Introduction

The essay mirrors a case scenario for a psychotic patient. The patient's age, gender,

medical and social history will form the foundation of the case. Secondly, the Evidence-

Based (EB) framework used to address patient`s psychosis ailment will be examined.

Several organizational setup principles, such as effective management, management

dynamics, and their interactions, will be evaluated. The essay will assess how Martha's care

team dealt with teamwork, delegation, decision-making, and conflict-resolution principles.

Lastly, a discussion of how Martha's complex care requirements were handled by the care

team`s coordinated effort will be evaluated. Accordingly, pseudonyms for people and places

shall be used to maintain privacy and confidentiality in accordance with the Nursing and

Midwifery Council's guidelines (NMC, 2018). The assignment will name the patient Martha.

Patch 1: Learning Outline 1: The patient's personal information

Martha is a 59-year-old woman who was diagnosed with psychosis in 2018. She is being

cared for and supported by staff at a local Mental Health facility because her family could not

live with her due to their work schedules. Before admission into the psychiatric unit, Martha

was staying with her husband and daughter in a rented apartment. In 2016, she had an

accident that affected most of her body parts and also claimed the life of her only daughter.

Resultantly, small tasks such as shaving, bathing, make up, and brushing teeth became a

challenge. Her marriage ended as she was unable to fulfil her wifely duties such as cooking

and taking care of the children.

Martha was found on top of the bridge by cyclists who suspected that she wanted to commit

suicide. They handed her over to the police who detained her under Section 136 of the

(Mental Health Act) (1983 as amended 2007). She told the police that there was no one to

sympathize with in her condition. She felt isolated and betrayed by relatives and friends who

have abandoned her during these difficult times. Hence, suicide was the only remedy for the

situation. In late 2017, she began exhibiting religious preoccupation and claiming to hear
God`s voice instructing her to fulfil his destiny. Martha had previously described visual

hallucinations of shadow figures following her around. After a short interview, the psychiatric

could not find coherence in what she was saying. Immediately, she began attacking

everyone, throwing things around and screaming. In an effort calm her aggressiveness, the

(GPs) chose to use Electroconvulsive therapy (ECT) even without getting consent (Mental

Health Act 1983; Mental Capacity Act, 2005). After a few sessions, Martha began to

experience confusion and disoriented. Nevertheless, the psychiatrists decided that she has

to undergo additional reviews.

Martha's prescription followed the BNF (2022) guidelines. She was prescribed Olanzapine

10 mg/day for agitation, Risperidone (oral) 2 mg for an acute manic episode, Procyclidine

Liquid 5 mg per 5 mL and, quetiapine 150 mg /day, which was later adjusted to 300 mg per

day. Martha's initial hospital examination revealed that she was rejected and socially

isolated. According to her sister, he has a history of drug and alcohol abuse. A drug test was

performed, and the results were confirmed as positive. Nevertheless, Martha adamantly

refused to be admitted to the psychiatric unit for treatment. Psychiatrists contemplate on

having Section 17 leave (MHA) (1983 as amended 2007), but rather employed Section 2 of

the MHA (1983 as amended 2007), citing that her condition needed more attention, and that

discharging her was a danger to her safety and the safety of others.

Patch Two: Learning Outline 1: Evidence based professional framework

EBP is essential for providing safe, high-quality patient care. It enables nurses and other

clinicians to give patients the highest quality and most cost-effective treatment possible.

However, it is of the utmost importance for nurses to be up-to-date on current techniques so

they can provide treatment for patients with complex and debilitating diseases (Brown and

Schmidt, 2011). The team chooses to follow the NICE (2014) guidelines for the prevention

and management of psychosis and schizophrenia in adults [CG 178]. Clinical

recommendations are systematically created statements to aid practitioners and patients in

making judgements about the most appropriate health care for particular clinical conditions

(NICE, 2012). Johnston (2016) states that in order to guarantee the best patient results and

deliver safe, high-quality care, healthcare practitioners are urged to apply research evidence

into practice. Similarly, the NHS (2019) emphasises the importance of nursing care being

evidence-based and governed by clinical guidelines and frameworks developed in

collaboration with the NMC (2018).

