Reflective Essay on Learning Disabilities †Psychological Well-being The WritePass Journal

Reflective Essay on Learning Disabilities – Psychological Well-being Background Reflective Essay on Learning Disabilities – Psychological Well-being ) emphasised that it is important to do mental notes when doing an assessment since this would provide some clue as to how the person is feeling. Hence, one must look at the appearance, behaviour, speech, emotional state, and thinking of the person being assessed. However, looking into these areas is not enough since misinterpretation or erroneous assumptions may take place. Rather, it is necessary to take into account the context, setting, social norms, and beliefs for the individual being assessed (Pender, Murdaugh, and Parsons 2006). Needs-led assessment will allow the nurse to place more emphasis on finding solutions (Coffey and Hannigan 2003). 2. Risk Assessment A significant role is played by risk assessment and management in the practice of mental health nurses and multi-disciplinary teams. These risks include threat/danger to others as well as self-harm, amongst others. Despite the presence of risks however, a balance must be considered between the needs of each individual service user (client) and people’s safety and protection. A further emphasis is placed on paucity of information and lack of knowledge about such risks, thereby leading to ‘clinical gambling’ that can further result in mishaps (Cordall 2009). It is necessary to provide focus on improved consistency in applying risk assessment and management strategies, considering their central role in the practice of mental health. Admittedly, risk assessment and management went through certain developments, including the area/s to be understood about risk assessment; its clarity and what must be assessed; strategy developments in nursing risk; proposals; and leaned enquiry-based lessons. Hence, risk language must be standardised and simplified, which requires improving clarity in the vital roles of the concept (Cordall 2009). When one speaks of risk assessment in mental health services, he/she deals with the broader possibility (risk) of an event or behaviour (outcome). The outcome is the principal area of interest since it is commonly connected to an extent of severity, which could be associated with the indications of dangerousness/illness. Important regard is given to the impact of such severity because both a high outcome risk with low impact and a low outcome risk with high impact can take place (Kettles and Woods 2009). A useful way to consider the manner through which events take place is much the same as researchers’ predictive ability to test a number of risk assessments, which is also a useful way to evaluate the success of outcomes. Contingency tables allow an examination of correct predictions and error rates, and are hence an excellent means to present these results. On the other hand, the severity of behaviour refers to the level of intensity of risk occurring, and may be classified as mild, moderate, or severe (Kettles and Woods 2009). Clinical practice in a range of settings involves the core feature of violence risk assessment. The focus on risk to others in the mental nursing health practice is that ignoring or failing to acknowledge it can leave medical personnel unprepared and a lack of preparation results in situations where less willingness to work with aggressive and violent patients might be felt by clinical staff. Moreover, as there is a widely-held awareness of the relatio nship between mental illness and violence, an increasing basis of risk assessments will be taking place in clinical, correctional, and legal settings (Woods, 2009). On the other hand, risk to self, which may include suicidal behaviour, physical and social self-neglect, and vulnerability to risk from others, must also be considered. Worthy of note here are the biologic theories of suicide, which look into the link between physical illness, increased risk, and neuro-biological factors of suicide (Murray and Upshall 2009). 3.Case Study The Purpose of Assessment and its Potential Impact for Promoting Inclusion The person who is the focus of this case study is an epileptic patient named Janet. She is 48 years old, very fragile (small and short), and is within the care facility because her medication was not acting on her. She was admitted for her best interest. Janet was admitted to the mental health hospital due to her episodes of self-harming, which is a risk to herself and to other service users (other patients).   Janet is on different psychotic tablets and mood stabilizers; she is unable to sleep despite having been prescribed with sleeping tablets. Her behaviour is very challenging: she bites, screams all day, and is out of control. She came to the hospital to be observed and to allow personnel to research on a suitable drug that could work for her. She came to the ward setting via a referral from both her General Practitioner (GP) and her Psychiatric consultant. In the ward, she was placed on a close observation at Level 3. She was also assessed by the speech and language therapist as well as the behavioural therapist because of her difficulty to swallow. Her mental health is very unstable and she is unable to communicate verbally. However, she uses and understands gestures. She only makes sounds, noises, and screams as a way to co mmunicate. She likes pulling and grabbing, and loves her