The Recovery Model

1. A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed?
1. “The goal of recovery is improved health and wellness.”
2. “The goal of recovery is expedient, comprehensive behavioral change.”
3. “The goal of recovery is the ability to live a self-directed life.”
4. “The goal of recovery is the ability to reach full potential.”

ANS: 2
Rationale: The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental health disorders and substance use disorders as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Change in recovery is not an expedient process. It occurs incrementally over time.

Cognitive Level: Application
Integrated Process: Evaluation

2. Which situation presents an example of the basic concept of a recovery model?
1. The client’s family is encouraged to make decisions in order to facilitate discharge.
2. A social worker, discovering the client’s income, changes the client’s discharge placement.
3. A psychiatrist prescribes an antipsychotic drug based on observed symptoms.
4. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.

ANS: 4
Rationale: The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care.

Cognitive Level: Analysis
Integrated Process: Evaluation

3. A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed?
1. “Recovery occurs via many pathways.”
2. “Recovery emerges from strong religious affiliations.”
3. “Recovery is supported by peers and allies.”
4. “Recovery is culturally based and influenced.”

ANS: 2
Rationale: SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope, recovery is person-driven, recovery occurs via many pathways, recovery is holistic, recovery is supported by peers and allies, recovery is supported through relationship and social networks, recovery is culturally based and influenced, recovery is supported by addressing trauma, recovery involves individual, family, and community strengths and responsibility, recovery is based on respect. Recovery emerges from hope but affiliation with any particular religion would have little bearing on the recovery process.

Cognitive Level: Application
Integrated Process: Evaluation

4. A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the SAMHSA, which dimension of recovery is supporting this client?
1. Health
2. Home
3. Purpose
4. Community

ANS: 2
Rationale: SAMHSA describes the dimension of Home as a stable and safe place to live.

Cognitive Level: Application
Integrated Process: Assessment

5. A client diagnosed with obsessive-compulsive disorder states, “I really think my future will improve because of my successful treatment choices. I’m going to make my life better.” Which guiding principle of recovery has assisted this client?
1. Recovery emerges from hope.
2. Recovery is person-driven.
3. Recovery occurs via many pathways.
4. Recovery is holistic.

ANS: 1
Rationale: The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope, recovery is person-driven, recovery occurs via many pathways, recovery is holistic, recovery is supported by peers and allies, recovery is supported through relationship and social networks, recovery is culturally based and influenced, recovery is supported by addressing trauma, recovery involves individual, family, and community strengths and responsibility, recovery is based on respect. This client has internalized hope. This hope is the catalyst of the recovery process.

Cognitive Level: Application
Integrated Process: Evaluation

6. A nurse maintains a client’s confidentiality, addressed the client appropriately, and does not discriminate based on gender, age, race, or religion. Which guiding principle of recovery has this nurse employed?
1. Recovery is culturally based and influenced.
2. Recovery is based on respect.
3. Recovery involves individual, family, and community strengths and responsibility.
4. Recovery is person-driven.

ANS: 2
Rationale: The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope, recovery is person-driven, recovery occurs via many pathways, recovery is holistic, recovery is supported by peers and allies, recovery is supported through relationship and social networks, recovery is culturally based and influenced, recovery is supported by addressing trauma, recovery involves individual, family, and community strengths and responsibility, recovery is based on respect. This nurse accepts and appreciates clients who are affected by mental health and substance use problems. This nurse protects the rights of clients and does not discriminate against them.

Cognitive Level: Application
Integrated Process: Implementation

7. A nurse on an inpatient unit helps a client understand the significance of treatments, and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the “Tidal Model of Recovery?”
1. Know that Change Is Constant
2. Reveal Personal Wisdom
3. Be Transparent
4. Give the Gift of Time

ANS: 3
Rationale: Barker & Buchanan-Barker developed a set of essential values termed the The 10 Tidal Commitments upon which the Tidal Model is based. They include: Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. This nurse is employing the Be Transparent commitment.

Cognitive Level: Application
Integrated Process: Implementation

8. Which is the priority focus of recovery models?
1. Empowerment of the health-care team to bring their expertise to decision-making
2. Empowerment of the client to make decisions related to individual health care
3. Empowerment of the family system to provide supportive care
4. Empowerment of the physician to provide appropriate treatments

ANS: 2
Rationale: The basic concept of a recovery model is empowerment of the client. The recovery model is designed to allow clients primary control over decisions about their own care.

Cognitive Level: Analysis
Integrated Process: Assessment

9. A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model should be employed, and what action reflects this step?
1. Step 3: Triggers that cause distress or discomfort are listed.
2. Step 4: Signs indicating relapse are identified and plans for responding are developed.
3. Step 5: A specific plan to help with symptoms is formulated.
4. Step 6: Following client-designed plan, caregivers now become decision-makers.

ANS: 4
Rationale: The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include: Step 1. Develop a Wellness Toolbox; Step 2. Daily Maintenance List; Step 3. Triggers; Step 4. Early Warning Signs; Step 5. Things Are Breaking Down or Getting Worse; Step 6. Crisis Planning. In step 6 (Crisis Planning) clients can no longer care for themselves, make independent decisions, or keep themselves safe. Caregivers take an active role in this step on behalf of the client and implement the plan that the client has previously developed. All other actions presented require the client to be functionally capable.

