Self-perceptions’ knowledge, training, management and personal experience in psychiatric emergencies according to work experience: an explorative study among Italian nurses employed in the Emergency Departments

doi:10.21203/rs.3.rs-3208132/v1

Background: In Italy, the number of incoming arrives in Emergency Departments (ED) that include psychiatric patients has significantly increased. To assess how ED nurses perceived their self-perceptions’ knowledge, the arguments of the greatest interest in the training and management of psychiatric emergencies and also personal experience in emergency psychiatric patients according to both nursing educational levels and work experience.

Methods: An observational, cohort, cross-sectional and multicenter study was conducted from August to September 2022.

Results: This study was completed with 413 Italian nurses surveyed. Knowledge in psychiatric emergency conditions was important for an emergency nurse (t=2.444, p=.015), and nurses considered as important current knowledge on issues of relevant to emergency psychiatry (t=3.516, p<.001). Significant associations were assessed between: nursing educational level and psychiatric aggressions received (t=-2.675, p=0.008) and arguments of interactions with psychiatric drugs (t=-2.106; p=0.036); with the hypochondriacally anxiety (t=-2.274; p=0.024); the hallucinated patients (t=2858; p=0.004); the use of counseling in psychiatric wards (t=1.555, p=0.121). Significant associations were recorded between work experience and pharmacological management of the psychiatric patients (t=-3.035; p=.003); psychiatric drugs in emergency (t=2.758; p=.006); medico-legal aspects in psychiatric emergencies (t=2.554; p=.011); the management of negative experiences of the multidisciplinary team towards the patient (t=-2.684; p=.008); patients who simulated (t=-2.138; p=.033).

Conclusions: ED nurses required to perform their knowledge to identify the psychological and the physical signs and symptoms of psychological distress as well as the skills to provide appropriate care at the EDs, by improving nurses’ competencies to recognize and manage psychiatric patients.

Knowledge

Management

Psychiatric Emergency

Self-perceptions

Training

Work experience

The World Health Organization (WHO) stated that psychiatric disorders progresses to arise by impacting on societies all around the world [1–3], in both moderate and severe forms, by involving individuals in children, young older individuals’ age groups [2, 4]. According to data from the Information System for Mental Health (SISM), in 2018, in Italy, 837,000 people suffered from psychiatric diseases [5]. Consequentially, the number of incoming arrives in Emergency Departments (ED) that include psychiatric patients has significantly increased [6–8]. Therefore, the ED should be considered as a dynamic department in which healthcare workers employed inevitably face up with different conditions requiring high standard of nursing management [9]. Therefore, nurses belonging to EDs are expected to have both knowledge and competences to manage both physical and psychological diseases, by including also psychiatric disorders, too [10]. In fact, most emergency episodes included alcohol and drugs abuse, behavioral and psychiatric disorders, which also arrive at the ED in association to chest pain, breathing difficulties, unaware attacks, dizziness or stroke, accomplished with a wide range of signs and symptoms, varying from moderate symptomatology, as anxiety, depression, suicide attempts, alcohol or drug abuse, panic attacks, to severe, as schizophrenia. somatic disorders, such as headaches, gastrointestinal problems or neurological and nervous tension. Moreover, mental disorders might be considered as a secondary disease after cancer, diabetes and heart disease [11–13]. In Swedish study it was evidenced that patients suffering from a combination of severe mental illness and somatic disease reported a higher risk in mortality rate, than patients without severe mental disorders [14]. This condition may be caused also by considering that individuals suffering from mental health disorders are presumably in primary necessity of somatic care than many other groups. Emergency and unscheduled hospital accesses are very frequent, particularly when a patient presents a combination of both mental and physical conditions [6]. Therefore, healthcare systems should totally include both psychiatric and physical healthcare conditions in order to perceive the individual as a whole system to link the existing gap between mental and physical healthcare efforts [15]. To guarantee high standards in quality care, nurses must be trained in the suitable attitudes in their advances to patients, mental health work tasks.

