Psychiatric and Mental Health Nursing Commons^™

Introducing Education For Sensory Approaches In Mental Health-Related Emergency Department Visits: A Quality Improvement Project To Enhance Patient-Centered Care, Jesse O'Neill

Master's Theses and Capstones

Background: Barriers to specialty care access have resulted in emergency departments (ED) operating as temporary psychiatric hold facilities for their communities. Patients boarding in the ED are demonstrated to use a disproportionate percentage of facility resources with minimal benefit to the patient. The Institute for Healthcare Improvement identifies the impact of the healthcare environment on patient outcomes and suggests staff training to foster trauma-informed practice culture (Schall et al., 2020).

Local Problem: High-stress healthcare environments can escalate maladaptive patient behaviors and the use of restrictive interventions. Traditional use of restrictive interventions lacks supportive evidence and contradicts person-centered care goals (Molloy …

Increasing The Frequency Of Behavior Assessment To Reduce Physical Restraint, Breanne N. Ford

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to implement a system that routinely assesses for behavior changes in psychiatric patients presenting to the emergency department to improve staff intervention of escalating behaviors and decrease physical restraint use.

Background: The project was implemented in a 45-bed emergency department in a community-based hospital affiliated with a large hospital system in Houston, Texas.

Methodology: The project utilizes the Behavioral Activity Rating Scale (BARS) to assess patients' behaviors at routine intervals throughout shifts and a comfort cart that houses several non-pharmacological intervention items to use to de-escalate adverse behaviors. The staff …

Using Education To Confidently Identify And Report Concerns Of Child Abuse And Neglect: A Qualitative Improvement Initiative Through Staff Development, Sarah E. Neilson

Master's Theses and Capstones

BACKGROUND: Pre-licensure education on child abuse and neglect is crucial for nurses in the healthcare field. It helps to equip them with the knowledge and skills necessary to effectively identify, report, and intervene in cases of child abuse and neglect. Having this education available and understanding the signs and effects of child abuse and neglect, empowers nurses to take quick and decisive action in early intervention and prevention. Within the microsystem of a local Operating Room (OR), this quality improvement (QI) project will determine the muchneeded addition to the healthcare curriculum.

METHODS: The Plan, Do, Study, Act (PDSA) framework was …

Utilizing A Validated Screening Tool And Treatment Protocol For Managing Agitation And Violence In A Psychiatric Emergency Services Unit, Zarah Ashcroft

Doctor of Nursing Practice

Background and Significance. Agitation is a significant concern in psychiatric units. If not detected early, agitated individuals are at high risk for becoming aggressive and violent, potentially causing harm to themselves, hospital staff, and property. The Psychiatric Emergency Services unit receives agitated and violent patients with psychiatric illnesses and substance use disorders. Purpose/Goal/Objectives. This quality improvement project aimed to implement a treatment protocol using the Broset Violence Checklist (BVC) to promote the early identification and management of potential for patient violence and aggression. Methods/Key Activities. Staff education for the nurses and providers on assessing patients at risk for aggression and …

Boarding Barriers For Psychiatric Patients In Emergency Departments, Emmeline B. Martin Bsn, Rn, Alison Rossano Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Objective To identify past or current literature about emergency department holds and psychiatric patients consisting of the evaluation of patient outcomes, satisfaction and equity of care. It is already known that shorter boarding times from the emergency department to a psychiatric unit have positive patient outcomes such as a decrease in readmissions, increase in patient satisfaction and efficiency in appropriate treatment.

Method A scoping review to analyze data by grouping articles into themes which included authors, date of publication, aims/purpose, methodology, sample, interventional details, and the key findings in each article. Excluded articles included those discussing COVID-19 and case management. …

Utilization Of The Calm Apparatus To Adult Men And Women With Atrial Fibrillation To Decrease Emergency Department Visits For Atrial Fibrillation, Ami Klein

Doctor of Nursing Practice Scholarly Projects

The purpose of this project is two-fold. The first is to determine if the CALM APP use by adult men and women with atrial fibrillation (AF) will decrease anxiety. The second is to determine if decreased anxiety utilizing the CALM APP will deter admissions to the emergency department (ED) for AF in the first month post-catheter ablation of AF. The Zung SAS was used to determine the pre- and post-anxiety scores. The Seven Days of Calm (free app) was used to teach deep breathing and meditation. This study showed a moderate decrease in ED visits with use of the Calm …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Increased Discharge Compliance Through Mental Health Follow-Up, Robert H. Kirby

