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Brousseau-Paradis C, Genest C, Maltais N, Séguin M, Rassy J. Emergency department care experience of suicidal patients: A qualitative analysis of patients' perspectives. Int Emerg Nurs 2024; 74:101449. [PMID: 38669791 DOI: 10.1016/j.ienj.2024.101449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Individuals experiencing suicidal ideation or behavior frequently seek assistance at the emergency department (ED), yet the care they receive does not consistently align with their needs. This study explores the ED care experience of suicidal patients from their own perspective and offers recommendations to improve ED care for this population. METHOD This qualitative study uses a descriptive interpretative design. Semi-structured interviews were conducted with 7 individuals who sought care in an ED due to suicidal ideation or behavior. Transcripts were analyzed using thematic analysis. FINDINGS Participants' experiences were marked by an unsuited physical environment described as uncomfortable, noisy, and depressing. The organization of care was perceived as inadequate as patients complained about limited front-line access to mental health expertise, long waiting times, overworked staff, and inequities between patients with physical injuries and those with mental health concerns. Participants reported feelings of being trapped, left on their own and mistreated during their ED stay. Most found their care experience unhelpful or distressing, leaving them reluctant to reconsult. Specific recommendations based on patients' testimonials and literature are provided to enhance the ED care experience of suicidal patients. CONCLUSION This study highlights several areas for improvement of the ED care experience of suicidal patients. Changes in current practices are needed to offer suicidal patients the satisfying care experience they deserve.
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Affiliation(s)
- Camille Brousseau-Paradis
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, 2900 boul. Édouard-Montpetit, bureau S-750, H3T 1J4 Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada.
| | - Christine Genest
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, Trauma Study Center, Montreal, QC, Canada; Center for Research and Intervention on Suicide, Ethical Issues and End-of- Life Practices, Montreal, QC, Canada.
| | - Nathalie Maltais
- Department of Health Sciences, University of Quebec at Rimouski, Rimouski, QC, Canada; Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada.
| | - Monique Séguin
- Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - Jessica Rassy
- Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, Montreal, QC, Canada; School of Nursing, University of Sherbrooke, Longueuil, QC, Canada.
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2
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Anstee L, Richards S, Shah C, Magon R, Zia A. Characteristics and outcomes of people in suicidal crisis at two emergency departments: a service evaluation. Emerg Nurse 2024:e2204. [PMID: 38742289 DOI: 10.7748/en.2024.e2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
Emergency departments (EDs) provide critical opportunities for nurses to support suicide prevention. This article details a service evaluation that was undertaken to explore the characteristics and outcomes of people in suicidal crisis at two EDs in the East of England during June 2023. Data routinely collected by the ED mental health liaison team were combined with a retrospective case note review of the local NHS mental health trust's electronic patient records. Attendees had a mean age of 35 years and seven months, and were often diagnosed with depression or emotionally unstable personality disorder. Most had a history of self-harm and were currently known to mental health services. Suicide-specific interventions were rarely recorded by nurses and relapse behaviours were prevalent after presentation. Local and national suicide prevention strategies should encourage nurses to address gaps in support, thereby improving patients' experiences in and beyond the ED.
