Caring for the Psychiatric Patient: Perception of Competency in Medical Surgical and Emergency Department Nurses

The purpose of this study was to explore the gap in knowledge and skills of emergency department (ED) and medical surgical nurses. In highlighting this need, better education and training could be developed for these nurses to feel more competent in working with patients with a comorbid psychiatric diagnosis in any setting across the spectrum of health care.

A qualitative descriptive design was conducted, using focus groups to assess levels of perceived self-competency of medical-surgical and ED nurses when working with patients with a psychiatric diagnosis.

Five themes were found from the participants' responses related to their perceptions of working with patients with psychiatric comorbidity in the ED and medical surgical floors. The 5 themes are as follows: (1) a chaotic, understaffed ward; (2) overuse of as-needed medications as an intervention; (3) difficult patients and increased anxiety; (4) negative reports at handoff; and (5) inadequate training and education.

Participants in this study described a lack of education, preparation, and understanding for how to manage patients who may present as combative and emotionally labile. In understanding the needs for nurses in clinical practice, specific interventions and educational programs should be developed beyond a traditional de-escalation program. Future research will allow educational programs to meet the needs of the nurses who will be working with this population and help them to be able to provide behavioral health interventions.