Previous studies suggested that the purpose of nursing practices differs, by depending on their education, degree and work experience, by impacting on the nature and level of the care they supply [16–18]. The two main barriers that obstacle patients suffering from mental disorders to receive the right care are: negative approaches and both individual and social stigma relating to mental disorders. Evidence suggested as nurses worked in psychiatric settings [19] compared to nurses working in somatic care reported a higher negative attitude in psychiatric patients, too. In this regard, nurses believe are overlapped, in many aspects to public believes on psychiatric disorders and their patients [20, 21].

Aim

The present study aimed to assess how nurses, who were employed in Emergency Departments, perceived their self-perceptions’ knowledge, the arguments of the greatest interest in the training and management of psychiatric emergencies and also personal experience in emergency psychiatric patients according to both nursing educational levels and work experience, respectively. Specifically, the present study purposed to assess if nursing educational levels and work experience could be very essential determinants in all these tasks related to manage psychiatric emergencies or not.

Study design

An observational, cohort, cross-sectional and multicenter study was conducted.

Study Approach

From August 2022 to September 2022, it was carried out thorough all the Italian territory an on-line study, which was spread through social media professional pages in Facebook and Instagram, using the “Snowball sampling” technique for statistical sampling until the sample was saturated.

Enrollment

All registered nurses who were employed both in private and public Emergency Department in all the Italian territory were potentially reachable to participate for the present study. The minimum statistically significant sample size was assessed through the Cochran formula [22]. By considering that in Italy there are a total of about 360,000 nurses employed and by fixing 95% as the confidence level and 5% as the confidence interval, the representative sample size of the Italian nursing population belonged to an emergency department was 378.

The questionnaire

In the first part of the questionnaire socio-demographic characteristics were collected, specifically:

Sex, as female and male;
Age, expressed in years, divided into five sub categories, like: until 30 years, 31–40 years, 41–50 years, 51–60 years and over 61 years;
Educational level in nursing, such as the participant had the Italian basic level in nursing (3 years in nursing education) or the specialized level (5 years in nursing education);
Job role, like: registered nurse, nursing coordinator or nursing manager;
Work experience in Emergency Department, specifically: until 1 year, until 5 years, until 10 years, until 20 years, until 30 years and over 31 years;
Shift work, as the interviewer was employed only during the morning, or both during the morning and the afternoon, or also during the night shift.

In the second part of the questionnaire, 3 items were proposed to assess self-perception’s knowledge in psychiatric emergency management in nurses. For each item a Linkert-scale was associated, in which value “1” was associated to a low self-perception, value “2” was linked to a medium level of perception and value “3” was associated to a high self-perception level.

Additionally, in the third part of the questionnaire it was proposed a total of 6 items which explored which personal experience in psychiatric emergencies interviewers experienced in their workplaces and if they perceived their workplaces as safe or not. For each item a Linkert scale was associated to indicate the frequency levels, such as:1 = rarely, 2 = on average, 3 = often.

Finally, in the fourth part of the questionnaire, 30 items were proposed which contained the most frequent arguments treated in the psychiatric emergencies, by asking to participants to expressed their grade of importance for them. For each items proposed a Likert scale was associated to indicate the interest level perceived, specifically: 1 = low, 2 = medium, 3 = high. All the items proposed in investigating nursing psychiatric emergency showed a good reliability, as α = .900.

Data assessment

All data were collected in an Excel data sheet and then processed thanks to the SPSS, IBM, version 20. all sampling characteristics collected were considered as categorical variables and presented as frequencies and percentages. Then, for all the three dimensions investigated relating to the psychiatric emergencies, linear regressions were performed in order to evaluate what conditions were significantly associated to nursing educational levels and work experience. Finally, for only significant associations, frequencies and percentages were explained in order to demonstrate how this trend was significant. All p-values < .05 were considered as statistical significant.

Ethical concerns

Informed consent

was obtained from all the participants. The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethical Committee of Polyclinic in Bari, Italy, with id number 7179/2022 (protocol code 0019642/28/02/2022, approval at February 28, 2022).

In the current study, 413 Italian nurses, all belonged to an Italian Emergency Department setting, voluntary agreed to participate in the present study. All sampling characteristics were explained in the Table 1.

