NU245 Unit 10 Recovery Seminar Reflection Example

She Still Hears Voices and Calls Herself Recovered: A Seminar Reflection Testing a Composite Woman's Account Against SAMHSA's Working Definition and the CHIME Framework, and the Charting Habit It Changed

[Student Name]

Purdue University Global

NU245: Mental Health Nursing

Unit 10 Seminar Reflection

[Instructor Name]

[Date]

The seminar case and classmates are composite; the reflection discusses recovery frameworks and does not describe any individual's treatment.

The Belief I Brought

I came into the seminar believing that recovery from a serious mental illness meant remission: no voices, no delusions, no symptoms. Most of what I knew came from acute care rotations, where I saw people at their worst, admitted because their symptoms had taken over. If someone still heard voices, I would have said she was not yet recovered.

The Case

[Ms. L.], composite, 46, has had schizophrenia for twenty years. She still hears voices on some days, usually when she is tired. She works twenty hours a week at a library, lives in her own apartment, sings in a church choir and has a close friend she calls every evening. She takes her medication, sees her therapist monthly and says, "I'm recovered. I still have schizophrenia, but it doesn't run my life."

Testing Her Account

SAMHSA's 2012 working definition treats recovery as an ongoing process in which a person improves health and wellness, directs their own life and works toward their potential, and it sets out four dimensions: health, home, purpose and community (Substance Abuse and Mental Health Services Administration, 2012). Against each: health, she manages her illness with medication and therapy; home, she has a stable apartment; purpose, she works and sings; community, she has friends, a choir and church. She meets all four while still having symptoms. The CHIME framework, from a systematic review of personal accounts of recovery, names five processes: connectedness, hope and optimism, identity, meaning in life and empowerment (Leamy et al., 2011). Connectedness: her friend and choir. Hope: she speaks about next year's goals. Identity: she separates herself from the illness, "I still have schizophrenia, but it doesn't run my life." Meaning: her library work. Empowerment: she manages her own medication and decides when to rest. Each element appears in her own words.

By every element of both frameworks she is recovered, and by my old definition she never could be; the frameworks were measuring her life, and I had been measuring her symptoms.

Clinical and Personal Recovery

The seminar helped me name two kinds of recovery. Clinical recovery is about symptoms and is measured by clinicians. Personal recovery is about living a meaningful life with or without symptoms and is defined by the person. They overlap, but they are not the same, and a person can have one without the other (Halter, 2022).

Rereading the Term's Notes

After the seminar I reread my clinical notes from this course. In nearly every note, I had charted symptoms: voices present, mood low, sleep poor. I had almost never charted what mattered to the person: the man who wanted to pick up his daughter on Fridays, the woman who missed her choir. When I did write those things, they were in the social history, not in the assessment.

What a Classmate Added

A classmate who works on an outpatient team said that the people she sees for years rarely talk about symptoms first; they talk about work, housing and relationships, and symptoms come up as things that get in the way. She said the outpatient notes on her team start with the person's goals and work backward to what the treatment is for. That gave me a model for what my own notes could look like, and showed me that the frameworks we discussed are already used in practice, not only in textbooks.

Why I Held the Old Belief

I held it because I had only seen people during crises, and because the language of acute care, symptom scores and discharge criteria, measures what is wrong. That vocabulary has its uses, yet it leaves out most of a life.

One Habit for the Next Course

In every mental health assessment I write, I will add one line in the person's words about what they want their life to look like, and one strength they bring. I will chart it in the assessment, not only in the history, and at midterm of my next course I will count how many of my notes include that line.

Open Questions

I cannot yet say how personal recovery should be weighed when a person in crisis says she is fine. I also want to understand how teams balance a person's own definition of recovery with the clinical picture when the two disagree, as they sometimes must.

References

Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier.

Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445-452. https://doi.org/10.1192/bjp.bp.110.083733

Substance Abuse and Mental Health Services Administration. (2012). SAMHSA's working definition of recovery (Publication No. PEP12-RECDEF). Substance Abuse and Mental Health Services Administration.