An emergency department-based mental health nurse practitioner outpatient service: Part 1, participant evaluation

Abstract

The mental health liaison nurse role in the emergency department (ED) has demonstrated a range of positive outcomes for both consumers and staff. In Australia, the added value associated with establishing mental health nurse practitioner (MHNP) positions based on this model is emerging. This paper presents qualitative findings from a study using a mixed-method design to evaluate an ED-based MHNP outpatient service in Sydney, Australia. In evaluating this new service, semistructured interviews were conducted with a random selection of study participants and a stratified sample of ED staff. This is the first of a two-part paper that presents an analysis of qualitative data from interviews conducted with study participants (n = 23). Participants reported numerous therapeutic benefits from the service, such as support, understanding, and a focus on solutions rather than problems, and high levels of satisfaction with the accessibility of the service and follow up. Suggestions for improving the service were also offered. Participants emphasized that overall ED service provision would be enhanced through additional resources, especially an extension of operating hours. Findings from these participant interviews provide strong support for an ED-based MHNP outpatient service.

Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants

“…Initial evaluations of the service provided by the MHNP identified reduced waiting times, therapeutic engagement and enhanced co-ordination of care as the main benefits of the role (Wand, 2004;Wand and Schaecken, 2006). The scope of the MHNP role at RPAH has expanded through the establishment of a structured and formalised outpatient service (Wand et al, 2011a(Wand et al, , 2011b(Wand et al, , 2012 whereby referred patients return to the ED for brief intervention within a mental health promotion and solution focused therapy framework.…”

Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care

“…[99][100][101] There was limited evidence of benefit in two Australian studies based on a limited range of outcomes but neither of these was a controlled trial. McDonough et al 99 found a reduction in mean waiting time (before, 235 minutes; after, 36 minutes) and an increase in nightly service user contact rate (before, 2.9; after, 3.75).…”

“…McDonough et al 99 found a reduction in mean waiting time (before, 235 minutes; after, 36 minutes) and an increase in nightly service user contact rate (before, 2.9; after, 3.75). A mixed-methods study by Wand et al 101 found largely positive feedback about the psychiatric nursing service in the ED, but there was no control group so it was difficult to determine the impact of the intervention.…”

Outcomes from the evaluation of an emergency department‐based mental health nurse practitioner outpatient service in Australia

“…Realistic evaluation (Pawson & Tilley, 1997), the methodology applied to this project, and the three phase process involved in developing and implementing the MHNP outpatient service (including structure and procedural considerations) has been detailed by the authors previously (Wand, White, & Patching, 2010a; Wand, White, Patching, Dixon, & Green, 2010). Realistic evaluation is a practical adaptation of critical realist philosophy and draws on a range of methods in order to understand how individuals respond to an intervention or program.…”