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

Mainstreaming
Feedback from the clinical nurse managers was positive in support of the
computerised pop-up screen and the Mental Illness Triage Tool; however there were issues
with the nursing assessment documentation. It was suggested staff would find it more user
friendly if it was combined with the other nursing assessment documents in booklet form.
At the initial stage of the implementation process slight delays were noted with the
triaging of patients however with constant supervision and encouragement from the change
teams, the waiting times were reduced. The clinical nurse managers expressed how staff
appeared more confident in their assessment of patients with mental illness and more assured
in their interactions with the psychiatry services. Many clinical nurse managers felt there had
been a reduction in the number of complaints and incidents regarding patients with mental
illness. The elements of the change project have been taken on and improvements have
resulted. Kotter (1996) suggests that the approach to change and its implementation are as
important as the support from influential senior management.
3.6 Conclusion
This project focused on the implementation of a change in the triage and assessment
of patients with mental illness in the ED. The change process was undertaken by utilising the
components of the HSE (2008) change model. The model provides for a structured approach
and helps to focus activities for the change agent and change teams. Recognition of the need
for change and communication of the need in a clear concise manner is very important.
Involving staff from the outset is essential and reduces the levels of resistance for
change. An establishment of trust helps in the transformation from the old to the new way of
doing things. Change needs to be developed in such a way that it is understood and managed
so that staff are able to cope with the transition. There needs to be a certain level of urgency
about the need for change and therefore a comprehensive communication of the vision is
32