Factors Influencing Emergency Department Staff Decision-Making for People Attending in Suicidal Crisis: A Systematic Review

McCarthy, Molly; McIntyre, Jason; Nathan, Rajan; Saini, Pooja

doi:10.1080/13811118.2023.2173113

Cited by 7 publications

(4 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Attitudes towards suicidal crisis were commonly discussed by all participants, both positively (empathy, compassion) and negatively (frustration, lack of understanding). Previous research into staff attitudes has also produced conflicting findings (McCarthy, McIntyre, et al., 2023). McCann et al.…”

Section: Discussionmentioning

confidence: 99%

Staff perspectives of emergency department pathways for people attending in suicidal crisis: A qualitative study

McCarthy,

McIntyre,

Nathan

et al. 2023

Psychiatric Ment Health Nurs

Self Cite

View full text Add to dashboard Cite

Accessible SummaryWhat is known on the subject? Emergency departments (ED) are key settings to support and manage suicidal crisis; thus, ED staff are often the first point of contact for people in suicidal crisis. Despite this, some ED staff receive little training and/or education on how to best support such patients. What the paper adds to existing knowledge Previous research focuses on one staffing role (e.g. triage nurses) whereas this paper includes staff working across the ED pathway. Administrative staff have often been excluded from research, despite representing a key part of the clinical pathway and being a person's initial contact with the ED. Overall findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. Staff also perceive there to be a negative ED culture, which often leads to poor attitudes towards suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention. Findings build upon previous research to highlight key challenges different staff face along the clinical pathway and the implications this can have on a patient's journey and follow‐up care provided. What are the implications for practice? Findings are of particular importance and relevance to ED managers, and more broadly NHS England. Negative ED culture, poor staff attitudes and confidence can have a detrimental impact on both staff health and wellbeing, as well as a patient's journey throughout the ED, resulting in repeat presentations and absconding as appropriate support is not received. Policymakers need to consider staff burnout and lack of resources in mental health care strategies, and training programmes should be developed to improve culture and confidence among ED staff and managers to improve care for people attending EDs in suicidal crisis. AbstractIntroductionEmergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway.AimsTo explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis.MethodQualitative study guided by thematic analysis of semi‐structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England.ResultsFindings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention.DiscussionStaff felt unequipped to deal with suicide‐related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction.Implications for PracticeFindings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED.

show abstract

Section: Discussionmentioning

confidence: 99%

Staff perspectives of emergency department pathways for people attending in suicidal crisis: A qualitative study

McCarthy,

McIntyre,

Nathan

et al. 2023

Psychiatric Ment Health Nurs

Self Cite

View full text Add to dashboard Cite

show abstract

“…MMAT is used to systematically appraise qualitative, quantitative, and mixed methods studies. MMAT is short but comprehensive and easy to use and has been validated and used extensively in reviews [37][38][39][40]. Disagreements will be resolved by TvdA.…”

Section: Assessment Of Methodological Qualitymentioning

confidence: 99%

Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review

Kachimanga¹,

Divala²,

Ket³

et al. 2023

JMIR Res Protoc

View full text Add to dashboard Cite

Background Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. Objective This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. Methods We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. Results In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. Conclusions This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. Trial Registration PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 International Registered Report Identifier (IRRID) DERR1-10.2196/44066

show abstract

“…confidence, training, knowledge) have all been found to influence decision-making around assessments for people presenting to hospital in suicidal crisis, including following self-harm. 16 Clinical practices and administrative policies in different settings may also play a role, as might macro-level factors, such as per capita spending on health and availability of trained staff, including specialist mental health professionals. 17 To date, however, no studies have comprehensively reviewed the proportion of patients receiving psychosocial assessment following an episode of self-harm and the factors that may affect this, with a view to providing recommendations to increase the consistency with which patients are provided these important therapeutic assessments.…”

Section: Factors Affecting Provision Of Psychosocial Assessments Afte...mentioning

confidence: 99%

Section: Factors Affecting Provision Of Psychosocial Assessments Afte...mentioning

confidence: 99%

Global prevalence of psychosocial assessment following hospital-treated self-harm: systematic review and meta-analysis

Witt,

McGill,

Leckning

et al. 2024

BJPsych open

View full text Add to dashboard Cite

Background Hospital-treated self-harm is common, costly and associated with repeated self-harm and suicide. Providing a comprehensive psychosocial assessment following self-harm is recommended by professional bodies and may improve outcomes. Aims To review the provision of psychosocial assessments after hospital-presenting self-harm and the extent to which macro-level factors indicative of service provision explain variability in these estimates. Method We searched five electronic databases to 3 January 2023 for studies reporting data on the proportion of patients and/or events that were provided a psychosocial assessment. Pooled weighted prevalence estimates were calculated with the random-effects model. Random-effects meta-regression was used to investigate between-study variability. Results 119 publications (69 unique samples) were included. Across ages, two-thirds of patients had a psychosocial assessment (0.67, 95% CI 0.58–0.76). The proportion was higher for young people and older adults (0.75, 95% CI 0.36–0.99 and 0.83, 95% CI 0.48–1.00, respectively) compared with adults (0.64, 95% CI 0.54–0.73). For events, around half of all presentations had these assessments across the age range. No macro-level factor explained between-study heterogeneity. Conclusions There is room for improvement in the universal provision of psychosocial assessments for self-harm. This represents a missed opportunity to review and tailor aftercare supports for those at risk. Given the marked unexplained heterogeneity between studies, the person- and system-level factors that influence provision of psychosocial assessments after self-harm should be studied further.

show abstract

Factors Influencing Emergency Department Staff Decision-Making for People Attending in Suicidal Crisis: A Systematic Review

Cited by 7 publications

References 50 publications

Staff perspectives of emergency department pathways for people attending in suicidal crisis: A qualitative study

Staff perspectives of emergency department pathways for people attending in suicidal crisis: A qualitative study

Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review

Global prevalence of psychosocial assessment following hospital-treated self-harm: systematic review and meta-analysis

Contact Info

Product

Resources

About