Introduction

The essay mirrors a case scenario for a psychotic patient. The patient's age, gender,
medical and social history will form the foundation of the case. Secondly, the
Evidence-Based (EB) framework used to address patient`s psychosis ailment will be
examined. Several organizational setup principles, such as effective management,
management dynamics, and their interactions will be evaluated. The essay will
assess how the care team dealt with teamwork, delegation, decision-making, and
conflict-resolution principles. Lastly, a discussion of how the patient`s complex care
requirements were handled by the care team`s coordinated efforts will be evaluated.
Accordingly, the pseudonym Martha shall be used to maintain privacy and
confidentiality in accordance with the Nursing and Midwifery Council's guidelines
(NMC, 2018).

Patch 1: Learning Outline 1: The patient's personal information

Martha is a 59-year-old woman who was diagnosed with psychosis in 2018. She was
being cared for and supported by staff at a local Mental Health facility because her
family could not live with her due to their work schedules. Before admission into the
psychiatric unit, Martha was staying with her husband and daughter in a rented
apartment. In 2016, she had an accident that affected most of her body parts and
also claimed the life of her daughter. Due to the accident, small tasks such as
shaving, bathing and brushing teeth became a challenge. She was also unable to
fulfil her wifely duties such as house chores and as a result her marriage ended.

Martha was found on top of the bridge by cyclists who suspected that she wanted to
commit suicide. They handed her over to the police who detained her under Section
136 of the Mental Health Act (1983 as amended 2007). She told the police that there
was no one to sympathize with in her condition. She felt isolated and betrayed by
relatives and friends who have abandoned her during these difficult times. Hence,
suicide was the only remedy for the situation. In late 2017, she began exhibiting
religious preoccupation and claiming to hear God`s voice instructing her to fulfil his
destiny. Martha had previously described visual hallucinations of shadow figures
following her around.
After a short interview, the psychiatrist could not find coherence in what she was
saying. Immediately, she began attacking everyone, throwing things around and
screaming. In an effort calm her aggressiveness, the general practitioners chose to
use Electroconvulsive therapy (ECT) as this was in the best interest of her (Mental
Health Act 1983; Mental Capacity Act, 2005). After a few sessions, Martha began to
experience confusion and seem disoriented

She was initially admitted to the urology ward before transferred to the psychiatry.
Following the British National Formulary (BNF) (2022) guidelines, she was
prescribed haloperidol 2.5 mg orally in the morning and 5mg orally at night.
Olanzapine 5 mg/day for agitation, Risperidone oral 2mg for an acute manic episode.
Tramadol 50 mg three times a day and flupenthixol decanoate 20 mg intramuscular,
was also prescribed.

Martha's initial hospital examination revealed that she was rejected and socially
isolated. According to her sister, she has a history of drug and alcohol abuse. A drug
test was performed, and the results were confirmed as positive. Nevertheless,
Martha adamantly refused to be admitted to the psychiatric unit for treatment.
Psychiatrists contemplated on having Section 17 leave MHA (1983 as amended
2007), but rather employed Section 2 of the MHA (1983 as amended 2007), citing
that her condition needed more attention, and that discharging her was a danger to
her safety and the safety of others. Martha was later discharge on day 50 of
admission under the Care Program Approach.

Patch Two: Learning Outline 1: Evidence based professional framework

Evidence Based Practice is essential for providing safe, high-quality patient care. It
enables nurses and other clinicians to give patients the highest quality and most
cost-effective treatment possible. However, it is of the utmost importance for nurses
to be up-to-date on current techniques so they can provide treatment for patients
with complex and debilitating diseases (Brown and Schmidt, 2011). The team
chooses to follow the NICE (2014) guidelines for the prevention and management of
psychosis and schizophrenia in adults [CG 178]. Clinical recommendations are
systematically created statements to aid practitioners and patients in making
judgements about the most appropriate health care for particular clinical conditions
(NICE, 2012). Johnston (2016) states that in order to guarantee the best patient
results and deliver safe, high-quality care, healthcare practitioners are urged to apply
research evidence into practice. Similarly, the NHS (2019) emphasises the
importance of nursing care being evidence-based and governed by clinical
guidelines and frameworks developed in collaboration with the NMC (2018).

Shadowing the aforementioned concept, the nursing staff implemented interventions

based on the mentioned guideline to give Martha a more comprehensive care (NICE,
2014). This framework focuses on providing care and treatment of first episode of
psychosis (FEP) using the combination of antipsychotic medication, psychological
therapies, and social support (NICE, 2014). The framework also recommends two
psychological approaches, Cognitive Behavioural Therapy (CBT) and Family
Interventions (FI), which have emerged as effective therapies with the strongest
evidence base among a variety of psychological approaches (Garety, 2003).

