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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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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Petreca VG, Barros JT, Hoblock C, Burgess AW. The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing. J Adv Nurs 2024. [PMID: 38225816 DOI: 10.1111/jan.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
AIM This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first-line behavioural crisis response. DESIGN This study used a descriptive, qualitative exploratory design and was informed by Systems Theory. METHODS The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co-response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed. REPORTING METHOD The Standards for Reporting Qualitative Research (SRQR) guidelines were used. RESULTS Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de-escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation. CONCLUSION This study proposes the creation of a novel nursing role within first-line multidisciplinary teams (MDTs) for crisis response-the Nurse-Police Assistance Crisis Team (N-PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug-related incidents. IMPLICATIONS Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system. IMPACT The N-PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Gillard S, Anderson K, Clarke G, Crowe C, Goldsmith L, Jarman H, Johnson S, Lomani J, McDaid D, Pariza P, Park AL, Smith J, Turner K, Yoeli H. Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental, qualitative and health economic evaluation. Health Soc Care Deliv Res 2023; 11:1-221. [PMID: 38149657 DOI: 10.3310/pbsm2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background People experiencing mental health crises in the community often present to emergency departments and are admitted to a psychiatric hospital. Because of the demands on emergency department and inpatient care, psychiatric decision units have emerged to provide a more suitable environment for assessment and signposting to appropriate care. Objectives The study aimed to ascertain the structure and activities of psychiatric decision units in England and to provide an evidence base for their effectiveness, costs and benefits, and optimal configuration. Design This was a mixed-methods study comprising survey, systematic review, interrupted time series, synthetic control study, cohort study, qualitative interview study and health economic evaluation, using a critical interpretive synthesis approach. Setting The study took place in four mental health National Health Service trusts with psychiatric decision units, and six acute hospital National Health Service trusts where emergency departments referred to psychiatric decision units in each mental health trust. Participants Participants in the cohort study (n = 2110) were first-time referrals to psychiatric decision units for two 5-month periods from 1 October 2018 and 1 October 2019, respectively. Participants in the qualitative study were first-time referrals to psychiatric decision units recruited within 1 month of discharge (n = 39), members of psychiatric decision unit clinical teams (n = 15) and clinicians referring to psychiatric decision units (n = 19). Outcomes Primary mental health outcome in the interrupted time series and cohort study was informal psychiatric hospital admission, and in the synthetic control any psychiatric hospital admission; primary emergency department outcome in the interrupted time series and synthetic control was mental health attendance at emergency department. Data for the interrupted time series and cohort study were extracted from electronic patient record in mental health and acute trusts; data for the synthetic control study were obtained through NHS Digital from Hospital Episode Statistics admitted patient care for psychiatric admissions and Hospital Episode Statistics Accident and Emergency for emergency department attendances. The health economic evaluation used data from all studies. Relevant databases were searched for controlled or comparison group studies of hospital-based mental health assessments permitting overnight stays of a maximum of 1 week that measured adult acute psychiatric admissions and/or mental health presentations at emergency department. Selection, data extraction and quality rating of studies were double assessed. Narrative synthesis of included studies was undertaken and meta-analyses were performed where sufficient studies reported outcomes. Results Psychiatric decision units have the potential to reduce informal psychiatric admissions, mental health presentations and wait times at emergency department. Cost savings are largely marginal and do not offset the cost of units. First-time referrals to psychiatric decision units use more inpatient and community care and less emergency department-based liaison psychiatry in the months following the first visit. Psychiatric decision units work best when configured to reduce either informal psychiatric admissions (longer length of stay, higher staff-to-patient ratio, use of psychosocial interventions), resulting in improved quality of crisis care or demand on the emergency department (higher capacity, shorter length of stay). To function well, psychiatric decision units should be integrated into the crisis care pathway alongside a range of community-based support. Limitations The availability and quality of data imposed limitations on the reliability of some analyses. Future work Psychiatric decision units should not be commissioned with an expectation of short-term financial return on investment but, if appropriately configured, they can provide better quality of care for people in crisis who would not benefit from acute admission or reduce pressure on emergency department. Study registration The systematic review was registered on the International Prospective Register of Systematic Reviews as CRD42019151043. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/70) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 25. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steve Gillard
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Katie Anderson
- School of Health and Psychological Sciences, City, University of London, London, UK
| | | | - Chloe Crowe
- Adult Acute Mental Health Services, North East London NHS Foundation Trust, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Jo Lomani
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Paris Pariza
- Improvement Analytics Unit, Health Foundation, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Jared Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heather Yoeli
- School of Health and Psychological Sciences, City, University of London, London, UK
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Van de Glind G, Galenkamp N, Bleijenberg N, Schoonhoven L, Scheepers FE, Crilly J, van Veen M, Ham WHW. Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review. BMJ Open 2023; 13:e072604. [PMID: 37918925 PMCID: PMC10626855 DOI: 10.1136/bmjopen-2023-072604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context. METHODS AND ANALYSIS The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results. ETHICS AND DISSEMINATION No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences. PROSPERO REGISTRATION NUMBER CRD42023390664 (https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Geurt Van de Glind
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Niek Galenkamp
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- University Medical Center Utrecht, Utrecht, The Netherlands
- University of Southampton, Southampton, UK
| | | | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark van Veen
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Wietske H W Ham
- Institute of Nursing Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
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García-Carpintero Blas E, Gómez-Moreno C, Moreno-Gomez-Toledano R, Ayuso-Del-Olmo H, Rodrigo-Guijarro E, Polo-Martínez S, Manso Perea C, Vélez-Vélez E. Help! Caring for People With Mental Health Problems in the Emergency Department: A Qualitative Study. J Emerg Nurs 2023; 49:765-775. [PMID: 37269252 PMCID: PMC10237324 DOI: 10.1016/j.jen.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION After coronavirus disease 2019, there has been an increase in patients in the emergency department with mental health conditions. They are usually received by professionals who are not specialized in mental health. This study aimed to describe nursing staff's experiences in the emergency department, in the care they provide to people with mental health problems who often feel stigmatized by society and also in health care settings. METHODS This is a descriptive qualitative study with a phenomenological approach. The participants were nurses from the Spanish Health Service from the emergency department of the Community of Madrid hospitals. Recruitment was performed by convenience sampling snowball sampling until data satruation was met. Data were collected through semistructured interviews conducted during January and February 2022. RESULTS The exhaustive and detailed analysis of the nurses' interviews made it possible to extract 3 main categories-health care, psychiatric patient, and work environment-with 10 subcategories. DISCUSSION The main study findings were the need to train emergency nurses to be prepared to care for people who experience mental health concerns including bias education and the need for implementation of standardized protocols. Emergency nurses never doubted their ability to care for people experiencing mental health disorders. Still, they recognized that they needed specialized professionals' support at certain critical moments.