meal, especially her cups of tea. Janet came from a low-income British family, never married, and never had children due to her apparent condition. She is second amongst four children and still has both of her parents. The above narrative shows an investigation of a patient with a mental and learning disability problem, who was admitted to a mental health setting expecting treatment. It is apparent that an assessment was done on the patient before any clinical personnel would have carried out a specific intervention procedure. The above has not only related the nature of the patient’s illness but also presented other information that may be gathered in order to conduct an accurate assessment that will aid a precise diagnosis. The diagnosis of learning disabilities/mental disorders requires assessment as the initial step, which was evidently carried out on Janet. Mental health assessment is conducted visvis a full clinical assessment, which is a systematic evaluation of the psychological, biological, and social factor of a person who is presented with a potential psychological disorder. Assessment begins with a process wherein a curative alliance occurs between the client and the mental health personnel, thereby forming the basis of a care plan. Empathy and compassion are necessarily involved in the process in order to support the development of trust between the client and the mental health personnel forming an alliance (Elder et al. 2013; Kettles and Collins 2002). The clinical personnel in charge of Janet were empathetic and compassionate of her condition. The health personnel took extra care to understand the client in crisis, taking into account her associated fear and distress level, especially if he r prior service experience had been difficult and/or if she underwent compulsory treatment. The mental health nurse took the major role in the performance of an accurate and ongoing assessment on Janet. Assessment may be generally described as a complicated process since the diagnosis it performs ascertains the treatment for the client. The client’s needs and strengths are gauged by thorough assessment. It must be noted that assessment seldom includes one function; patients might be assessed to determine who they are, to describe and appraise particular problems of living as well as personal and social resources. All of these are embodied in a global assessment. Through assessment, the mental health nurse was able to obtain some understanding of the significance of Janet’s condition and problems (Elder et al. 2013; Morrison-Valfre 2013). The mental health nurse engaged in Janet’s condition acknowledged the different systems and levels of care for the person-in-care and ensured that she received treatment with dignity and respect so as to enable her to go back eventually to the highest possible level of self-care (Griffin, 2012). All patients must be treated with dignity and respect, giving careful considerations to the manner of communication with them (Hindle, Coates, and Kingston 2011). Thus, being aware of Janet’s systems and levels of care visvis her condition allowed the mental health nurse and care specialists to determine her treatment and receive it with respect and dignity. Types of assessment may be classified as global, focused, and ongoing.   Global assessment enables the provision of baseline data, such as the client’s health history and current needs assessment. Focused assessment, on the other hand, has a limited scope in its aim to focus on a specific need or potential risk.   Ongoing assessment pertains to systematic monitoring and observation related to certain problems (Elder et al. 2013).   The case study adopts a global assessment. Prior to assessing the service user being referred to in crisis, it is necessary to find out if she experienced mental health services and consulted their crisis plan. It is also important to enquire of her preference for a male or female care professional to carry out the assessment. In this case, Janet’s family specified female care professionals. Moreover, crisis assessment needs to clarify the information and its potential outcomes, addressing the client’s individual needs. Assessment for mental health must involve the client’s relationships, social and economic circumstances, behaviour, symptoms, diagnosis, and current treatment (NHS 2011). It is evident that amongst these concerns, the assessment made on Janet was focused most on her behaviour, symptoms, diagnosis, and current treatment. Her family history, social and economic circumstances, and the like, were also mentioned in the assessment. It must be recognised that assessments and diagnoses performed must be evidence-based and need the use of accepted methods. Assessments are carried out by suitably qualified staff with training and experience to assess mental health problems, and where possible, in the client’s preferred setting, with respect to the safety of all concerned. Collecting information about the person can be performed by the person himself/herself, or by other people who have prior observation of the person’s behaviour, such as family or carers. In this regard, it was the latter which was applied to Janet due also to her inability to communicate effectively. What the mental health nurse needs to know about the patient determines how he/she gathers the information. Knowing about what the person feels or thinks necessitates asking him directly in order to gather the