond to the needs o f the client in a much more empathic manner. During any intervention with a patient with dementia and their carer would need careful non judgmental management. The CMHNSP would draw from their knowledge of counselling interventions that they had learnt and use these to offer the carer much needed support, to enable them to run short forward and allow both patient and carer to make informed decisions about their care needs through the CPA assessment process. Along with an assessment of needs of the carer as their receive needs are often overlooked or hidden by the carer. (Ref Required)During any dialogue with the patient and carer as an Internal Supervisor, the CMHNSP would make a mental note that careful documentation of any conversation would be needed using patients own words where appropriate. Where specialist assessments are carried out notes would be taken during such interventions to capture intricate details. (ref to KG something) taking time out to think about and plan wh at needs to be written in the notes would also allow the CMHNSP to make sense of the concomitant through reflection whilst recording the intervention in the fact notes. holding good records forms an essential part of nursing and midwifery practice, and instigates the provision of unattackable and well-organized care. It should form an essential task not to be missed even if there are time constraints NMC (2009). Encouraging the Carer to make their own notes will help them in reflecting on the issues and decisions that need to be made. Part of the CPA assessment involves both the patient and carer taking part in indite there own care plans. This process breaks down the issues at self-aggrandizing into smaller stepped targets which can set clear achievable goals. By fracture down the items increases the chances of success and goal achievement (Kottler et al 2008). Patients records are right as significant if not more so than the practitioners records. Patients obtain recyclab le information that they can use both during and after the counselling Nelson-Jones (2002). Goals papa into the conversation often not being noticed by the person pursuit counsel often needing the helper to point out the goals Tschudin(1995). Therefore providing the patient and carer with specialist knowledge or assisting them in knowing where to find it may help the patient and carer to see their situation in a different light and thus provide a basis for action. (Elgan 1994) Cited in, freshwater (2003) Elgan argues that information sharing skills are challenging as they can secure the patient and carer to see themselves and their situation quite differently. For this reason he urges a sense of caution and tact when using information-sharing skills Cited in, Freshwater (2003). In the case of diagnosis and dementia there is evidence to suggest that the sufferer may not want the immediate family or friends to know and it can also work the other way around, so tact is required whe n accumulation what could be sensitive information (Ref disclosure of diagnosis required).Listening is an important feature and is made up of many components, in order to in effect communicate both ways. The CMHNSP should allow for this by pausing, being attentive and allowing time for both the patient and carer to speak. Bayne.et al (199842) suggests that The first quality that anyone needs who wants to help another person, or hear what needs to be said, is attentiveness. A booming counselling relationship can be instigated by ensuring a arctic environment, somewhere where there is privacy and free of intrusion. Asking do they feel comfortable in the environment to go ahead with the assessment or intervention? During the intervention giving reassurance to both patient and carer to take their time when answering any questions shows that the CMHNSP can be empathetic. By doing this it creates an atmosphere that creates a therapeutic relationship and with this comes the willingness of the Patient and carer to participate at each grade of the relationship. These Phases are discussed by (Roach 2001) who suggests that the therapeutic relationship Development process where curse is developed is seen as the first stage there are two more, Working phase where goal setting takes place and Terminating phase which is self limiting and where the patient and carer might achieve independence, if this decease phase is not met then the phases can be cyclic in action and the process can continue.At times the CMHNSP needs to be aware that carers aim may be present, during certain aspects of the assessment or intervention and need to be sensitive to this fact and to be aware that both the patient or carer may be holding back information either one would not wish the other to hear. For example Silence during the dialogue by either party. Recognition of this non-verbal communication instigates sensitivity on the CMHNs part. At other times of silence the CMHNSP should pause , allowing both the patient and carer time to reflect so they could collect their thoughts and emotions. Furthermore the CMHNSP could when appropriate radiate that they too are human, by appropriately self disclosing. In context to the discussion the CMHNSP could recover a time when they felt the need to write things down to help them to remember. Through showing this sensitivity the CMHN would be able to build on a trusting relationship and nurture good communication by sharing similarity.Nelson-Jones (2002223)The ability of counsellors to be real is very important for assisting clients to give feelings. Rogers used call like congruence and genuineness(Rogers, 19571995). Existential psychologists use terms like presence and authenticity (Bugental, 1981May, 1958 Mayay Yalom, 2000). Bugental views presence as consisting of an intake side called accessibility, allowing what happens in situations to affect one as a person , and an takings side called expressiveness, making availab le some of the content of ones subjective cognizance without editing.On each engagement