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Peart T, Kerr D, Searby A. Novice nurses' experiences in provision of mental ill health care within a regional emergency department: A descriptive qualitative study. Int J Ment Health Nurs 2023; 32:458-468. [PMID: 36562518 DOI: 10.1111/inm.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Talitha Peart
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia.,Ballarat Health Services, Ballarat, Victoria, Australia
| | - Debra Kerr
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
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McIntosh JT. Emergency department nurses' perceptions of caring behaviors toward individuals with mental illness: A secondary analysis. Int Emerg Nurs 2023; 68:101271. [PMID: 37003054 DOI: 10.1016/j.ienj.2023.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 04/03/2023]
Abstract
AIM The aim of this study was to determine emergency department (ED) nurses' caring behaviors toward individuals with mental illness; and the influence of stigma on their caring behaviors. METHOD This is a secondary analysis of a cross-sectional study with (n = 813) ED nurses working in the United States from March 2021 to April 2021. The Caring Behaviors Inventory-24 item (CBI-24) and the Mental Illness: Clinicians' Attitudes Scale-4 (MICA v4) were used to collect data. RESULTS The mean CBI-24 score was 4.6 (SD = 0.8).The MICA v4 had an overall sum of 53.4 (SD = 9.2). Caring behaviors and stigma were found to have significant weak inverse relationship (r = - 0.23, p <.001). Age and level of education had a significant inverse relationship with caring behaviors (r = - 0.12; r = -. 19, p <.01 respectively). CONCLUSION The results of this study may contribute to the quality, equity, and safety of the emergency nursing care of individuals with mental illness, thereby improving health outcomes. It is recommended that the diversity of nurses and the characteristics of the ED be taken into consideration when designing trainings, providing leadership support, and managing resources to support the care of individuals with mental illness.
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Affiliation(s)
- Jennifer T McIntosh
- Adelphi University, College of Nursing and Public Health, One South Street, Garden City, NY 11530, USA; Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA.
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Gripko M, Joseph A, MohammadiGorji S. Effects of the physical environment on children and families in hospital-based emergency departments: A systematic literature review. J Environ Psychol 2023; 86:101970. [PMID: 37366532 PMCID: PMC10292152 DOI: 10.1016/j.jenvp.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Every year, millions of children seek care in emergency departments (EDs) for various conditions. Though the physical environment of the ED provides the context and setting for care delivery, influences workflows, and shapes interactions between users, the noisy, sterile, stimulating nature of the ED can be counter-therapeutic to pediatric patients and families. This systematic literature review investigates this complex dynamic and asks how the physical environment of emergency departments affects children and their families or guardians. Using PRISMA methods, this review searched four databases to identify and analyze twenty-one peer-reviewed articles that explored the impacts of the physical environment of hospital-based EDs on children or family members. Several themes emerged from the literature - concerning control, positive distractions, family and social supports, and designing for a safe and comfortable experience - that illustrate opportunities for future ED design and highlight knowledge gaps and avenues for future research.
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Affiliation(s)
- Monica Gripko
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
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Cullen SW, Bowden CF, Olfson M, Marcus SC, Caterino JM, Ross AM, Doupnik SK, True G. "Treat Them Like a Human Being…They are Somebody's Somebody": Providers' Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior. Community Ment Health J 2023; 59:253-265. [PMID: 35931907 PMCID: PMC10373641 DOI: 10.1007/s10597-022-01003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Abstract
To understand ED providers' perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to "What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?" were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully.
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Affiliation(s)
- Sara Wiesel Cullen
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA.
| | - Cadence F Bowden
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Mark Olfson
- New York State Psychiatric Institute and Clinic and the Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA
- Penn Center for Mental Health, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 751 Prior Hall 376 W 10th Ave, Columbus, OH, 43210, USA
| | - Abigail M Ross
- Graduate School of Social Service, Fordham University, 113 W. 60th St, #721-D, New York, NY, 10023, USA
| | - Stephanie K Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA
- Department of Pediatrics, University of Pennsylvania, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Gala True
- Section of Community and Population Medicine, Louisiana State University Health Sciences Center - New Orleans School of Medicine, 533 Bolivar St., New Orleans, LA, 70117, USA
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, 533 Bolivar St, New Orleans, LA, 70117, USA
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McConnell KJ, Watson K, Choo E, Zhu JM. Geographical Variations In Emergency Department Visits For Mental Health Conditions For Medicaid Beneficiaries. Health Aff (Millwood) 2023; 42:172-181. [PMID: 36745838 DOI: 10.1377/hlthaff.2022.00796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite Medicaid's importance as a payer and source of coverage for mental health care, relatively little is known about how prevalence, access, and quality might vary among Medicaid beneficiaries. This study used national Medicaid data from 2018 to assess regional variations in emergency department (ED) visits for mental health conditions, a measure that may reflect unmet needs for behavioral health care. We found substantial variations, with rates in the region with the highest visit rates eight times higher than those in the region with the lowest rates. Many regions with high rates of ED visits for mental health conditions also had high rates of outpatient mental health use. Regional patterns differed substantially, with some regions exhibiting high rates of ED visits related to anxiety but low rates for schizophrenia and vice versa. The presence of large variations in ED visits for mental health conditions, with substantial differences in the composition across regions, suggests a need for context-specific solutions, including assessments of the ways in which mental health benefits are structured at the state Medicaid agency level and of differences in provider accessibility and an understanding of the types of mental illness underlying high rates of use.
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Affiliation(s)
- K John McConnell
- K. John McConnell , Oregon Health & Science University, Portland, Oregon
| | | | - Esther Choo
- Esther Choo, Oregon Health & Science University
| | - Jane M Zhu
- Jane M. Zhu, Oregon Health & Science University
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McIntosh JT. Illuminating Emergency Nurses' Perceptions of Stigma, Attribution, and Caring Behaviors Toward People With Mental Illness Through the Lens of Individualized Care: A Cross-sectional Study. J Emerg Nurs 2023; 49:109-123.e4. [PMID: 36266094 DOI: 10.1016/j.jen.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Emergency nurses' negative attitudes and lack of caring have been identified as factors affecting the experience of individuals with mental illness in emergency departments. This study examined the relationships between emergency nurses' perceptions of stigma, attribution, caring behaviors, and individualized care toward people with mental illness. METHODS A cross-sectional study was conducted among 813 nurses working in United States emergency departments. Data were collected using a demographic questionnaire; the Mental Illness: Clinicians' Attitudes Scale-4; the Attribution Questionnaire; 24-Item Caring Behaviors Inventory; and the Individualized Care Scale-Nurse version. Data analyses consisted of descriptive and correlation statistics and multiple linear regression. RESULTS The findings from the final regression analysis revealed that caring had a significant relationship with individualized care (version A: β = 0.70, P < .001; Version B: β = 0.73; P < .001). Stigma and attribution had significant inverse relationships with individualized care (β = -0.07, P < .01; β = -0.06, P < .05, respectively). DISCUSSION The results of this study indicated that emergency nurses' perception of individualized care toward people with mental illness is mostly associated with the nurses' level of caring behaviors toward this population. Stigma and attribution had little to no effect. Findings from this study reinforce nurses' altruistic and caring qualities. The findings suggest the need for a possible paradigm shift from antistigma training to trainings that prioritize caring behaviors toward mental illness. This could ultimately improve health equity, safety, and overall outcomes for people with mental illness.