Evidence-based practice (EBP) is acknowledged as the gold standard for providing

secure and efficient person-centred care. Nonetheless, decades after its inception,
nurses continue to face challenges in applying EBP (Ladwig and Ackley, 2010), and
while models for its implementation offer progressive ways, elements such as the
context of care and its mechanistic nature function as impediments to successful and
consistent application (Woolf et al., 1999). As a result, it is critical for (HCPs) to
discover solution to the way evidence is implemented in practise (Reed et al., 2018)

According to the UK Francis Report (2013), improving patient care is a crucial issue
for the health care system. In the management of a major psychiatric condition,
medication compliance is crucial yet difficult (Cutler et al., 2018). Research has it
that non adherence to medications as prescribed might exacerbate patient’s
condition, make treatment less successful, or make patients less responsive to
further treatment (Haddad, Brian and Scott, 2014). However, EBP offer solutions to
avert non adherence to medication related problems such as the implementation of
Depot injection (Jones and Jones, 2016).

Since the early 19th century, disturbed eating behaviours have been frequently
associated with psychotic disorders (Stogios et al., 2020). There is also evidence
that the first phase of antipsychotic (AP) therapy leads to compulsive eating
behaviours like binge eating (Musil et al., 2014). Therefore, following the NICE
(2014) framework, Martha’s weight gain and other metabolic issues were prevented.
Patient-centred care was implemented and ongoing evaluations were performed at
each review. The nutritionist's plans took Martha's individual requirements,
preferences and capacity for change into consideration. The NHS Long-Term Plan
(2019) emphasizes individualized care and patient participation, which enhance
health outcomes and lower the risk of deterioration. Accordingly, the NICE (2014)
guideline aims to enhance care by emphasizing long-term recovery and early
detection and treatment of psychosis. It also suggests tracking out coexisting health
issues and assisting family members and caregivers in the care process (NICE,
2014).
Martha was discharged under the Care Programme Approach (CPA). She was
visited a month later and assigned to the EIS Team (Kingdon, 2019), who made sure
she had a care coordinator to ensure that her scheduled treatment appointments,
psycho-education, counselling, and pertinent psychotherapies continued (Mace,
2004)

Patch Three

A hospital is not a permanent home, but a place of recovery before discharge

(Department of Health and Social Care, 2022). Feely (1994) champions assessment
as the first step in nursing care and serves as the care plan's foundation. Upon
admission to the psychiatric facility, nurses assessed Martha's condition in order to
grasp her condition’s demands and record all the information in clearly and
systematically manner (NMC, 2018). This procedure demonstrates the nurse’s
leadership and management abilities (Wihl et al., 2020). Following establishing
Martha’s needs, treatment plan was created to address existing and anticipated
challenges. This helped build client-centred goals, prioritise needs and facilitates
early discharge (Atwal, 2002). Care planning also aids clinicians share patient
information to enhance continuity of care (Department of Health, 2013; NICE, 2021)

Giddens (2018) asserts that HCPs must always satisfy expectations and adapt to
changing situations within the care organisation. Lateef (2011) added that rising
patient expectations must be handled to improve results and reduce liability. To
successfully meet Martha's care needs, the team employed a transformational
leadership style (West et al., 2015), which has been regarded as the pinnacle
standard of leadership (Cope, 2017). According to the Darzi Report (2008), effective
leadership in healthcare is vital for safeguarding and enhancing human health.
Transformational leadership style was vital in giving the team integrated care with
distinct roles and responsibilities (RCN, 2015).

Additionally, transformational leadership involves inspiring others to take charge of

their activities and sharpen their skills in specific situations (Hawkins, 2017), and also
encourage the development of specialized working relationships in healthcare
settings, which has an impact on patient outcomes, employee satisfaction, and
safety culture (Sfantou et al., 2017). According to Darzi (2008) leadership is not just
about individualism but about teams. Accordingly, Martha's medical conditions, as
well as ongoing reviews needed the team to employ transformational leadership
style and initiatives to avoid negative outcomes. The transformational leadership
style replaces conventional and autocratic methods of leadership (Murphy, 2005).
Accordingly, Martha was at the centre of her care, with access to information related
to her care service. There was no alternative leadership style since the efficiency of
the leadership style is determined by the type of leadership on the ground.

In mental health, nurses uses models to identify the causes of behaviours and to
plan necessary actions (Roy, 2018). Models offers templates to help nurses give
respect-filled patient`s care that enhances positive results (McKenna, 1997). In
Martha`s case, the Tidal Recovery Model (2010) was employed. Its methodology is
based on chaos theory, which highlights that experiences are marked by constant
change and expectations (Barker 2001a). On that note, the model was used with the
understanding that Martha’s mental health was unstable and marked by constant
change. Therefore, the care plans needed to reflect this change and adjusted time to
time. As cited by Barker (2001b), the model combines discrete processes to re-
empower the person who has been disempowered by mental distress, psychiatric
services, or both. To effectively provide best care, nurses were accessible, focused,
and receptive to both Martha and the family dynamics as a whole (Brookes, 2006).