needed information. Hence, the mental health personnel oftentimes asked Janet about what she thought or felt about certain things , people, or food. If the mental health nurse needed to know the manner in which Janet might behave in certain circumstances, Janet must be asked to reflect on her behaviour, or someone may be asked to observe Janet’s behaviour, or both. Further, it is essential to understand the lived experiences of both Janet and her carers in the assessment. Necessary information for understanding such lived experience involves Janet’s or the carer’s manner of interpreting what is taking place with Janet besides knowledge about her life, including her interests, personality characteristics, social resources, and personal circumstances. Janet’s family was involved in the treatment in the earliest possible way because of their in-depth information about how the symptoms of mental illness have developed, including their knowledge of the social and emotional environments contributing to the flourishing of such symptoms in Janet. Interviews, diaries/personal records, questi onnaires, and direct observations are the major assessment methods that can be performed to obtain the needed information for the assessment (Wilkinson and Treas 2011).   In Janet’s assessment, relevant information was collected through interviews, direct observations, and a referral from her GP and her psychiatric consultant. Interviews were performed with her family members and carers who observed her behaviour.   Models of Assessment and How They Impact on Inclusive, Responsive and Responsible Practice The new model of care is exemplified by new care practices whereby best practices as advanced by research evidence present the new model of care (Kleinpell 2013).   According to Freeman (2005), a biopsychosocial assessment of the patient is considered in an effective intervention, with a recommendation of a multi-method and multi-modal format. Moreover, these domains of information are used for assessment: biological, affective, behavioural, and cognitive domains, alongside the units of assessment, including the patient, his family, the health care process, and the socio-cultural setting in which the patient exists. The mental health personnel must understand the current status and history of the patient, and the assessment must identify problem areas and consider the patient’s assets and resources. This model can be employed in contemplating the patient’s change of behaviour to improve his quality of life, prevent illness, and promote well-being (Freeman 2005). The biopsychosocial assessment model also investigates the interrelatedness amongst the physical, psychological, behavioural, environmental, and social aspects of an individual’s life. The biological system focuses on the anatomical state of disease and its effect on the individual’s biological functioning. On the other hand, the effects of psychological factors, including personality and motivation, are emphasised in psychological system as the individual experiences mental illness. Further, the social system looks at the familial and cultural effects of the experience of illness. The causal ordering of biopsychosocial model is intrinsically biomedical, which means that rather than the causes, biochemical abnormalities can affect a person’s social environment. One criticism of this model is that it tends to rule out structural and social factors, but can however be considered as a useful framework for understanding the experience of mental illness (Freeman 2005) . The psychosocial model, on the other hand, is considered a holistic perspective to mental disorders and presents the interdependent areas of biological, psychological, and social factors in the assessment of mental health disorders (Boyd 2008). It is significant to note that standardised assessment methods promote inclusion in the mental health. The strategy of the European Union (EU) for mental health identifies best practice in the domain and in fostering social inclusion. A holistic approach is required in any effort to recognise best practice in social inclusion rather than to simply emphasise on aspects relating to mental health. Social exclusion cannot be addressed by just looking at the mental health problem of a person since one of the fundamental reasons for social exclusion of people with mental health illnesses is the propensity to take an exclusive emphasis on their medical symptoms rather than resolving the fundamental causes of their problems. Issues needing attention are equality and diversity, access to physical and mental health care and social networks, to name a few (House of Lords, 2007). The relevance of action to promote and improve social inclusion is embodied in mental health policy and is safeguarde d in the National Service Framework, which affirms that discrimination against people with mental health problems must be resisted and their social inclusion must be fostered. This signifies that mental health workers must regard the promotion of social inclusion a primary concern. The Effectiveness of Formal and Informal Assessments as Mechanisms to Develop a Shared Understanding of Need Either a formal or informal assessment may be carried out by the mental health nurse. A formal assessment involves an ordered interview plan and tools including questionnaires, checklists, etc. to acquire important information to aid the assessment interview. On the other hand, an