Shadowing the aforementioned concept, the nursing staff implemented interventions based

on the mentioned guideline to give Martha a more comprehensive care (NICE, 2014). This

framework focuses on providing care and treatment of first episode of psychosis (FEP) using

the combination of antipsychotic medication, psychological therapies, and social support

(NICE, 2014). The framework also recommends two psychological approaches, Cognitive

Behavioural Therapy (CBT) and Family Interventions (FI), which have emerged as effective

therapies with the strongest evidence base among a variety of psychological approaches

(Garety, 2003).

Evidence-based practice (EBP) is acknowledged as the gold standard for providing secure

and efficient person-centred care. Nonetheless, decades after its inception, nurses continue

to face challenges in applying EBP (Ladwig and Ackley, 2010), and while models for its

implementation offer progressive ways, elements such as the context of care and its

mechanistic nature function as impediments to successful and consistent application (Woolf

et al., 1999). As a result, it is critical for (HCPs) to discover solution to the way evidence is

implemented in practise (Reed et al., 2018)

According to the UK Francis Report (2013), improving patient care is a crucial issue for the

health care system. In the management of a major psychiatric condition, medication

compliance is crucial yet difficult (Cutler et al., 2018). Research has it that non adherence to

medications as prescribed might exacerbate patient’s condition, make treatment less

successful, or make patients less responsive to further treatment (Haddad, Brian and Scott,
2014; Semahegn et al., 2020). However using EBP will offer solutions to avert non

adherence to medication related problems such as the implementation of Depot injection

(Jones and Jones, 2016).

Since the early 19th century, disturbed eating behaviours have been frequently associated

with psychotic disorders (Stogios et al., 2020). There is also evidence that the first phase of

antipsychotic (AP) therapy leads to compulsive eating behaviours like binge eating (Musil et

al., 2014; Alvarez-Jimenez et al., 2008). Therefore, shadowing the NICE (2014) framework

Martha’s weight gain and other metabolic issues were prevented. Patient-centred care was

implemented and ongoing evaluations were performed at each review. The nutritionist's

plans took Martha's individual requirements, preferences and capacity for change into

consideration. The NHS Long-Term Plan (2019) emphasizes individualized care and patient

participation, which enhance health outcomes and lower the risk of deterioration.

Accordingly, the (NICE 2014) guideline aims to enhance care by emphasizing long-term

recovery and early detection and treatment of psychosis. It also suggests tracking out

coexisting health issues and assisting family members and caregivers in the care process

(NICE, 2014).

Patch Three:

A hospital is not a permanent home, but a place of healing before discharge (Department of

Health and Social Care, 2022). Feely (1994) says assessment is the first step in nursing and

serves as the care plan's foundation. Therefore, nurses must grasp patient demands and

record information clearly and systematically (NMC, 2018b). Upon admission to the

psychiatric facility, nurses assessed Martha's condition. This procedure demonstrates the

nurse's and MDT's leadership and management abilities (Wihl et al., 2020). Following

establishing a patient's needs, treatment plan must address existing and anticipated

difficulties. This helps build client-centred goals, prioritise needs and facilitates early
discharge (Atwal, 2002). Care planning aids clinicians share patient information to enhance

continuity of care. (Department of Health, 2013a; NICE, 2021)

Giddens (2018) asserts that HCPs must always satisfy expectations and adapt to changing

situations within the care organisation. Lateef (2011) added that rising patient expectations

must be handled to improve results and reduce liability. To successfully meet Martha's care

needs, the team employed a transformational leadership style (West et al., 2015), which has

been regarded as the pinnacle standard of leadership (Cope, 2017). According to the Darzi

Report (2008), effective leadership in healthcare is vital for safeguarding and enhancing

human health. Transformational leadership style was vital in giving the team integrated care

with distinct roles and responsibilities (RCN, 2015). The transformational leadership

approach provided nurses with the freedom to think outside the box and take initiative

(Hawkins, 2017).

