Lets Talk Solutions
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Transcript of Lets Talk Solutions
THERAPY IN NURSING INITIATIVE
ACUTE INPATIENT SETTING
August 2009
Albert Morrison CNS
10th Victorian Collaborative Psychiatric Nursing Conference
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Thank You For Coming
A Solution Focused Approach
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The Integration Of Solution Focused Brief Therapy
Into Nursing Practice
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Literature
Solution Focused Brief Therapy
Integration of SFBT into Nursing Practice
Is it helpful to Mental Health Nurses?
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“…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”
(Mullen, 2009)
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Where have the talk therapies gone?
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“by talking about themselves, people become more
aware of how they are ‘living’ – and perhaps by
‘doing whatever needs to be done’, they might
move beyond their problems, into a new story of
their own making”
Barker, P. & Buchanan-Barker, P. (2007)
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Literature Review Ferraz & Wellman, (2008)
Literature relating integration of SFBT in mental health (MH) nursing practice
with special focus on inpatient care.
Evidence for suitability & relevance to MH Nursing
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Published articles 1980-2006
203 citations
9 papers met the inclusion criteria
Ferraz & Wellman, (2008)
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SFBT congruent with the philosophical underpinning of mental health nursing.
Can be safely incorporated into nursing practice
May positively impact on nurses’ willingness to communicate with their patients
Helps nurses create a collaborative, goal-orientated approach
Ferrez & Wellman, (2008)
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SFBT techniques relevant to nursing practice
Cost effective approach
SFBT provides framework & easily understood
Harmonious with nursing values
Bowles, Mackintosh & Torn, (2001)
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SFBT may be helpful to clients May be useful in a broad range of
applications Research moving in the right
direction Efficacy phase More careful study needed
Gingerich, J. W., & Eisengart, S. (2000)
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SFBT was first developed by:
Steve De Shazer & Insoo Kim Berg
(1985, 1998) at the Brief Family
Therapy Centre in Milwaukee, USA.
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“The clientconstructs his or her
own solution based on his or her own resources and successes”
(De Shazer, 1988, P.50)
Principles If it isn't broken don’t fix it
If it works do more of it
If its not working try something different
Change is inevitable
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Problem Free Talk
Acknowledge problem
Not problem solving
Solution building
Jong & Berg, (2008)
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Assumptions The client is not the problem the
problem is the problem Assumes the client has strengths Things will get better Problem not always there Change is inevitable
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Practice Development 2008-2009
Therapy In Nursing Initiative
Adult acute inpatient setting
25 beds
32 Nursing staff
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Question 1 List three things that you know about
Solutionfocused Brief Therapy?
Question 2 Please rate your confidence in using
SFBT in your Nursing practice?
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Question 3 Mental Health nurses should provide psychosocial interventions such as SFBT toclients in the inpatient setting.
Question 4 How long have you been working in mental health?
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Total session 5
Total staff attended 31
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Content Origins of Solution Focused Brief
Therapy
Influences
Major Tenants
Basic principles
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The presentation was relevant to my nursing practice The objectives of the session were clearly explained I found the information informative & interesting I know more about SFBT after this session
Opportunity given to ask questions
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“…bring on the training”
“Presentation…informative & interesting”
“Case study example was good…more please”
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“good work”
“We find that we do a lot of this already but this is more structured
and better focused”
“Great programme…looking forward to see how it goes”
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12 of those emailed responded and agreed to be part of the project
Registered Nurses x 5
Clinical Nurse Specialists x 4
Endorsed Enrolled Nurses x 2
Clinical Nurse Educator x 1
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Moving forward to change
Interviewing for strengths
Case study role play
DVD footage Solution building
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At the end of this training session on a scale of 0 to 10
0 being I’m not at all confident at having a go at using SFBT in
my clinical practice 10 being I’m very confident that I will be using SFBT in myclinical practice
Where would you put yourself on this scale right now?
0….1….2….3….4….5….6….7….8….9….10
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Nurse 1 (3)
What tells you that you’re at that number?
“Willing to give it a go”“It’s not going to kill anyone”“A little knowledge goes a long way”
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Nurse 1
What needs to happen to get you to the next
couple of numbers on the scale?
“Practice…practice…practice”
“More in-services & more knowledge”
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Nurse 1 When you get to the next couple of numbers
on the scale, how will you know?
“I’ll feel more confident”“Will be able to identify those that might
benefit” “I’ll be more at ease in using SFBT” “I will be getting more detail from the client”
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Nurse 1What will you be doing different that will
tell you that you have moved up the scale?
“Finding out what their solution is”“It will be a normal part of my practice”“Using SFBT in a practical situation with a mentor”
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“Be more confident in selecting someone”
“Will be focusing more on what the client says,
rather than worry that I'm asking the right
question”
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Getting Started
First Session Outline Introduce self, problem free talk, SF question, MQ & Scaling
Second Session Outline What’s better? What’s changed?
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Solution Focused Question
When you’re discharged, say at the end of the
week…how will you know that being here in
hospital has been helpful…what will tell you that
being here has been of some help to you?
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MIRACLE QUESTION What will tell you that the problem that brought
you here is gone?
What's the first thing that you will notice?
What will be different?
Shazer & Dolan, (2007)
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SCALING
0....1....2....3....4....5....6....7....8....9...10
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What’s better since we last spoke?
What’s changed?
Where are you on the scale today?
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ACTION STAGE Small steps Part of practice Part of care planning Session guidelines used and placed in
notes SFBT magnets on bed list Sticker in notes
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What next? Continue to work with champions Monitor occasions when used Document session for discussion Follow up workshops Clinical supervision 12 month review
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Thank You
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References: Barker, P. & Buchanan-Barker, P. (2007). The Tidal Model: Mental Health,Reclamation and Recovery. Electronic copy pdf
Bowles, N., Mackintosh, C. & Torn, A, (2001). Nurses’ communication skills: an
evaluation of the impact of solution-focused communication training, Journal of
Advanced Nursing. 36 (3), 347-354
De Jong, P & Berg, K., I. (2008) Interviewing For Solutions (3rdEd) Thomas Brooks/Cole Belmont, CA
De Shazer, S. (2007). More Than Miracles: The State of the Art of Solution-Focused Brief Therapy. Routledge, New York
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Ferraz, H., & Wellman, N. (2008). The integration of solution-Focused brief
therapy principles in nursing: a literature review. Journal of Psychiatric and
Mental Health Nursing. 15. 37-44
Gingerich, J., W. & Eisengart, (2000). Solution-Focused Brief Therapy: A Review
of the Outcome Research. Family Practice 39. (4) 477-498
Mullen, A. (2009). Mental health nurses establishing psychosocial intervention
Within acute inpatient setting. International Journal of Mental Health Nursing .
18, 83-90
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