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Affiliation(s)
- Lottie Anstee
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, England
| | - Sabrina Richards
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, England
| | - Chetan Shah
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, England
| | - Rakesh Magon
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, England
| | - Asif Zia
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, England
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3
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McCullough MH, Small M, Jayawardena B, Hood S. Mapping clinical interactions in an Australian tertiary hospital emergency department for patients presenting with risk of suicide or self-harm: Network modeling from observational data. PLoS Med 2024; 21:e1004241. [PMID: 38215082 PMCID: PMC10786386 DOI: 10.1371/journal.pmed.1004241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Reliable assessment of suicide and self-harm risk in emergency medicine is critical for effective intervention and treatment of patients affected by mental health disorders. Teams of clinicians face the challenge of rapidly integrating medical history, wide-ranging psychosocial factors, and real-time patient observations to inform diagnosis, treatment, and referral decisions. Patient outcomes therefore depend on the reliable flow of information through networks of clinical staff and information systems. This study aimed to develop a quantitative data-driven research framework for the analysis of information flow in emergency healthcare settings to evaluate clinical practice and operational models for emergency psychiatric care. METHODS AND FINDINGS We deployed 2 observers in a tertiary hospital emergency department during 2018 for a total of 118.5 h to record clinical interactions along patient trajectories for presentations with risk of self-harm or suicide (n = 272 interactions for n = 43 patient trajectories). The study population was reflective of a naturalistic sample of patients presenting to a tertiary emergency department in a metropolitan Australian city. Using the observational data, we constructed a clinical interaction network to model the flow of clinical information at a systems level. Community detection via modularity maximization revealed communities in the network closely aligned with the underlying clinical team structure. The Psychiatric Liaison Nurse (PLN) was identified as the most important agent in the network as quantified by node degree, closeness centrality, and betweenness centrality. Betweenness centrality of the PLN was significantly higher than expected by chance (>95th percentile compared with randomly shuffled networks) and removing the PLN from the network reduced both the global efficiency of the model and the closeness centrality of all doctors. This indicated a potential vulnerability in the system that could negatively impact patient care if the function of the PLN was compromised. We developed an algorithmic strategy to mitigate this risk by targeted strengthening of links between clinical teams using greedy cumulative addition of network edges in the model. Finally, we identified specific interactions along patient trajectories which were most likely to precipitate a psychiatric referral using a machine learning model trained on features from dynamically constructed clinical interaction networks. The main limitation of this study is the use of nonclinical information only (i.e., modeling is based on timing of interactions and agents involved, but not the content or quantity of information transferred during interactions). CONCLUSIONS This study demonstrates a data-driven research framework, new to the best of our knowledge, to assess and reinforce important information pathways that guide clinical decision processes and provide complementary insights for improving clinical practice and operational models in emergency medicine for patients at risk of suicide or self-harm. Our findings suggest that PLNs can play a crucial role in clinical communication, but overreliance on PLNs may pose risks to reliable information flow. Operational models that utilize PLNs may be made more robust to these risks by improving interdisciplinary communication between doctors. Our research framework could also be applied more broadly to investigate service delivery in different healthcare settings or for other medical specialties, patient groups, or demographics.
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Affiliation(s)
- Michael H. McCullough
- School of Computing, The Australian National University, Acton, ACT, Australia
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, The Australian National University, Acton, ACT, Australia
| | - Michael Small
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, WA, Australia
- Mineral Resources, Commonwealth Scientific and Industrial Research Organisation, Kensington, WA, Australia
| | - Binu Jayawardena
- North Metropolitan Health Service, Government of Western Australia, WA, Australia
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Crawley, WA, Australia
| | - Sean Hood
- North Metropolitan Health Service, Government of Western Australia, WA, Australia
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Crawley, WA, Australia
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4
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McIntosh JT, Jacobowitz W. Attitudes of Emergency Nurses toward Clients with Mental Illness: A Descriptive Correlational Study in a Nationwide U.S. Sample. Issues Ment Health Nurs 2024; 45:105-113. [PMID: 38190395 DOI: 10.1080/01612840.2023.2278773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Introduction: Individuals with mental illness often experience stigma from healthcare professionals, including emergency nurses. The purpose of this study was to identify personal and professional attributes of emergency nurses that may be related to their level of stigma toward people with mental illness in the U.S. Methods: Secondary analysis of a cross-sectional study to analyze emergency nurses' characteristics against their perceptions of stigma toward mental illness as measured by the Mental Illness: Clinicians' Attitudes Scale-4 (MICA v4). Data analyses consisted of descriptive statistics; stepwise linear regression; and analysis of the internal consistency of the MICA v4 in the current sample. Results: The mean MICA v4 scores for this sample were 53.4. The linear regression analysis revealed a significant model explaining 23.5% of the variance of MICA v4 scores (F[34] = 6.4, p < 0.001, R2 = 0.235). Many attributes were found to have a strong association with lower stigmatizing attitudes. Discussion: The results of this study indicated high levels of stigma toward individuals with mental illness. Findings from this study can inform nursing education and research, and ultimately improve the health outcomes of individuals with mental illness.