Table 1

Sampling characteristics (n = 413)
Sampling characteristics	n(%)
Sex Female Male	282(66.3) 131(31.7)
Age Until 30 years 31–40 years 41–50 years 51–60 years Over 61 years	222(53.8) 118(28.6) 35(8.5) 35(8.5) 3(0.7)
Work Experience Until 1 year Until 5 years Until 10 years Until 20 years Until 30 years Over 31 years	38(9.2) 193(46.7) 61(14.8) 66(16) 35(8.5) 20(4.8)
Educational level 3 years 5 years	404(97.8) 9(2.2)
Job profile Registered Nurse Coordinator Nurse Manager Nurse	382(92.5) 29(7) 2(0.5)
Work shift One shift (during the morning) Two shifts (during the morning and the afternoon) Three shifts (during the morning, the afternoon and the night)	9(2.2) 57(13.8) 347(84)

In Table 2, the association between self-perception knowledge in psychiatric emergencies and work experience were assessed. Data showed that knowledge of psychiatric emergency conditions was important for an emergency nurse (t = 2.444, p = .015), and nurses considered as important current knowledge on issues of relevant to emergency psychiatry (t = 3.516, p < .001). On the other hand, none significant associations were recorded between nursing educational level and the three items reported.

Table 2

Linear associations between self-perception knowledge in psychiatric emergencies and work experience.
	Nursing educational level		Work experience
Items	t	p-value	t	p-value
Item no.1 Do you think that knowledge of psychiatric emergency situations is important for an emergency nurse?	1.561	.119	2.444	0.015*
Item no.2 How do you assess your current knowledge of issues relevant to emergency psychiatry?	.293	.770	3.516	> 0.001*
Item no.3 After managing the PE (psychiatric emergency), does your emotional burden result?	.393	.695	-1.560	0.120
Note: Adjust R²(Nursing educational level) = 0.002; Adjust R²(Work experience) = 0.027; *p < 0.05 is statistical significant.

In Table 3, none significant associations were assessed between personal experience in psychiatric emergencies and work experience. Meanwhile, significant associations were measured between nursing educational level and psychiatric aggressions received (t=-2.675, p = 0.008) and the use of counseling in psychiatric wards (t = 1.555, p = 0.121).

Table 3

Personal experience on psychiatric emergencies associated to work experience.
	Nursing educational level		Work experience
Items	t	p-value	t	p-value
Item no.4 How often PE (psychiatric emergency) arrived?	0.134	0.893	-1.845	0.066
Item no.5 Have you ever been a victim of assault by the psychiatric patient during his shift?	-2.675	0.008*	1.959	0.051
Item no.6 Does he feel safe in the workplace?	0.179	0.858	.422	0.673
Item no.7 How many times have you been the victim of aggressive behavior?	1.876	0.061	1.240	0.216
Item no.8 How often do you resort to the use of restraints?	-0.708	0.479	.655	0.513
Item no.9 How often do you resort to the use of counseling / hospitalization in psychiatry wards?	2.914	0.004*	1.555	0.121
Note: Adjust R²(Nursing educational level) = 0.027; Adjust R²(Work experience) = 0.035; *p < 0.05 is statistical significant.

In Table 4, the association between the arguments of the greatest interest in the training and management in psychiatric emergencies and nursing educational level and work experience were evaluated. Data highlighted significant associations between nursing educational level and arguments of interactions with psychiatric drugs (t=-2.106; p = 0.036); with the hypochondriacally anxiety (t=-2.274; p = 0.024); and also the hallucinated patients (t = 2858; p = 0.004). Additionally, findings demonstrated significant associations between work experience and pharmacological management of the psychiatric patients (t=-3.035; p = .003); psychiatric drugs in emergency (t = 2.758; p = .006); medico-legal aspects in psychiatric emergencies (t = 2.554; p = .011); the management of negative experiences of the multidisciplinary team towards the patient (t=-2.684; p = .008); patients who simulated (t=-2.138; p = .033).

