Key Aspects of Recovery-Oriented Practice in Caring for People With Mental Ill-Health in General Emergency Departments: A Modified Delphi Study

AIM

To identify key aspects of recovery-oriented practice in caring for people with mental ill-health in general emergency departments.

DESIGN

A modified Delphi study with three rounds.

METHODS

A 24-member expert panel was recruited consisting of people with lived experience of mental ill-health, registered nurses working in emergency care, registered nurses specialised in psychiatric and mental health nursing and mental health recovery researchers. In the initial round, important aspects of recovery-oriented practice were identified through focus group interviews. Thematic analysis generated statements that were then reformulated as a questionnaire for subsequent rounds. The experts rated each statement's perceived importance on a 5-point Likert scale. The consensus level was set at ≥ 80%. Descriptive statistics were used to analyse the data.

RESULTS

Consensus was reached on the importance of 39 of 73 statements, with ≥ 80% deemed 'very important' in recovery-oriented practice in general emergency departments.

CONCLUSION

The study emphasises the delicate balance between the essential elements of recovery-oriented practice, their practical feasibility and the predominant biomedical perspective in general emergency department care. It proposes strategies to empower nursing staff and managers to adopt recovery-oriented practices that enhance the quality of care for people with mental ill-health. Enabling staff by providing the necessary prerequisites and a care environment that supports reflective practices is crucial. The responsibility for facilitating these changes needs to be a shared commitment between nursing staff and managers.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The identified issues can serve as a framework for interventions, education and training to support the integration of recovery-oriented practice in general emergency care. They can also be used to develop tools for evaluating emergency care environments and promoting alignment with recovery-oriented principles.

IMPACT

Problem addressed: People with mental ill-health are at risk of being neglected, judged and dismissed in general emergency department care, creating obstacles to their mental health recovery.

MAIN RESULTS

The Delphi study identified 39 key aspects of recovery-oriented practice in general emergency departments, emphasising person-centred, strength-based, collaborative and reflective care.

IMPACT

The research seeks to establish a foundation for developing training programmes, education and interventions and for the integration of recovery-oriented practices in general emergency care. It thus has the potential to enhance the quality and equality of care for patients with mental ill-health in emergency care. The impact extends to nursing staff and managers as it seeks to empower them to systematically reflect on and reevaluate established emergency department practices to ensure that every person, irrespective of their health condition, is treated with dignity and respect in emergency department settings.

REPORTING METHOD

The CREDES guidance on conducting and reporting Delphi studies.

PATIENT OR PUBLIC CONTRIBUTION

The authors have nothing to report.

Nursing students' metaphors of first clinical experiences of encountering patients with mental disorders

BACKGROUND

Psychiatric wards are one of the most stressful medical centers. Apprenticeship in mental health can cause feelings of stress and anxiety among nursing students. Investigating nursing students' beliefs about mental illnesses is very important to improve nursing education. The present study aimed to identify nursing students' metaphors for their first clinical experiences of encountering patients with mental disorders.

METHODS

This descriptive qualitative study was conducted on 18 undergraduate nursing students studying in two nursing colleges at Guilan University of Medical Sciences, in the north of Iran, in 2022. The data were collected through semi-structured interviews and analyzed using Critical Metaphor Analysis by the MAXQDA 2007 software.

RESULTS

The analysis of nursing students' metaphors led to the emergence of 36 metaphors and 5 categories. These categories were "experience of dealing with a mental patient is similar to fear mixed with excitement", " patient is similar to an errant human", " psychiatric hospital is similar to a prison", "nurse is similar to a prison guard", and "clinical instructor is similar to a supporter, sympathetic and knowledgeable friend".

CONCLUSIONS

The results showed their negative attitude towards the psychiatric hospital and health care providers. It is suggested that the findings of this study be taken into consideration in the planning of clinical education of nursing students.

Novice nurses' experiences in provision of mental ill health care within a regional emergency department: A descriptive qualitative study

Emergency departments are often the first point of contact for individuals presenting to healthcare services for assistance and treatment for mental ill health. Emergency departments, particularly those in regional areas, can experience high staff turnover and rely on novice nurses for workforce sustainability. The aim of this paper is to explore the experiences of novice nurses (nurses with <3 years of experience) in providing care to individuals presenting with mental ill health in the emergency department. Semi-structured interviews were conducted with novice nurses (N = 13) in a regional emergency department, using qualitative description as the guiding framework. The following three main themes were identified: (i) confidence in providing quality and safe nursing care, (ii) perceived barriers to providing quality and safe nursing care, and (iii) factors that increase confidence. Our findings indicate that proving safe and appropriate nursing care is affected in novice nurses by factors that lead to a perceived lack of confidence, such as how individuals present to the emergency department (e.g. intoxicated or violent), an inability to conduct conversations to assess accurately and perceived shortfalls in the emergency department environment itself. Future research should examine the curriculum for relevance of undergraduate education regarding acute mental health presentations and develop training strategies that enhance communication with individuals who present to the emergency department with mental ill health.