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Affiliation(s)
- Jennifer T McIntosh
- Yale School of Nursing, Orange, Connecticut, USA
- Adelphi University, Garden City, New York, USA
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5
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Stubbs JM, Chong S, Achat HM, Brakoulias V. Sociodemographic characteristics and clinical outcomes for people presenting to emergency departments with mental health diagnoses. Int Emerg Nurs 2023; 71:101372. [PMID: 37852061 DOI: 10.1016/j.ienj.2023.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital emergency departments (EDs) are experiencing a growth in presentations with mental health (MH) diagnoses. AIM Describe and compare sociodemographic characteristics and clinical outcomes for people with MH and non-MH diagnoses. METHODS A retrospective study examined routinely collected data for ED presentations in a health district in western Sydney, Australia from 2016 to 2019. Regression models examined variables according to MH status, overall and by age. RESULTS Individuals with MH diagnoses accounted for 3.4% of 647,787 ED presentations. MH presentations were most commonly female (51.5%), aged 16-39 years (62.5%), arrived after hours (60.3%) and via ambulance (52.8%). MH presentations were more likely to be triaged category 2 (OR = 1.58,95%CI = 1.54-1.63) and not seen on time (OR = 1.20,95%CI = 1.17-1.24). They had higher odds of a longer ED stay (OR = 1.96,95%CI = 1.90-20.1), after which they were less likely to be admitted (OR = 0.56, 95%CI = 0.55-0.58) and more likely to be transferred (OR = 3.81,95%CI = 3.66-3.97) or leave before treatment was completed (OR = 1.83,95%CI = 1.74-1.92). CONCLUSION Characteristics and outcomes for people presenting to ED with a MH diagnosis significantly differ from those without a MH diagnosis. Provision of timely care is a particular concern. Identifying causes for delays within and external to the ED, and implementing targeted strategies to ameliorate them are required to optimise care.
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Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Shanley Chong
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Vlasios Brakoulias
- Mental Health Service, Western Sydney Local Health District, Westmead, NSW, Australia; School of Medicine and Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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6
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Integrating Nurse Practitioner–Led Mental Health Care in Emergency Departments. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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7
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Campbell K, Massey D, Lakeman R. Working with People Presenting with Symptoms of Borderline Personality Disorder: The Attitudes, Knowledge and Confidence of Mental Health Nurses in Crisis Response Roles in Australia. Issues Ment Health Nurs 2022; 43:913-922. [PMID: 35724400 DOI: 10.1080/01612840.2022.2087011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many people diagnosed with or presenting with borderline personality disorder (BPD) attend the emergency department (ED) when in crisis, and are often referred to mental health nurses for further assessment, and to arrange appropriate follow-up (MHNs). Little is known about the knowledge, skills, confidence and competence of MHNs working with this group in these specialist roles. This study sought to describe the attitudes of MHNs working in EDs and crisis services towards people who present with symptoms characteristic of BPD and to explore their knowledge of the diagnostic criteria of BPD. A descriptive survey tool comprised of 23 questions was adapted from a previously used survey with clinicians in a mental health service in Australia. Fifty-four nurses who identified as MHNs and were currently employed in EDs or crisis settings completed the survey online. These MHNs were found to hold positive attitudes towards people with BPD including being optimistic about recovery and treatment. The experience and education of MHNs now employed in EDs may have contributed to positive attitudes and self-reported confidence relative to other nurses. Further research ought to focus on how MHNs assist people with a diagnosis of BPD who present in crisis meet immediate needs and facilitate access to effective ongoing care and treatment.