Table 4

Arguments of the greatest interest in the training and management of psychiatric emergencies according to work experience.
	Nursing educational level		Work experience
Items	t	p-value	t	p-value
Item no.10 The aggressive and / or violent patient	0.517	0.605	1.163	0.246
Item no.11 Pharmacological management of the psychiatric patient	-0.034	0.973	-3.035	0.003*
Item no.12 Alcohol abuse	1.657	0.098	.873	0.383
Item no.13 Psychiatric drugs in emergency	-0.350	0.727	2.758	0.006*
Item no.14 Prevention of PTSD	-1.879	0.061	.395	0.693
Item no.15 Communication of Bad News	0.386	0.699	− .476	0.635
Item no.16 The medico-legal aspects in psychiatric emergencies	0.828	0.408	2.554	0.011*
Item no.17 Mental disorders that simulate medical pathologies	0.863	0.389	.144	0.885
Item no.18 Mental disorders from medical causes	-0.758	0.449	.616	0.539
Item no.19 Adverse reactions to neuroleptics	0.640	0.523	1.604	0.109
Item no.20 Interactions of psychiatric drugs	-2.106	0.036*	− .837	0.403
Item no.21 Behavioral intervention in emergencies	1.504	0.133	.608	0.543
Item no.22 Hypochondriacally anxiety	-2.274	0.024*	.422	0.673
Item no.23 The patient who is a victim of trauma	1.431	0.153	1.468	0.143
Item no.24 Psychiatric counseling and the request for hospitalization	0.037	0.970	.837	0.403
Item no.25 Substance abuse	-0.280	0.780	1.460	0.145
Item no.26 The management of negative experiences of the multidisciplinary team towards the patient	1.960	0.051	-2.684	0.008*
Item no.27 Psychomotor arrest	-0.237	0.813	− .430	0.668
Item no.28 The patient who refuses treatment	-1.452	0.147	-1.806	0.072
Item no.29 The confused and agitated patient	-0.839	0.402	1.361	0.174
Item no.30 The suicidal risk	-0.194	0.847	-1.091	0.276
Item no.31 The hallucinated patient	2.858	0.004*	.217	0.828
Item no.32 The brief psychiatric evaluation	0.034	0.973	-1.198	0.232
Item no.33 Nursing management	0.299	0.765	− .346	0.729
Item no.34 Psychiatric disorders	0.890	0.374	− .612	0.541
Item no.35 The patient who simulates	-1.010	0.313	-2.138	0.033*
Item no.36 Pseudo-dementia	0.487	0.627	− .627	0.513
Item no.37 Epileptic pseudo-crises	1.711	0.088	.407	0.684
Item no.38 The panic attack	-1.417	0.157	-1.165	0.245
Note: Adjust R²(Nursing educational level) = 0.010; Adjust R²(Work experience) = 0.050; *p < 0.05 is statistical significant.

In Table 5, variations in significant associations were assessed according to nursing educational level.

Table 5

How varied significant linear associations according to nursing educational level.
Items/ nursing educational level	3 year	5 years
Item no.5 Low Medium High	61(14.8) 184(44.6) 159(38.5)	2(0.5) 5(1.2) 2(0.5)
Item no.9 Low Medium High	30(7.3) 181(43.8) 193(46.7)	0(0) 0(0) 9(2.2)
Item no.20 Low Medium High	18(4.4) 95(239 291(70.5)	0(0) 3(0.7) 6(1.5)
Item no.22 Low Medium High	31(7.5) 89(21.5) 284(68.8)	0(0) 4(1) 5(1.2)
Item no.31 Low Medium High	15(3.6) 65(15.7) 324(78.5)	0(0) 0(0) 9(2.2)

In Table 6, variations in significant associations were assessed according to work experience.

