Improving the Assessment and Triage of Patients with Mental Illness ...

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efore an acceptable standard is achieved. The World health report (2001) made several recommendations of ways to tackle this worldwide mental health crisis (Appendix C) 2.3 Negative attitudes to mental illness. The frequent presentation of individuals with mental illness places an immense burden on an already overstretched resource that is the Emergency Department and therefore places further challenges on the ED staff of all disciplines (Rowe et al, 2011). They must contend with busy overcrowded departments, cope with abusive and aggressive individuals frustrated by long waiting times and still maintain a level of professionalism and competence in line with care for critically ill patients. This environment may be stressful for the staff but more importantly it can have adverse effects on the individual presenting with a mental illness (Thompson, 2005). In addition to this the patient may come in contact with a nurse or other healthcare professional with negative attitudes which can further distress the individual. Many emergency department staff will have had no formal training in the area of mental illness, in their formative years and hence there is a lack of confidence when caring for this particular group of patients (Wand, 2004, Thompson, 2005). Alongside this, many find this particular cohort of patient more difficult to deal with as it is considered that in some instances that they are attention seeking (Wheatley & Austin-Payne, 2009). This lack of knowledge and expertise leads to inconsistencies in the provision of appropriate and timely care of the mentally ill patient (McCann et al. 2007). N.I.C.E (2004) recommends that staff should be provided with training to enhance level of understanding, knowledge and competence. This should be addressed through carefully planned instruction, training and community awareness not just within the hospital setting but nationally. Given the prevalence of mental illness, it is of paramount importance that nurses and other health care professionals are trained adequately to meet the needs of this often marginalized group. The majority of research into the concept of negative “attitudes” towards self-harm. These studies cite self-harm as a major source of negative attitudes on the part of health care staff. One such study by McAllister et al (2002) surveyed thirty seven different hospitals in 8
Australia. The data was collected by way of questionnaires with a 35% response rate. The large sample size lends the study credibility. The researchers obtained their results by focusing on four aspects of nurses’ attributes, namely, confidence, empathy, dealing effectively with patients and the management of legal and hospital regulations. It found that nurses who obtained the higher scores in respect of all four were confident in their ability to care for these patients however there was still a high level of negativity towards the patients that self-harm. The research proposed that nurses should be up-skilled and educated in the assessment of patients that self-harm. It was indicated that continuous education is of great importance in the effort of reducing negative attitudes. The research of Wheatley and Austin- Payne (2009) also concluded that lack of education was a major contributing factor for negative attitudes to mental illness. As has been outlined, there are a number of reasons for negative attitudes towards those with mental illness. Nevertheless, the common theme cropping up in the review of the literature pertaining to the subject appears to be the lack of education on the issue of mental illness. It has been suggested that employing Mental Health Nurse Practitioners would enhance the delivery of a quality service to these patients (Wand, 2004). In that context, it is useful to turn attention once more to Australia, which appears, on the surface at least, to be investing huge resources into this particular area of healthcare provision. An example of this is The Royal Prince Alfred Hospital in Sydney has developed a role descriptor for its Mental Health Nurse Practitioners (Appendix D). The Australians have also taken the time to develop and introduce a triage tool which is used for the assessment and guidance of mental illness within Emergency Departments. This shall be discussed in the next section of this literature review. 2.4 A Triage Tool for Assessing Mental Illness in the Emergency Department. Triage originated from the French word, ‘trier’ which means to sort out, classify or choose to select (Smeltzer et al, 2010). Triage is generally used in the Emergency Department to assess those patients requiring emergency care. It involves immediate evaluation of the patients’ condition and the prioritizing of their care following a brief clinical assessment 9
Page 1 and 2: Royal College of Surgeons in Irelan
Page 3 and 4: Improving the Assessment and Triage
Page 5 and 6: Abstract Since the amalgamation of
Page 7 and 8: Table of Contents Abstract Acknowle
Page 9 and 10: Chapter 1 Introduction 1.1 Introduc
Page 11 and 12: However there are a large number of
Page 13 and 14: Chapter 2 The Literature Review 2.1
Page 15: with mental health issues, who pres
Page 19 and 20: Following implementation of the Nat
Page 21 and 22: Consequently the subsequent chapter
Page 23 and 24: must analyse their surroundings and
Page 25 and 26: After consideration of the aforemen
Page 27 and 28: questioning the patient about their
Page 29 and 30: The benefits of successful implemen
Page 31 and 32: Establishing trust was significant
Page 33 and 34: Group One: Nursing documentation- C
Page 35 and 36: Developing the implementation plan.
Page 37 and 38: Communication As discussed in relat
Page 39 and 40: Nevertheless as a change agent and
Page 41 and 42: crucial. The change agent or change
Page 43 and 44: The observational audit carried out
Page 45 and 46: Limitations arise as the project wa
Page 47 and 48: 5.5 Conclusion Improving the triage
Page 49 and 50: Cartwright, T., Baldwin, D. (2007)
Page 51 and 52: Happell, B., Summers, M., Pinikahan
Page 53 and 54: McAuliffe, E., Van Vaerenbergh, C.
Page 55 and 56: National Institute for Clinical Exc
Page 57 and 58: Wand, T. (2004) Mental Health Liais
Page 59 and 60: Appendices Appendix A Mental Illnes
Page 61 and 62: Appendix A Mental Illness Nursing A
Page 63 and 64: Appendix C Recommendations in World
Page 65 and 66: Appendix E Manchester Triage Algori
Page 67 and 68:
Appendix G Health Service Executive
Page 69 and 70:
Appendix I Change Management Projec
Page 71 and 72:
Appendix K Mental Illness Triage To
Page 73 and 74:
Appendix M Force Field Analysis Dri
Page 75 and 76:
Appendix O Questionnaire results re
Page 77:
Appendix Q 16 Triage Category alloc
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