The Tidal Model (2010) was opted instead of the Orem's Self-Care Deficit Theory
(2001). The Orem hypothesis makes the fundamental assumption that individuals
should be self-sufficient and accountable for their own care. Nevertheless, this
paradigm did not apply to Martha because she did not practise self-care such as
exercise, bathing and not able to feed herself.

The coordination and provision of efficient and secure care depend on clinical risk
management (Roy et al., 2002). The Health of the Nation Outcomes Scales
(HoNOS), was used to assess outcomes of Martha mental health issues (Bebbington
et al., 1999). HoNOS is easy to use, provides consistent measurements,
summarises behaviours and functioning, and provides monitoring and outcome data.
It also enables all staff to work with the same criteria (Roy et al., 2002).

Patch 4: Teamwork, Decision Making, Delegation, and Conflict Resolution

Teamwork discourse is a distinctive component of healthcare reform because it is

needed for safe, efficient, and patient-centred care (Finn et al., 2010). A team is a
group of people with varied abilities who work together towards a common goal
(Daft, 2003). Thus, the most important aspect of teamwork is collaboration
(Valentine, 2015). The UK's Department of Health repeatedly reiterates in all of its
publications such as the Darzi Report that, healthcare is delivered by a team
(Department of Health, 2008). Moreover, the delivery of efficient healthcare has
gotten increasingly complicated, necessitating the collaboration of teams of
healthcare experts. Similarly, the NMC (2018) urges nurses to function efficiently and
cooperatively in teams. In Martha's care, psychologists, counsellors, therapists,
clinical social workers and psychiatrist collaborated to reach a common goal; her
recovery (Truglio-Lonndrigan and Slyer, 2018). Teamwork and effective
communication within the team increased transparency and openness about daily
tasks and requirements. Teamwork helps maintain the rhythm and fluency of the
care process.

Delegation, according to the Health Education and Improvement Wales (HEIW)

(2019), is the practise through which the delegator assigns clinical or non-clinical
care and support to a capable person. Importantly, the registered nurse retains legal
responsibility for the delegated nursing care (NMC, 2018; Shore et al., 2022). In
Martha’s care, duties had to be transferred to the assistant nurses and health care
assistants. HCAs support worker activities have been classified as direct care,
including routine duties related to personal hygiene and mobilization (Blay and
Roche, 2020). Before assigning the tasks, the nurse had to conduct assessments of
the person's abilities and competency levels. Additionally, the nurse made certain
that any delegation was made with Martha’s best interests and that full assessments
of the situation's justification were always conducted (NMC, 2018).

Undoubtedly, healthcare professionals working in hospitals, including doctors,

nurses, and allied health professionals make decisions and solve problems on a
regular basis (Levenson, 2010). Moreover, regarding patient autonomy and the
nurse's professional duty of care, joint decision-making is vital (NMC, 2018). In
nursing, decision-making is a dynamic process and theories underscore adaptation
and reflective practice in identifying factors that affect patient care (Pearson, 2013).
Shared decision making in Martha’s care involved assessing, interpreting,
evaluating, and managing specific situations (Dougherty et al., 2015). RCN (2018)
noted that to deliver person and family centred care, clinical decisions should be
based on thorough assessments and involve patients' families through a professional
relationship. Therefore, the team never left Martha's family behind in decisions
making process (Lloyd, 2010).

Burnell (2019) recognises that conflict exists in all human interactions, whether with
patients or with co-workers. In such, Martha's case was no exception. Martha's
family appears to lack faith in the medical staff in charge of Martha care. They
frequently criticise the healthcare system as being incompetent, citing that their
relative has been in the hospital for a while and nothing appears to have changed
concerning her condition. The family insisted that they would prefer to transfer
Martha to another facility. This conflict had an impact on how the team and Martha's
family interacted. As highlighted by NHS (2017), there should always be conflict
management measures on standby to avert escalation of conflict. To resolve this
conflict, the nurse in charge assured the family of the team`s efforts to stabilise
condition and they agreed on not to transfer her to another facility.

Stitching:

Mental health care service is complex, demanding and associated with a care
delivery problem because of the high levels of clinical resources needed to address
patient psychological impairment (Moudatsou et al., 2021). Despite its complexity,
the collaborative efforts of the team paid off. Collaboration and teamwork between
health practitioners include sharing problem solving and decision making
responsibilities in developing and implementing patient care plans (O'Daniel and
Rosenstein, 2008). Similarly, the NMC Code's Section 2 emphasises the significance
of working in collaboration with patients to give them effective high-quality care and
including them in their treatment, which includes empowering patients with the ability
to make their own decisions (NMC, 2018). Accordingly, Martha was treated as an
equal partner, with access to information, participation in treatment decisions, and
respect for her opinions (Scie, 2016). Martha was at the centre of her treatment with
emphasis given to the interconnected physical, psychological, social and spiritual
aspects of her existence. Partnership allows different team members to contribute
directly towards the improvement of Martha`s health and wellbeing (Standing, 2017).

