Jelinek George A, Weiland Tracey J, Mackinlay Claire, Gerdtz Marie, Hill Nicole
Emergency Practice Innovation Centre, St, Vincent's Hospital, Melbourne, Australia.
Int J Emerg Med. 2013 Jan 15;6(1):2. doi: 10.1186/1865-1380-6-2.
Mental health related presentations are common in Australian Emergency Departments (EDs). We sought to better understand ED staff knowledge and levels of confidence in treating people with mental health related problems using qualitative methods.
This was a qualitative learning needs analysis of Australian emergency doctors and nurses regarding the assessment and management of mental health presentations. Participants were selected for semi-structured telephone interview using criterion-based sampling. Recruitment was via the Australasian College for Emergency Medicine and College of Emergency Nursing Australasia membership databases. Interviews were audio-recorded and transcribed verbatim. Thematic framework analysis was used to identify perceived knowledge gaps and levels of confidence among participants in assessing and managing patients attending EDs with mental health presentations.
Thirty-six staff comprising 20 doctors and 16 nurses consented to participate. Data saturation was achieved for four major areas where knowledge gaps were reported. These were: assessment (risk assessment and assessment of mental status), management (psychotherapeutic skills, ongoing management, medication management and behaviour management), training (curriculum and rotations), and application of mental health legislation. Participants' confidence in assessing mental health patients was affected by environmental, staff, and patient related factors. Clinicians were keen to learn more about evidence based practice to provide better care for this patient group. Areas where clinicians felt the least confident were in the effective assessment and management of high risk behaviours, providing continuity of care, managing people with dual diagnosis, prescribing and effectively managing medications, assessing and managing child and adolescent mental health, and balancing the caseload in ED.
Participants were most concerned about knowledge gaps in risk assessment, particularly for self-harming patients, violent and aggressive patients and their management, and distinguishing psychiatric from physical illness. Staff confidence was enhanced by better availability of skilled psychiatric support staff to assist in clinical decision-making for complex cases and via the provision of a safe ED environment. Strategies to enhance the care of patients with mental health presentations in Australian emergency departments should address these gaps in knowledge and confidence.
与心理健康相关的就诊情况在澳大利亚急诊科很常见。我们试图通过定性方法更好地了解急诊科工作人员在治疗有心理健康相关问题的患者方面的知识和信心水平。
这是一项针对澳大利亚急诊医生和护士关于心理健康就诊评估和管理的定性学习需求分析。采用基于标准的抽样方法选择参与者进行半结构化电话访谈。通过澳大利亚急诊医学学院和澳大利亚急诊护理学院的会员数据库进行招募。访谈进行了录音并逐字转录。采用主题框架分析来确定参与者在评估和管理到急诊科就诊的有心理健康问题的患者时所感知到的知识差距和信心水平。
36名工作人员（包括20名医生和16名护士）同意参与。在报告存在知识差距的四个主要领域实现了数据饱和。这些领域是：评估（风险评估和精神状态评估）、管理（心理治疗技能、持续管理、药物管理和行为管理）、培训（课程和轮转）以及心理健康立法的应用。参与者对评估心理健康患者的信心受到环境、工作人员和患者相关因素的影响。临床医生渴望了解更多基于证据的实践，以便为该患者群体提供更好的护理。临床医生最缺乏信心的领域是对高风险行为的有效评估和管理、提供连续护理、管理双重诊断患者、开药和有效管理药物、评估和管理儿童及青少年心理健康以及平衡急诊科的工作量。
参与者最关注风险评估方面的知识差距，特别是对于有自伤行为的患者、暴力和攻击性患者及其管理，以及区分精神疾病和身体疾病。通过更好地配备熟练的精神科支持人员以协助复杂病例的临床决策，以及提供安全的急诊科环境，增强了工作人员的信心。澳大利亚急诊科改善对有心理健康问题患者护理的策略应解决这些知识和信心方面的差距。