informal assessment is less structured and the questions raised are those that the interviewer views to be relevant at the time he/she asks them. The formal interview has more benefits than the informal one since it is able to carry out a more or less similar assessment of people through the tools and structured interview plan thus devised. In addition, the individual’s biases and value judgments are less expected to influence the interview, as can take place in an informal assessment. The decision to use either formal or informal assessment methods is ascertained by the person in care as well as the adopted standardised assessment procedures (Pryjmachuk 2011). A formal assessment is emphasised on some form of structure and is commonly planned and studied with care, i.e. through some research. An informal assessment, on the other hand, involves information gathered through less structured methods.   Despite the almost similarity in the appearance of both methods, such similarity is however superficial. In both cases, the care personnel (e.g. nurse) would ask the person-in-care certain questions relating to his condition, noting his replies. However, a formal interview will have the questions carefully prepared earlier and might even be worded in a certain way, whilst the informal interview lacks this feature. Instead, the nurse conducting an informal assessment would ask certain questions she thinks relevant at that time, phrasing them in such manner she considers appropriate. Albeit both kinds of assessment are commonly used in mental health settings, it is important to recognise the significant advantages of any formal system over the l ess structured ways of investigating the condition of persons-in-care. The guidelines and procedures embodied in a formal system allow various people-in-care to be examined in a relatively the same fashion. This results in reduction, if not total cancellation, of one’s own prejudices. Regardless of who completes the assessment, its outcome must be the same, and such cannot be said of informal methods (Barker 2004).   The first point of information must be the patient’s basic demographics and condition/illness. An evaluation of physiological symptoms, history, risk factors, and treatment procedures must be considered visvis biological targets. His current moods, feelings about the illness/mental problem, support network, amongst others, constitute the patient’s affective targets. Crucial to his comprehensive evaluation is an assessment of his behavioral targets, which include self-care, functional capabilities, and occupational/recreational abilities (Freeman 2 005). All of these must be embodied in the assessment made on Janet. Critical Application of Legal, Ethical and Socio-Political Factors to the Practice of Assessment The use of assessment and clinical procedures involve some ethical issues. Ethical dilemmas may occur when diagnosis is performed in such situations, whereby diagnosing a person arbitrarily is often entailed. However, health care personnel have the clinical, ethical, and legal obligation to screen patients for life-threatening problems such as bipolar disorder, suicidal depression, and the like. It is necessary to point out that exclusive reliance on standardised treatments for certain problems may invite ethical concerns because of the questionable nature of the reliability and validity of these empirically-based strategies. Along with this is the fact that human change is complex and that measuring beyond a simplistic level is a difficult task, thereby making the change meaningless (Corey 2013). Thorough reflections on ethical considerations relative to health technologies are involved in the assessment for health technologies and value-based decisions. Since methods of retrieving information for effectiveness assessment are not appropriate to retrieving information on ethical issues, it is important to adopt a specific methodological approach (Scholarly Editions 2012). In addition, ethical principles such as autonomy, fidelity, and justice, amongst others, are involved in the provision of mental nursing care. National professional organisations set the standards for professional nurses’ ethical behaviours (Boyd 2008). Likewise, the healthcare organisation must ascertain its training needs and design structures to enable its healthcare personnel to understand ethical values and principles and hence integrate them into daily practice. With the provision of training, ethical values might not be recognised by several staff personnel whenever they occur, and thus they might impair their ability to recognise a suitable course of action. A formal assessment process is viable in enhancing an ethical framework within the healthcare organisation (Corey 2013). A point to consider is that the mental health care system faces certain magnified legal issues. The legal aspects of the assessment process in the practice of assessment involve such example where the nurse is held responsible for her judgments as well as the safety and well-being of the person-in-care. Every nurse must be aware of the three legal concepts that might affect their practice of care: negligence, malpractice, and liability (Davies and Janosik, 1991). Negligence occurs when a person (e.g. nurse) has become careless or has failed to act prudently, or has acted in such a way that is contrary to the conduct of a reasonable person. Malpractice takes place when a person commits