Interprofessional care formed a key component of Martha's care. Effective

Interprofessional collaboration practise occurs when several health professionals
from various backgrounds collaborate with patients, families, carers, and
communities to provide the highest standard of care across contexts (WHO, 2010). It
results in a thorough, well resourced, secure, and patient-centred healthcare system.
Additionally, effective Interprofessional collaboration encourages the effective use of
resources, improves work satisfaction and lessened stress among health
professionals.

Using the Evidence-Based Framework that is governed by clinical recommendations,

helped the nurses easily to navigate through Martha’s case form the point of
planning to the treatment options available. The cooperation and teamwork from
committed specialists, doctors, psychologists, nurses, healthcare assistants,
dieticians, and pharmacists played crucial roles in improving Martha’s care (WHO,
2009). The team through collaboration created a treatment plan that included
interventions that were tailored to address several aspects of her wellbeing. These
interventions included the use of Cognitive Behavioural Therapy (CBT), family
intervention, self-help groups, exercise routine and diet modification (NHS 2019;
NICE, 2014).
The accident that claimed Martha's only daughter may have been the genesis of her
underlying condition. To keep the condition from worsening, the nursing team made
sure she received psychological and emotional support from family, friends, and
specialists. Additionally, religion and spirituality are important to the vast majority of
patients seeking treatment (Swihart and Martin, 2020). Unfortunately, when making
critical medical decisions for patients and their families, medical professionals
sometimes fail to take these into account. Nevertheless, Martha's spirituality was
respected. This was accomplished by involving her religious sect in the care plan to
offer spiritual support.

The core function of a Multidisciplinary Team (MDT) is to bring together a group of

healthcare professionals from different fields to determine patients' treatment plans
(Tarbena et al., 2020). MDT is significant in acute wards, which are often branded by
rapidly changing environments and time pressures (Reader, 2017). Additionally,
organisations decide to collaborate with other organisations in order to successfully
address a variety of concerns or challenges that may be too complicated to be
addressed by a single organisation (Carnwell and Buchanan, 2004; Scie, 2016). In
many scenarios, the team was faced with a quandary while attempting to solve a
problem. However, by consulting others who could see the situation from a different
perspective, they were able to change the direction of thoughts thereby finding up
solutions to the challenging scenario. The multidisciplinary care was further
demonstrated in the areas of drug management, record keeping and Martha`s
transfer.

The use of a patient centred approach ensured the delivery of more individualised
care. Martha was empowered and received the support she needed to manage her
psychosis condition. As mentioned by Seddon et al., (2016) that drug use during the
early stages of psychosis has been linked to an increase in psychotic symptoms,
Martha was equipped with knowledge, particularly regarding the effects of drugs on
her condition. This was accomplished through interventions like rehabilitation, which
aimed to increase her self-awareness so she could manage her condition and
become as independent as she could (NHS, 2019).
The provision of care was made possible by the team's effective communication.
Effective communication enabled information to be relayed amongst team members
during handovers and takeover period. This was crucial in preventing any slowdowns
and mistakes in the provision of care. Martha's care was guided by effective
leadership, decision-making, and cooperation to satisfy her requirements. Martha
was no longer showing any signs of depression, her psychotic level reduced and she
frequently engaged in conversation with others while telling her story.

To conclude, evidence-based practice is unquestionably a useful, practical method

for managing treatment. Healthcare professionals give patients the finest care by
reading and evaluating the most recent highest quality research. Working in
partnership enabled activity coordination and cooperation among the concerned
partners, which facilitated the implementation and attainment of the intended aims
and objectives. Additionally, high-quality care was provided as a result of realising
the impact that family and religion have on patients. Thus, it is crucial for healthcare
professionals to learn about and comprehend EBP technique.

Reference
Alligood M. R. and Marriner-Tomey, A. (2002) (Eds) Nursing Theorists and Their
Work 5th edn. London: Mosby.

Anonson, J., Walker, ME., Arries, E., Maposa, S., Telford, P. and Berry, L. (2014)
‘Qualities of exemplary nurse leaders: Perspectives of frontline nurses’, Journal of
Nursing Management, 22(1), pp. 127-136. Available at:
https://doi.org/10.1111/jonm.12092

Álvarez-Jiménez, M., González-Blanch, C., Crespo-Facorro, B., Hetrick, S.,

Rodríguez-Sánchez, J.M., Pérez-Iglesias, R. and Vázquez-Barquero, J.L. (2008)
‘Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic
Disorders’, CNS Drugs, 22(7), pp. 547–562. Available at:
http://dx.doi.org/10.2165/00023210-200822070-00002

Atwal A. (2002) ‘Nurses' perceptions of discharge planning in acute health care: a

case study in one British teaching hospital’, Journal of advanced nursing, 39(5), pp
450-458. Available at: https://doi.org/10.1046/j.1365-2648.2002.02310.x

Barker, P. (2001a) ‘The tidal model: the lived-experience in person-centred mental

health nursing care’, Nurs Philos, 2: pp. 213-223

Barker, P. (2001b) ‘The Tidal Model: developing an empowering, person-centred

approach to recovery within psychiatric and mental health nursing’, Journal of
Psychiatric and Mental Health Nursing, 8(3), pp. 233-240. Available at:
http://dx.doi.org/10.1046/j.1365-2850.2001.00391.x

Barker, P. and Buchanan-Barker, P. (2010) ‘The Tidal Model of Mental Health

Recovery and Reclamation: Application in Acute Care Settings’, Issues in Mental
Health Nursing, 31(3), pp. 171-180. Available at:
http://dx.doi.org/10.3109/01612840903276696.

