Patient and staff experience with a new model of emergency department based mental health nursing care implemented in two rural settings

Wand, Timothy; Collett, Gemma; Cutten, Alexa; Buchanan‐Hagen, Sally; Stack, Amanda; White, Kathryn

doi:10.1016/j.ienj.2021.101013

Cited by 15 publications

(25 citation statements)

References 20 publications

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“…The review relates to data published up to 2019. A further search conducted on 21 st June 2021 found only one new study with papers meeting the search criteria (Wand et al 2020(Wand et al , 2021. These papers re-evaluate perceptions of the MHLN service P9 already included in this review and focus on patient, ED, and mental health staff's experiences, so may be of interest to include in future reviews.…”

Section: Limitationsmentioning

confidence: 99%

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

Sacre

Albert

Hoe

2021

Int J Mental Health Nurs

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Historically, dualistic healthcare systems have resulted in limited mental healthcare provision within physical health settings, with service users reporting poor care specifically while attending emergency departments (EDs) in a mental health crisis. Modern approaches to healthcare recognize these inequalities and are moving towards integrating healthcare systems that allow more holistic and seamless experiences for service users. This mixed-method review examines the experiences and perceptions of service users attending EDs for a mental health crisis. Systematic searches of eight databases on two platforms (EBSCO, OVID) and grey literature databases (Open Grey, Base) were conducted. Studies were systematically screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. Ten studies consisting of qualitative and mixed-method designs were included in the review. Five overarching themes emerged from the synthesis: social constructs, service provider, service provision, effectiveness, and emotional impact. The findings from this review show that service users continue to have negative experiences in EDs due to stigmatizing attitudes and low skill in managing mental health needs, whereas more positive experiences are attributed to the availability of mental health liaison services. Tackling stigma, improving communication and staff training, providing calm environments, and addressing structural issues that promote better interagency working and reduce gaps in services are needed to improve mental health service user experience. Future research should focus on trauma-informed approaches in EDs to improve person-centred care for service users experiencing a mental health crisis.

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Section: Limitationsmentioning

confidence: 99%

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

Sacre

Albert

Hoe

2021

Int J Mental Health Nurs

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“…Initial evaluation of this is promising, showing a reduction in ED length of stay, less wait times to see a professional, referrals to community mental health teams, and clinician and patient acceptability [ 46 ]. Patients acknowledged the therapeutic benefits including being listened to and understood [ 47 , 48 ]. Implementation of such a model in Canada would require significant resources and organizational change.…”

Section: Discussionmentioning

confidence: 99%

“…However, as our results indicate, the EDs are currently significantly under resourced, especially for people presenting with MHSU concerns. The authors conducting this work in Australia acknowledge the need for resources, structural considerations within the ED, and connections to other mental health services [ 47 ] which would all be necessary considerations for a similar model to be used within Canada.…”

Section: Discussionmentioning

confidence: 99%

Exploring how to enhance care and pathways between the emergency department and integrated youth services for young people with mental health and substance use concerns

Glowacki

Whyte

Weinstein

et al. 2022

BMC Health Serv Res

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Background Integrated youth services (IYS) provide multidisciplinary care (including mental, physical, and social) prioritizing the needs of young people and their families. Despite a significant rise in emergency department (ED) visits by young Canadians with mental health and substance use (MHSU) concerns over the last decade, there remains a profound disconnect between EDs and MHSU integrated youth services. The first objective of this study was to better understand the assessment, treatment, and referral of young people (ages 12–24 years) presenting to the ED with MHSU concerns. The second objective was to explore how to improve the transition from the ED to IYS for young people with MHSU concerns. Methods We conducted semi-structured one-on-one video and phone interviews with stakeholders in British Columbia, Canada in the summer of 2020. Snowball sampling was utilized, and participants (n = 26) were reached, including ED physicians (n = 6), social workers (n = 4), nurses (n = 2), an occupational therapist (n = 1); a counselor (n = 1); staff/leadership in IYS organizations (n = 4); mental health/family workers (n = 3); peer support workers (n = 2), and parents (n = 3). A thematic analysis (TA) was conducted using a deductive and inductive approach conceptually guided by the Social Ecological Model. Results We identified three overarching themes, and factors to consider at all levels of the Social Ecological Model. At the interpersonal level inadequate communication between ED staff and young people affected overall care and contributed to negative experiences. At the organizational level, we identified considerations for assessments and the ED and the hospital (wait times, staffing issues, and the physical space). At the community level, the environment of IYS and other community services were important including wait times and hours of operation. Policy level factors identified include inadequate communication between services (e.g., different charting systems and documentation). Conclusions This study provides insight into important long-term systemic issues and more immediate factors that need to be addressed to improve the delivery of care for young people with MHSU challenges. This research supports intervention development and implementation in the ED for young people with MHSU concerns.

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“…Evaluate the impact of a specific nurse role (eg, advanced nurse practitioner) on the experience of patients and staff (n=3 studies; n=8 key interactions identified). [48][49][50] Improved communications between the patient and the service (n=2); positive impact on care (n=1); better coordination of services (n=1); patients described an increased level of confidence in the service (n=1); reduction in unnecessary hospital admissions (n=1); reduction of waiting time (patient's perceptions; n=1); improved practice (n=1).…”

Section: Continuedmentioning

confidence: 99%

Studying both patient and staff experience to investigate their perceptions and to target key interactions to improve: a scoping review

et al. 2022

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ObjectiveThe improvement of patient experience (PE) is related to the experience of staff caring for them. Yet there is little evidence as to which interactions matter the most for both patients and staff, or how they are perceived by them. We aimed to summarise the interactions and the perceptions between patients and staff from studies by using both patient and staff experience data in healthcare institutions.DesignScoping review.MethodsWe conducted a scoping review, including studies dealing with PE and staff experience. Two authors independently reviewed each title/abstract and the selected full-text articles. A list of variables (objective, study design, data sources, tools used, results, interactions, perceptions and actions) was charted and summarised using a narrative approach including both qualitative and quantitative data. Studies were grouped according to their objective and the key interactions summarised according to this stratification. The perceptions of patients and staff were identified in the results of selected studies and were classified into four categories: commonalities and disagreements of perceptions, patients’ perceptions not perceived by professionals and professional’s perceptions not perceived by patients.ResultsA total of 42 studies were included. The stratification of studies by type of objective resulted in six groups that allowed to classify the key interactions (n=154) identified in the results of the selected studies. A total of 128 perceptions related to interaction between patient and staff were reported with the following distribution: commonalities (n=35), disagreements (n=18), patients’ perceptions not perceived by professionals (n=47) and professional’s perceptions not perceived by patients (n=28). We separated positive and negative perceptions, which resulted in seven scenarios, each with actions that can be carried out for one or both populations to overcome barriers.ConclusionThe study of both patient and staff experience allowed the identification of actions that can be taken to change the perceptions of patients and staff.

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Patient and staff experience with a new model of emergency department based mental health nursing care implemented in two rural settings

Cited by 15 publications

References 20 publications

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review

Exploring how to enhance care and pathways between the emergency department and integrated youth services for young people with mental health and substance use concerns

Studying both patient and staff experience to investigate their perceptions and to target key interactions to improve: a scoping review

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