Recovery Oriented Approach Teaching activities and resources
This section supports educators with the knowledge and skills required to incorporate the foundational concept of a recovery-oriented perspective into mental health and addiction entry-level nursing curricula.
At the end of this section, the educator will:
- Identify definitions, relevant theories and principles of recovery.
- Understand concepts related to dignity, hope, empowerment and resilience.
- Identify differences between medical model versus recovery models.
- Identify barriers and facilitators to recovery. Acknowledge the importance of experiential knowledge (i.e., lived client experience/family experience).
- Understand the nurse’s role in adopting a recovery perspective, including identify strategies to promote recovery.
The concept of “recovery” in mental health refers to living a satisfying, hopeful, and contributing life, even when mental health problems and mental illnesses cause ongoing limitations. Recovery — a process in which people living with mental health issues and mental illnesses are actively engaged in their own journey of well-being — is possible for everyone. Recovery journeys build on individual, family, cultural, and community strengths and can be supported by many types of services, supports, and treatments. Recovery includes a process of refining oneself, learning to accept one’s vulnerabilities, overcoming stigma, discrimination, looking beyond what is lacking in one’s life, regaining responsibility, control and hope in one’s life and becoming involved in meaningful social activities and community citizenship (Snow, 2010). The process for recovery requires genuine interest, and open and transparent therapeutic relationships where the client and health-care provider work in partnership to establish mutual goals (Snow, 2010). Specifically, a recovery model for mental health expands on clinical dialogues to include valued life goals, facilitates hope through education about realistic possibilities and probability of recovering to the point of having a good quality of life, is holistic and treats the person as a person, is sensitive to labeling and stigma and understands the importance of theraputic relations.
Implementing recovery-oriented practices that will enhance health outcomes and quality of life for people with lived experience and their families is at the heart of the Mental Health Commission of Canada’s Mental Health Strategy for Canada, and stands on two pillars:
- Recovery approaches recognize that each person is unique and has a right to determine their recovery journey. Using a recovery-orientated approach, clients take an active role in determining their own treatment paths (Cirpili & Shoemaker, 2014; Mental Health Commission of Canada, 2015).
- Recovery approaches provide recognition that individuals live in complex societies where there are many intersecting factors (biological, psychological, social, economic, cultural, and spiritual) which have an impact on health and well-being.
The nurses' role in recovery
Future nurses must understand how the recovery perspective guides nurses’ engagement with clients along the spectrum of care. Nurses can support recovery with the client by understanding the recovery perspective’s overarching guiding principles of dignity, hope, resilience, relationships, creating meaning of one’s life, and self-efficacy in each person’s unique and evolving journey (Deegan, 1988; Forchuk, 2003; Jacobson, 2012; Jacobson & Curtis, 2000). Nurses can also provide support by:
- Understanding recovery is personal and unique to each individual.
- Understanding each individual has a right to their own path and journey towards wellness.
- Honouring diversity.
- Being culturally responsive and safe.
- Facilitating interconnections between community and health-related resources for their care.
- Fostering and building positive environments that address clients’ true needs and fostering a culture and language of hope (Cirpili & Shoemaker, 2014 & Mental Health Commission of Canada, 2015).
Moreover, the perspective acknowledges that recovery is:
- A long-term process of internal change, and that these internal changes are processed through various stages (Substance Abuse and Mental Health Service Administration [SAMHSA], 2005).
- An ongoing process of refining oneself and learning to accept one’s vulnerabilities, overcoming stigma and discrimination, regaining hope, control, and responsibility in one’s life.
- Involves becoming engaged in meaningful social activities and community citizenship (Snow, 2010).
There is a concern expressed by mental health stakeholders that principles associated with the recovery approach, such as autonomy and peer accountability, will be used to limit or avoid providing services (MHCC, 2015), or, that by being assimilated into mainstream, there is a potential to turn recovery into a task which professionals ‘do’ or ‘facilitate’, rather than recovery being a process (Barker & Buchanan-Barker, 2005, p 238-239). In order to combat these obstacles to recovery, it’s important for nurses to develop and promote individualized care planning.