Bebbington, P., Brugha, T., Hill, T., Marsden, L., and Window, S. (1999) ‘Validation
of the Health of the Nation Outcomes Scales’, British Journal of
Psychiatry, 174, 389-394.CrossRef Google Scholar
Berbiglia, V. A. (2002) ‘Orem’s self-care deficit nursing theory in practice. In Alligood
MR and Marriner-Tomey A (Eds)’, Nursing Theorists and Their Work. 5th edn.
London, Mosby.

Blay, N. and Roche, M.A., (2020) ‘A systematic review of activities undertaken by the
unregulated Nursing Assistant’, Journal of Advanced Nursing, 76(7), pp.1538-1551.

British National Formulary (BNF) (2022). BNF Publications. Bnf.org. Available at:
https://www.bnf.org/products/bnf-online/ (Accessed: 3 November 2022)

Brookes, N. (2006) ‘Phil Barker. The Tidal Model of health recovery. In A. M. Tomey
and M. R. Alligood (Eds.)’, Nursing theorists and their work. 6th end. pp. 696-725. St
Louis, MI: Mosby Elsevier.

Brooker, D. (2007) Person-centred dementia care. London: Jessica Kingsley

Brown, J. and Schmidt, N. (2011). Evidence-Based Practice for Nurses: Appraisal

and Application Research. Burlington: MA.

Burnell, R. (2019). How to resolve conflict as a nurse. Available at:

https://www.nursinginpractice.com/professional/how-to-resolve-conflict-as-a-nurse/
(Accessed: 5 December 2022).

Carnwell, R and Buchanan, J. (2004) Effective Practice in Health and Social Care.
McGraw-Hill Education.

Cope V, Murray M. (2017) Leadership styles in nursing. Nursing Standard. Available

at: https://journals.rcni.com/nursing-standard/leadership-styles-in-nursing-
ns.2017.e10836 (Accessed: 13 December 2022)

Cramer, J.A. and Rosenheck, R., (1998) ‘Compliance with medication regimens for
mental and physical disorders’, Psychiatric services, 49(2), pp.196-201.

Cutler, R. L., Fernandez, L. F., Frommer, M., Benrimoj, C. and Garcia, C.V. (2018)
‘Economic impact of medication non-adherence by disease groups: a systematic
review’, BMJ Open, 8(1) Available at: https://doi.org/10.1136/bmjopen-2017-016982
Daft, R. (2003) ‘Chapter 19: Teamwork in organisations’, In R. Daft (ed.)
Management. Ohio, USA: South Western, pp. 614-636.

Darzi, A. (2008) A High-Quality Care for All: NHS Next Stage Review Final Report.
Available at: https://www.gov.uk/government/publications/high-quality-care-for-all-
nhs-next-stage-review-final-report (Accessed: 8 December 2022).

David, D., Cristea, I, and Hofmann, S. G. (2018) ‘Why Cognitive Behavioral Therapy
is the current gold standard of psychotherapy’, Front Psychiatry, 9(4)

Department of Health and Social Care (2022) Hospital discharge and community
support guidance. Available at: https://www.gov.uk/government/publications/hospital-
discharge-and-community-support-guidance/hospital-discharge-and-community-
support-guidance (Accessed: 20 December 2022).

Department of Health (DoH) (2013) Care planning in the treatment of long-term

conditions: final report of the CAPITOL Project. Available at:
https://tinyurl.com/7399vphc (Accessed 1 November 2022).

Dougherty, L., Sque, M., and Crouch, R. (2012) ‘Decision-making processes used by
nurses during intravenous drug preparation and administration’, Journal of advanced
nursing, 68(6), pp. 1302-1311. Available at: https://doi.org/10.1111/j.1365-
2648.2011.05838.x

Finn, R., Learmonth, M. and Reedy, P. (2010) ‘Some unintended effects of teamwork
in healthcare’, Social Science and Medicine, 70(8), pp. 1148-1154. Available at:
http://dx.doi.org/10.1016/j.socscimed.2009.12.025.

Francis Report (2013). Report of the Mid Staffordshire NHS Foundation Trust Public
Enquiry. Google Scholar (Accessed 10 November 2022)

Gaebel, W., and Zielasek, J. (2015) ‘Schizophrenia in 2020: Trends in Diagnosis and
Therapy’, Psychiatry and Clinical Neurosciences, 69 (11), pp. 661-673.

