Are peds psych patients unhappy with care?
Refer them to community resources
Pediatric patients and their caregivers coming to an ED for mental health concerns expected help and guidance, as well as assessment, evaluation, and diagnosis, according to research that surveyed 241 patients and their caregivers.1 Unfortunately, they often leave dissatisfied.
When providing care in a busy ED with a high level of acuity, triage nurses might not perceive a high level of urgency in the patient's presenting complaint, says Paula Cloutier, MA, the study's lead author and a research associate at the Mental Health Patient Service Unit at the Children's Hospital of Eastern Ontario in Canada. "Youth and their caregivers' subjective experience of distress, coupled with a lack of knowledge of mental health resources in the community, might lead them to seek assistance in the ED, even when an outpatient mental health setting would be more appropriate," says Cloutier.
Triage nurses "need to be mindful of the patient and family's perspective," she says. "A good understanding of mental health issues in youth provides a foundation for empathy in clinicians."
In a separate research project, Cloutier found that confidence with assessing and triaging youth with mental health issues was positively correlated with the number of years working in the ED.2
"The majority of triage nurses expressed the desire to have further training in mental health through hospital in-services," says Cloutier. "Training in mental health would also play an important role in de-stigmatizing mental health issues."
ED nurses also might be involved in the post-triage assessment of a child with mental health issues. "Some have specialized training in mental health, but many would not," says Cloutier. "Addressing gaps in training in mental health is important for all ED clinical staff." Here are some ways to improve care:
Educate ED staff about mental health resources.
"This would permit them to inform patients and their caregivers about the mental health referral process and available community services," says Cloutier. (See related story, p. 35, on underlying medical conditions.)
Acknowledge that patients and caregivers cannot necessarily have their expectations met.
"They may not leave the ED satisfied with the service they receive," says Cloutier.
Remind patients and families that the ED is always open.
Denise Downey, RN, MSN, CPEN, nurse educator for emergency services at Children's Hospital Boston, says, "This is one of the most important interventions we can do upon discharge. I always make sure they have the phone number to the ED and give them permission to call or return if they have any serious concerns."
References
- Cloutier PM, Kennedy A, Maysenhoelder H, et al. Pediatric mental health concerns in the emergency department: Caregiver and youth perceptions and expectations. Ped Emerg Care 2010;26:99-106.
- Dion, J, Kennedy, A, Cloutier, P, et al. Evaluating crisis intervention services for youth within an ED: A view from within. Child Care Practice 2010;16:241-256.
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