Meeting the Needs of Older Adults with Mental Ill-Health in Non-Psychiatric Care Settings: Self-Rated Confidence in Helping and its Co-Variates within a Multiprofessional Study Sample

In this paper we sought to explore health and social care professionals' self-rated confidence in helping older adults with mental ill-health in non-psychiatric care settings. A cross-sectional survey study was performed exploring the participants' (n = 480) confidence in helping. Confidence in helping was analyzed together with background characteristics and selected explanatory variables, such as the workplace and work experience of the participants, their personal experiences of and attitudes to mental ill-health, as well as their knowledge in mental ill-health among older adults, by means of descriptive statistics and logistic regression analysis. We found that approximately half (55%) of the participants were confident in helping older adults with mental ill-health. The odds ratios for being confident in helping were significantly associated to the workplace of the professionals, professionals' attitude to and experience of mental ill-health, and knowledge of mental health among older adults. To increase confidence in helping older adults with mental ill-health, we recommend confidence-building interventions, for example, educational programs, through which knowledge of mental health among older adults is increased and negative attitudes are challenged, especially within the context of specialist somatic healthcare.

Nursing Staff's Experiences of Caring for People with Mental Ill-Health in General Emergency Departments: A Qualitative Descriptive Study

While people with mental ill-health report unsatisfying experiences and poor treatment in general emergency departments, nursing staff report a lack of adequate knowledge and training. This study describes nursing staff's experiences caring for people with mental ill-health in general emergency departments. A qualitative descriptive design was used and 14 interviews were subjected to qualitative content analysis. Results show that nursing staff are dealing with uncertainty and competing priorities when caring for people with mental ill-health. Nursing staff must both take and be given the opportunity to maintain and develop confidence and independence and need support in promoting mental health recovery.

Nurses' experiences of encountering patients with mental illness in prehospital emergency care - a qualitative interview study

BACKGROUND

Nurses working in prehospital emergency care (PEC) encounter patients with all types of health conditions. Increasingly, they are encountering patients suffering from mental illness and this trend reflects the worldwide increase in mental illness. There is very little current knowledge of encounters between nurses and patients with mental illness in 'PEC', especially from the nurses' perspectives.

AIM

The aim of the study is to investigate nurses' experiences of encountering patients with mental illness in 'PEC'.

METHODS

The participants were recruited in a region in southeast Sweden (that covers approximately 5600 km2 and has 300,000 inhabitants). In total, 17 nurses consented to participate. The participants were asked to narrate their individual experience of encountering patients with mental illness. The interviews were transcribed verbatim, then analysed with qualitative content analysis.

RESULTS

The result is presented in terms of three themes and eight sub-themes. The main themes are 'Lacking trust in the patient and one's own abilities', 'Being under internal and external influences' and 'Moving towards a genuine nurse-patient relationship'.

CONCLUSION

The results show that nurses strive to lay the foundation for a trusting relationship. Simultaneously nurses encountering is characterized by a mistrust and it is influenced by pre-understanding and emotions when they take care for patients. The findings could be used to develop nurses' readiness and capability to encounter patients with mental illness and to respond appropriately to the patients somatic and mental care needs.

Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey

Ambulance nurses in prehospital emergency care must assess, treat, and triage patients with mental health issues. This study aimed to investigate the self-perceived competence of ambulance nurses in prehospital emergency care of patients with mental illness. A cross-sectional questionnaire survey was done, a question-index value (Q-IV; range: 0–1.0) was defined as a summary of the proportion of positive responses (%). Correlations of self-perceived competence with education and professional experience were also examined. Overall self-perceived competence was good (mean Q-IV, 0.80). For six of the nine questions, women rated their abilities slightly lower than men. Women rated themselves as fairly good in providing “information about types of effective help available” (Q-IV, 0.55) and in “suggesting tactics for helping a person with mental illness feel better” (Q-IV, 0.56). Men rated their competence as fairly good in “directing patients to appropriate sources of help” (Q-IV, 0.58). Self-perceived competence did not correlate with education level or professional experience. In conclusion, these results indicate that in encounters with patients who have mental illness, ambulance nurses perceive their overall competencies as good, with some sex-based differences in self-perception for specific knowledge areas. Education level and professional experience did not correlate with self-perceived competence.

'Acknowledge me as a capable person': How people with mental ill health describe their experiences with general emergency care staff - A qualitative interview study

People with mental ill health attend general emergency care more often than others for physical and psychiatric care needs. Staff in general emergency care report they lack knowledge and strategies to meet with and care for people with mental ill health. This study aimed to describe how people with mental ill health experience encounters with staff in general emergency care. We conducted individual semi-structured interviews with 11 people with mental ill health about their experiences in general emergency care and subjected the interview data to qualitative content analysis. Our results show the importance to people with mental ill health of being acknowledged as capable persons, and how this relates to their experiences of being recognized, ignored, or dismissed by staff in general emergency care. Even small, ordinary aspects of staff/patient interactions can have major impacts on a person's recovery and well-being. The study is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines.