Recovery is a concept that patients, family members’ and health professionals aim as an ultimate outcome measure when a patient is presented to a care environment. Even though all parties join forces to achieve recovery, perspectives of recovery vary among different disciplines (Huiting, 2013). Recovery in the mental health setting refers to the “process of changing one’s attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by illness” (Anthony, 1993).
In physical health context, recovery is recognized as a progress towards pre-illness state “defined by improvement in functional status and the perception that one is recovering” (Allvin, Berg, Idvall & Nilsson, 2006). Lack of consensus in definitions of recovery among different health care disciplines increase the risk of concept misuse or over-use as suggested by Brennaman & Lobo (2005). To avoid misconception, it is essential for the nurses to focus not only on what recovery means to them, but endeavor to explore and comprehends patients’ and family members’ perceptions.
Research studies show that clarifying concept improves care planning, nurse-patient relationship and patients’ healthcare outcome and experience (Allvin et. al. , 2006). Operationalizing concept of recovery is essential to mental health nursing practice because it encourages unambiguous use of the concept. As a result, this paper will explore concept of “Recovery” in Mental illness and identify other factors that influence it. Method. Using Walker and Avant system of concept analysis as a framework, “Recovery in Mental Health” concept will be explored using peer reviewed journals, Thesaurus, Dictionary and text books.
Recognized Health Journals such as “International Journal of Caring Science” and government website, such as US Department of Health and Human Services is used to research and select trending concept related to nursing. After selecting recovery concept, these research literatures will also be used in defining the concept, its attributes, antecedents, consequences discussed in the article “Recovery in Mental illness: A Concept analysis” by Xie Huiting, PhD. Findings The Merriam-Webster dictionary (2013) edition defines recovery as “the act or process of becoming healthy after an illness or injury.
It further described recovery as a “process of returning to a normal state after a period of difficulty”. Thesaurus online linked synonyms of recovery to these words: recuperation, improvement, cure, rehabilitation and restoration. The difference in the definitions of these synonyms contributes to inconsistent usage of “recovery” concept among different disciplines (Clearly & Dowling, 2009). Use of the concept It is essential to understand crucial attributes of “recovery in different fields before analysis of “Recovery in mental health”.
Economists see “recovery” as a period of growing business activity indicating the end of an economic downturn. This definition suggests that recovery “takes place to change things into its original, better state” (Huiting, 2013). In another interpretation, recovery is said to be” a return to wholeness that occurs by conservation of energy and reinstatement of integrity” (Levine, 1991*). In Aerospace Science, Berger (2007*) describes “recovery” as a process of bringing back Spacecraft for repair and reuse.
Brennaman & Lobo (2011) also describes recovery associated with organ donation as a surgical remover of viable “organs and tissues and prepares them for transplantation to a recipient”. It was noted that the recovery in this situation applies to the organ but not the recipient. In psychological setting,” recovery represents achieving psychological well-being and wholeness, reinstated integrity, transition from illness to health, loss of depression, anger, anxiety, fatigue and passivity”( Alvin, et al. , 2006).
In mental ealth context, concept of recovery is not operationalized. Lack of consensus among different healthcare specialties, healthcare professionals, patients and family caused US Department of Health with collaboration of other local mental health organizations to come up with consensus statement that clearly define the concept. Recovery in Mental Health is defined as” a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential” (SAMHSA, 2004).
To circumvent ambiguous use of the concept in mental health setting, US Department of Health (2004) identified 10 fundamental components of recovery that must be taken into consideration. These components are “Selfdirection, individualized and person-centered, empowerment, holistic, Non-Linear, strength-based, hope, peer support, respect and responsibility”. Avant and Walker (2005) explained that process of concept analysis involves finding defining attributes that are associated with a concept.
Recovery is going through gradual transformation in everyday use, therefore, it is essential to examine all related concept in order to accommodate constant variation and expectations of mental health patients (Rodgers, 2000*). After careful examination of the original article, defining characteristics related to recovery concept are not clearly stated. However, many other related literatures repeatedly talked about remission, response, rehabilitation and resilience as concepts that are associated with recovery.
Response is defined as a “clinically significant reductions in mental health symptoms while remission is refer to the virtual absence of mental health symptoms after a response” (Manderscheid, Ryff, Freeman et al, 2010). Clinicians have unintentionally replaced recovery with remission in different context. However, they are not identical (Jacobson et. al, 2005*). Rehabilitation is another attributes of recovery that explains view of healthcare caregivers. Although rehabilitation definition is closely related to recovery term, however, it does not convey essence of recovery concept (Lunt, 2000*).
Resilience is refer to as” a defense mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment”( Davydov, Stewart, Ritchie & Chaudieu, 2010). Evidence shows that lack or low level of resilience increases mental illness risks while high level of resilience reduce risk of having mental illness. (Shrivastava & Desousa, 2016). Antecedent and Consequences Antecedent is described as the conditions or attributes that must ensue before occurrence of the concept (Walker & Avant, 2005).
Before recovery in mental health can occur, individual must have been initially diagnosed or experience some form of psychiatric illness. Consequences are the situations that arises secondary to occurrence of a concept. (Walker & Avant, 2005). When mentally ill patients achieved recovery, the patients return to a more stable condition and move to or near preillness state. The events or attributes that occur after recovery is term consequences and is commonly seen as a positive outcome. Model Case Mr. NH is a 49 years old recently male.
He is a graduate of recognized university and he worked in Wall Street with six figures annual salary. In 2009, during economic downturn, NH lost all his investments including his job and house. NH was unable to handle these stressors, resolved to illicit drug use and alcohol because of extreme anxiety. He was taken to the emergency room after he overdosed Xanax. NH was diagnosed with Major Depression and placed on suicide watch. After receiving psychiatric treatment for more than 2 years, NH was able to put himself together, maintains sobriety and secured a job as a telemarketer in a started looking for job.
NH case demonstrates concept of recovery and validates all attributes related to it. NH prior situation before achieving recovery was the psychiatric problem he experienced secondary to unexpected life events. But, he shows resilience in the presence of all these stressors by committing himself to treatment plan that helped him back to stable state. Perspectives of nursing team that worked with NH was that he has achieved recovery despite continuous usage of antidepressant medications. However, NH and his family perception is different.
NH acknowledged that he is stable medically, but not yet near pre-illness state in terms of financial stability. The dynamic nature of recovery concept, especially in mental health nursing is noticeable in the case of NH has both patient and nurses have different view of recovery. This lack of consensus impacts the patients’ health outcomes. As a result of this, more research is needed to appropriately analyze this concept. If accurately understood, recovery approach will help the nurses in designing clinical interventions that is consumer-centered.