MSN Capstone Projects

Emergency departments are being strained to their breaking points as a result of the recent COVID pandemic. These departments are in need of programs that can help to reduce stress on not only limited budgets but also reduce the strain on their overwhelmed staff. One such strain on emergency departments and their limited resources is the readmittance of mental health patients as a result of non-compliance of the discharge instructions. The change project looks to address whether following up 10 days post discharge can increase discharge instruction compliance and ultimately reduce readmissions. The aim of the project is through the …

Implementing Safeplan: A Communication Template For Emergency Nurses Caring For Psychiatric Patients, Michele Leigh Rudisill

Doctor of Nursing Practice Projects

This DNP Project explored the impact of introducing a communication template for emergency department (ED) nurses to use during handoff when caring for psychiatric patients. This need was identified as ED nurses are now caring for psychiatric patients for longer periods of time in the ED setting, sometimes weeks to months, due to limited inpatient mental health resources and resources in the community. ED nurses’ perceptions were surveyed and the need for a standardized, yet flexible communication template was identified. The literature was reviewed, and no such template was identified specific to ED nurses caring for the psychiatric patient population. …

Improving Emergency Department Nurses' Self-Perceived Self-Efficacy In Early Recognition Of Patients In A Mental Health Crisis, Mary Kay Silverman

DNP Scholarly Projects

Abstract

The two largest counties within Southwest Florida (SWFL) are Lee and Collier where mental health evaluations for children under the state’s Baker Act have more than doubled between 2011 and 2017 (Gluck & Zeitlin, 2019, p. 4). Given the marked increase in mental health evaluations, early recognition, assessment with initiation of treatment by nurses in the pediatric emergency department (ED) who present with behavioral health complaints must be a priority for emergency department leaders. Purpose: This quality improvement (QI) project proposed to improve a nurses’ self-efficacy through expanding knowledge in the recognition and identification of the signs and symptoms …

Evaluation Of Adolescent Adherence Treatment Following An Emergency Department Visit, Marcus Seaton

DNP Projects

Mental Health disorders affect 1 of 5 youth in the United States and are chronic conditions that affect adolescents’ ability to function at home, school, work, and with interpersonal relationships. Follow up adherence is imperative to ensure treatment goals are met. The purpose of this Doctor of Nursing (DNP) project was to examine factors associated with adherence to outpatient mental health (MH) treatment following an emergency department (ED) visit among adolescents admitted to an ED of a large hospital in a multi-system healthcare organization located in a metropolitan area of the southeastern United States (U.S.). This DNP project aims were …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Teaching And Evaluation Of Suicidal Assessment, Five-Step Evaluation And Triage (Safe-T) In The Emergency Department, Evangeline Rico

Doctoral Projects

Suicide remains to be a global and a national problem, and it continues to be one of the leading causes of death in the United States (U.S.) The Emergency Department (ED), being the gateway to the hospital can provide a great opportunity to assess each patient for suicidal ideation, and evaluate if patients present with risk factors for suicide. The competency of the ED staff plays a critical role in early recognition of patients who are at risk, and in implementing a plan of care for those with positive screens. However, researchers showed that knowledge deficit and lack of education …

Assessment And Re-Assessment Of Psychiatirc Patients Boarded In The Emergnecy Department: The Impact Of Compliance With Best Practice Standards On Patient Outcomes, Jacquelyn Byrd

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Psychiatric patients have been “deinstitutionalized” over recent decades with their care shifting from the inpatient to outpatient setting. As a result of the closing of more than 13,500 in-patient psychiatric beds between 2005 and 2010, emergency departments (ED) across the nation have become both safe havens and holding areas for psychiatric patients seeking care in the ED. The boarding of psychiatric patients in the ED impacts the timeliness of care provide to psychiatric and non-psychiatric patients alike lengthening door to discharge time for all patients. The purpose of this study is to assess the nursing staff’s compliance with departmental standards …