Garety, P. (2003) ‘The future of psychological therapies for psychosis’, World

Psychiatry, 2(3), pp. 147-152. Available
at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525111 (Accessed: 1 December
2022).

Gilbert, J. H., Yan, J., and Hoffman, S. J. (2010) ‘A WHO report: framework for
action on Interprofessional education and collaborative practice’, Journal of allied
health, 39 Supply 1, pp. 196-197.

Haddad, P. M., Brain, C., and Scott, J. (2014) ‘Non adherence with antipsychotic
medication in schizophrenia: challenges and management strategies’, Patient-
Related Outcome Measures, 5, pp. 43-62. Available at:
https://doi.org/10.2147/PROM.S42735

Hawkins, P. (2017) Leadership Team Coaching: Developing Collective

Transformational Leadership. UK: Kogan Page.

Health Education and Improvement Wales (2019) All Wales Guideline for
Delegation. Available at: https://heiw.nhs.wales/files/covid-19/delegation-guidelines/
(Accessed: 22 December 2022)

Jones, A., and Jones, M. (2016) ‘Reviewing depot injection efficacy in the treatment
of schizophrenia’, Nursing standard (Royal College of Nursing (Great Britain),
30(33), pp. 50-59.Available at: https://doi.org/10.7748/ns.30.33.50.s45

Johnston, B. C., and Guyatt, G. H. (2016) ‘Best (but oft-forgotten) practices:

intention-to-treat, treatment adherence, and missing participant outcome data in the
nutrition literature’, The American journal of clinical nutrition, 104(5), pp.1197-1201.
Available at: https://doi.org/10.3945/ajcn.115.123315

Kingdon, D. (2019) ‘Care Programme approach – time to move beyond?’ BJPsych

Bulletin. Cambridge University Press, 43(3), pp. 101-103. Available at:
https://doi.org/10.1192/bjb.2018.73
Lateef, F. (2011). Patient expectations and the paradigm shift of care in emergency
medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132352/
(Accessed: 3 December 2022)

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh,
C., O’Connor, M., Corrigan, M., Burke, F., Hayes, M., Lynch, H., Sahm, L.,
Heffernan, E., O’Keeffe, E., Blake, C., Horgan, F. and Hegarty, J. (2018) ‘Evidence-
based practice education for healthcare professions: an expert view’, BMJ Evidence-
Based Medicine, 24(3), pp.103-108. Available at: https://doi.org/10.1136/bmjebm-
2018-111019

Levenson S. A. (2010) The health care decision-making process framework.

Maryland medicine: MM: a publication of MEDCHI, the Maryland State Medical
Society, 11(1), 13–17. Available at: https://pubmed.ncbi.nlm.nih.gov/21140861/
(Assessed: 4 November 2022)

Ladwig, G. and Ackley, B. (2010). Nursing Diagnosis Handbook: An Evidence-Based

Guide to Planning Care. Philadelphia, PA: Mosby Publishing

Lloyd, M. (2010). A practical guide to care planning in health and social care.
Maidenhead: Open University Press.

Mace, C. (2004) ‘Implementing the care programme approach in psychotherapeutic

settings’, Advances in Psychiatric Treatment, Cambridge University Press, 10(2), pp.
124-130. Available at: https://doi.org/10.1192/apt.10.2.124

McKenna, H. 1997. Nursing Theories and Models | Hugh McKenna | Taylor and
Francis eBooks, 1st ed. Routledge, p. 288. Available at:
https://www.taylorfrancis.com/books/mono/10.4324/9780203135440/nursing-
theories-models-hugh-mckenna. (Accessed: 3 December 2022)

Moudatsou, M. et al. (2021) Caring for Patients with Psychosis: Mental Health
Professionals’ Views on Informal Caregivers’ Needs. Available at:
https://www.mdpi.com/1660-4601/18/6/2964 (Accessed: 9 December 2022).
Mental Health Act (2007) Available at:
https://www.legislation.gov.uk/ukpga/2007/12/contents(Accessed: 1 December
2022).

MIND (2020) Mental Health Act (MHA) (1983). Available at:

https://www.mind.org.uk/information-support/legal-rights/mental-health-act-1983/
about-the-mha-1983/ (Accessed: 1 December 2022).

Montgomery, J.H. and Vasu, D. (2007). The Use of Electroconvulsive Therapy in

Atypical Psychotic Presentations: A Case Review. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860524/ (Accessed: 15 November
2022).

Murphy, L., (2005) ‘Transformational leadership: a cascading chain

reaction’, Journal of nursing management, 13(2), pp.128-136.Available at:
https://doi.org/10.1111/j.1365-2934.2005.00458.x

Musil, R., Obermeier, M., Russ, P. and Hamerle, M. (2014) ‘Weight gain and
antipsychotics: a drug safety review’, Expert Opinion on Drug Safety, 14(1), pp. 73-
96. Available at: http://dx.doi.org/10.1517/14740338.2015.974549.