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Derblom K, Molin J, Gabrielsson S, Lindgren BM. Nursing Staff's Experiences of Caring for People with Mental Ill-Health in General Emergency Departments: A Qualitative Descriptive Study. Issues Ment Health Nurs 2022; 43:1145-1154. [PMID: 36383445 DOI: 10.1080/01612840.2022.2138653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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Roennfeldt H, Wyder M, Byrne L, Hill N, Randall R, Hamilton B. Subjective Experiences of Mental Health Crisis Care in Emergency Departments: A Narrative Review of the Qualitative Literature. Int J Environ Res Public Health 2021; 18:9650. [PMID: 34574574 DOI: 10.3390/ijerph18189650] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022]
Abstract
Mental health presentations to the emergency department (ED) have increased, and the emergency department has become the initial contact point for people in a mental health crisis. However, there is mounting evidence that the ED is not appropriate nor effective in responding to people in mental health crises. Insufficient attention has been paid to the subjective experience of people seeking support during a mental health crisis. This review aims to describe the qualitative literature involving the subjective experiences of people presenting to the ED during a mental health crisis. The method was guided by Arksey and O’Malley’s framework for scoping studies and included keyword searches of PsycINFO, CINAHL, Medline and Embase. A narrative analysis, drawing on the visual tool of journey mapping, was applied to summarise the findings. Twenty-three studies were included. The findings represent the experience of accessing EDs, through to the impact of treatment. The review found points of opportunity that improve people’s experiences and characteristics associated with negative experiences. The findings highlight the predominance and impact of negative experiences of the ED and the incongruence between the expectations of people presenting to the ED and the experience of treatment.
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14
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Aebi NJ, Caviezel S, Schaefert R, Meinlschmidt G, Schwenkglenks M, Fink G, Riedo L, Leyhe T, Wyss K. A qualitative study to investigate Swiss hospital personnel's perceived importance of and experiences with patient's mental-somatic multimorbidities. BMC Psychiatry 2021; 21:349. [PMID: 34253168 PMCID: PMC8274261 DOI: 10.1186/s12888-021-03353-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mental-somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel's perceived importance of and experiences with mental-somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. METHODS Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. RESULTS Four themes emerged from the data analysis: 1) the relevance of mental-somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental-somatic multimorbidity, and 4) interprofessional collaboration for handling mental-somatic multimorbidity in hospital settings.The mental-somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental-somatic multimorbidity in general hospitals. CONCLUSION To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental-somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.
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Affiliation(s)
- Nicola Julia Aebi
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Seraina Caviezel
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Rainer Schaefert
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland ,grid.461709.d0000 0004 0431 1180Division of Clinical Psychology and Cognitive Behavioural Therapy, International Psychoanalytic University, Berlin, Germany ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- grid.6612.30000 0004 1937 0642Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Günther Fink
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Lara Riedo
- Department of Health Canton Basel-Stadt, Division of Prevention, Basel, Switzerland
| | - Thomas Leyhe
- grid.6612.30000 0004 1937 0642University of Basel, Geriatric Psychiatry, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland ,grid.412556.10000 0004 0479 0775University of Basel, Center of Old Age Psychiatry, Psychiatric University Hospital, Basel, Switzerland
| | - Kaspar Wyss
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
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15
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True G, Pollock M, Bowden CF, Cullen SW, Ross AM, Doupnik SK, Caterino JM, Olfson M, Marcus SC. Strategies to Care for Patients Being Treated in the Emergency Department After Self-harm: Perspectives of Frontline Staff. J Emerg Nurs 2021; 47:426-436.e5. [PMID: 33610311 PMCID: PMC8122035 DOI: 10.1016/j.jen.2020.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Every year, approximately 500 000 patients in the United States present to emergency departments for treatment after an episode of self-harm. Evidence-based practices such as designing safer ED environments, safety planning, and discharge planning are effective for improving the care of these patients but are not always implemented with fidelity because of resource constraints. The aim of this study was to provide insight into how ED staff innovate processes of care and services by leveraging what is available on-site or in their communities. METHODS A total of 34 semi-structured qualitative phone interviews were conducted with 12 nursing directors, 11 medical directors, and 11 social workers from 17 emergency departments. Respondents comprised a purposive stratified sample recruited from a large national survey in the US. Interview transcripts were coded and analyzed using a directed content analysis approach to identify categories of strategies used by ED staff to care for patients being treated after self-harm. RESULTS Although respondents characterized the emergency department as an environment that was not well-suited to meet patient mental health needs, they nevertheless described 4 categories of strategies to improve the care of patients seen in the emergency department after an episode of self-harm. These included: adapting the ED environment, improving efficiencies to provide mental health care, supporting the staff who provide direct care for patients, and leveraging community resources to improve access to mental health resources postdischarge. DISCUSSION Despite significant challenges in meeting the mental health needs of patients treated in the emergency department after self-harm, the staff identified opportunities to provide mental health care and services within the emergency department and leverage community resources to support patients after discharge.
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Affiliation(s)
- Gala True
- Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans School of Medicine, New Orleans, LA
- South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, New Orleans, LA
| | - Miranda Pollock
- Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans School of Medicine, New Orleans, LA
| | - Cadence F. Bowden
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sara Wiesel Cullen
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
| | - Abigail M. Ross
- Fordham University Graduate School of Social Service, New York, NY
| | - Stephanie K. Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- Department of Pediatrics, University of Pennsylvania
| | | | - Mark Olfson
- Columbia University Irving Medical Center, New York, NY
| | - Steven C. Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- Center for Mental Health, University of Pennsylvania
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16
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Baker D, Blyth D, Stedman T, Meehan T. Case manager perceptions of emergency department use by patients with non-fatal suicidal behaviour. Int J Ment Health Nurs 2021; 30:487-494. [PMID: 33159377 DOI: 10.1111/inm.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
Repeat presentations to the emergency department (ED) for non-fatal suicidal behaviour (NFSB) are common in Australia and overseas. The challenges faced by mental health services in managing this sub-group of patients have not been fully explored. In this qualitative study, we consider how case managers view frequent ED use by patients with NFSB. Individual interviews with case managers were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Four main themes emerged: a logical place to go; not a lot of benefit from an ED visit; focus on managing risk; and building a life outside of the ED. The case managers noted that patients with NFSB tend to have complex presentations that are challenging to address in the ED. The focus tends to be on assessment of risk with referral to community support agencies. The findings point to the need to identify more intensive care options that support patients to reduce their dependency on the ED. Insights gleaned from the study have implications for those working with NFSB patients.