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Affiliation(s)
- Katrina Campbell
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Australia
| | - Deb Massey
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Australia
| | - Richard Lakeman
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Australia
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8
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Glowacki K, Whyte M, Weinstein J, Marchand K, Barbic D, Scheuermeyer F, Mathias S, Barbic S. Exploring how to enhance care and pathways between the emergency department and integrated youth services for young people with mental health and substance use concerns. BMC Health Serv Res 2022; 22:615. [PMID: 35525965 PMCID: PMC9077976 DOI: 10.1186/s12913-022-07990-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Integrated youth services (IYS) provide multidisciplinary care (including mental, physical, and social) prioritizing the needs of young people and their families. Despite a significant rise in emergency department (ED) visits by young Canadians with mental health and substance use (MHSU) concerns over the last decade, there remains a profound disconnect between EDs and MHSU integrated youth services. The first objective of this study was to better understand the assessment, treatment, and referral of young people (ages 12–24 years) presenting to the ED with MHSU concerns. The second objective was to explore how to improve the transition from the ED to IYS for young people with MHSU concerns. Methods We conducted semi-structured one-on-one video and phone interviews with stakeholders in British Columbia, Canada in the summer of 2020. Snowball sampling was utilized, and participants (n = 26) were reached, including ED physicians (n = 6), social workers (n = 4), nurses (n = 2), an occupational therapist (n = 1); a counselor (n = 1); staff/leadership in IYS organizations (n = 4); mental health/family workers (n = 3); peer support workers (n = 2), and parents (n = 3). A thematic analysis (TA) was conducted using a deductive and inductive approach conceptually guided by the Social Ecological Model. Results We identified three overarching themes, and factors to consider at all levels of the Social Ecological Model. At the interpersonal level inadequate communication between ED staff and young people affected overall care and contributed to negative experiences. At the organizational level, we identified considerations for assessments and the ED and the hospital (wait times, staffing issues, and the physical space). At the community level, the environment of IYS and other community services were important including wait times and hours of operation. Policy level factors identified include inadequate communication between services (e.g., different charting systems and documentation). Conclusions This study provides insight into important long-term systemic issues and more immediate factors that need to be addressed to improve the delivery of care for young people with MHSU challenges. This research supports intervention development and implementation in the ED for young people with MHSU concerns.
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Affiliation(s)
- Krista Glowacki
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada. .,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Madelyn Whyte
- Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada
| | - Jade Weinstein
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David Barbic
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Y 1Z6, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Y 1Z6, Canada
| | - Steve Mathias
- Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Sacre M, Albert R, Hoe J. What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review. Int J Ment Health Nurs 2022; 31:400-423. [PMID: 34941023 DOI: 10.1111/inm.12968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
Historically, dualistic healthcare systems have resulted in limited mental healthcare provision within physical health settings, with service users reporting poor care specifically while attending emergency departments (EDs) in a mental health crisis. Modern approaches to healthcare recognize these inequalities and are moving towards integrating healthcare systems that allow more holistic and seamless experiences for service users. This mixed-method review examines the experiences and perceptions of service users attending EDs for a mental health crisis. Systematic searches of eight databases on two platforms (EBSCO, OVID) and grey literature databases (Open Grey, Base) were conducted. Studies were systematically screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. Ten studies consisting of qualitative and mixed-method designs were included in the review. Five overarching themes emerged from the synthesis: social constructs, service provider, service provision, effectiveness, and emotional impact. The findings from this review show that service users continue to have negative experiences in EDs due to stigmatizing attitudes and low skill in managing mental health needs, whereas more positive experiences are attributed to the availability of mental health liaison services. Tackling stigma, improving communication and staff training, providing calm environments, and addressing structural issues that promote better interagency working and reduce gaps in services are needed to improve mental health service user experience. Future research should focus on trauma-informed approaches in EDs to improve person-centred care for service users experiencing a mental health crisis.