Additionally, transformational leadership involves inspiring others to take charge of their

activities and sharpen their skills in specific situations and also encourage the development

of specialized working relationships in healthcare settings, which has an impact on patient

outcomes, employee satisfaction, and safety culture (Sfantou et al., 2017). According to

Darzi (2008) leadership is not just about individualism but about teams. In the same lines,

Martha's multiple medical conditions, as well as ongoing reviews and checkups needed the

team to employ transformational leadership style and initiatives to avoid negative outcomes.

The transformational leadership style replaces conventional and autocratic methods of

leadership (Murphy, 2005). Accordingly, Martha was at the centre of her care, with easy

access to information related to her care service. Nevertheless, there was no alternative

leadership style since the efficiency of the style is determined by the type of leadership on

the ground.

Psychiatry uses models to identify the causes of behaviours and to plan necessary actions

(Roy, 2018). Models offers templates to help nurses give respect-filled patient`s care that
enhances positive results (McKenna, 1997). In Martha`s case, the Tidal Recovery Model

(2010) found a role to play. Its methodology is based on chaos theory, which highlights that

experiences are marked by constant change and expectations (Barker 2001a). On that note,

the model was used with the understanding that Martha’s mental health was unstable and

marked by constant change. Therefore, the care plans needed to reflect this change and

adjusted time to time. As cited by Barker (2001b), the model combines discrete processes to

re-empower the person who has been disempowered by mental distress, psychiatric

services, or both. In order to effectively provide mental healthcare, nurses were accessible,

focused, and receptive to both Martha and the dynamics of the family as a whole (Brookes,

2006).

Instead of the Orem's Self-Care Deficit Theory (2001), the Tidal Model was chosen (2001).

The Orem hypothesis makes the fundamental assumption that individuals should be self-

sufficient and accountable for their own care as well as the care of any dependent family

members. This paradigm did not apply to Martha because she did not practise self-care.

Effective medical care revolves around safety (Roy et al., 2002). The coordination and

provision of efficient and secure care depend on clinical risk management. The Black

Country Partnership NHS Foundation Trust anticipates applying the best practise guidelines

for clinical risk management across all of its service lines. The Health of the Nation

Outcomes Scales (HoNOS), which was created and validated, was used to assess

outcomes of Martha mental health issues (Bebbington et al., 1999). HoNOS is easy to use,

provides consistent measurements, summarises behaviours and functioning, and provides

monitoring and outcome data. It also enables all staff to work with the same criteria (Roy et

al., 2002).

Patch 4: Teamwork, Decision Making, Delegation, and Conflict Resolution

Teamwork discourse is a distinctive component of healthcare reform because it is needed

for safe, efficient, and patient-centred care (Finn et al., 2010). A team is a group of people

with varied abilities who work together towards a common goal (Rosengarten, 2021; Daft,

2003). Thus, the most important aspect of teamwork is collaboration (Valentine, 2015). The

UK's Department of Health repeatedly reiterates in all of its publications, such as the Darzi

Report that, Healthcare is delivered by a team (Department of Health, 2008). Moreover, the

delivery of efficient healthcare has gotten increasingly complicated, necessitating the

collaboration of teams of healthcare experts. In a similar manner, NMC (2018) instructs

nurses to function efficiently and cooperatively in teams. In Martha's care, the team

collaborated with other healthcare professionals to reach a common goal: her recovery

(Truglio-Lonndrigan and Slyer, 2018). Ultimately, teamwork and effective communication

within the team increased transparency and openness about daily tasks and requirements.

Teamwork also helps maintain the rhythm and fluency of the care process.

