The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department

Wong, Ambrose H.; Combellick, Joan; Wispelwey, Beth Ann; Squires, Allison; Gang, Maureen

doi:10.1111/acem.13117

Cited by 41 publications

(40 citation statements)

References 51 publications

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“…Participants expressed their appreciation for compassionate communication, coordinated care, and their de‐escalation. These findings are consistent with reports from studies of healthcare workers into the need for empathy and compassion when caring for these complex patients . Participants with previous experience, or having recollection of their BE management, expressed confidence in care, because ED staff were able to provide a rapid response with a structured team approach.…”

Section: Discussionsupporting

confidence: 84%

“…Individuals presenting with a BE often have highly complex health and psychosocial problems . Frequent similar re‐presentation to the ED often leads healthcare providers to stereotype these patients as manipulative and less important .…”

Section: Discussionmentioning

confidence: 99%

“…Frequent similar re‐presentation to the ED often leads healthcare providers to stereotype these patients as manipulative and less important . Healthcare providers repeatedly express their frustration around “revolving door presentation.” Despite the challenge of maintaining objectivity and empathy, it is crucial for healthcare providers to recognize that individuals presenting to the ED with a BE are a diverse group, and they need to be treated according to the cause of their presentations.…”

Section: Discussionmentioning

confidence: 99%

“…Several qualitative studies have explored the perceptions and experience of healthcare providers in caring for patients presenting with BEs to EDs . Giving opportunities to these marginalized patients to share their experiences allows others to understand that an agitated patient has similar needs and wants to other medical emergency patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have reported healthcare providers’ experiences in caring for agitated patients in the ED, but have not explored patients’ accounts of their experiences. Our study aimed to provide a voice for patients who received care during their BEs in a single ED.…”

mentioning

confidence: 99%

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Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department

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Knott

Kong

et al. 2017

Academic Emergency Medicine

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department

Yap

Knott

Kong

et al. 2017

Academic Emergency Medicine

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Experiences of Individuals Who Were Physically Restrained in the Emergency Department

et al. 2020

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IMPORTANCE Individuals with behavioral disorders are increasingly presenting to the emergency department (ED), and associated episodes of agitation can cause significant safety threats to patients and the staff caring for them. Treatment includes the use of physical restraints, which may be associated with injuries and psychological trauma; to date, little is known regarding the perceptions of the use of physical restraint among individuals who experienced it in the ED. OBJECTIVE To characterize how individuals experience episodes of physical restraint during their ED visits. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semistructured, 1-on-1, in-depth interviews were conducted with 25 adults (ie, aged 18 years or older) with a diverse range of chief concerns and socioeconomic backgrounds who had a physical restraint order associated with an ED visit. Eligible visits included those presenting to 2 EDs in an urban Northeast MAIN OUTCOMES AND MEASURES Basic participant demographic information, self-reported responses to the MacArthur Perceived Coercion Scale, and experiences of physical restraint in the ED. RESULTS Data saturation was reached with 25 interviews (17 [68%] men; 18 [72%] white; 19 [76%]non-Hispanic). The time between the patient's last restraint and the interview ranged from less than 2 weeks to more than 6 months. Of those interviewed, 22 (88%) reported a combination of mental illness and/or substance use as contributing to their restraint experience. Most patients (20 [80%]) said that they felt coerced to present to the ED. Three primary themes were identified from interviews, as follows: (1) harmful experiences of restraint use and care provision, (2) diverse and complex personal contexts affecting visits to the ED, and (3) challenges in resolving their restraint experiences, leading to negative consequences on well-being. CONCLUSIONS AND RELEVANCEIn this qualitative study, participants described a desire for compassion and therapeutic engagement, even after they experienced coercion and physical restraint during their visits that created lasting negative consequences. Future work may need to consider more patient-centered approaches that minimize harm. Findings This qualitative study of 25 patients who were physically restrained in the emergency department found the 3 following major themes: harmful experiences of restraint use and care provision, diverse and complex personal contexts affecting visits to the emergency department, and challenges in resolving their restraint experiences, leading to negative consequences on well-being. Meaning Results of this study suggest that the participants in this study desired compassion and therapeutic engagement during physical restraint, warranting further attention to patientcentered approaches and coercionreduction techniques that fit with the needs of emergency care.

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Workplace Violence in Trauma Care

Scarlet

Dreesen

2020

Violence, Trauma, and Trauma Surgery

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The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department

Cited by 41 publications

References 51 publications

Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department

Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department

Experiences of Individuals Who Were Physically Restrained in the Emergency Department

Workplace Violence in Trauma Care

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