Table 6

How varied significant linear associations according to work experience.
Items/ work experience	Until 1 year	Until 5 years	Until 10 years	Until 20 years	Until 30 years	Over 31 years
Item no.1 Low Medium High	0(0) 12(2.9) 26(6.3)	11(2.7) 52(12.6) 130(31.5)	0(0) 11(2.7) 50(12.1)	0(0) 22(5.3) 44(10.7)	1(0.2) 10(2.4) 24(5.8)	0(0) 4(1) 16(3.9)
Item no.2 Low Medium High	5(1.2) 15(3.6) 18(4.4)	26(6.3) 92(22.3) 75(18.2)	2(0.5) 32(7.7) 27(6.5)	5(1.2) 20(4.8) 41(9.9)	5(1.2) 10(2.4) 20(4.8)	0(0) 9(2.2) 11(2.7)
Item no.11 Low Medium High	0(0) 5(1.2) 33(8)	6(1.5) 35(8.5) 152(36.8)	1(0.2) 18(4.4) 42(10.2)	0(0) 17(4.1) 49(11.9)	2(0.5) 7(1.7) 26(6.3)	2(0.5) 2(0.5) 16(3.9)
Item no.13 Low Medium High	0(0) 6(1.5) 32(7.7)	15(3.6) 31(7.5) 147(35.6)	0(0) 12(2.9) 49(11.9)	1(0.2) 5(1.2) 60(14.5)	0(0) 1(0.2) 34(8.2)	0(0) 3(0.7) 17(4.1)
Item no.16 Low Medium High	1(0.2) 5(1.2) 32(7.7)	21(5.1) 47(11.4) 125(30.3)	4(1) 11(2.7) 46(11.1)	1(0.2) 6(1.5) 59(14.3)	0(0) 6(1.5) 29(7)	1(0.2) 5(1.2) 14(3.4)
Item no.26 Low Medium High	2(0.5) 4(1) 32(7.7)	22(5.3) 51(12.3) 120(29.1)	9(2.2) 11(2.7) 41(9.9)	10(2.4) 8(1.9) 48(11.6)	2(0.5) 5(1.2) 28(6.8)	2(0.5) 5(1.2) 13(3.1)
Item no.35 Low Medium High	0(0) 3(0.7) 35(8.5)	11(2.7) 36(8.7) 146(35.4)	2(0.5) 6(1.5) 53(12.8)	1(0.2) 12(2.9) 53(12.8)	2(0.7) 6(1.5) 26(6.3)	0(0) 5(1.2) 15(3.6)
*p < 0.05 is statistical significant.

The present study aimed to assess how nurses, who were employed in Emergency Departments, perceived their self-perceptions’ knowledge, the arguments of the greatest interest in the training and management of psychiatric emergencies and also personal experience in emergency psychiatric patients according to both nursing educational levels and work experience, respectively. Specifically, the present study purposed to assess if nursing educational levels and work experience could be very essential determinants in all these tasks related to manage psychiatric emergencies or not.

Data highlighted that knowledge of psychiatric emergency conditions was important for an emergency nurse and nurses considered as important current knowledge on issues of relevant to emergency psychiatry. Additionally, significant associations were reported between nursing educational level and psychiatric aggressions suffered and the use of counseling in psychiatric wards.

Arguments considered as important for nurses, by considering their educational levels, were: the interactions with psychiatric drugs, the hypochondriacally anxiety, and also the hallucinated patient management. Additionally, arguments considered important in relation to their work experience were: pharmacological management, psychiatric drugs’ administration during emergency, medico-legal aspects in psychiatric emergencies, negative experience management throughout a multidisciplinary team, the management of patients who simulated.

Always literature have shown that by associating knowledge to practice was one starting point in both nursing qualities delivered and outcomes reached, too. Although, it seemed that there was a a knowledge gap between educational and practical training in psychiatric emergency management during the nursing undergraduate education [23]. In fact, it was highlighted that nurses, who were employed in EDs reported low skills in this field by also encountering obstacles in identifying psychological disorders than physical ones, since they emphasized physical symptoms rather than psychological ones [24, 25]. Additionally, nurses in EDs reported more difficulties in psychological and psychiatric disorders management, which represented also a confounding factor during the triage phase, too [23, 26]. In the AlShibi et al. [27], study it was suggested that work experience in EDs nurses had no significant correlation with their competencies in managing psychological and psychiatric emergencies [27], meanwhile nurses who were trained for specialized courses in psychiatric and psychological management registered higher levels in these skills than the other ones. Findings suggested the importance of specific training courses in this field for nurses employed in EDs [28–31], since the EDs were always the first department where psychiatric patients with acute episodes received assistance. However, when ED nurses delivered nursing assistance to patients, they often suffered also from abuse, aggression, by experiencing negative emotions of loneliness and helplessness, that required, at the same time, patient’s sedation. Therefore, gap in ED nursing knowledge in psychiatric emergencies management could be a key- factor in stress inducing in EDs nurses, which could negatively reflect in the willingness of ED nurses in caring for psychiatric patients [32], which also underlined the importance of suitable nursing intervention in emergency care in psychiatric patients [33]. In this field, the present study was a “near” pilot study, since in the current literature there were very few studies which examined nursing in ED, specifically for psychiatric patients [34, 35]. Additionally, EDs are very busy environments where there was always a lack in appropriate communication and listening comfortable techniques adopted by nurses toward patients [36, 37]. These findings were supported to previous studies in which both ED nurses highlighted lack communication abilities [37] and also psychiatric patients recognized how ED nurses may be good at resuscitation but not at communication and listening practices [38], by reporting a gap in nurse–patient communication competences which need to be warranted [37].