Delegation, according to the Health Education and Improvement Wales (HEIW) (2019:10), is

the practise through which the delegator assigns clinical or non-clinical care and support to a

capable person. Importantly, the registered nurse retains legal responsibility for the

delegated nursing care (NMC, 2018; Shore et al., 2022). In Martha’s care, duties had to be

transferred to the assistant nurses and health care assistants. HCAs support worker

activities have been classified as direct care, including routine duties related to personal

hygiene and mobilization (Blay and Roche, 2020). Before assigning the tasks, the nurse had

to conduct assessments of the person's abilities and competency levels. Additionally, the

nurse made certain that any delegation was made with Martha’s best interests in mind and

that full assessments of the situation's justification were always conducted (NMC, 2018).

All healthcare professionals working in hospitals, including doctors, nurses, and allied health

professionals, must make decisions and solve problems on a regular basis (Levenson,

2010), and all professions occasionally participate in Interprofessional teams (Weinberg et

al., 2011). Decision-making in nursing involves assessing, interpreting, evaluating, and

managing patient-specific situations (Dougherty et al., 2015). Regarding patient autonomy

and the nurse's professional duty of care, joint decision-making is vital (NMC, 2018). Martha

and her healthcare providers share decision-making about her care. RCN (2018) adds that

to deliver person- and family-centred care, clinical decisions should be based on thorough

assessments and involve patients' families through a professional relationship. In nursing,

decision-making is a dynamic process, and theories underscore adaptation and reflective

practice in identifying factors that affect patient care (Pearson, 2013). Health practitioners

never left Martha's family behind to help her make decisions (Lloyd, 2010). Unless Martha

proved otherwise, nurses presumed she could make her own decisions (Mental Capacity Act

of 2005)

Burnell (2019) recognises that conflict exists in all human interactions, whether with patients

or with co-workers. In such, Martha's case was no exception. As highlighted by NHS (2017),

there should always be conflict management tool on standby to avert escalation of conflict.

Martha's family appears to lack faith in the medical staff in charge of Martha care. They

frequently criticise the healthcare system as being incompetent, citing that their relative has

been in the hospital for a while and nothing appears to have changed concerning her

condition. They insisted that they would prefer home-based care. This conflict had an impact

on how the care facility and Martha's family interacted. To resolve this conflict, two parties

agreed to meet and discuss. The family was assured of team`s efforts to stabilise condition

and that discharging her would only exacerbate her condition. Based on the aforementioned,

it was determined that conflict is healthy, rather than the popular misconception that it is

unhealthy.

Stitching:

Mental health care service is complex, demanding and associated with a care delivery

problem because of the high levels of clinical resources needed to address patient
psychological impairment (Moudatsou et al., 2021). Despite its complexity, the collaborative

efforts of the HCPs paid off. Collaboration and teamwork within and between health

practitioners include sharing problem solving and decision making responsibilities in

developing and implementing patient care plans (O'Daniel and Rosenstein, 2008). Similarly,

the NMC Code's Section 2 emphasises the significance of working in collaboration with

patients to give them effective high-quality care and including them in their treatment, which

includes empowering patients with the ability to make their own decisions (NMC, 2018b).

Accordingly, Martha was treated as an equal partner, with access to information,

participation in treatment decisions, and respect for her opinions (Scie, 2016). Martha was at

the centre of her treatment with emphasis given to the interconnected physical,

psychological, social, and spiritual aspects of her existence. Partnership allows different

team members to contribute directly towards the improvement of Martha`s health and

wellbeing (Standing, 2017).

Interprofessional care formed a key component of Martha's care. Effective Interprofessional

collaboration practise occurs when several health professionals from various backgrounds

collaborate with patients, families, carers, and communities to provide the highest standard

of care across contexts (WHO, 2010). It results in a thorough well-resourced, secure, and

patient-centred healthcare system. Additionally, effective Interprofessional collaboration

encourages the effective use of resources, improves work satisfaction and lessened stress

among health professionals. Undoubtedly, the effective Interprofessional partnership

produced a number of beneficial outcomes in Martha`s care.

