Emergency Departmental Barriers to Caring for Mental Health Boarders

Patients often seek care for mental health conditions through the emergency department, however, there are many concerns with the provision of mental health care in the emergency department. This includes workflow issues at odds with mental health care needs, a challenging environment, staffing issues, and long waits for definitive mental health care in a practice known as boarding. While there are several articles on emergency nurses' perceptions of caring for mental health patients in general, there is little research on non-mental health aspects of emergency department care for mental health boarders.

This qualitative descriptive study aimed to explore bedside emergency nurses' perceptions on non-mental health aspects of emergency department care that impact the care of mental health boarders. A purposive sample of current bedside emergency registered nurses in the United States was used. Data collection occurred via 1-on-1 semi-structured interviews with an interview guide informed by the Theory of Planned Behavior.

Eighteen emergency nurses participated in this study. Four themes were discovered: emergency department workflow and overcrowding, emergency department physical environment, activities of daily living, and lack of distractions.

Adequate resources including staffing and supportive workflows are needed to provide quality care to mental health boarders. Safe, calming environments are needed to prevent deterioration, which may require structural changes to emergency departments or the use of spaces outside the emergency department.