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

Abstract

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.

Keywords: Delphi study; Delphi technique; emergency department; emergency nursing; mental health recovery; mental illness; mental ill‐health; recovery‐oriented practice.