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Affiliation(s)
- Maya Sacre
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
| | - Rikke Albert
- Tower Hamlets Mental Health Liaison and Psychological Medicine, Royal London Hospital, London, UK
| | - Juanita Hoe
- Division of Nursing, School of Health Sciences, City, University of London, London, UK
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10
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Østervang C, Geisler Johansen L, Friis-Brixen A, Myhre Jensen C. Experiences of nursing care for patients who self-harm and suggestions for future practices: The perspectives of emergency care nurses. Int J Ment Health Nurs 2022; 31:70-82. [PMID: 34506045 DOI: 10.1111/inm.12933] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Self-harm is a major challenge in healthcare systems. Emergency department nurses provide care to numerous patients with self-harm injuries. Accordingly, nurse-patient interactions are vital to improve the physical and psychological outcomes of this complex patient group. Previous studies have proposed the establishment of improved teaching programs to increase the competence of emergency department nurses within mental health care; however, few studies have comprehensively investigated the experiences and suggestions for future nursing practices. Therefore, we gathered in-depth knowledge of Danish emergency department nurses' experiences caring for patients who self-harm and obtained their suggestions on future nursing practices. Ten semi-structured interviews were conducted to capture the nurses' individual perspectives. The scientific theory is based on phenomenology and hermeneutics. Interpretative phenomenological analysis was used, and three themes were identified: (i) importance of having the competences to establish a relationship in the acute phase; (ii) acute care from a biomedical perspective; and (iii) highlighting ideas for improved future practices. The emergency department nurses were aware of the importance of mental health care but found their competence and motivation situated in medical care. The nurses felt that they lacked skills to undertake in-depth mental care for patients who self-harm and that the healthcare system failed to help this group of patients. Based on these findings, rather than aiming at improving nursing skills, we suggest a close collaboration between the emergency and psychiatric departments to improve the quality of care for patients who self-harm. We also recommend organizational changes within the emergency department, such as the introduction of a so-called 'social track'.
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Affiliation(s)
- Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laerke Geisler Johansen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | - Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopedics Surgery and Traumatology, University of Southern Denmark, Odense, Denmark
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11
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Pawaskar R, Mahajan N, Wangoo E, Khan W, Bailey J, Vines R. Staff perceptions of the management of mental health presentations to the emergency department of a rural Australian hospital: qualitative study. BMC Health Serv Res 2022; 22:87. [PMID: 35042496 PMCID: PMC8764646 DOI: 10.1186/s12913-022-07476-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Current research demonstrates higher prevalence of mental health related emergency department (ED) presentations in rural areas, despite similar overall prevalence of these conditions in rural and metropolitan contexts. This stems from shortages in availability of specialised mental health professionals, greater stigma against mental illness, greater socioeconomic disadvantages, and access to means of self-harm in rural regions. Little is known, however, about the specific characteristics of mental health presentations to rural emergency departments (EDs) in Australia. Additionally, studies have shown that ED staff feel uncomfortable managing mental health presentations to ED due to factors such as lack of confidence and stigma against mental illnesses. Aim This qualitative study sought to examine ED staff perceptions regarding the management of mental health presentations in a rural Australian ED. Methods A qualitative study design was used, incorporating semi-structured interviews of current ED staff. Ten interviews were conducted in person or over the phone by two researchers and thematically analysed to draw out key themes from the data. Results Staff perceived deficiencies in availability of mental health expertise, de-escalation, and referral pathways as major barriers to effective patient management. These factors contributed to increased retention of mental health patients in ED due to uncertainties regarding their definitive care. Despite acknowledging the value of practical experience with mental health presentations as the best way of increasing clinician confidence, staff expressed a desire for more face-to-face training to better equip them to respond to mental health presentations. Conclusion A combination of departmental and hospital-wide issues in conjunction with individual staff attitudes regarding mental health conditions contributes to issues in mental health patient care in this ED. In particular, limited training in mental health and resources available to ED staff affects confidence in managing mental health presentations and contributes to prolonged time to definitive treatment.
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12
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Guthrie E, Romeu D, Czoski-Murray C, Relton S, Walker A, Trigwell P, Hewison J, West R, Fossey M, Hulme C, House A. Experiences of people seen in an acute hospital setting by a liaison mental health service: responses from an online survey. BMC Health Serv Res 2021; 21:1050. [PMID: 34610845 PMCID: PMC8493711 DOI: 10.1186/s12913-021-06974-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background In recent years the UK has expanded the provision of liaison mental health services (LMHS). Little work has been undertaken to explore first-hand experiences of them. Aims The aim of this study was to gain insights into the experiences of users of LMHS in both emergency departments and acute inpatient wards in the UK. Methods This cross-sectional internet survey was initially advertised from May-July 2017 using the social media platform Facebook. Due to a paucity of male respondents, it was re-run from November 2017-February 2018, specifically targeting male respondents. The survey featured a structured questionnaire divided into three categories: the profile of the respondent, perceived professionalism of LMHS and overall opinion of the service. Analysis Responses to the structured questionnaire were analysed using descriptive statistics and latent class analysis. Free-text responses were transcribed verbatim and interpreted using thematic analysis. Results 184 people responded to the survey. 147 were service users and 37 were partners, friends or family members of service users. Only 31% of service users and 27% of close others found their overall contact helpful. Latent class analysis identified three clusters − 46% of service users generally disliked their contact, 36% had an overall positive experience, and 18% did not answer most questions about helpfulness or usefulness. Features most frequently identified as important were the provision of a 24/7 service, assessment by a variety of healthcare professionals and national standardisation of services. Respondents indicated that the least important feature was the provision of a separate service for older people. They desired faster assessments following referral from the parent team, clearer communication about next steps and greater knowledge of local services and third sector organisations. Conclusions This survey identified mixed responses, but overall experiences were more negative than indicated in the limited previous research. The evaluation and adaptation of LMHS along the lines suggested in our survey should be prioritised to enhance their inherent therapeutic value and to improve engagement with treatment and future psychiatric care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06974-4.