Therefore, professional psychiatric nursing training or continued education was essential for psychiatric patient management. Arguments considered as important in this specific training were also recognized in the present study.

The present study contributed an in-depth understanding of the experiences of ED nurses who faced up also psychiatric patients. The open environment of EDs increased gaps in privacy, exposed patients to external stimuli, also in aggressions, by arising the difficulties in ED nurses in stress management and care delivering in psychiatric patients. Increasing psychiatric care competencies could be considered as urgent needs for ED nurses. Emergency nursing practices and continuing nursing education at EDs could facilitate also policy decision-makers. ED nurses required to perform their knowledge to identify the psychological and the physical signs and symptoms of psychological distress as well as the skills to provide appropriate care at the EDs, by improving nurses’ competencies to recognize and manage psychiatric patients.

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethical Committee of Polyclinic in Bari, Italy, with id number 7179/2022 (protocol no. 0019642/28/02/2022, approval at February 28, 2022).

Consent for publication

Not applicable.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available since they will be object for further analyses, but are available from the corresponding author on reasonable request.

Competing interests

None.

Funding

None.

Authors' contributions

Y.C.C: contributed to manuscript writing and supervision.

R.M. collected data.

E.V. contributed to the study conception and design, material preparation, data collection and analysis, manuscript writing and supervision.

All authors read and approved the final manuscript.

Acknowledgements

Authors thank all Nurses who participated in the present study.