professional misconduct, or has discharged his professional duties improperly, or fails to meet the standard of care as a professional, thereby resulting in harm to another. Liability, on the other hand, occurs as an obligation for having failed to act on something (Davies and Janosik, 1991). Mental health care is also influenced by sociopolitical factors, whereby the power of social justice is emphasised in the rectification of socio-cultural insensitivities (James and O’Donohue 2009). Mental health issues necessitate increased understanding of the sociopolitical context. This would include increased emigration in various parts of the world, which presents greater attention to the manner in which mental health issues may be effectively addressed within a broader global context. Studies involving culturally diverse samples would enable researchers to assess the generalisability of the diagnostic classification of mental problems across cultures and would likewise determine culturally specific events that might be influential to prevalence rates. Not being able to recognise the significant cultural differences amongst peoples impliedly promotes the ‘one-size-fits-all’ approach that is often criticised in the current diagnostic system for mental problems .   It has been emphasised that cultural and sociopolitical factors could indeed influence the assessment of certain mental illnesses, thereby enabling mental clinicians to consider cultural issues as necessary aspects of the assessment and diagnostic process (Chang 2012). Culturally able mental health care involves suitable treatments that take into account the client’s culture and social setting. The literature indicates that the primary objectives of mental health are to return to function, contribute to society, and maintain relationships (Markowitz and Weissman 2012). 4. Application to Practice How the Role and Function of the Nursing Profession Relates to the Theory and Practice of Assessment All mental health practitioners are responsible for developing certain strategies that allow people to maintain and build relationships, social roles, activities, etc. that are vital to social inclusion (Harrison, Howard and Mitchell 2004). The provision of high-quality mental health disqualifies biases and instead understands these biases at a range of levels, such as practitioner level, community level, and practice programme (Shieves 2008). It is recognised in this work that such biases can lead to social exclusion in the domain, which is not desired. Pondering on the provision of mental health care would necessitate its interpretation by psychodynamic theories, which looks at interpersonal concepts and examines the development of the mind within a lifetime (Dillion 2007). Behavioural theories provide emphasis on normal behaviour rather than the causes of mental problems/disorders. The objective is to effect behavioural change by means of conditioning, positive reinforcement, and so on (Dillion 2007). Meanwhile, cognitive theories involve understanding by focusing on behaviour and the individual’s cognition, including the way he processes his thoughts. The value of cognitive theory is seen in patient-therapist collaboration and the client’s active involvement in the occurrence of change (Dillion 2007). This is contrary to the situation where the client has learning disability and hence would find it difficult to pursue all these. Social Theories, on the other hand, involve socio-cultural perspectives and family dynamics, to name two, and convey that the development of a care plan for the patient necessitates certain socio-cultural aspects (Dillion 2007). This is suggestive of an inclusive care plan (Harrison et al., 2004). The importance of these theories to practice is that learning disabilities and mental problems as well as their causes can be more increasingly understood through their aid, thereby providing treatment to the patient with a consideration of their behaviour, cognition, socio-cultural context, and so on.   These theories also aid in pursuing further the concept of inclusion in health care and in understanding further the relevance of the assessment process. Through theories that aid practice, mental illness can be more accurately understood using integrative approaches. The conceptual framework of psychiatric domain involves various theoretical perspectives, with the absence of a single best explanatory model explaining mental illness. As this conceptual framework takes its development towards an increasingly integrative viewpoint, more effective and efficient integrative assessments will be the result of an understanding of complex relationships amongst various processes associated with normal human functioning and mental illness (Lake 2007). The Effectiveness and Efficiency of Assessment Strategies within the Current Practice and Overall Service The extent of effectiveness and efficiency of assessment within the current practice of the mental health nurse are seen in the impact of assessment as a life-changing experience for many persons-in-care. The rapport that the mental health nurse is able to establish with the client with a learning disability/mental problem as a result of the ‘therapeutic alliance’ provides the client a holistic approach to care. It confirms the need for a multi-disciplinary and team approach to the mental health service provision. Through an assessment, the mental health nurse becomes aware of the need for a supportive environment whilst collecting necessary data. The assessment also enables the mental health nurse to liaise with appropriate professionals, such as in Jane’s case where her GP and psychiatric consultant submitted a referral to the mental health hospital in order to aid in her diagnosis. Various tools, such as Life Skills Questionnaire, are used to gather additional information, which assist in developing a relationship with the service user (Acquah 2012).   