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Affiliation(s)
- Debra Baker
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Deborah Blyth
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Terry Stedman
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Queensland, Australia
| | - Tom Meehan
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Queensland, Australia
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17
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Garvey L, Willetts G, Sadoughi N, Olasoji M. Undergraduate nursing students' experience of mental health simulation post-clinical placement: A Qualitative study. Int J Ment Health Nurs 2021; 30:93-101. [PMID: 33098155 DOI: 10.1111/inm.12801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022]
Abstract
In nursing, it is vital that educational techniques are developed to improve students' capabilities to communicate with and assess mental health consumers while on placement. Simulation is a valid learning technique used to prepare students to encounter consumers with mental illness before exposure in the clinical environment. The aim of this study was to explore undergraduate nursing students' experience mental health simulation following their mental health clinical placement. An explorative descriptive qualitative study. Participants were recruited from a metropolitan Melbourne university using purposive convenience sampling. The participants were interviewed after their mental health clinical placement using semi-structured interview format. A total of n = 14 participants were interviewed. Overall, the participants expressed the fact that the mental health simulation enhanced their clinical placement experience. Two themes were identified: 'The things I might see' and 'Felt better prepared'. There was a total of five subthemes: 'The link between…', 'Having the know how', 'Like an 8-hour shift', 'Took away the fear factor' and 'Feeling more confident'. It is important that nursing students entering mental health settings receive adequate preparation prior to the commencement of their placements. Students need to be prepared in the areas of building therapeutic relationships, communication, assessment and how to work within a mental health clinical setting. The mental health simulation enhanced students' confidence and better prepared them to undertake their clinical placement which can ultimately affect the care provided to consumers.
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Affiliation(s)
- Loretta Garvey
- Faculty of Health, Arts and Design, Swinburne University of Technology, Wantirna, VIC, Australia
| | - Georgina Willetts
- Faculty of Health, Arts and Design, Swinburne University of Technology, Wantirna, VIC, Australia
| | - Navideh Sadoughi
- Faculty of Health, Arts and Design, Swinburne University of Technology, Wantirna, VIC, Australia
| | - Michael Olasoji
- Faculty of Health, Arts and Design, Swinburne University of Technology, Wantirna, VIC, Australia
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18
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Meehan T, Baker D, Blyth D, Stedman T. Repeat presentations to the emergency department for non-fatal suicidal behaviour: Perceptions of patients. Int J Ment Health Nurs 2021; 30:200-207. [PMID: 32851778 DOI: 10.1111/inm.12773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/22/2020] [Accepted: 07/21/2020] [Indexed: 02/02/2023]
Abstract
Presentations to emergency departments (EDs) for non-fatal suicidal behaviour (NFSB) are increasing in Australia and overseas. Our understanding of the factors contributing to this trend remains unclear. In this qualitative phenomenological study, we explored patient perceptions of their ED experience and the interventions provided. The study group comprised 10 adults who had had 3 or more presentations to the ED in a 12-week period for NFSB. Individual interviews were conducted in person with participants and transcribed verbatim. Three broad themes emerged from analysis of the transcripts: ED - a safety net; 'treatment - what treatment!'; and maintaining ED dependence. The findings highlight a failure to understand the needs of those with NFSB and establish better ED treatment strategies and models of aftercare for this sub-group of patients. The findings have implications for mental health nurses working with consumers in the ED and in broader case management roles.
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Affiliation(s)
- Tom Meehan
- Psychiatry, University of Queensland, Brisbane, Queensland, Australia
| | - Debra Baker
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Deborah Blyth
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Terry Stedman
- Psychiatry, University of Queensland, Brisbane, Queensland, Australia
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19
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Daniel C, Mukaro V, Yap CYL, C Knott J, Kelly P, Innes A, Braitberg G, Gerdtz M. Characteristics and clinical outcomes for mental health patients admitted to a behavioural assessment unit: Implications for model of care and practice. Int J Ment Health Nurs 2021; 30:249-260. [PMID: 32929864 DOI: 10.1111/inm.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/15/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short-term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July-December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2-2.0% vs 13.6%; CI 9.3-19.5%); more arrived with police (28.8%; CI 23.8-34.3 vs 5.1%; CI 2.7-9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8-15.0% vs 4.4%; CI 2.3-8.5%), as was the use of chemical restraint (4.2%; CI 2.4-7.2 vs 0.0% CI 0.0 - 2.1%). Those requiring specialist MH assessment had a longer length of stay (12.7 vs 5.2 hours). Further development of the BAU model of care must include targeted, evidence-based strategies to minimize the use of restrictive interventions and ensure timely access to acute mental health services.
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Affiliation(s)
- Catherine Daniel
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Violet Mukaro
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Celene Y L Yap
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan C Knott
- Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Health, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Kelly
- Melbourne Health, Parkville, Victoria, Australia
| | - Andrew Innes
- Emergency Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - George Braitberg
- Melbourne Health, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Perrone McIntosh JT. Emergency department nurses' care of psychiatric patients: A scoping review. Int Emerg Nurs 2020; 54:100929. [PMID: 33302241 DOI: 10.1016/j.ienj.2020.100929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/06/2020] [Accepted: 09/08/2020] [Indexed: 10/22/2022]
Abstract
The emergency department (ED) is a difficult place for psychiatric patients. However, individuals with mental illness often use the Emergency Department as a primary source of healthcare. This study was conducted to identify and examine published literature related to ED nurses' care of individuals with mental illness and to identify associated research gaps. A scoping review within the Arksey and O'Malley [11] framework was undertaken to answer, "what factors influence ED nurses' care of individuals with mental illness?" Sixteen studies met the inclusion criteria. The PRISMA method [16] was used to illustrate the flow of studies. The review resulted in three main themes influencing ED nurses' care for psychiatric patients. These were concerns related to environment; beliefs and perceptions; and knowledge and confidence. The results are described and framed within Biddle's role theory [33], and the gaps in the literature related to research and recommendations for specific investigations are presented.
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Affiliation(s)
- Jennifer T Perrone McIntosh
- Adelphi University, Garden City, NY 11531, United States; Farmingdale State College, Farmingdale, NY 11735, United States.
