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Lets Talk Solutions

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Conference Presentation 2009 Melbourne

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Lets Talk Solutions

  1. 1. <ul><li>THERAPY IN NURSING INITIATIVE </li></ul><ul><li>ACUTE INPATIENT SETTING </li></ul><ul><li>August 2009 </li></ul><ul><li>Albert Morrison CNS </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  2. 2. <ul><li>Thank You For Coming </li></ul><ul><li>A Solution Focused Approach </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  3. 3. <ul><li>The Integration Of Solution Focused Brief Therapy </li></ul><ul><li>Into Nursing Practice </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  4. 4. <ul><li>Literature </li></ul><ul><li>Solution Focused Brief Therapy </li></ul><ul><li>Integration of SFBT into Nursing Practice </li></ul><ul><li>Is it helpful to Mental Health Nurses? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  5. 5. <ul><li>“… recovery based philosophies are being eroded…mental health nursing practice is too custodial and essentially operates within an observational framework without actively providing psychosocial interventions” </li></ul><ul><li>(Mullen, 2009) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  6. 6. <ul><li>Where have the talk therapies gone? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  7. 7. <ul><li>“ by talking about themselves, people become more </li></ul><ul><li>aware of how they are ‘living’ – and perhaps by </li></ul><ul><li>‘ doing whatever needs to be done’, they might </li></ul><ul><li>move beyond their problems, into a new story of </li></ul><ul><li>their own making ” </li></ul><ul><li>Barker, P. & Buchanan-Barker, P. (2007) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  8. 8. <ul><li>Literature Review Ferraz & Wellman, (2008) </li></ul><ul><li>Literature relating integration of SFBT in </li></ul><ul><li>mental health (MH) nursing practice with </li></ul><ul><li>special focus on inpatient care. </li></ul><ul><li>Evidence for suitability & relevance to MH Nursing </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  9. 9. <ul><li>Published articles 1980-2006 </li></ul><ul><li>203 citations </li></ul><ul><li>9 papers met the inclusion criteria </li></ul><ul><li>Ferraz & Wellman, (2008) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  10. 10. <ul><li>SFBT congruent with the philosophical underpinning of mental health nursing. </li></ul><ul><li>Can be safely incorporated into nursing practice </li></ul><ul><li>May positively impact on nurses’ willingness to communicate with their patients </li></ul><ul><li>Helps nurses create a collaborative, goal-orientated approach </li></ul><ul><li>Ferrez & Wellman, (2008) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  11. 11. <ul><li>SFBT techniques relevant to nursing practice </li></ul><ul><li>Cost effective approach </li></ul><ul><li>SFBT provides framework & easily understood </li></ul><ul><li>Harmonious with nursing values </li></ul><ul><li>Bowles, Mackintosh & Torn, (2001) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  12. 12. <ul><li>SFBT may be helpful to clients </li></ul><ul><li>May be useful in a broad range of applications </li></ul><ul><li>Research moving in the right direction </li></ul><ul><li>Efficacy phase </li></ul><ul><li>More careful study needed </li></ul><ul><li>Gingerich, J. W., & Eisengart, S. (2000) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  13. 13. <ul><li>SFBT was first developed by: </li></ul><ul><li>Steve De Shazer & Insoo Kim Berg </li></ul><ul><li>(1985, 1998) at the Brief Family </li></ul><ul><li>Therapy Centre in Milwaukee, USA . </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  14. 14. 10th Victorian Collaborative Psychiatric Nursing Conference
  15. 15. 10th Victorian Collaborative Psychiatric Nursing Conference “ The client constructs his or her own solution based on his or her own resources and successes” (De Shazer, 1988, P.50)
