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THERAPY IN NURSING INITIATIVE

ACUTE INPATIENT SETTING

August 2009

Albert Morrison CNS

10th Victorian Collaborative Psychiatric Nursing Conference

Thank You For Coming

A Solution Focused Approach

The Integration Of Solution Focused Brief Therapy

Into Nursing Practice

Literature

Solution Focused Brief Therapy

Integration of SFBT into Nursing Practice

Is it helpful to Mental Health Nurses?

“…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)

Where have the talk therapies gone?

“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)

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

Published articles 1980-2006

203 citations

9 papers met the inclusion criteria

Ferraz & Wellman, (2008)

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)

SFBT techniques relevant to nursing practice

Cost effective approach

SFBT provides framework & easily understood

Harmonious with nursing values

Bowles, Mackintosh & Torn, (2001)

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)

SFBT was first developed by:

Steve De Shazer & Insoo Kim Berg

(1985, 1998) at the Brief Family

Therapy Centre in Milwaukee, USA.

“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

Problem Free Talk

Acknowledge problem

Not problem solving

Solution building

Jong & Berg, (2008)

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

Practice Development 2008-2009

Therapy In Nursing Initiative

Adult acute inpatient setting

25 beds

32 Nursing staff

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?

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?

Total session 5

Total staff attended 31

Content Origins of Solution Focused Brief

Therapy

Influences

Major Tenants

Basic principles

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

“…bring on the training”

“Presentation…informative & interesting”

“Case study example was good…more please”

“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”

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

Moving forward to change

Interviewing for strengths

Case study role play

DVD footage Solution building

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

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”

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”

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”

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”

“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”

Getting Started

First Session Outline Introduce self, problem free talk, SF question, MQ & Scaling

Second Session Outline What’s better? What’s changed?

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?

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)

SCALING

0....1....2....3....4....5....6....7....8....9...10

What’s better since we last spoke?

What’s changed?

Where are you on the scale today?

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

What next? Continue to work with champions Monitor occasions when used Document session for discussion Follow up workshops Clinical supervision 12 month review

Thank You

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

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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