National Health Insurance Administration. Top 20 Diseases in Medical Expenses of Universal Health Insurance in 2015. Available online: www.nhi.gov.tw/Resource/webdata/ (accessed on October 16, 2021).
Mental Disorders. (2019). https://www.who.int/en/news-room/factsheets/detai l/menta l-disor ders/ (accessed on October 162020).
Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014 Apr;43(2):476-93. doi: 10.1093/ije/dyu038.
Holzer BM, Minder CE, Rosset N, et al. Patient characteristics and patterns of intoxication: one-time and repeated use of emergency ambulance services. Journal of Studies on Alcohol and Drugs. 2013 May;74(3):484-489. doi: 10.15288/jsad.2013.74.484.
Monteleone P, Amore M, Cabassi A, Clerici M, Fagiolini A, Girardi P, Jannini EA, Maina G, Rossi A, Vita A, Siracusano A. Attitudes of Italian Psychiatrists Toward the Evaluation of Physical Comorbidities and Sexual Dysfunction in Patients With Schizophrenia. Implications for Clinical Practice. Front Psychiatry. 2019; 10:842. doi: 10.3389/fpsyt.2019.00842.
Duncan EAS, Best C, Dougall N, et al. Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study. Scand J Trauma Resusc Emerg Med. 2019;27(1):34. doi:10.1186/s13049-019-0611-9
Prener C, Lincoln AK. Emergency medical services and "psych calls": Examining the work of urban EMS providers. Am J Orthopsychiatry. 2015 Nov;85(6):612-9. doi: 10.1037/ort0000077.
Harley A, Johnston ANB, Denny KJ, Keijzers G, Crilly J, Massey D. Emergency nurses' knowledge and understanding of their role in recognising and responding to patients with sepsis: A qualitative study. Int Emerg Nurs. 2019 Mar;43:106-112. doi: 10.1016/j.ienj.2019.01.005.
McCaffery M, Grimm MA, Pasero C, Ferrell B, Uman GC. On the meaning of "drug seeking". Pain Manag Nurs. 2005 Dec;6(4):122-36. doi: 10.1016/j.pmn.2005.08.002. PMID: 16337561.
Wilsey BL, Fishman SM, Crandall M, Casamalhuapa C, Bertakis KD. A qualitative study of the barriers to chronic pain management in the ED. Am J Emerg Med. 2008 Mar;26(3):255-63. doi: 10.1016/j.ajem.2007.05.005.
Banks E, Byles JE, Gibson RE, Rodgers B, Latz IK, Robinson IA, Williamson AB, Jorm LR. Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study. Med J Aust. 2010 Sep 6;193(S5):S62-7. doi: 10.5694/j.1326-5377.2010.tb03931.x.
Holden L, Scuffham P, Hilton M, Vecchio N, Whiteford H. Psychological distress is associated with a range of high-priority health conditions affecting working Australians. Aust N Z J Public Health. 2010 Jun;34(3):304-10. doi: 10.1111/j.1753-6405.2010.00531.x.
Wang PS, Angermeyer M, Borges G, Bruffaerts R, Tat Chiu W, DE Girolamo G, Fayyad J, Gureje O, Haro JM, Huang Y, Kessler RC, Kovess V, Levinson D, Nakane Y, Oakley Brown MA, Ormel JH, Posada-Villa J, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Chatterji S, Ustün TB. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2007 Oct;6(3):177-85.
Lundin A, Modig K, Halldin J, et al. Mental disorder and long-term risk of mortality: 41 years of follow-up of a population sample in Stockholm, Sweden. Epidemiology and Psychiatric Sciences. 2016;25(4):384-392. doi: 10.1017/s2045796015000487.
Vreeland B. Bridging the gap between mental and physical health: a multidisciplinary approach. J Clin Psychiatry. 2007;68 Suppl 4:26-33.
McCann TV, Savic M, Ferguson N, et al. Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics. BMJ Open 2018;8:e023860. doi:10.1136/ bmjopen-2018-023860
Roberts L, Henderson J. Paramedic perceptions of their role, education, training and working relationships when attending cases of mental illness. Australasian Journal of Paramedicine [Internet]. 2009Aug.6 [cited 2023May27];7(3).
Sjölin H, Lindström V, Hult H, Ringsted C, Kurland L. What an ambulance nurse needs to know: a content analysis of curricula in the specialist nursing programme in prehospital emergency care. Int Emerg Nurs. 2015 Apr;23(2):127-32. doi: 10.1016/j.ienj.2014.09.002.
Chambers M, Guise V, Välimäki M, Botelho MA, Scott A, Staniuliené V, Zanotti R. Nurses' attitudes to mental illness: a comparison of a sample of nurses from five European countries. Int J Nurs Stud. 2010 Mar;47(3):350-62. doi: 10.1016/j.ijnurstu.2009.08.008.
Björkman T, Angelman T, Jönsson M. Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care. Scand J Caring Sci. 2008 Jun;22(2):170-7. doi: 10.1111/j.1471-6712.2007.00509.x.
