Year

2015

Degree Name

Doctor of Philosophy

Department

School of Nursing

Abstract

Mental health reforms have changed the Australian health care landscape, altering the location of mental health services and impacting their accessibility. A consequence of the restructuring is that people who are experiencing a mental health crisis often access mental health care through the Emergency Departments of general hospitals. Registered Nurses, many with no formal mental health training, often care for consumers as part of their daily practice. The Emergency Department is now an integral link to both mental health inpatient and community services and has a significant role in supporting the optimal transition of consumers between services.

Recovery underpins contemporary mental health care in Australia, and a recovery oriented approach has been formally adopted into policy within national, state and territory governments and is firmly embedded in mental health services. However, in the healthcare sector there exists disparity in the meaning of recovery. Within the Emergency Department environment the dominant and generally accepted medical meaning of recovery encompasses a return to normal function and cessation of symptoms. This notion is very different to recovery as it is understood by people with lived-experience of mental illness, which acknowledges the deeply personal and individual journey of engaging in a meaningful life, while facing the challenges that may occur when living with a mental illness.

Recovery means different things to different people depending on the lens through which it is viewed. This research aimed to understand how Registered Nurses working in the Emergency Department conceptualise recovery for people who are experiencing mental illness.

This study used a phenomenographic approach and utilised individual in-depth interviews with fourteen participants. The iterative analysis of the data resulted in the elucidation of six discrete categories of description representing the critical variation that exists in the participants’ collective understanding of the phenomenon of recovery. The categories of description that were identified for Emergency Department Registered Nurses’ conceptions of recovery were - recovery not occurring; seeking help from the Emergency Department; getting through the acute mental health crisis; referral to other areas of mental health care; implementing strategies for ongoing care, and living in the community. The categories of description are presented as a phenomenographic outcome space that expresses the logical relations existing between conceptions. This structure maps this relationship within three hierarchical levels, as conceptualisations of recovery progress through levels of increasing complexity and understanding.

Research findings conclude that Emergency Department Registered Nurses have limited cognisance of the meaning of recovery for people with a mental illness, and their conceptualisation of recovery predominantly remains bound to the dominant medical notion of recovery. This research adds to the body of knowledge, as this is the first study to identify and describe Registered Nurses’ conceptualisations of recovery as it applies to people who are experiencing mental illness within the Emergency Department.

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