A Prehospital Emergency Psychiatric Unit in an Ambulance Care Service from the Perspective of Prehospital Emergency Nurses: A Qualitative Study

Abstract

The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, the ambulance vehicle, non-conveyed patients, cooperation with the police and meetings with patients and next of kin. In conclusion, these results suggest that in ambulance care in general, there is a lack of knowledge and skills about mental illnesses and initial care options. The PAP concept opened new avenues for the care of patients with mental illness, which the PENs described very positively as being helpful and valuable.

The ways specialist nursing students understand the work in the ambulance service - a national Swedish phenomenographic study

“…Internationally, the contemporary AS are faced with patient needs and societal changes resulting in a development towards more than just protocol driven emergency medical treatment and an expanding scope of practice (Jensen, 2020 ; Plummer et al, 2017 ; Vázquez-Casares & Vidal, 2020 ). These developments are related to an increasing number of patients (Lowthian et al, 2011 ) with e.g., non-emergency conditions (Rosén et al, 2018 ), mental health care needs (Todorova et al, 2022 ), and older adults with multimorbidity and palliative care needs (Van Vuuren et al, 2021 ). This has resulted in the need for advanced medical assessments, care measures, and triaging patients to different levels of care and/or decisions concerning the conveyance or the non-conveyance (Lederman et al, 2019 ).…”

Psychosocial Care Circuit: the systematization of intervention in psychic crisis in mobile pre-hospital care

“…Other authors mention that education programs for approaches in psychic crises cannot be focused solely on controlling the "scene" and that dialogue and the patient's experience must be taken into account in order to guarantee good care 26 . Finally, the multi-professional mental health team that regularly attends ongoing education processes have increased levels of confidence and knowledge, especially in high-risk situations for the patient 27 .…”

Circuito dos Cuidados Psicossociais: sistematização de intervenção na crise psíquica no atendimento pré-hospitalar móvel

“…Outros autores mencionam que os programas de educação para abordagens em crises psíquicas não podem ser voltados apenas para o controle da "cena" e o diálogo e a experiência do paciente devem ser considerados para se garantir uma boa assistência 26 . Por fim, a equipe multiprofissional de Saúde Mental que frequenta regularmente processos de educação continuada tem níveis de confiança e conhecimento aumentados, principalmente em situações com alto risco para o paciente 27 .…”