Abstract
Introduction
Emergency departments increasingly treat patients for deliberate self-harm. This study
sought to understand emergency department nursing leadership perspectives on how to
improve the quality of emergency care for these patients.
Methods
ED nursing managers and directors from a national sample of 476 hospitals responded
to an open-ended question asking for the 1 thing they would change to improve the
quality of care for self-harm patients who present in their emergency departments.
We identified and coded key themes for improving the emergency management of these
patients, then examined the distribution of these themes and differences by hospital
characteristics, including urbanicity, patient volume, and teaching status.
Results
Five themes regarding how to improve care for deliberate self-harm patients were identified:
greater access to hospital mental health staff or treatment (26.4%); better access
to community-based services and resources (26.4%); more inpatient psychiatric beds
readily accessible (20.9%); separate safe spaces in the emergency department (18.6%);
and dedicated staff coverage (7.8%). Endorsement of findings did not differ based
on hospital characteristics.
Discussion
ED nursing leadership strongly endorsed the need for greater access to both hospital-
and community-based mental health treatment resources for deliberate self-harm patients.
Additional ED staff and training, along with greater continuity among systems of care
in the community, would further improve the quality of emergency care for these patients.
Broad policies that address the scarcity of mental health services should also be
considered to provide comprehensive care for this high-risk patient population.
Key words
Emergency department management of self-harm; Mental health care; Emergency nursing
care
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Biography
Sara Wiesel Cullen is a researcher at the School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA.
Biography
Amaya Diana is a research assistant at the Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA.
Biography
Mark Olfson is Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law and Professor of Epidemiology at Columbia University, and a research psychiatrist at New York State Psychiatric Institute, New York, NY.
Biography
Steven C. Marcus is a Research Associate Professor at the School of Social Policy & Practice, University of Pennsylvania, Philadelphia PA.
Article info
Publication history
Published online: September 05, 2019
Footnotes
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Copyright
© 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
