Nurses’ experiences of encountering patients with mental illness in prehospital emergency care – a qualitative interview study

Abstract

Background Nurses working in prehospital emergency care (PEC) encounter patients with all types of health conditions. Increasingly, they are encountering patients suffering from mental illness and this trend reflects the worldwide increase in mental illness. There is very little current knowledge of encounters between nurses and patients with mental illness in ‘PEC’, especially from the nurses’ perspectives. Aim The aim of the study is to investigate nurses’ experiences of encountering patients with mental illness in ‘PEC’. Methods The participants were recruited in a region in southeast Sweden (that covers approximately 5600 km2 and has 300,000 inhabitants). In total, 17 nurses consented to participate. The participants were asked to narrate their individual experience of encountering patients with mental illness. The interviews were transcribed verbatim, then analysed with qualitative content analysis. Results The result is presented in terms of three themes and eight sub-themes. The main themes are ‘Lacking trust in the patient and one’s own abilities’, ‘Being under internal and external influences’ and ‘Moving towards a genuine nurse-patient relationship’. Conclusion The results show that nurses strive to lay the foundation for a trusting relationship. Simultaneously nurses encountering is characterized by a mistrust and it is influenced by pre-understanding and emotions when they take care for patients. The findings could be used to develop nurses’ readiness and capability to encounter patients with mental illness and to respond appropriately to the patients somatic and mental care needs.

Care relationship and interaction between patients and ambulance clinicians: A qualitative meta‐synthesis from a person‐centred perspective

“…ACs attempted to adjust their communication strategies to create trust and reduce anxiety among patients with cognitive impairment, often by spending longer time in broader conversations about patients' lives [26]. Emotional and psychological barriers needed to be broken, clear boundaries needed to be set and control of the situation taken by ACs to establish trust with patients with mental illness [29]. A respectful approach was the essence of building trust and creating a care relationship.…”

“…It was also important for ACs to give hope and promote patients' human dignity by allowing them to share their personal stories and to speak for themselves [36]. Respect for patient dignity was shown by ACs being receptive and non‐judgmental and by showing respect for the patients' home, environment and lifestyle [29]. Respecting a patient's reality and the patient as a unique person promoted the patient's dignity [37].…”

“…Although the electronic documentation system was used with the patient's well‐being in focus, the distance between patients and ACs could increase when ACs focused more on documentation than on the patient's condition [34]. The presence of other professions, such as the polices and fire fighters, in some cases made building relationships with patients more difficult [29].…”

“…Creating a relationship with a patient with mental illness could create a potentially dangerous situation by provoking threatening behaviour in the patient. Patients with mental illness may be uninterested in taking part in their own care, and in the case of suicide attempts, patients are cared for against their will [29]. Sometimes patients' independent decision‐making capacity was reduced by alcohol or drug use [25].…”

“…Furthermore, verbal and non‐verbal communication were highlighted as important factors in the care relationship. The results of this study show that listening to patients and focusing on what they say was one of the most important ways to create a relationship between ACs and patients [28, 29]. Listening to patients' narratives offers a way to initiate a partnership is precisely the position taken in the work of Ekman et al [11].…”