National Institute for Clinical Excellence (2012) The guidelines manual. Available at:
https://www.nice.org.uk/process/pmg6/resources/how-nice-clinical-guidelines-are-
developed-an-overview-for-stakeholders-the-public-and-the-nhs-2549708893/
chapter/nice-clinical-guidelines#what-is-a-nice-clinical-guideline
(Accessed: 3 November 2022)

National Institute for Clinical Excellence (2014) Psychosis and Schizophrenia in

adults: prevention and management: Clinical guidance [CG178]. Available at:
https://www.nice.org.uk/guidance/cg178 (Accessed: 5 December 2022).

National Institute for Clinical Excellence (2021) what to expect during assessment
and care planning. Available at: https://tinyurl.com/63hm5vvp (Accessed: 1
November 2022)
Nursing and Midwifery Council (2018) The code: professional standards of practice
and behavior for nurses, midwives and nursing associates. Available at:
https://www.nmc.org.uk/standards/code/ (Accessed: 20 November 2022).

National Health Service (2022) Overview - Cognitive behavioral therapy (CBT).

Available at: https://www.who.int/publications/i/item/framework-for-action-on-
interprofessional-education-collaborative-practice(Accessed: 3 November 2022)

O’Daniel, M., and Rosenstein, A. H. (2008) ‘Professional communication and team

collaboration’, In Hughes R. G. (Ed.), Patient safety and quality: An evidence‐based
handbook for nurses, pp. 1-59. Rockville, MD: Agency for Healthcare Research and
Quality U.S. Department of Health and Human Services.

Pearson, H. (2013) ‘Science and intuition: do both have a place in clinical decision
making?’ British Journal of Nursing, 22(4), pp. 212-215. Available at:
http://dx.doi.org/10.12968/bjon.2013.22.4.212

Royal College of Nursing (RNC) (2015) Leadership: clinical governance. Available

at: https://www.rcn.org.uk/clinical-topics/clinical-governance (Accessed: 8 December
2022).

Royal College of Nursing (RNC) (2021) Accountability and Delegation. Available at:
https://www.rcn.org.uk. (Accessed: 8 December 2022).

Reader, T. W. (2017) ‘Team decision making’, In Salas R. R. E., and Passmore J.

(Eds.), The Wiley Blackwell handbook of the psychology of team working and
collaborative processes, pp. 271-296. West Sussex, UK: Wiley Blackwell.

Reed, J.E., Howe, C., Doyle, C. and Bell, D. (2019) ‘Successful Healthcare
Improvements from Translating Evidence in complex systems (SHIFT-Evidence):
simple rules to guide practice and research’, International Journal for Quality in
Health Care, 31(3), pp. 238-244. Available at: https://doi.org/10.1093/intqhc/mzy160

Rethink Mental Illness. (2021) Care Programme Approach (CPA). Rethink Mental
Illness. Available at: https://www.rethink.org/advice-and-information/living-with-
mental-illness/treatment-and-support/care-programme-approach-cpa/ (Accessed: 3
November 2022).

Roy C. (2018) ‘Key issues in nursing theory: Developments, challenges, and future
directions’, Nurs Research, 67 (2), pp. 81-92. Available at:
https://doi.org/10.1097/NNR.0000000000000266

Roy, A., Matthews, H., Clifford, P., Fowler, V., and Martin, D. (2018) ‘Health of the
Nation Outcome Scales for People with Learning Disabilities (HoNOS–LD)’, British
Journal of Psychiatry, 180(1), pp. 61-66. Available at:
https://doi.org/10.1192/bjp.180.1.61

Scie. (2016) Collaborate Working and Partnerships. Available at:

https://www.scie.org.uk/care-act-2014/safeguarding-adults/safeguarding-adults-
boards-checklist-and-resources/collaborative-working-and-partnership/ (Accessed:
12 December 2022).

Seddon, J.L. et al. (2016) Cannabis Use Is Associated With Increased Psychotic
Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A
Report From the UK National EDEN Study. Available at:
https://academic.oup.com/schizophreniabulletin/article/42/3/619/2413898 (Accessed:
9 December 2022).

Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., and Ankomah, A.
(2020) ‘Psychotropic medication non-adherence and its associated factors among
patients with major psychiatric disorders: a systematic review and meta-analysis’,
Systematic Reviews, 9(17). Available at: https://doi.org/10.1186/s13643-020-1274-

Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., and
Patelarou, E. (2017) ‘Importance of Leadership Style towards Quality of Care
Measures in Healthcare Settings’, A Systematic Review. Healthcare (Basel,
Switzerland), 5(4), 73. Available at: https://doi.org/10.3390/healthcare5040073

Shore, C. B., Maben, J., Mold, F., Winkley, K., Cook, A., and Stenner, K. (2022)
‘Delegation of medication administration from registered nurses to non-registered
support workers in community care settings: A systematic review with critical
interpretive synthesis’, International journal of nursing studies, 126, 104121.
Available at: https://doi.org/10.1016/j.ijnurstu.2021.104121

Squire, L.R. and Slater, P.C. (1983) ‘Electroconvulsive Therapy and Complaints of
Memory Dysfunction: A Prospective Three-Year Follow-up Study’, British Journal of
Psychiatry. Cambridge University Press, 142(1), pp. 1-8.vailable at:
http://dx.doi.org/10.1192/bjp.142.1.1

Singh, S. P. (2010) ‘Early intervention in psychosis’, British Journal of Psychiatry,

Cambridge University Press, 196(5), pp. 343-345. Available at:
https://doi.org/10.1192/bjp.bp.109.075804

Stogios, N. et al. 2020. Exploring Patterns of Disturbed Eating in Psychosis: A

Scoping Review. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768542/ (Accessed: 1 December
2022).

Swihart, D., Martin, R., (2020) Cultural Religious Competence in Clinical Practice.
Available at: https://www.ncbi.nlm.nih.gov/books/NBK493216/. (Accessed: 8
December 2022).

Taylor, P.J. (1983) ‘Consent, competency and ECT: a psychiatrist’s view’, Journal of
Medical Ethics, 9(3), pp. 146–151. Available at: http://dx.doi.org/10.1136/jme.9.3.146

Taberna, M., Gil Moncayo, F., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana,
E., Peralvez Torres, E., and Mesía, R. (2020) ‘The Multidisciplinary Team (MDT)
Approach and Quality of Care’, Frontiers in oncology, 10, 85. Available at:
https://doi.org/10.3389/fonc.2020.00085

Townsend, M. (2011). Psychiatric Mental Health Nursing: Concepts of Care in

Evidence-Based Practice. Philadelphia, PA: F. A. Davis Company.
Truglio-Londrigan, M. and Slyer, J. T. (2018) ‘Shared Decision-Making for Nursing
Practice: An Integrative Review’, The Open Nursing Journal, 12(1), pp. 1-14.
Available at: https://doi.org/10.2174/1874434601812010001

Valentine, M. A., Nembhard, I. M., and Edmondson, A. C. (2015) ‘Measuring

teamwork in health care settings: a review of survey instruments’, Medical Care,
53(4), e16-e30. Available at:
https://doi.org/10.1097/MLR.0b013e31827feef61/jonm.12092

Vasquez M. A. (1992) ‘From theory to practice: Orem's self-care nursing model and
ambulatory care’, Journal of post anaesthesia nursing, 7(4), pp. 251-255. Available
at: https://pubmed.ncbi.nlm.nih.gov/1386628/ (Assessed: 17 November 2022)

Weinberg, D. B., Cooney-Miner, D., Perloff, J. N., Babington, L., and Avgar, A. C.
(2011) ‘Building collaborative capacity: promoting interdisciplinary teamwork in the
absence of formal teams’, Medical care, 49(8), pp. 716-723. Available at:
https://doi.org/10.1097/MLR.0b013e318215da3f

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T. and Lee, A. (2015)
Leadership and Leadership Development in Health Care: The Evidence Base.
Available at:
https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/leadership-
leadership-development-health-care-feb-2015.pdf (Accessed: 8 December 2022)

Wing, J. K., Beevor, A. S., Curtis, R. H., Park, S. B., Hadden, S., ad Burns, A. (1998)'
Health of the Nation Outcome Scales (HoNOS)', Research and development. The
British journal of psychiatry: the journal of mental science, 172, pp.11-18. Available
at: https://doi.org/10.1192/bjp.172.1.11h.gov/1386628/

Wihl, J., Rosell, L., Bendahl, P. O., De Mattos, C. B. R., Kinhult, S., Lindell, G., von
Steyern, F. V., and Nilbert, M. (2020) ‘Leadership perspectives in multidisciplinary
team meetings; observational assessment based on the ATLAS instrument in cancer
care’, Cancer treatment and research communications, 25, 100231.
https://doi.org/10.1016/j.ctarc.2020.100231
Woolf, S.H., Grol, R., Hutchinson, A., Eccles, M. and Grimshaw, J. (1999) ‘Clinical
guidelines: Potential benefits, limitations, and harms of clinical guidelines’, BMJ
318(7182), pp. 527-530. Available at: http://dx.doi.org/10.1136/bmj.318.7182.527

World Health Organisation (WHO) (2009) Patient Safety Curriculum Guide for
Medical School. Available at: Patient Safety Curriculum Guide for Medical Schools |
HRH Global Resource Center (hrhresourcecenter.org) (Assessed: 4 January 2023)

World World Health Organization (WHO) (2010) Framework for Action on

Interprofessional Education and Collaborative Practice. Available at:
https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-
education-collaborative-practice (Assessed: 15 December 2022)