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21
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Wand T, Collett G, Cutten A, Buchanan-Hagen S, Stack A, White K. Patient and clinician experiences with an emergency department-based mental health liaison nurse service in a metropolitan setting. Int J Ment Health Nurs 2020; 29:1202-1217. [PMID: 32789961 DOI: 10.1111/inm.12760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/24/2022]
Abstract
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) team established in the emergency department (ED) of a metropolitan hospital in New South Wales, Australia. Semi-structured interviews were conducted with a sample of ED patients (n = 26), ED nurses (n = 10), ED consultants (n = 9), and members of the consultation-liaison psychiatry team (n = 5). Data were analysed thematically. Patients emphasized the numerous therapeutic qualities of the MHLN role, the promptness with which they were seen and the value of follow-up. Privacy was identified as important, and some negative experiences were reported. Staff identified that the MHLN team are able to respond to a variety of ED presentations in a timely manner. There was recognition that the MHLN team needs to be integrated within the ED as a specialist resource that builds ED capacity. Consistent staffing of the MHLN team with designated clinicians was also considered essential. Integrating a nurse practitioner-led MHLN team within the ED has demonstrated multiple benefits for patients, ED staff, and overall service provision. Incorporating a specialist mental health nursing service within the ED builds confidence in ED clinicians. Members of the psychiatry team also acknowledge the value of aligning the clinical governance of the MHLN team within the ED and the reduced workload this model of care has on their service provision to ED, freeing them up to concentrate on their broader general hospital role.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia.,Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Gemma Collett
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Alexa Cutten
- Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Sally Buchanan-Hagen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Amanda Stack
- Western NSW Local Health District, Dubbo, New South Wales, Australia
| | - Kathryn White
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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22
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Quirke MB, Donohue G, Prizeman G, White P, McCann E. Experiences and perceptions of emergency department nurses regarding people who present with mental health issues: a systematic review protocol. ACTA ACUST UNITED AC 2020; 17:1877-1882. [PMID: 31318736 DOI: 10.11124/jbisrir-d-18-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to identify, appraise and synthesize available evidence related to the experiences and perceptions of emergency department (ED) nurses regarding people with any mental health issue who present at the ED. INTRODUCTION The ED is often the first point of contact for patients with a mental health issue, due to a shortage of available mental health services. Nursing staff in the ED are involved in key clinical decision making and hands-on care for these patients, despite a lack of mental health specialist training. In order to improve patient outcomes in the ED setting, it is necessary to have a thorough understanding of how ED nurses' experiences with this population affect their clinical decision making. INCLUSION CRITERIA This review will consider studies that include ED nurses, with or without mental health specialist training, working in urban and rural EDs in healthcare settings worldwide. Qualitative studies that explore the experiences and perceptions of ED nurses regarding people who present with mental health issues in the ED setting will be considered. Studies published in English will be considered, with no date limitations. METHODS CINAHL complete, MEDLINE, PsycINFO, Embase, Scopus, Web of Science and Google Scholar will be searched, along with several sources of gray literature. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Findings will be pooled using meta-aggregation, and a ConQual Summary of Findings will be presented.
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Affiliation(s)
- Mary B Quirke
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Grainne Donohue
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Prizeman
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Patricia White
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Edward McCann
- School of Nursing and Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
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23
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Goldsmith LP, Smith JG, Clarke G, Anderson K, Lomani J, Turner K, Gillard S. What is the impact of psychiatric decision units on mental health crisis care pathways? Protocol for an interrupted time series analysis with a synthetic control study. BMC Psychiatry 2020; 20:185. [PMID: 32326915 PMCID: PMC7178744 DOI: 10.1186/s12888-020-02581-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK mental health system is stretched to breaking point. Individuals presenting with mental health problems wait longer at the ED than those presenting with physical concerns and finding a bed when needed is difficult - 91% of psychiatric wards are operating at above the recommended occupancy rate. To address the pressure, a new type of facility - psychiatric decision units (also known as mental health decision units) - have been introduced in some areas. These are short-stay facilities, available upon referral, targeted to help individuals who may be able to avoid an inpatient admission or lengthy ED visit. To advance knowledge about the effectiveness of this service for this purpose, we will examine the effect of the service on the mental health crisis care pathway over a 4-year time period; the 2 years proceeding and following the introduction of the service. We use aggregate service level data of key indicators of the performance of this pathway. METHODS Data from four mental health Trusts in England will be analysed using an interrupted time series (ITS) design with the primary outcomes of the rate of (i) ED psychiatric presentations and (ii) voluntary admissions to mental health wards. This will be supplemented with a synthetic control study with the same primary outcomes, in which a comparable control group is generated for each outcome using a donor pool of suitable National Health Service Trusts in England. The methods are well suited to an evaluation of an intervention at a service delivery level targeting population-level health outcome and the randomisation or 'trialability' of the intervention is limited. The synthetic control study controls for national trends over time, increasing our confidence in the results. The study has been designed and will be carried out with the involvement of service users and carers. DISCUSSION This will be the first formal evaluation of psychiatric decision units in England. The analysis will provide estimates of the effect of the decision units on a number of important service use indicators, providing much-needed information for those designing service pathways. TRIAL REGISTRATION primary registry: isrctn.com Identifying number: ISRCTN77588384 Link: Date of registration in primary registry: 27/02/2020. PRIMARY SPONSOR St George's, University of London, Cramner Road, Tooting, SW17 ORE. Primary contact: Joe Montebello.
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Affiliation(s)
- L P Goldsmith
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK.
| | - J G Smith
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - G Clarke
- The Health Foundation, 8 Salisbury Square, London, UK
| | - K Anderson
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - J Lomani
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - K Turner
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - S Gillard
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
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Guzmán EM, Tezanos KM, Chang BP, Cha CB. Examining the impact of emergency care settings on suicidal patients: A call to action. Gen Hosp Psychiatry 2020; 63:9-13. [PMID: 30077397 DOI: 10.1016/j.genhosppsych.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The emergency department (ED) offers a critical and unique opportunity to assess and intervene on suicide risk. Despite its potential benefits, the ED setting presents several potential sources of stress. The present paper calls attention to how suicidal patients may be especially vulnerable to stressful ED experiences. METHOD This research synthesis cites the growing literature on ED-related stressors, as they have been shown to affect both psychiatric and nonpsychiatric patient populations. RESULTS We identified specific interpersonal, physical, and temporal features of the ED that have been shown to affect multiple patient populations, including suicidal individuals. Beyond this, there appears to be broad underutilization of therapeutic care in ED settings. CONCLUSIONS It is important to consider how the ED setting may be both helpful and harmful toward suicidal patients. We conclude with recommended domains of study and methodological considerations when pursuing these future directions. The proposed research agenda would help address this known high risk period around hospitalization and discharge, and ultimately optimize suicide prevention efforts.
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Affiliation(s)
- Eleonora M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Katherine M Tezanos
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, United States of America
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America.
