Triage Nurse’s Important Role In Combating the Mental Health Crisis

By Portia Wofford

Triage nurses play a significant role in the treatment of mental health patients who present at the emergency department (ED). One in eight visits to the emergency department is related to a mental health or substance abuse issue. A 2017 report by the Agency for Healthcare Research and Quality found that the number of ER visits related to mental health and substance-use issues increased more than 44% with suicidal ideation visits growing by nearly 415%. 

With the demand for services increasing, the nursing shortage, the lack of services, multiple policies and procedures geared toward those with mental illnesses, the outcome is crippling for the patients. Most protocols are currently geared toward medical rather than mental illnesses. For the uninsured who come seeking help in the ED, many are left stuck, for days, without proper placement to a psychiatric or mental health facility. 

So, what can triage nurses do to help?

1. Accurate and timely triage. Many ED triage nurses perform the point-of-entry mental health assessment. According to American Nurse Today "psychiatric emergency care begins with accurate, timely triage using the emergency severity index, an algorithm that stratifies patients into groups, from 1 (most urgent) to 5 (least urgent). 

During this process, the ED nurse combines both clinical judgment and emotional connections to assess the patient’s situation to identify possible mental health issues."

The triage nurse’s role is to attempt to obtain the most accurate medical history and assessment to rule out medical conditions that could present similar symptoms as mental health or psychiatric illnesses. At this point, it’s important to follow their hospital’s policies on the assessment and monitoring of patients with symptoms of mental illnesses. 

Additionally, nurses should always check their biases and stereotypical thoughts, at the door. Having preconceived notions and distinctive sets of thinking can lead to error in the treatment of patients. 

2. Manage the environment. Nurses should assess risks and the patient's potential for elopement. A busy ED environment paired with a long wait period can cause those with psychiatric or mental health conditions to become anxious or agitated. 

The Emergency Nurses Association recommends treating patient agitation as if it’s “the chest pain of behavioral emergencies.” The ENA suggests the following guidelines: 

• Promptly share your assessment of rapidly escalating situations or increasing agitation with the treatment team. 
• Evaluate the level of risk to the patient and others. 
• Agitated patients should be removed from public spaces (such as the waiting area) and into a safe, quiet environment, with trained staff. This room should be secure with no objects to that can be used as a potential weapon.
• Never leave the patient alone, respect his or her personal space, and speak and behave calmly.

3. Manage uncertainty. Not all patients will be able to accurately describe their condition, history, medical conditions, or other pertinent information. It is left to the nurse to decipher this uncertainty. 

• Assess the situation. How is the patient presenting? Is he or she unkept or disheveled? Malnourished? Is his or her speech coherent? Are they answering questions appropriately? Hallucinating? Delusional? Rambling? 
• Address the whole patient! One common occurrence within mental health care in the ED is "diagnostic overshadowing." This happens when the focus on a patient's mental health diagnosis overshadows their physical health needs. 
• Be an advocate. Triage nurses are valuable to the emergency department. They are the first to communicate with, provide support to, and manage patients with psychiatric or mental health issues. Acting as a patient’s initial advocate can be life-changing for that patient.

Portia Wofford is a nurse, millennial strategist, healthcare writer, entrepreneur, and micro-influencer. Chosen as a brand ambassador or collaborative partner for various organizations, Wofford strives to empower nurses by offering nurses resources for career development--while providing organizations with tools to close generational gaps within their nursing staff. Follow her on Instagram and Twitter for her latest.

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