The mental health nurse pays attention to the person’s feelings, thoughts, and behaviour, which are ways in which humans respond to life problems. If a person experiences increased detachment from one’s surroundings and the people in it, alongside the presence of distorted thought processes, the person can thus become problematic with satisfying to live a meaningful existence. The role of the nurse in this context is to identify how those behavioural changes hold back the person’s ability to pursue his own life and then design a specific care that will aid the person to address them. The utmost goal is certainly to help the person return to his usual normal activities and contribute to society. Through the nurse’s task to identify the effects of behavioural changes on the individual and to carry out a specific plan of care, the nurse thus considers the conseque nces of the learning difficulty/problem the basis of intervention. Further consideration of the client’s needs and interests is the principal value embodied in the establishment and execution of nursing services. This value must be implied in a nursing approach for the care of patients having been diagnosed for learning disability/mental illness. Along with this claim, the notion of a disease in the mental care must be given up as the center of mental health care and instead look at the patient as a person (Barker, 2004). In general, information about the nature and the extent of the patient’s problems are considered in a nursing assessment; hence, the nurse finds out the problem of the patient and how big it is. These questions must be asked in the most detailed manner possible, especially if the focus is to evaluate the impact of various forms of care. However, the means through which such information is gathered usually depends on the problem involved, in which even the personality of the person-in-care can even influence such means of information collection. The things that the nurse must consider are accurate information about the biophysical needs of the person needing mental care; the reflection of the need for precision and reliability for the adopted method; and the influence of the attitude or mood of the person conducting the assessment (Barker 2004). There are similar aims for most assessments; however, the manner in which they are carried out can vary greatly. These differences are very important and can have enormous influences on the value of information being produced. The means through which an assessment is conducted can spell a worthwhile exercise or otherwise.   The key differences between methods of assessment convey the way in which information is gathered (Barker 2004). Upon the assessment process, the nurse explains to the person-in-care such process and its contents, providing feedback for his collaboration with clients and healthcare team members to collect holistic assessments. Such assessments are conducted through interviews, observations, and examinations whilst being aware of confidential issues and relevant legal policies (Videbeck 2011). Additionally, policies and legal issues must be integrated in relation to ensuring the protection of other persons-in-care. Improvements in secondary care teams (e.g. mental health, learning disability, etc.) are necessary to ensure a consistent approach to care (Woods and Kettles 2009). The Nurse’s Role in the Assessment Process It must be noted that the mental health nurse takes the role of a coordinator as he/she interacts with other disciplines in the care delivery. A patient always receives a nursing care plan, but other disciplines are necessarily involved in such plan or individualised treatment plan (Boyd 2008). Further, the mental health nurse plays an important role in the assessment process where data are collected and organised, leading to the identification of diagnoses in which data are as well analysed. This would then lead to the planning phase, whereby prioritisation of problems is highlighted, along with identification of goals, selection of nursing intervention, and care plan documentation. The implementation features the nursing orders being carried out whilst documenting the nursing care and client responses. This leads to the evaluation phase, which involves monitoring the client outcomes and resolving, maintaining, and/or revising the current care plan (Timby 2009). Indeed, the mental h ealth nurse demonstrates a range of roles in the entire nursing process, as much as in the assessment practice. His/her performance in the assessment process determines the delivery of the next stage of the nursing process; hence it is required that such assessment is both precise and correct. For the nurse’s own future learning and development, there are perceived tremendous developments in his role, which are expected to take place within the managed care environment vis-a-vis his professional knowledge, skills, and attitude. Those who have carried out strong assessment and patient