School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, ML 40 Locked Bag 4, Maroochydore DC, QLD 4558, Australia.
School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
Contemp Nurse. 2020 Apr-Jun;56(3):280-295. doi: 10.1080/10376178.2020.1841014. Epub 2020 Nov 16.
Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for.
去机构化后，精神卫生主流化导致大量患者前往急诊部（ED）就诊。评估过程需要 ED 分诊护士对患者进行快速评估，分配一个临床适当的分诊分数，然后将患者转介给精神科临床医生。初步评估很重要，许多因素会影响分诊、转介和反应过程，包括对精神卫生就诊严重性的理解。为了了解影响精神疾病患者 ED 分诊评估、转介和临床反应的因素。本研究采用民族志方法作为研究设计的基础。在一家地区医院工作的 ED 分诊护士和精神卫生分诊护士通过访谈和观察提供了见解。该研究还参考了有关分诊的机构政策和程序。通过对深入访谈、现场笔记和备忘录进行分析，采用了归纳主题过程。精神卫生分诊护士和 ED 分诊护士一致认为，分诊是 ED 就诊的精神健康问题患者评估过程的重要组成部分。及时且临床准确的评估，随后的转介和反应受到用户对精神卫生分诊量表的了解程度以及对精神卫生严重性的理解程度的强烈影响。这两个专业护理群体之间的相互冲突的理解，被称为专业文化取向，进一步影响了这个过程。对精神卫生分诊的专业文化取向和对严重性理解的认知会影响紧急精神卫生分诊的过程，因此可能会影响患者的最佳治疗效果。需要进一步研究 ED 分诊设计、ED 分诊教育以及对严重性的共识。