  16. 16. <ul><li>Principles </li></ul><ul><li>If it isn't broken don’t fix it </li></ul><ul><li>If it works do more of it </li></ul><ul><li>If its not working try something different </li></ul><ul><li>Change is inevitable </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  17. 17. <ul><li>Problem Free Talk </li></ul><ul><li>Acknowledge problem </li></ul><ul><li>Not problem solving </li></ul><ul><li>Solution building </li></ul><ul><li>Jong & Berg, (2008 ) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  18. 18. <ul><li>Assumptions </li></ul><ul><li>The client is not the problem the problem is the problem </li></ul><ul><li>Assumes the client has strengths </li></ul><ul><li>Things will get better </li></ul><ul><li>Problem not always there </li></ul><ul><li>Change is inevitable </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  19. 19. <ul><li>Practice Development 2008-2009 </li></ul><ul><li>Therapy In Nursing Initiative </li></ul><ul><li>Adult acute inpatient setting </li></ul><ul><li>25 beds </li></ul><ul><li>32 Nursing staff </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  20. 20. <ul><li>Question 1 </li></ul><ul><li>List three things that you know about Solution </li></ul><ul><li>focused Brief Therapy? </li></ul><ul><li>Question 2 </li></ul><ul><li>Please rate your confidence in using SFBT in your </li></ul><ul><li>Nursing practice? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  21. 21. <ul><li>Question 3 </li></ul><ul><li>Mental Health nurses should provide </li></ul><ul><li>psychosocial interventions such as SFBT to </li></ul><ul><li>clients in the inpatient setting. </li></ul><ul><li>Question 4 </li></ul><ul><li>How long have you been working in mental </li></ul><ul><li>health? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  22. 22. <ul><li>Total session 5 </li></ul><ul><li>Total staff attended 31 </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  23. 23. <ul><li>Content </li></ul><ul><li>Origins of Solution Focused Brief Therapy </li></ul><ul><li>Influences </li></ul><ul><li>Major Tenants </li></ul><ul><li>Basic principles </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  24. 24. <ul><li>The presentation was relevant to my nursing practice </li></ul><ul><li>The objectives of the session were clearly explained </li></ul><ul><li>I found the information informative & interesting </li></ul><ul><li>I know more about SFBT after this session </li></ul><ul><li>Opportunity given to ask questions </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  25. 25. <ul><li>“… bring on the training” </li></ul><ul><li>“ Presentation…informative & interesting” </li></ul><ul><li>“ Case study example was good…more please” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  26. 26. <ul><li>“ good work” </li></ul><ul><li>“ We find that we do a lot of this already but this is more structured and better focused” </li></ul><ul><li>“ Great programme…looking forward to see how it goes” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  27. 27. 10th Victorian Collaborative Psychiatric Nursing Conference
  28. 28. <ul><li>12 of those emailed responded and agreed to be </li></ul><ul><li>part of the project </li></ul><ul><li>Registered Nurses x 5 </li></ul><ul><li>Clinical Nurse Specialists x 4 </li></ul><ul><li>Endorsed Enrolled Nurses x 2 </li></ul><ul><li>Clinical Nurse Educator x 1 </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  29. 29. <ul><li>Moving forward to change </li></ul><ul><li>Interviewing for strengths </li></ul><ul><li>Case study role play </li></ul><ul><li>DVD footage Solution building </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  30. 30. <ul><li>At the end of this training session on a scale of 0 to 10 </li></ul><ul><li>0 being I’m not at all confident at having a go at using SFBT in </li></ul><ul><li>my clinical practice </li></ul><ul><li>  </li></ul><ul><li>10 being I’m very confident that I will be using SFBT in my </li></ul><ul><li>clinical practice </li></ul><ul><li>Where would you put yourself on this scale right now? </li></ul><ul><li>0….1….2 …. 3 …. 4….5….6….7….8….9….10 </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  31. 31. <ul><li>Nurse 1 (3) </li></ul><ul><li>What tells you that you’re at that number? </li></ul><ul><li>“ Willing to give it a go” </li></ul><ul><li>“ It’s not going to kill anyone” </li></ul><ul><li>“ A little knowledge goes a long way” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  32. 32. <ul><li>Nurse 1 </li></ul><ul><li>What needs to happen to get you to the next </li></ul><ul><li>couple of numbers on the scale? </li></ul><ul><li>“ Practice…practice…practice” </li></ul><ul><li>“ More in-services & more knowledge” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  33. 