with the patient and carer the CMHNSP would gradually encourage both to become more aware of their situation where appropriate through exploration and expression of feelings. This would empower and enabled them both to move from one place to another. Allowing them as an individual to explore in this way, would enable them both to decide how they would move promote forward. This process would be helped through goal setting as mentioned earlier within the care plan as auctioned by the CPA. Albert wit observed, The significant problems we face cannot be solved at the same level of thinking we were at when we created them. Cited in Covey (2004).The CMHNSP needs to be aware that the carer initially could be holding back due to their shoot being there. As the assessment progresses this might not be the issue, further active listening could draw out the more prominent issues. It is important to dir ect how the carer are they blaming themselves do they feel hopeless for not managing the changes in their charge or cared one. These expectations carers sometimes have of themselves could hide further issues they are not yet ready to address. These could be grief, loss and change. Firstly the carer could be vaguely grieving the loss of the person, mother, loved one they once knew due to Dementia. You are losing and grieving piece of music youre providing the care, because Charlie isnt Charlie anymore, Frank (2008). Frank goes on to say that studies were downstairstaken and lay out that The fundamental barrier experienced by Alzheimers caregivers appears to be a combination of anticipatory grief and ambiguous loss, rather than hands-on care issues, further more Frank hopes the study results can be used to help design new support and intervention programs for dementia caregivers. There has not been much change in the treatment options for dementia patients in the last 20 years bu t there are policies in place to decrease the burden of carers. (REF Required). Secondly the carer could have further issues such as the changing of their role from Son or daughter or economize to main carer, and decision maker.Here the CMHN would feel empathy for the carer, and want to help them, not being judgmental but offering unconditional positive regard (UCR). Unconditional positive regard, a term coined by the humanist Carl Rogers, is pall acceptance and support of a person regardless of what the person says or does. Rogers believes that unconditional positive regard is essential to healthy development. (Ref required).There is an important skill that CMHNSP should develop in recognising that through the reflective process it can became evident that the CMHNSP could also be avoiding the issue of the carer grieving the loss of the person they once knew. It is important to reflect on such feelings. If this is the case after further analysis the CMHNSP might feel that they wer e out of their depth in that area of counselling and should refer the carer on to a specialist.Dryden et al (199415) said Think of developing your referral skills as a positive enhancement of your boilersuit practice. Lazarus, a therapist of considerable experience and standing, uses referral (which he considers a proficiency in its own right) for a variety of reasons, not least of which is the actualisation of his own non-omnipotence.Seeking clinical supervision on this identified need through reflection of practice enables the CMHNSP develop their clinical practice weaknesses into stronger make do strategies that will enable and instigate the CMHNSP to further develop their role, through seeking effective evidence based practices and action seeking the these practices in practice under clinical supervision. Evidently the role of the CMHNSP is constantly cyclically evolving using such research methods.The conclusion should draw together the main strands of the discussion and sug gest implications for the development of clinical practice and research on assessment and intervention skills in the profession.AppendicesAppendix 1During our visit to Australia, we were shown the following job advertisement for the placement of carer by the Chief Executive of Carers New South Wales. It had been written by a carer. We reproduce this here as an illustration of how some carers see their lives.Critical role for self starter for hands on roleExperience in first aid, counselling, occupational health and safety, pharmacology, cooking, cleaning, communication skills, separate out management and ability to self medicate may be required.The undefeated applier must be able to forgo personal privacy and the choice to do what you want.You will be required to lose your independent thinking ability and become invisible to the community at large.The boffo applicant must be able to endure the lack of joy, amour propre and relationships indefinitely.Must also be able to functi on alone as friends leave due to your state of depression.Although entitled to holidays, the thriving applicant will not usually be able to have them due to lack of support or financial difficulties.The successful applicant must be able to function credibly with a smile while end on the inside from lack of laughter due to losing your mind.Reassessment qualities are essential while you lose your sense of self, your reasons to get up in the morning, your dress sense, your hair and your sense of humour and identity.The successful applicant may be required and therefore willing to move home to withstand the client and be happy developing bad nerves and fretting 24/7.The successful applicant may be required to counterbalance every day to remember five things to be grateful for while letting go of everything held dear. Must be able to let go and find comfort in a state of being stunned.The successful applicant must be able to cope with slowly sacking insane and back on a continual b asis. The successful applicant must learn to live in silence to enjoy this real challenging lifestyle.(House of Commons Work and Pensions Committee Valuing and Supporting Carers2008).