Empowerment the defining characteristic of nursing interventions is the empowerment of people to achieve or recover and maintain their independence, taking into account individual physiological, psychological, social, cultural and spiritual needs (Royal college of nursing 2003).
Attention deficit hyperactivity disorder: a model of nursing care
Sue Keoghan describes how the role of specialist nurse practitioner can be expanded to include the diagnosis and treatment of adults with this condition
Abstract People with attention deficit hyperactivity disorder (ADHD) can suffer its consequences throughout their lives. This article considers the development of a specialist nurse practitioner role and the adoption of a nursing model of care in delivering innovative services for adults with ADHD.
Keywords Attention deficit hyperactivity disorder, specialised care
Correspondence susan.keoghan2@swyt.nhs.uk
Date of acceptance April 4 2011
Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software
Author guidelines www.mentalhealthpractice.co.uk
MHP1503Nov2011 20-22 fSK660.indd 20 10/10/2011 17:05
MENTAL HEALTH PRACTICE November 2011 | Volume 15 | Number 3 21
Feature
this characteristic has informed the development of nursing theories and models over the past 50 years (Alligood and tomey 2009). nursing models guide and enhance the assessment, planning, implementation and evaluation of care delivery. Many aspects of nursing practice and the role of the nurse have changed since the conception of nursing models, and there are differing views about their usefulness. As Aggleton and chalmers (2000) and Wimpenny (2002) have pointed out, however, nursing models that allow nurses to work flexibly and creatively remain pertinent, particularly at a time when nursing roles are changing. one such model was devised by the influential nursing theorist Hildegard Peplau (1988). Her developmental model of nursing, which emphasises the importance of the nurse-patient relationship and the psychobiological experiences of the patient (Aggleton and chalmers 2000, Alligood and tomey 2009), is useful in diagnosing and treating adults with ADHD. these adults often present with complex problems that require systematic assessment before treatment plans can be formulated. Peplau (1988) recognises that gathering data can be problematic and, to make the process easier, identifies four phases of the nurse-patient relationship and patient journey. these phases are: ■■ orientation, when nurses learn about patients’ difficulties and help patients to understand them until a mutual regard and trust has been developed and patients feel secure. ■■ identification, when patients identify nurses as the source of help and goals for recovery are set. ■■ exploitation, when nurses act as educators, providers of resources and counsellors to promote personal and interpersonal growth. ■■ Resolution, when patients cease to rely on professional support and act independently, with or without the support of informal networks, and nurses can reflect on what has been achieved. Like other recovery-focused approaches, Peplau’s (1988) nursing model may lead to only temporary resolutions and patients may continue to require access to specialist support services as their lives become more demanding. the model is particularly useful in treating people with ADHD who are in transition from children to adult services. Historically, a medical approach has been taken to treat such people, and this may explain why some young adults with ADHD struggle to engage with services. Missed appointments, reliance on parents and avoidance of therapy-based interventions are
common among this population, and such behaviour often becomes more frequent over time. Goldstein and ellison (2002) consider the difficulties encountered by young adults during their transitions to independence, as the protection of significant others, such as parents and teachers, is reduced. the increasing demands of adult life, such as those concerning planning, organisation, decision making and self-control, further exacerbate the difficulties associated with ADHD. Young adults with the condition need to develop new coping and protective strategies to self-manage the effects of its symptoms. Recovery approaches such as Peplau’s (1988) encourage people with ADHD to consider their strengths and abilities, and take part in strategies that lead to behavioural change.
