Emergency Nurses' Experiences of Caring for Individuals with Mental Health Concerns: A Focused Ethnography

Canadians' mental health has deteriorated over the past decade, increasing MH-related conditions and ED use. Evidence indicates that EDs are ill-suited to managing complex MH needs, negatively affecting care quality and nurses' experiences. Nurses face challenges including fear of violence, limited MH training, and insufficient organizational support. This study aimed to explore nurses' experiences and identify factors that contribute to or hinder their ability to care for individuals with MH concerns in the ED. Using a focused ethnography approach, we collected data mainly through semi-structured interviews (n = 12), non-participant observations, and a review of clinical documents. We analyzed data iteratively using reflexive thematic analysis. Analysis was primarily deductive, guided by Bandura's social cognitive theory (SCT), while remaining open to inductive insights. Three interrelated themes emerged: nursing role under strain, structural challenges in EDs, and persistent stigmatization, reflecting an incompatible healthcare system that fails to meet patients' MH needs adequately and contributes to difficult, sometimes dangerous experiences for nurses. Systemic reorganization is needed to support MH care in EDs, particularly by improving access to specialized expertise, creating safer care environments, and developing targeted MH skills.