Using the evidence-Based Framework that is governed by clinical recommendations, helped

the nurses easily navigate through Martha’s case form the point of planning to the treatment

options available. The team through collaboration created a treatment plan that included

interventions that were tailored to address several aspects of her wellbeing. Notably, the

successful outcome of Martha`s care was primarily the result of the awakened efforts and

knowledge of a variety of disciplines. The cooperation and teamwork from committed

specialists, doctors, psychologists, nurses, healthcare assistants, dieticians, and

pharmacists, all played crucial roles in improving Martha’s care (WHO, 2009). The team's

intervention focused on her social needs in addition to her medical needs. These

interventions included the use of Cognitive Behavioural Therapy (CBT), family intervention,

self-help groups, rehabilitation such as exercise routine, and diet modification (NHS 2019;

NICE, 2014).

Martha's accident that claimed her only daughter may have been the genesis her underlying

condition. To keep her condition from worsening, the nursing team made sure she received

psychological and emotional support from family, friends, and specialists. This intervention

was conducted under NICE 2014 guidelines for preventing and managing psychosis and

schizophrenia in adults [CG 178]. David, Cristea, and Hofmann (2018) call CBT the "gold

standard in psychotherapy." Inpatient and outpatient psychiatric nurses trained in CBT can

treat patients with anxiety and depression (Stickley and Wright, 2014). CBT addresses the

process of influencing behaviour (NHS, 2022). Psychiatric nurses focused on Martha's

behaviours and opinions using this technique. Religion and spirituality are important to the

vast majority of patients seeking treatment (Brooker, 2007; Swihart and Martin, 2020).

Unfortunately, when making critical medical decisions for patients and their families, medical

professionals sometimes fail to take religious beliefs into account. Martha's spirituality was

also respected in her care. This was accomplished by involving her religious sect in the care

plan to offer spiritual support.

The core function of a Multidisciplinary Team (MDT) is to bring together a group of

healthcare professionals from different fields to determine patients' treatment plans (Tarbena

et al., 2020). MTD is significant in acute wards, which are often branded by rapidly changing

environments and time pressures (Reader, 2017). Additionally, organisations decide to

collaborate with other organisations in order to successfully address a variety of concerns or

challenges that may be too complicated to be addressed by a single organisation. In many

scenarios, the team was faced with a quandary while attempting to solve a problem.

However, by consulting others who could see the situation from a different perspective, they

were able to change the direction of their thoughts thereby finding up solutions to the

challenging scenario. The multidisciplinary care was further demonstrated in the areas of

drug management, rehabilitation, record keeping and Martha`s transfer.

The use of a patient centred approach ensured the delivery of more individualised care,

which was successful. Martha was empowered and received the support she needed to

manage her psychosis condition. Drug use during the early stages of psychosis has been

linked to an increase in psychotic symptoms (Seddon et al., 2016). Therefore, Martha was

equipped with knowledge, particularly regarding the effects of drugs on her condition. This

was accomplished through interventions like rehabilitation, which aimed to increase her self-

awareness and skills so she could manage her condition and become as independent as

she could (NHS, 2019).

The Tidal model produced a methodical procedure for the creation, execution, and

assessment of Martha`s treatment plan. This resulted in effective care delivery that included

multidisciplinary and extensive intervention efforts. The nursing model has also proven to be

greatly aided by the team's effective communication. Effective communication made sure

that all necessary information was relayed amongst team members during the handovers

and takeover. This was crucial in preventing any slowdowns and mistakes in the provision of

care. Martha's care was guided by effective leadership, decision-making, and cooperation to

satisfy her requirements. Martha was no longer showing any signs of depression, her

psychotic level reduced and she frequently engaged in conversation with others while telling

her story.

To conclude, evidence-based practice is unquestionably a useful, practical method for

managing treatment. Healthcare professionals give patients the finest care by reading and

evaluating the most recent, highest-quality research. In order to enable the implementation
and attainment of the intended aims and objectives, working partnership made sure that

there was enough communication, activity coordination, and cooperation amongst the

concerned partners. Additionally, high-quality care was provided as a result of realising the

impact that family and religion have on patients. Thus, it is crucial for healthcare

professionals to learn about and comprehend EBP technique.

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