อำนาจการกำหนดลักษณะของการรักษาพยาบาลคือ อำนาจของคนที่ประสบความสำเร็จ หรือการกู้คืน และรักษาความเป็นอิสระของพวกเขา คำนึงถึงสรีรวิทยา จิตวิทยา สังคม วัฒนธรรม และจิตวิญญาณความจำเป็น (รอยัลวิทยาลัยพยาบาล 2003) สมาธิ: รูปแบบการพยาบาลดูแลSue Keoghan อธิบายวิธีสามารถขยายบทบาทของผู้ประกอบการพยาบาลผู้เชี่ยวชาญเพื่อการวินิจฉัยและการรักษาของผู้ใหญ่ด้วยเงื่อนไขนี้สมาธิ (ภาระผูกพัน) นามธรรมคนสามารถประสบผลที่เกิดขึ้นตลอดชีวิต บทความนี้พิจารณาการพัฒนาของผู้ประกอบการพยาบาลผู้เชี่ยวชาญบทบาทและยอมรับของรูปแบบการพยาบาลดูแลในการส่งมอบบริการนวัตกรรมสำหรับผู้ใหญ่ที่มีภาระผูกพัน คำสำคัญสมาธิ ดูแลพิเศษติดต่อของ susan.keoghan2@swyt.nhs.ukวันรับรอง 4 2554 เมษายนเพื่อนตรวจสอบบทความนี้แล้วต้องตรวจทานสองคนตาบอด และมีการตรวจสอบโดยใช้ซอฟต์แวร์ antiplagiarismสร้างแนวทางที่ www.mentalhealthpractice.co.ukMHP1503Nov2011 20-22 fSK660.indd 20 10/10/2011 17:05ปฏิบัติการสุขภาพจิต 2554 | ปริมาตร 15 | หมายเลข 3 21ลักษณะการทำงานthis characteristic has informed the development of nursing theories and models over the past 50 years (Alligood and tomey 2009). nursing models guide and enhance the assessment, planning, implementation and evaluation of care delivery. Many aspects of nursing practice and the role of the nurse have changed since the conception of nursing models, and there are differing views about their usefulness. As Aggleton and chalmers (2000) and Wimpenny (2002) have pointed out, however, nursing models that allow nurses to work flexibly and creatively remain pertinent, particularly at a time when nursing roles are changing. one such model was devised by the influential nursing theorist Hildegard Peplau (1988). Her developmental model of nursing, which emphasises the importance of the nurse-patient relationship and the psychobiological experiences of the patient (Aggleton and chalmers 2000, Alligood and tomey 2009), is useful in diagnosing and treating adults with ADHD. these adults often present with complex problems that require systematic assessment before treatment plans can be formulated. Peplau (1988) recognises that gathering data can be problematic and, to make the process easier, identifies four phases of the nurse-patient relationship and patient journey. these phases are: ■■ orientation, when nurses learn about patients’ difficulties and help patients to understand them until a mutual regard and trust has been developed and patients feel secure. ■■ identification, when patients identify nurses as the source of help and goals for recovery are set. ■■ exploitation, when nurses act as educators, providers of resources and counsellors to promote personal and interpersonal growth. ■■ Resolution, when patients cease to rely on professional support and act independently, with or without the support of informal networks, and nurses can reflect on what has been achieved. Like other recovery-focused approaches, Peplau’s (1988) nursing model may lead to only temporary resolutions and patients may continue to require access to specialist support services as their lives become more demanding. the model is particularly useful in treating people with ADHD who are in transition from children to adult services. Historically, a medical approach has been taken to treat such people, and this may explain why some young adults with ADHD struggle to engage with services. Missed appointments, reliance on parents and avoidance of therapy-based interventions are ทั่วไปในหมู่ประชากรนี้ และพฤติกรรมดังกล่าวมักจะบ่อยกว่าช่วงเวลา Goldstein และเอลลิสัน (2002) พิจารณาปัญหาที่พบ โดยผู้ใหญ่ในระหว่างช่วงการเปลี่ยนภาพของพวกเขาเพื่อความเป็นอิสระ เป็นของสำคัญอื่น ๆ เช่นผู้ปกครองและครู จะลดลง ความต้องการเพิ่มขึ้นของชีวิตผู้ใหญ่ เช่นเกี่ยวกับการวางแผน องค์กร การตัดสินใจ และควบคุมตน เอง เพิ่มเติมทำให้รุนแรงความยากลำบากที่เกี่ยวข้องกับภาระผูกพัน ผู้ใหญ่ มีเงื่อนไขต้องพัฒนาใหม่รับมือและป้องกันกลยุทธ์เพื่อจัดการผลกระทบของอาการของตนเอง กู้คืนยื่นของ Peplau (1988) ส่งเสริมให้คนที่ มีภาระผูกพันในการพิจารณาจุดแข็งและความสามารถของพวกเขา และเป็นส่วนหนึ่งในกลยุทธ์ที่นำไปสู่การเปลี่ยนแปลงพฤติกรรม
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