The Philip Barker’s Tidal Model, which emphasizes empowering interactions rooted in the lived experience of the client (Pagé, 2010), can be used to guide such strategies. Rather than conducting an assessment, the interaction is a nurse-client collaboration, where the nurses seek to understand who clients are by listening to their stories and perspectives (Barker, 2005). There are 10 commitments of the model and they include: value the voice; respect the language; develop genuine curiosity; become the apprentice; reveal personal wisdom; be transparent; use the available toolkit; craft the step beyond; give the gift of time; and, know that change is constant. Indeed, at the core of this model is change, so the nurse needs to be responding and adapting the focus to the changing needs of the client across the continuum of care (Pagé, 2010).
For more information, see Resources in this section.
Teaching and Learning Activities
The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to recovery oriented approaches.
- Yale Program for Recovery and Community Health, The Recovery Knowledge Inventory (other recovery self-assessments)
- Case studies across lifespan, life transitions, and with different populations/contexts (Section 9.3)
- Review of films portraying mental health/illness and examining use of recovery-oriented perspectives
- Lived client experiences/family experience (Appendix H)
- Arts-based approaches
Learner Engagement Questions
The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding using recovery perspectives. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.
- Who defines recovery?
- Does recovery mean that you no longer have an illness?
- What is the difference between traditional medical care versus recovery care?
- What are the benefits of peer support?
- What is positive risk taking?
- How would you promote informed choice and options to clients in relation to care planning?
- How do you balance autonomy with beneficence?
- How do we promote recovery to a client who is hospitalized against their will (i.e., by court order)?
- How would you engage in a conversation about what brings meaning to someone’s life?
- What is relapse prevention?
Evaluation and Self-reflection
The following tools can be used to evaluate students in their understanding and application of recovery perspectives:
Reflection question: If you had depression/anxiety, what would you want that would be unique to your background/experience/knowledge/strengths?
- Mental Health Commission of Canada
- Psychosocial Rehabilitation (PSR) Réadaptation Psychosociale (RPS) Canada PSR Society of Canada
- Recovery Journey (Schizophrenia Society of Canada)
- The Wellness Recovery Action Plan®
- Consumer Survivor Initiative (Ontario Peer Development Initiative)
- Therapeutic Relationships: From Hospital to Community
- Alcoholics Anonymous
- Canadian Assembly of Narcotics Anonymous
- Love Life, A Recovery Story
- Safewards by Len Bowers
GUIDES AND GUIDELINES
- RNAO 2015, Person- and Family- Centred Care. Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2002, Strengthening and Supporting Families through Expected and Unexpected Life Events. Toronto, ON. Registered Nurses’ Association of Ontario.
- 100 Ways to Promote Recovery (Mike Slade)
- Barker, P.& Buchanan-Barker, P. (2009). The Tidal Model®: A guide for mental health professionals. East Sussex, New York. Routledge.
- Mental Health Commission of Canada (2015). Guidelines for Recovery-Oriented Practice.
- Deegan, P. (1996). Coping with: Recovery is a journey to the heart. Psychiatric Rehabilitation Journal. 19(3), pp 91-97.
- Forchuk, C., (2007). The Transitional Discharge Model: comparing implementation in Canada and Scotland. Journal of Psychosocial Nursing Mental Health Services,. (11), 31-8.
- Reynolds, W., (2004). The effects of a transitional discharge model for psychiatric patients. Journal of Psychiatric Mental Health,. 11 (1), 82-8.
- Snow, S. (2010). Psychiatric and mental health nursing interventions. In W. Austin & M.A. Boyd (Eds.), Psychiatric and mental health nursing for Canadian practice (2nd ed.) (pp. 198-213). Philadelphia, PA: Lippincott Williams & Wilkins.