The mental health nurse: contributing to improved outcomes for patients in the emergency department

doi:10.1054/aaen.2000.0248

Accident and Emergency Nursing

Volume 9, Issue 3, July 2001, Pages 166-176

https://doi.org/10.1054/aaen.2000.0248 Get rights and content

Abstract

Fundamental changes to health-care policy in Australia have led to an increase in the extent to which emergency department staff come into contact with patients experiencing mental health problems. This has been problematic for nurses, many of whom perceive themselves as lacking the skills and expertise to provide appropriate care and treatment to this client group. Psychiatric/mental health consultation-liaison nursing within the emergency department is becoming established as a means to overcome some of the problems identified. Despite this growth there is a paucity of literature evaluating the effectiveness of this position. This paper presents the results of an evaluation of the mental-health consultation-liaison nurse role in an inner city teaching hospital in Sydney Australia. The survey involved a three stage approach to data collection. The data collected at the commencement of the position included focus groups to ascertain the needs of emergency department nurses and a questionnaire designed to measure the skills, confidence and perceived knowledge of emergency department nursing and medical staff. An evaluation of the satisfaction of nurses and doctors was conducted towards the end of the three month pilot programme. The results confirmed the need for positions of this type and suggested a high level of satisfaction with the service provided.

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This repeating cycle allows new trainees and regular staff to practice deescalation skills, as well as prepare for use of medication and restraints together. Emergency nurses and nonpsychiatric physicians commonly perceive themselves as lacking the knowledge, skills, and expertise to provide appropriate care and treatment to psychiatric emergency pediatric patients.31–34 Lack of educational preparation in the care of psychiatric patients is frequently cited as an important contributing factor.
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Health services are required to implement new models of care that streamline transition through the ED for people presenting with mental health related concerns and to support ED staff. The benefits associated with mental health nurse service provision in the ED have been recognised from numerous evaluations conducted internationally (Callahan et al., 2001; Clarke et al., 2005; Eales et al., 2006; Morgan and Coleman, 2000; Sinclair et al., 2006; Wand and Happell, 2001). However, there is significant variation in the way such services are designed and operate within the ED, such as team structure and where that sits within the ED, reporting mechanisms, patient referral and follow up.
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The new service was met with high levels of approval by patients and staff. MHLN team members were challenged by their new role but considered the service reduced waiting times, provided therapeutic benefits, and enhanced communication and support for emergency staff.
A nurse practitioner-led extended hours MHLN service embedded within the ED team structure provides prompt and effective access to specialised mental health care for people with ‘undifferentiated health problems’ and removes a significant workload from nursing and medical staff.
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Developing this NP role has involved a systematic process of consultation with key stakeholders, evaluation, and publication. The mental health NP role was instigated after a successful pilot6 and is funded by the local mental health service as an ED position. Subsequent evaluations of the service provided by the mental health NP obtained via surveys of both ED staff and patients identified reduced waiting times, therapeutic engagement, and enhanced coordination of care as the central attributes of the role.7,8
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Furthermore, a better understanding of ED triage decision-making has the potential to increase the accuracy and defensibility of these complex and crucial clinical decisions. Mental health patients have reported that they feel they are stigmatized by ED staff, they wait longer, their access to ED care is inequitable and they are considered less of a priority when compared to patients with medical or trauma presentations (Broadbent et al., 2010; Clarke et al., 2007; Kirby and Keon, 2004; Wand and Happell, 2001). Accordingly, patient satisfaction with care can be adversely affected by their beliefs that ED staff belittle them or classify their symptoms as inappropriate for the ED (Strike et al., 2006).
Little is known about how emergency department (ED) nurses make decisions and even less is known about triage nurses’ decision-making. There is compelling motivation to better understand the processes by which triage nurses make decisions, particularly with complex patient populations such as those with frequently emotive mental health and illness issues. While accuracy and reliability of triage decisions generally have been improved through the introduction of standardised triage scales and instruments, other factors such as lack of knowledge or confidence related to mental health issues, past experiences that may elicit transference and countertransference, judgments about individuals based on their behavioural presentations may impact on decisions made at triage. In this paper, we review the current research regarding the effectiveness of triage tools particularly with mental health presentations, present a theoretical framework that may guide research in understanding how triage nurses approach decision-making, and apply that framework to thinking about research in mental health-related triage. Developing a better understanding of how triage nurses make decisions, particularly in situations where issues related to mental health and illness may raise the levels of uncertainty, is crucial to ensure that they have the skills and tools they need to provide the most effective, sensitive, and compassionate care possible.

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Regular ArticleThe mental health nurse: contributing to improved outcomes for patients in the emergency department

Abstract

Comprehensive Psychiatry

National Mental Health Plan.

Psychiatric emergency service. Using available resources

Journal of Nurse Administration

The prevalence of psychiatric morbidity in general hospital inpatients

Australian and New Zealand Journal of Psychiatry

The care of psychiatric patients in the emergency department

Journal of Emergency Nursing

Consultation-liaison psychiatric nursing in Australia

Unpublished Masters of Nursing Project

Oxford textbook of psychiatry, 3rd edn.

Focus Group Interviews as a tool for nursing research

Australian and New Zealand Journal of Mental Health Nursing

Regular Article
The mental health nurse: contributing to improved outcomes for patients in the emergency department