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Diana AH, Olfson M, Cullen SW, Marcus SC. The Relationship Between Evidence-Based Practices and Emergency Department Managers' Perceptions on Quality of Care for Self-Harm Patients. J Am Psychiatr Nurses Assoc 2020; 26:288-292. [PMID: 31747823 PMCID: PMC10373860 DOI: 10.1177/1078390319889673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To understand the extent to which implementation of evidence-based practices affects emergency department (ED) nurse managers' perceptions of quality of care provided to deliberate self-harm patients. METHODS: ED nursing leadership from a nationally representative sample of 513 hospitals completed a survey on the ED management of deliberate self-harm patients, including the quality of care for deliberate self-harm patients on a 1 to 5 point Likert-type scale. Unadjusted and adjusted analyses, controlling for relevant hospital characteristics, examined associations between the provision of evidence-based practices and quality of care. RESULTS: The overall mean quality rating was 3.09. Adjusted quality ratings were higher for EDs that routinely engaged in discharge planning (β = 0.488) and safety planning (β = 0.736) processes. Ratings were also higher for hospitals with higher levels of mental health staff (β = 0.368) and for teaching hospitals (β = 0.319). CONCLUSION: Preliminary findings suggest a national institutional readiness for further implementation of evidence-based practices for deliberate self-harm patients.
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Affiliation(s)
- Amaya H Diana
- Amaya H. Diana, The University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Olfson
- Mark Olfson, MD, MPH, Columbia University, New York, NY, USA
| | - Sara Wiesel Cullen
- Sara Wiesel Cullen, PhD, MSW, The University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Marcus
- Steven C. Marcus, PhD, The University of Pennsylvania, Philadelphia, PA, USA
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Slemon A, Jenkins E, Bungay V, Brown H. Undergraduate students' perspectives on pursuing a career in mental health nursing following practicum experience. J Clin Nurs 2019; 29:163-171. [DOI: 10.1111/jocn.15074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/29/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Allie Slemon
- School of Nursing University of British Columbia Vancouver BC Canada
| | - Emily Jenkins
- School of Nursing University of British Columbia Vancouver BC Canada
| | - Vicky Bungay
- School of Nursing University of British Columbia Vancouver BC Canada
| | - Helen Brown
- School of Nursing University of British Columbia Vancouver BC Canada
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Marynowski-Traczyk D, Broadbent M, Kinner SA, FitzGerald G, Heffernan E, Johnston A, Young JT, Keijzers G, Scuffham P, Bosley E, Martin-Khan M, Zhang P, Crilly J. Mental health presentations to the emergency department: A perspective on the involvement of social support networks. Australas Emerg Care 2019; 22:162-167. [PMID: 31300299 DOI: 10.1016/j.auec.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 12/30/2022]
Abstract
The involvement of families, carers and significant others (i.e. social support networks) has a positive corollary for a person experiencing mental health problems. Accordingly, in Australia involvement of social support networks within mental health services is endorsed in national health policy and service guidelines. Despite the endorsement, this is yet to be fully realised in all areas that provide mental health services, including emergency departments. Social support networks are integral in the provision of mental health consumers' care. Supporting the involvement of social support networks in the emergency department can provide healthcare services with opportunities for enhanced and cost-effective care, contributing to improved outcomes for consumers. An overview of some of the barriers and facilitators of social support network involvement is provided. The intention of this paper is to encourage reflection and dialogue on this important area of mental health service provision and support the evolution of a new paradigm of research into social support network involvement in the emergency department.
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Affiliation(s)
- Donna Marynowski-Traczyk
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, QLD, Australia.
| | - Marc Broadbent
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, QLD, Australia
| | - Stuart A Kinner
- Murdoch Children's Research Institute, Centre for Adolescent Health, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, VIC, Australia; University of Queensland, Mater Research Institute-UQ, QLD, Australia; Griffith University, Griffith Criminology Institute, QLD, Australia; Monash University, School of Public Health and Preventive Medicine, VIC, Australia
| | - Gerard FitzGerald
- Queensland University of Technology, School of Public Health and Social Work, QLD, Australia
| | - Ed Heffernan
- Queensland Forensic Mental Health Service, Queensland Health, QLD, Australia
| | - Amy Johnston
- University of Queensland, School of Nursing, Midwifery and Social Work, QLD, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, QLD, Australia
| | - Jesse T Young
- Murdoch Children's Research Institute, Centre for Adolescent Health, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, VIC, Australia; University of Western Australia, School of Population and Global Health, WA, Australia; Curtin University, National Drug Research Institute, WA, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, QLD, Australia; Bond University, School of Medicine, QLD, Australia; Griffith University, School of Medicine, QLD, Australia
| | - Paul Scuffham
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; Griffith University, School of Medicine, QLD, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Information Support, Research and Evaluation, QLD, Australia
| | - Melinda Martin-Khan
- University of Queensland, Centre for Health Services Research, QLD, Australia
| | - Ping Zhang
- Griffith University, Menzies Health Institute Queensland, QLD, Australia
| | - Julia Crilly
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; Department of Emergency Medicine, Gold Coast Health, QLD, Australia
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Baia Medeiros DT, Hahn-Goldberg S, Aleman DM, O'Connor E. Planning Capacity for Mental Health and Addiction Services in the Emergency Department: A Discrete-Event Simulation Approach. J Healthc Eng 2019; 2019:8973515. [PMID: 31281618 DOI: 10.1155/2019/8973515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/02/2019] [Accepted: 05/08/2019] [Indexed: 01/26/2023]
Abstract
Ontario has shown an increasing number of emergency department (ED) visits, particularly for mental health and addiction (MHA) complaints. Given the current opioid crises Canada is facing and the legalization of recreational cannabis in October 2018, the number of MHA visits to the ED is expected to grow even further. In face of these events, we examine capacity planning alternatives for the ED of an academic hospital in Toronto. We first quantify the volume of ED visits the hospital has received in recent years (from 2012 to 2016) and use forecasting techniques to predict future ED demand for the hospital. We then employ a discrete-event simulation model to analyze the impacts of the following scenarios: (a) increasing overall demand to the ED, (b) increasing or decreasing number of ED visits due to substance abuse, and (c) adjusting resource capacity to address the forecasted demand. Key performance indicators used in this analysis are the overall ED length of stay (LOS) and the total number of patients treated in the Psychiatric Emergency Services Unit (PESU) as a percentage of the total number of MHA visits. Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure.