teaching abilities would be considered to have the most marketability. The nurse’s role in mental health assessment has radically evolved from merely using the client’s five senses to assessing his overall condition. Today, nurses use communication and physical assessment methods to come up with a clinical judgment relating to the client’s mental state. Additionally, technological advancements have developed the role of assessment, which correspondingly allowed managed care to develop the need for assessment skills (Weber and Kelley 2009). For example, the most broadly functioning measures used for people with learning disability/ mental problems are the Global Asse ssment Scale (GAS) and the Global Assessment of Functioning Scale (GAF), which is a modification of the GAS. The GAS is aimed for clinicians to decide on mental health along a single dimension on a scale of 100 points. The lowest functioning level of the individual during the previous week is the basis of GAS ratings (Thornicroft and Tansella, 2010). Furthermore, assessment helps the mental health nurse to decide the extent that the patient can do independently alongside the extent of help they need and the type of intervention necessary. A patient with a mental health problem for example, may need more encouragement for their hygiene needs, which means that their therapeutic care plan may include this aspect (Spouse, Cook and Cox 2008). This can be further considered in Jane’s case. Reflecting on Policy on Mental Health Capacity Implementation of mental health policy is an intricate process, including a number of different financial, technical, and political issues.   Teaching programmes for mental health policy usually intend to develop the knowledge of the public on health professionals and other people playing a significant role in the development of mental health policy.   Some programmes are specifically focused on issues of policy and service development; in particular, tackling the needs of those who are directly involved in the accomplishment of mental health policy, as well as in the development of research capacity (Patel, Minas, Cohen et al. 2013). Recommendations Recommendations for the nurse’s speciality include the following: Provide specialist skills and special therapeutic orientation to mental health nurses. This will train them to deliver research-based care and treatment to service users with learning disability/mental problems. Identify the need for the mental health nurse to develop skills in psychotherapy, which is resonant to interpersonal relations perspective to mental health nursing. This will highlight the nurse’s central role in mental health, which is his personal relationship with the patient (Norman and Ryrie 2013). Develop electronic health record systems for assessment. This will prepare professionals of health information management assess their situation in a more realistic manner. These record systems are necessary because of their use in storing patient data over time, such as test result data, diagnoses, problem lists, and so on. The client’s clinical information is necessarily retrieved by practitioners through their work station. Standard coding systems defining data consistently are suggested, specifying the capacity to pursue the outcomes of the health care process (Harman, 2001). How the Nurse Can Contribute to Best Practice and Actively Justify and Promote Quality Care The nurse can contribute to best practice by establishing an active participation in the mental health process via the integration of appropriate technology that can speed up the assessment process. Through evidence-based and person-centred intervention, the nurse will be able to help tackle several mental health needs, which can benefit clients like Jane. Evidence-based practice is now a current adoption in mental health care, which involves selecting the best interventions with a specific client and promoting specific interventions for definite problems/illness based on treatments that are supported empirically. Such evidence-based practice includes a consideration of the patient’s characteristics, preferences, and culture (Corey 2013), which the mental health nurse must take account of. These aspects had been mentioned in Jane’s case but needed further highlights to become more viable to the assessment process. The concept of social inclusion in mental health presents best practice to the mental health nurse, who has the primary role in conducting an inclusive assessment process. With the promotion of social inclusion, the mental health nurse becomes culturally competent in providing a service that harmonises with the client’s cultural and social background and value system. This is an area of best practice for the mental health nurse’s task in the assessment process. Further, looking at the cultural and social context of the patient needing care rather than merely focusing on his demographics as well as the historical development of the mental illness provide evidence-based considerations for future practice. Racial and ethnic differences in mental health care had been documented to demonstrate this point. Such factors as gaps in access, disputed diagnostic procedures, and limited specifications of competent treatments are reflective of what needs to be further emphasised in mental health care. In conclusion, the assessment process within the mental health care for patients with learning disabilities and mental