33. <ul><li>Nurse 1 </li></ul><ul><li>When you get to the next couple of numbers on </li></ul><ul><li>the scale, how will you know? </li></ul><ul><li>“ I’ll feel more confident” </li></ul><ul><li>“ Will be able to identify those that might benefit” </li></ul><ul><li>“ I’ll be more at ease in using SFBT” </li></ul><ul><li>“ I will be getting more detail from the client” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  34. 34. <ul><li>Nurse 1 </li></ul><ul><li>What will you be doing different that will tell you </li></ul><ul><li>that you have moved up the scale? </li></ul><ul><li>“ Finding out what their solution is” </li></ul><ul><li>“ It will be a normal part of my practice” </li></ul><ul><li>“ Using SFBT in a practical situation with a </li></ul><ul><li>mentor” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  35. 35. <ul><li>“ Be more confident in selecting someone” </li></ul><ul><li>“ Will be focusing more on what the client says, </li></ul><ul><li>rather than worry that I'm asking the right </li></ul><ul><li>question ” </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  36. 36. <ul><li>Getting Started </li></ul><ul><li>First Session Outline </li></ul><ul><li>Introduce self, problem free talk, SF question, MQ & Scaling </li></ul><ul><li>Second Session Outline </li></ul><ul><li>What’s better? What’s changed? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  37. 37. <ul><li>Solution Focused Question </li></ul><ul><li>When you’re discharged, say at the end of the </li></ul><ul><li>week…how will you know that being here in </li></ul><ul><li>hospital has been helpful…what will tell you that </li></ul><ul><li>being here has been of some help to you? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  38. 38. <ul><li>MIRACLE QUESTION </li></ul><ul><li>What will tell you that the problem that brought you here is gone? </li></ul><ul><li>What's the first thing that you will notice? </li></ul><ul><li>What will be different? </li></ul><ul><li>Shazer & Dolan, (2007) </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  39. 39. <ul><li>SCALING </li></ul><ul><li>0....1....2....3....4....5....6....7....8....9...10 </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  40. 40. <ul><li>What’s better since we last spoke? </li></ul><ul><li>What’s changed? </li></ul><ul><li>Where are you on the scale today? </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  41. 41. <ul><li>ACTION STAGE </li></ul><ul><li>Small steps </li></ul><ul><li>Part of practice </li></ul><ul><li>Part of care planning </li></ul><ul><li>Session guidelines used and placed in notes </li></ul><ul><li>SFBT magnets on bed list </li></ul><ul><li>Sticker in notes </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  42. 42. <ul><li>What next? </li></ul><ul><li>Continue to work with champions </li></ul><ul><li>Monitor occasions when used </li></ul><ul><li>Document session for discussion </li></ul><ul><li>Follow up workshops </li></ul><ul><li>Clinical supervision </li></ul><ul><li>12 month review </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  43. 43. <ul><li>Thank You </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  44. 44. <ul><li>References: </li></ul><ul><li>Barker, P. & Buchanan-Barker, P. (2007). The Tidal Model: Mental Health, </li></ul><ul><li>Reclamation and Recovery. Electronic copy pdf </li></ul><ul><li>Bowles, N., Mackintosh, C. & Torn, A, (2001). Nurses’ communication skills: an </li></ul><ul><li>evaluation of the impact of solution-focused communication training, Journal of </li></ul><ul><li>Advanced Nursing. 36 (3), 347-354 </li></ul><ul><li>De Jong, P & Berg, K., I. (2008) Interviewing For Solutions (3rdEd) Thomas </li></ul><ul><li>Brooks/Cole Belmont, CA </li></ul><ul><li>De Shazer, S. (2007). More Than Miracles: The State of the Art of Solution- </li></ul><ul><li>Focused Brief Therapy. Routledge, New York </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference
  45. 45. <ul><li>Ferraz, H., & Wellman, N. (2008). The integration of solution-Focused brief </li></ul><ul><li>therapy principles in nursing: a literature review. Journal of Psychiatric and </li></ul><ul><li>Mental Health Nursing. 15. 37-44 </li></ul><ul><li>Gingerich, J., W. & Eisengart, (2000). Solution-Focused Brief Therapy: A Review </li></ul><ul><li>of the Outcome Research. Family Practice 39. (4) 477-498 </li></ul><ul><li>Mullen, A. (2009). Mental health nurses establishing psychosocial intervention </li></ul><ul><li>Within acute inpatient setting. International Journal of Mental Health Nursing . </li></ul><ul><li>18, 83-90 </li></ul>10th Victorian Collaborative Psychiatric Nursing Conference

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