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Johnston ANB, Spencer M, Wallis M, Kinner SA, Broadbent M, Young JT, Heffernan E, Fitzgerald G, Bosley E, Keijzers G, Scuffham P, Zhang P, Martin‐Khan M, Crilly J. Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review. Emerg Med Australas 2019; 31:715-729. [DOI: 10.1111/1742-6723.13335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/17/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Amy NB Johnston
- Health and Behavioural SciencesThe University of Queensland Brisbane Queensland Australia
- Department of Emergency MedicinePrincess Alexandra Hospital, Metro South Health Brisbane Queensland Australia
| | - Melinda Spencer
- Menzies Health Institute QueenslandGriffith University Brisbane Queensland Australia
| | - Marianne Wallis
- School of Nursing and MidwiferyUniversity of the Sunshine Coast Sunshine Coast Queensland Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global HealthThe University of Melbourne Melbourne Victoria Australia
| | - Marc Broadbent
- School of Nursing and MidwiferyUniversity of the Sunshine Coast Sunshine Coast Queensland Australia
| | - Jesse T Young
- The University of Melbourne Melbourne Victoria Australia
| | - Ed Heffernan
- Queensland Centre for Mental Health Research Brisbane Queensland Australia
| | - Gerry Fitzgerald
- Queensland University of Technology Brisbane Queensland Australia
| | - Emma Bosley
- Queensland Ambulance Service Brisbane Queensland Australia
| | - Gerben Keijzers
- Gold Coast University Hospital Gold Coast Queensland Australia
| | - Paul Scuffham
- Menzies Health Institute QueenslandGriffith University Brisbane Queensland Australia
| | - Ping Zhang
- Griffith University – Gold Coast Campus Gold Coast Queensland Australia
| | - Melinda Martin‐Khan
- Centre for Health Services ResearchThe University of Queensland Brisbane Queensland Australia
| | - Julia Crilly
- Gold Coast Hospital and Health Service Gold Coast Queensland Australia
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Dombagolla MH, Kant JA, Lai FW, Hendarto A, Taylor DM. Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management). Australas Emerg Care 2019; 22:8-12. [DOI: 10.1016/j.auec.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/17/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
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Baia Medeiros DT, Hahn-goldberg S, O’connor E, Aleman DM. Analysis of emergency department length of stay for mental health visits: A case study of a Canadian academic hospital. CAN J EMERG MED 2019; 21:374-83. [PMID: 30152299 DOI: 10.1017/cem.2018.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjectiveThe objective of this study was to examine temporal trends in mental health visits to the emergency department (ED) and to determine differences in length of stay (LOS) between mental health visits and visits for non-mental health conditions.MethodsA population-based retrospective study was conducted for patients who visited the ED of an academic hospital located in Toronto, ON, between fiscal years 2012 and 2016. Trends in the number of visits and descriptive statistics were calculated for both mental health and non-mental health groups. Quantile regression was used to compare the median and 90th percentile LOS.ResultsIn five years, the absolute increase in the number of mental health visits to the ED was 55.7%. The 90th percentile LOS was similar for mental and non-mental health visits that were internally transferred (10.7 hours v. 8.3 hours) but significantly higher for those who were discharged (11.4 hours v. 7.3 hours), admitted (52.6 hours v. 29.3 hours), and externally transferred (21.9 hours v. 10.0 hours). After adjusting for other variables, the 90th percentile LOS was 3.3 hours longer for mental health visits resulting in discharge (p<0.001), 24.5 hours longer for those admitted (p<0.001), and 12.7 hours longer for those externally transferred (p<0.001).ConclusionThe number of mental health visits to the ED is linearly increasing over time, and the LOS in the ED is significantly longer for mental health visits for almost all discharge dispositions. Thus, systematic changes are needed to address the ED capacity to provide care for the growing mental health population.
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Digel Vandyk A, Young L, MacPhee C, Gillis K. Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons. Qual Health Res 2018; 28:587-599. [PMID: 29231128 DOI: 10.1177/1049732317746382] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants' experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.
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Affiliation(s)
| | | | - Colleen MacPhee
- 3 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- 4 The Ottawa Hospital, Ottawa, Ontario, Canada
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Cranwell K, Polacsek M, McCann TV. Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services. J Psychiatr Ment Health Nurs 2017; 24:337-347. [PMID: 27500593 DOI: 10.1111/jpm.12322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. ABSTRACT Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses' perspectives of the experience of service users with medical co-morbidity in tertiary medical services, and to identify how to improve care planning and coordination for service users transitioning between tertiary medical and primary care services. Method Embedded within an experience-based co-design study, focus group discussions were conducted with 17 emergency department nurses and other clinicians, in Melbourne, Australia. Results Three main themes were abstracted from the data: feeling confused and frustrated, enhancing service users' transition and experience and involving families and caregivers. Participants perceived the service user experience to be characterized by fear, confusion and a sense of not being listened to. They highlighted that service users' transition and experience could be enhanced by facilitating transitions and improving coordination and continuity of care. They also emphasized the need to increase family and caregiver participation. Conclusion Our findings contribute to knowledge about improving the way service users are treated in emergency departments and improving care planning and coordination; in particular, facilitating transitions, improving coordination and continuity of care and increasing family and caregiver participation.
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Affiliation(s)
- K Cranwell
- Department of Community Services, Western Health, Melbourne, VIC, Australia
| | - M Polacsek
- Department of Community Services, Western Health, Melbourne, VIC, Australia
| | - T V McCann
- Centre for Chronic Disease, College of Health and Biomedicine (Discipline of Nursing), Victoria University, Melbourne, VIC, Australia
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Kunst EL, Mitchell M, Johnston ANB. Using simulation to improve the capability of undergraduate nursing students in mental health care. Nurse Educ Today 2017; 50:29-35. [PMID: 28011335 DOI: 10.1016/j.nedt.2016.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/30/2016] [Accepted: 12/13/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment. INTERVENTION Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges. METHODS Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting. RESULTS Students who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting. DISCUSSION This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.
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Affiliation(s)
- Elicia L Kunst
- Southern Cross University, Gold Coast Campus, Southern Cross Drive, Bilinga, QLD 4225, Australia; Menzies Health Institute Queensland, Griffith University Gold Coast Campus, QLD 4222, Australia.
| | - Marion Mitchell
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, QLD 4222, Australia; Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
| | - Amy N B Johnston
- Menzies Health Institute Queensland, Griffith University Gold Coast Campus, QLD 4222, Australia; Department of Emergency Medicine, Gold Coast University Hospital, D Block, LG096 1 Hospital Blvd, Southport, QLD 4215, Australia.
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McKenna B, McEvedy S, Kelly K, Long B, Anderson J, Dalzell E, Maguire T, Tacey M, Furness T. Association of methamphetamine use and restrictive interventions in an acute adult inpatient mental health unit: A retrospective cohort study. Int J Ment Health Nurs 2017; 26:49-55. [PMID: 27860236 DOI: 10.1111/inm.12283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to describe incidences of restrictive interventions and the association of methamphetamine use at an acute adult inpatient mental health unit in metropolitan Melbourne, Victoria, Australia. A total of 232 consecutive consumer admissions to the inpatient unit across a 3-month period were described for illicit substance use and the use of restrictive interventions (seclusion, mechanical restraint, and physical restraint) prior to and during admission. Of all admissions, 25 (10.8%) involved consumers subjected to a restrictive intervention. Methamphetamine use was either self-reported or detected by saliva test for 71 (30.6%) consumers. Following multivariate analyses, methamphetamine use (odds ratio (OR): 7.83, 95% confidence interval (CI): 2.33-26.31) and restrictive intervention in the emergency department prior to admission (OR: 8.85, 95% CI: 2.83-27.70) were significant independent predictors of the use of restrictive interventions after inpatient admission. Anecdotal observations provided by clinical mental health staff that consumers intoxicated with methamphetamine appear to require restrictive intervention more frequently than other consumers was confirmed with the results of the current study. As the state of Victoria in Australia is on a pathway to the elimination of the use of restrictive interventions in mental health services, clinicians need to develop management strategies that provide specialist mental health care using the least-restrictive interventions. Although 26.8% of methamphetamine users were secluded after admission, restrictive interventions should not be the default management strategy for consumers who present with self-report or positive screen for methamphetamine use.
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Affiliation(s)
- Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand
| | - Samantha McEvedy
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,The Royal Melbourne Hospital, NorthWestern Mental Health, Parkville, Victoria, Australia
| | - Kathleen Kelly
- Sunshine Acute Adult Psychiatric Unit, NorthWestern Mental Health, Sunshine, Melbourne, Australia
| | - Bec Long
- Sunshine Acute Adult Psychiatric Unit, NorthWestern Mental Health, Sunshine, Melbourne, Australia
| | - Jess Anderson
- Sunshine Acute Adult Psychiatric Unit, NorthWestern Mental Health, Sunshine, Melbourne, Australia
| | - Elaine Dalzell
- Sunshine Acute Adult Psychiatric Unit, NorthWestern Mental Health, Sunshine, Melbourne, Australia
| | - Tessa Maguire
- Forensicare, Melbourne, Victoria, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Mark Tacey
- Melbourne EpiCentre, The Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,The Royal Melbourne Hospital, NorthWestern Mental Health, Parkville, Victoria, Australia
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Poremski D, Harris DW, Kahan D, Pauly D, Leszcz M, O'Campo P, Wasylenki D, Stergiopoulos V. Improving continuity of care for frequent users of emergency departments: service user and provider perspectives. Gen Hosp Psychiatry 2016; 40:55-9. [PMID: 26906469 DOI: 10.1016/j.genhosppsych.2016.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention. METHOD We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers. RESULTS Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs. CONCLUSION Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration.
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Affiliation(s)
- Daniel Poremski
- Institute of Mental Health, Singapore; St. Michael's Hospital Centre for Research on Inner City Health, Canada.
| | | | - Deborah Kahan
- University of Toronto Department of Psychiatry, Canada
| | | | - Molyn Leszcz
- University of Toronto Department of Psychiatry, Canada; Mount Sinai Hospital, USA
| | - Patricia O'Campo
- St. Michael's Hospital Centre for Research on Inner City Health, Canada; University of Toronto Dalla Lana School of Public Health, Canada
| | - Donald Wasylenki
- St. Michael's Hospital Centre for Research on Inner City Health, Canada; University of Toronto Department of Psychiatry, Canada
| | - Vicky Stergiopoulos
- St. Michael's Hospital Centre for Research on Inner City Health, Canada; University of Toronto Department of Psychiatry, Canada
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Hall A, McKenna B, Dearie V, Maguire T, Charleston R, Furness T. Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: a pilot study. BMC Nurs 2016; 15:21. [PMID: 27013926 PMCID: PMC4806472 DOI: 10.1186/s12912-016-0141-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/16/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Practicing with trauma informed care (TIC) can strengthen nurses' knowledge about the association of past trauma and the impact of trauma on the patient's current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Although mental health nurses can be TIC leads in multidisciplinary environments, the translation of TIC into clinical practice by nurses working in emergency departments (EDs) is unknown. However, before ED nurses can begin to practice TIC, they must first be provided with meaningful and specific education about TIC. Therefore, the aims of this study were to; (1) evaluate the effectiveness of TIC education for ED nursing staff and (2) describe subsequent clinical practice that was trauma informed. METHODS This project was conducted as exploratory research with a mixed methods design. Quantitative data were collected with an 18-item pre-education and post-education questionnaire. Qualitative data were collected with two one-off focus groups conducted at least three-months after the TIC education. Two EDs were involved in the study. RESULTS A total of 34 ED nurses participated in the TIC education and 14 ED nurses participated in the focus groups. There was meaningful change (p < 0.01, r ≥ 0.35) in 9 of the 18-items after TIC education. Two themes, each with two sub-themes, were evident in the data. The themes were based on the perceived effectiveness of TIC education and the subsequent changes in clinical practice in the period after TIC education. CONCLUSION Emergency department nurses became more informed of the interplay of trauma on an individual's mental health. However, providing care with a TIC framework in an ED setting was a considerable challenge primarily due to time constraints relative to the day-to-day ED environment and rapid turnover of patients with potentially multiple and complex presentations. Despite this, nurses understood the effect of TIC to reduce the likelihood of re-traumatisation and expressed a desire to use a TIC framework.
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Affiliation(s)
- Andrea Hall
- Emergency Department, The Royal Melbourne Hospital, Melbourne Health, Parkville, Australia
| | - Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Vikki Dearie
- Western Victorian Mental Health Learning & Development Cluster, Melbourne Health, Parkville, Australia
| | - Tessa Maguire
- Forensicare, Fairfield, Australia ; Centre for Forensic Behavioural Science, Swinburne University, Clifton Hill, Australia
| | - Rosemary Charleston
- Western Victorian Mental Health Learning & Development Cluster, Melbourne Health, Parkville, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia ; NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Australia
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Harris B, Beurmann R, Fagien S, Shattell MM. Patients' experiences of psychiatric care in emergency departments: A secondary analysis. Int Emerg Nurs 2015; 26:14-9. [PMID: 26459607 DOI: 10.1016/j.ienj.2015.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 09/05/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
The number of psychiatric emergencies presenting to EDs in the United States continues to rise. Evidence suggests that psychiatric ED care encounters can have less than optimal outcomes, and result in stress for providers. The primary aim of this study is to describe the perceptions of ED visits by persons experiencing emotional distress, identifying themes among these that may guide nursing interventions that minimize stress and optimize outcomes in the treatment of psychiatric emergency. This secondary analysis used a qualitative, phenomenological method to analyze a de-identified data set originally collected in a study of experiences of psychiatric emergency in a community based crisis management setting. Findings consist of three major themes: "Emergency rooms are cold and clinical", "They talk to you like you're a crazy person", and "You get put away against your will". An overarching theme through all three is the influence of RN communication, both positive and negative, on patient perceptions of their ED encounters. While nurse-patient communication is basic to all areas of practice, it may be a low priority in the urgent and chaotic context of the ED. However, our findings suggest that increased attention to timely, empathic and validating communication and openness to the patient's reality may decrease severity of symptoms, optimize outcomes, and decrease provider stress.
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Affiliation(s)
- Barbara Harris
- School of Nursing, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614, USA.
| | - Ross Beurmann
- School of Nursing, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614, USA
| | - Samantha Fagien
- School of Nursing, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614, USA
| | - Mona M Shattell
- School of Nursing, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614, USA
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