Vitale E, Lupo R, Lezzi A, Zacchino S, Calabrò A, Carvello M, ... & Conte L. General population attitudes in mental disorders: an investigatory study on psychiatric disorders and religion beliefs. Official Journal of the Italian Society of Psychopathology 2022; 28: 15-26.
Cochran WG. Sampling Techniques, 2nd Ed., New York: John Wiley and Sons, Inc, 1963.
Ghannam BM, Hamdan-Mansour AM, Al Abeiat DD. Psychological Correlates of Burden Among Jordanian Caregivers of Patients With Serious Mental Illness. Perspect Psychiatr Care. 2017 Oct;53(4):299-306. doi: 10.1111/ppc.12179.
Jelinek GA, Weiland TJ, Mackinlay C, Gerdtz M, Hill N. Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study. Int J Emerg Med. 2013 Jan 15;6(1):2. doi: 10.1186/1865-1380-6-2.
Polevoi SK, Jewel Shim J, McCulloch CE, Grimes B, Govindarajan P. Marked reduction in length of stay for patients with psychiatric emergencies after implementation of a comanagement model. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2013; 20(4): 338–343. doi: 10.1111/acem.12105
Sivakumar S, Weiland TJ, Gerdtz MF, Knott J, Jelinek GA. Mental health-related learning needs of clinicians working in Australian emergency departments: a national survey of self-reported confidence and knowledge. Emerg Med Australas. 2011 Dec;23(6):697-711. doi: 10.1111/j.1742-6723.2011.01472.x.
AlShibi AN, Hamdan-Mansour AM. Nurses' Knowledge and Skills to Manage Patients with Psychological Distress in Emergency Departments. The Open Nursing Journal 2020; 14(1).
World Health Organization; Psychological first aid: Guide for field workers Retrieved June 2, 2019. Avaiable on: https://apps.who.int/iris/bitstream/handle/10665/44615/9789241548205_eng.pdf;jsessionid=C1B91DA343B0878EA26711A16F186CC5?sequence=1 Accessed on October 20,2022
Fawaz M, Tassi A, Hamdan-Mansour A. Challenges facing nursing education in the advanced healthcare environment. Int J Afr Nurs Sci. 2018; 9: 105-10. doi:10.1016/j.ijans.2018.10.005
Fawaz MA, Hamdan-Mansour AM. Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students. Nurse Educ Today. 2016 Nov;46:36-42. doi: 10.1016/j.nedt.2016.08.026.
Atallah MA, Hamdan-Mansour AM, Al-Sayed MM, Aboshaiqah AE. Patients' satisfaction with the quality of nursing care provided: the Saudi experience. Int J Nurs Pract. 2013 Dec;19(6):584-90. doi: 10.1111/ijn.12102.
Saurman E, Kirby SE, Lyle D. No longer 'flying blind': how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study. BMC Health Serv Res. 2015 Apr 14;15:156. doi: 10.1186/s12913-015-0839-7.
Hakenewerth AM, Tintinalli JE, Waller AE, Ising A. Emergency Department Visits by Older Adults with Mental Illness in North Carolina. West J Emerg Med. 2015 Dec;16(7):1142-5. doi: 10.5811/westjem.2015.8.27662.
Pereira LP, Duarte MLC, Eslabão AD. Care for people with psychiatric comorbidity in a general emergency unit: vision of the nurses. Rev Gaucha Enferm. 2019 Jun 10;40:e20180076. Portuguese, English. doi: 10.1590/1983-1447.2019.20180076.
Marynowski-Traczyk D, Moxham L, Broadbent M. Emergency Department Registered Nurses' conceptualisation of recovery for people experiencing mental illness. Australas Emerg Nurs J. 2017;20(2):75-81. doi: 10.1016/j.aenj.2017.04.002.
Thomas KC, Owino H, Ansari S, Adams L, Cyr JM, Gaynes BN, Glickman S W. Patient-Centered Values and Experiences with Emergency Department and Mental Health Crisis Care. Administration and policy in mental health 2018; 45(4): 611–622. doi: 10.1007/s10488-018-0849-y
Lopes PF, Melo LL, Moreno V, Toledo VP. Embracement of the person with mental illness at an emergency hospital service: a qualitative research. Rev Bras Enferm. 2020 Mar 9;73(2):e20180671. English, Portuguese. doi: 10.1590/0034-7167-2018-0671.
Lindström V, Sturesson L, Carlborg A. Patients' experiences of the caring encounter with the psychiatric emergency response team in the emergency medical service-A qualitative interview study. Health Expect. 2020 Apr;23(2):442-449. doi: 10.1111/hex.13024.

No competing interests reported.

Self-perceptions’ knowledge, training, management and personal experience in psychiatric emergencies according to work experience: an explorative study among Italian nurses employed in the Emergency Departments

Status:

Version 1

Abstract

Introduction

Aim

Materials and Methods

Study design

Study Approach

Enrollment

The questionnaire

Data assessment

Ethical concerns

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1