Umeå University's logo

Background: Negative experiences and inadequate treatment can impact the well-being and mental health recovery of people with mental ill-health seeking general emergency care. In addition to people with mental ill-health reporting that their physical and mental health needs are not being met in this context, nursing staff in general emergency departments (EDs) describe a lack of knowledge and training regarding mental ill-health. While person-centred, recovery-oriented practices are advocated for in mental health care, their practical application in general emergency care remains unexplored, highlighting the need for research in this area.

Aim: The overarching aim of this thesis is to generate knowledge on how nursing staff in general emergency care can support mental health recovery, with a focus on recovery-oriented practices.

Methods: Studies I and II employed a qualitative design aimed at describing the experiences of people with mental ill-health in general emergency care (I) and the nursing staff caring for them in general EDs (II). In both studies, individual semi-structured interviews were conducted and analysed using qualitative content analysis. The participants included 11 people with experiences of mental ill-health (I) and 14 nursing staff working in general EDs (II). Study III employed a modified Delphi technique to systematically gather explicit and implicit knowledge from a 24-member expert panel, with the goal of reaching group consensus on key aspects of recovery-oriented practices in general ED care. The expert panel included people with lived experience of mental ill-health, registered nurses (RNs) working in emergency care, RNs specialized in psychiatric and mental health nursing and mental health recovery researchers.

Findings: The findings from these studies (I, II, III) suggest three values as central to guiding nursing staff in supporting mental health recovery through recovery-oriented practices in general emergency care. First, the recognition of patients’ experiences and self-knowledge is vital. For ED nursing staff, this recognition involves actively listening to and acknowledging patients with mental ill-health as capable persons with valuable insights and perspectives regarding their own health issues and situations. It also requires ED nursing staff to reflect on their own biases, knowledge gaps, and attitudes towards mental ill-health, as these factors may affect their engagement with patients. Second, kindness, manifested through small caring actions, can influence the interactions between ED nursing staff and patients with mental ill-health, making a difference in both the short and long term. For ED nursing staff, such kindness involves recognising and reflecting on the importance of seemingly ‘simple’ personal interactions alongside technical care, where these interactions can often be perceived as challenging and are underestimated. Third, knowledge-sharing which emphasises the recognition and integration of the ED nursing staff’s experience-based and practical knowledge, alongside the opportunities to learn from patient encounters. Such knowledge-sharing requires a culture of collaboration and support within the ED, with dedicated time and resources for sharing experiences and insights through reflection.

Conclusion: By prioritizing recognition, kindness, and knowledge-sharing, ED nursing staff can support the mental health recovery of people with mental ill-health through recovery-oriented practices. Such practices can not only promote epistemic justice but also highlight the importance of a deeper understanding of kindness, manifested through small caring actions, and underscore the need for reflective practice. In conclusion, this thesis demonstrates that discussing mental health recovery is meaningful within the context of general emergency care.