Cognitive Level: Analysis
Integrated Process: Evaluation

10. A nursing instructor is teaching about components present in the recovery process as described by Andresen and associates that led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed?
1. “A client has a better chance of recovery if he or she truly believes that recovery can occur.”
2. “If a client is willing to give the responsibility of treatment to the health-care team, they are likely to recover.”
3. “A client who has a positive sense of self and a positive identity is likely to recover.”
4. “A client has a better chance of recovery if he or she has purpose and meaning in life.”

ANS: 2
Rationale: In examining a number of studies, Andresen and associates identified four components that were consistently evident in the recovery process. These components are hope, responsibility, self and identity, and meaning and purpose. Under responsibility, this model tasks the client, not the health-care team, with taking responsibility for his or her life and well-being.

Cognitive Level: Analysis
Integrated Process: Evaluation

11. A client states, “My illness is so devastating, I feel like my life is on hold.” The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates?
1. Moratorium
2. Awareness
3. Preparation
4. Rebuilding

ANS: 1
Rationale: Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 1: Moratorium, Stage 2: Awareness, Stage 3: Preparation, Stage 4: Rebuilding, and Stage 5: Growth. The moratorium stage is identified by dark despair and confusion. It is called moratorium, because it seems that “life is on hold.”

Cognitive Level: Analysis
Integrated Process: Evaluation

12. A client states, “I have come to the conclusion that this disease has not paralyzed me.” The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates?
1. Moratorium
2. Awareness
3. Preparation
4. Rebuilding

ANS: 2
Rationale: Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 1: Moratorium, Stage 2: Awareness, Stage 3: Preparation, Stage 4: Rebuilding, and Stage 5: Growth. In the awareness stage, the individual comes to a realization that a possibility for recovery exists. Andresen and associates state, “It involves an awareness of a possible self other than that of ‘sick person’: a self that is capable of recovery.”

Cognitive Level: Analysis
Integrated Process: Evaluation

13. A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to fine when assessing this client?
1. A client feeling confident about achieving goals in life.
2. A client who is aware of the need to set goals in life.
3. A client who has mobilized personal and external resources.
4. A client who begins to actively take control of his or her life.

ANS: 1
Rationale: Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 1: Moratorium, Stage 2: Awareness, Stage 3: Preparation, Stage 4: Rebuilding, and Stage 5: Growth. In the growth stage, the individual feels a sense of optimism and hope of a rewarding future. Skills that have been nurtured in the previous stages are applied with confidence, and the individual strives for higher levels of well-being.

Cognitive Level: Analysis
Integrated Process: Assessment

Multiple Response

14. Which of the following has the SAMHSA described, as major dimensions of support for a life of recovery? (Select all that apply)
1. Health
2. Community
3. Home
4. Religious affiliation
5. Purpose

ANS: 1, 2, 3, 5
Rationale: SAMHSA suggests that a life in recovery is supported by four major dimensions, which include health, home, purpose, and community. Religious affiliation is not included in the listed dimensions.

Cognitive Level: Application
Integrated Process: Assessment

15. A nurse uses the commitments of the Tidal Model of Recovery in psychiatric nursing practice. Which of the following nursing actions reflect the use of the Develop Genuine Curiosity commitment? (Select all that apply.)
1. The nurse expresses interest in the client’s story.
2. The nurse asks for clarification of certain points.
3. The nurse encourages the client to speak his own words in his own unique way.
4. The nurse assists the client to unfold the story at his or her own rate.
5. The nurse provides the clients with copies of all documents relevant to care.

ANS: 1, 2, 4
Rationale: Barker & Buchanan-Barker developed a set of essential values termed the The 10 Tidal Commitments, upon which the Tidal Model is based. They include: Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. This nurse is employing the Develop Genuine Curiosity commitment, by expressing interest, asking for clarification, and assisting the client to unfold the story at his or her own rate.

Cognitive Level: Application
Integrated Process: Implementation

Ordered Response

16. Order the six steps of The Wellness Recovery Action Plan(WRAP) Model as described by Copeland et al.
1. ________ Daily Maintenance List
2. ________ Things Are Breaking Down or Getting Worse
3. ________ Crisis Planning
4. ________ Develop a Wellness Toolbox
5 _________ Early Warning Signs
6._________ Triggers

ANS: The correct order is 2, 5, 6, 1, 4, 3
Rationale: The WRAP model is a step-wise process, through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include: Step 1. Develop a Wellness Toolbox; Step 2. Daily Maintenance List; Step 3. Triggers; Step 4. Early Warning Signs; Step 5. Things Are Breaking Down or Getting Worse; Step 6. Crisis Planning.

Cognitive Level: Analysis
Integrated Process: Assessment

Fill-in-the-Blank

17. _________________________ from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

ANS: Recovery
Rationale: Recovery from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Recovery is the restoration to a former or better state or condition.

Cognitive Level: Application
Integrated Process: Assessment