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Affiliation(s)
- Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Daniel Romeu
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK. .,Leeds and York Partnership NHS Foundation Trust, Leeds, UK.
| | | | - Samuel Relton
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew Walker
- Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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13
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Wand T, Collett G, Keep J, Cutten A, Stack A, White K. Mental Health Nurses' Experiences of Working in the Emergency Department of Two Rural Australian Settings. Issues Ment Health Nurs 2021; 42:893-898. [PMID: 33979236 DOI: 10.1080/01612840.2021.1913773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Providing effective mental health care in Emergency Departments (ED) is a fundamental expectation, as EDs increasingly become the first point of contact with health services for people in mental distress. As part of a larger multi-site translational research project this study explored the experiences, perspectives and recommendations of mental health liaison nurses (MHLN) employed in the EDs of two rural hospitals in New South Wales, Australia. Participants identified numerous benefits associated with embedding the MHLNs within the ED team. Some challenges associated with changing thinking and practice were recognised and recommendations for improving ED mental health care provided.
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Affiliation(s)
- Timothy Wand
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Emergency Department, Royal Prince Alfred Hospital Sydney Local Health District, NSW, Australia
| | - Gemma Collett
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Joel Keep
- Illawarra Shoalhaven Mental Health Service, NSW, Australia
| | - Alexa Cutten
- Hunter New England Local Health District, NSW, Australia
| | - Amanda Stack
- Western NSW Local Health District, NSW, Australia
| | - Kathryn White
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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14
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Wand T, Collett G, Cutten A, Buchanan-Hagen S, Stack A, White K. Patient and staff experience with a new model of emergency department based mental health nursing care implemented in two rural settings. Int Emerg Nurs 2021; 57:101013. [PMID: 34134083 DOI: 10.1016/j.ienj.2021.101013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As part of a larger multi-site translational research project this study explored patient and staff experiences, perspectives and recommendations in relation to a mental health liaison nursing (MHLN) service implemented in the emergency department (ED) of two rural hospitals in New South Wales, Australia. METHODS Semi-structured interviews were conducted across the two sites with a sample of ED patients (n = 32), ED nurses (n = 14), ED medical officers (n = 11) and psychiatrists (n = 3). Data were analysed thematically. FINDINGS Patients highlighted the therapeutic benefits of the MHLNs, particularly being listened to and understood. Patients appreciated being seen promptly and having effective follow-up. Some negative experiences were encountered. Staff recognized that embedding the new model of care in the ED impacted positively on ED culture and practice. A nurse practitioner position as clinical lead instituted at one site made the most substantial contribution to integrating mental health care within the ED. Room for improvement was also noted. CONCLUSIONS Findings from this study indicate that an ED-based model of MHLN care developed in a metropolitan setting was successfully translated to two rural EDs. While translating a model of care from one context to another is not without its challenges, adherence to the key principles of this model of MHLN care was associated with the most positive outcome.
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Affiliation(s)
- Timothy Wand
- University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Gemma Collett
- Translational Research Manager, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Alexa Cutten
- Translational Research Manager, Hunter New England Local Health District, Australia.
| | - Sally Buchanan-Hagen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Amanda Stack
- Translational Research Manager, Western NSW Local Health District, Australia.
| | - Kathryn White
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia.
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