problems needs procedures and strategies that are aligned to social inclusion and considers ethical, social, and political aspects of the process. Hence, a specialist assessment may be carried out in order to evaluate the patient’s strengths and difficulties alongside their current distress and potential replicable support. References Acquah, F. (2012) Utilising Untouched Mental Health Nursing Skills in Private Practice. Australian College of Mental Health Nurses: Mental Health Nursing in Primary Care: Putting the Pieces Together. Canberra. Barker, P. J. (2004) Assessment in Psychiatric and Mental Health Nursing: In Search of the Whole Person. Second Edition. UK: Nelson Thornes Ltd. Basavanthappa, B. T. (2007) Psychiatric Mental Health Nursing. India: Jaypee Brothers Medical Publishers (P) Ltd. Boyd, A. (2008) Psychiatric Nursing: Contemporary Practice. PA: Lippincott Williams Wilkins. Chang, E. C. (2012) Handbook of Adult Psychopathology in Asians: Theory, Diagnosis, and Treatment. London: Oxford University Press. Coffey, M. and Hannigan, B. (2003) The Handbook of Community Mental Health Nursing. First Edition. Oxon: Routledge. Cordall, J. (2009) ‘Risk Assessment and Management’.   In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Corey, G. (2013) Theory and Practice of Counselling and Psychotherapy. Ninth Edition. Mason, OH: Cengage Learning. Davies, J. L. and Janosik, E. H. (1991) Mental Health and Psychiatric Nursing: A Caring Approach. Boston, MA: Jones and Bartlett Publishers, Inc. Dillion, P. M. (2007) Nursing Health Assessment: A Critical Thinking, Case Studies Approach. PA: F.A. Davis Company. Elder, R., Evans, K., and Nizette, D. (2013) Psychiatric and Mental Health Nursing. Third Edition. NY: Elsevier Health Sciences. Freeman, A. (2005) Encyclopedia of Cognitive Behavior Therapy. NY: Springer Science. Griffin, D. J. (2012) Hospitals: What They Are and How They Work. London: Jones Bartlett Learning, LLC. Harman, L. B. (2001) Ethical Challenges in the Management of Health Information. London: Aspen Publishers Inc. Harrison, M., Howard, D., and Mitchell, D. (2004) Acute Mental Health Nursing: From Acute Concerns to the Capable Practitioner. First Edition. London: SAGE Publications Ltd. Hindle, A., Coates, A., and Kingston, P. (2011) Nursing Care of Older People. London: Oxford University Press. House of Lords (2007) Improving the Mental Health of the Population: Can the European Union Help? Volume II: Evidence. London: The Stationery Office. Hopp, L. and Rittenmeyer, L. (2012) Introduction to Evidence-Based Practice: A Practical Guide for Nursing. PA: E.A. Davis Company. James, L. C. and O’Donohue, W. T. (2009) The Primary Care Toolkit: Practical Resources for the Integrated Behavioral Care Provider. New York: Springer. Kettles, A. M. and Collins, M. (2002) Therapeutic Interventions for Forensic Mental Health Nurses. England: Jessica Kingsley Publishers Ltd. Kettles, A. M. and Woods, P. (2009) ‘The Theory of Risk’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Kleinpell, R. M. (2013) Outcome Assessment in Advanced Practice Nursing. Third Edition. New York: Springer Publishing Company LLC. Lake, J. (2007) ‘Integrative Mental Health Care: From Theory to Practice, Part 1’. Alternative Therapy of Health Medicine, 13 (6), 50-56. Markowitz, J.C.   and Weissman, M. M. (2012) Casebook of Interpersonal Psychotherapy. London: Oxford University Press. Morrison-Valfre, M. (2013) Foundations of Mental Health Care. Fifth Edition. London: Mosby, Inc. Murray, B. L. and Upshall, E. (2009) ‘Risk to Self’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. [NHS] National Health Service (2011) Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services. Retrieved on November 7, 2013 from nice.org.uk/nicemedia/live/13629/57534/57534.pdf Norman, I. J. and Ryrie, I. (2013) The Art and Science of Mental Health Nursing: Principles and Practice. England: Open University Press. Patel, V., Minas, H., Cohen, A., and Prince, M. J. (2013) Global Mental Health: Principles and Practice. New York: Oxford University Press. Pender, N. J., Murdaugh, C. L., and Parsons, M. A. (2006) Health Promotion in Nursing Practice. PA: Lippincott Williams Wilkins. Pryjmachuk, S. (2011) Mental Health Nursing: An Evidence Based Introduction. First Edition. London: SAGE Publications Ltd. Scholarly Editions (2012) Issues in Healthcare Technology and Design. Atlanta, Georgia: Scholarly Editions. Shieves, R. (2008) Basic Concepts of Psychiatric-Mental Health Nursing. Seventh Edition. PA: Lippincott Williams Wilkins. Spouse, J., Cook, M. J., and Cox, C. (2008) Common Foundation Studies in Nursing. Fourth Edition. London: Churchill Livingstone. Thornicroft, G.   and Tansella, M. (2010) Mental Health Outcome Measures. Third Edition. London: The Royal College of Psychiatrists. Timby, B. K. (2009) Fundamental Nursing Skills and Concepts. Ninth Edition. London: Lippincott Williams Wilkins. Videbeck, S. L. (2011) Psychiatric-Mental Health Nursing. London: Lippincott Williams Wilkins. Weber, J. and Kelley, J. (2009) Health Assessment in Nursing. London: Lippincott Williams Wilkins. Wilkinson, J. M. and Treas, L. S. (2011) Fundamentals of Nursing – Volume 1: Theory, Concepts, and Applications. US: F. A. Davis Company. Woods, P. (2009) ‘Risk to Others’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Woods, P.   and Kettles, A. M. (2009) Risk Assessment and Management in Mental Health Nursing. London: Blackwell Publishing Ltd.