The Nurse‐Police Assistance Crisis Team (N‐PACT): A new role for nursing

Abstract

Aim

This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first‐line behavioural crisis response.

Design

This study used a descriptive, qualitative exploratory design and was informed by Systems Theory.

Methods

The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co‐response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed.

Reporting Method

The Standards for Reporting Qualitative Research (SRQR) guidelines were used.

Results

Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de‐escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation.

Conclusion

This study proposes the creation of a novel nursing role within first‐line multidisciplinary teams (MDTs) for crisis response—the Nurse‐Police Assistance Crisis Team (N‐PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug‐related incidents.

Implications

Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system.

Impact

The N‐PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises.

Patient or Public Contribution

No patient or public contribution.

1. INTRODUCTION

Over the past few decades, the expectations and scope of police departments worldwide have undergone a profound transformation to effectively respond to the evolving needs of society, with a focus on fair and equitable responses to cases involving behavioural and/or mental health crises (Paterson & Pollock, 2016). Previously centred on law enforcement and crime control, policing has experienced a paradigm shift driven by dynamic cultural changes, emerging societal challenges, shifting public opinion, and unmet community needs (Kurtz & Tucker, 2023). This shift has driven an expansion, specialization, and diversification of the police role, so law enforcement agencies could better serve and safeguard the communities they serve (Dempsey et al., 2020).

Although interventions such as community‐based mental health programs and mobile crisis services, which incorporate disciplines such as nursing, counselling/psychology and social work, have demonstrated a measure of effectiveness (Marcus & Stergiopoulos, 2022), a significant burden still falls upon the police force when these community resources fail to successfully prevent or manage behavioural crises, whether or not they are associated with a mental health condition (Bailey et al., 2022). It is estimated that 10%–20% of all 911 or emergency calls to the police involve a behavioural crisis or mental health incident (Abramson, 2021; Balfour et al., 2022). There are concerns associated with these type of cases, as past research indicates that a significant proportion, ranging from 20% to 50%, of law enforcement fatalities are linked to individuals with a diagnosed mental illness (DeGue et al., 2016). Recognizing the need for a more holistic and community‐centred approach for first response in behavioural crisis calls, law enforcement agencies have actively forged partnerships across disciplines, creating multidisciplinary strategies (e.g. collaboration between law enforcement and mental health clinicians) that focus on various intercept points (Abella et al., 2022). This approach extends to cases involving potential criminal occurrences and aims to explore alternatives to incarceration whenever feasible (Bailey et al., 2022). Nevertheless, there has been a distinct lack of exploration or proposals for partnerships between nursing professionals and law enforcement for addressing behavioural crises in first‐response scenarios, despite the noteworthy contributions of nurses in forensic, psychiatric and mental health contexts (Dikeç et al., 2017).

1.1. Background

Police departments have proactively broadened their scope by introducing innovative diversion programs, which have brought forth diverse models for addressing and assessing behavioural crisis situations (Marcus & Stergiopoulos, 2022; Rogers et al., 2019). Some programs prioritize equipping officers with specialized crisis intervention training, such as Crisis Intervention Team (CIT), while others recognize the benefits from assembling collaborative approaches for first response that integrate mental health professionals, also known as co‐response clinicians, with law enforcement personnel in multidisciplinary teams (MDT) (Balfour et al., 2022). These progressive approaches showcase a collective effort to enhance the response and management of behavioural crisis cases, underscoring the increased involvement of police‐led responses in this type of incidents (Bailey et al., 2022; Rogers et al., 2019).

Although nurses, including those who have a forensic specialization, have historically played a critical role in crisis and emergency cases, their involvement has typically been limited to hospital‐based settings (e.g. emergency department), forensic facilities or specialized emergency response teams, such as med‐flight nurses. In these roles, nurses often serve as secondary points of contact with patients after the initial scene has been addressed by first responders (Gorman, 2019). To consider the potential added benefit and/or feasibility of forensic nurses in collaborative police‐led crisis responses, it is imperative to acknowledge that although forensic nurses are not conventionally regarded as a core element of MDTs or first‐response teams, they invariably participate in providing comprehensive care to several individuals experiencing crisis situations (Innes et al., 2013; Van Dijk et al., 2020). This is frequently the scenario in cases involving changes in mental status, physical injuries, sexual victimization or instances where an individual may pose a safety risk to themselves or others (Nizum et al., 2020). Importantly, in its current configuration, this care begins after the initial scene, specifically as these individuals transition into the healthcare system or, in some cases, the correctional system (Innes et al., 2013; Kent‐Wilkinson, 2010). Forensic nurses, particularly those who specialize in psychiatry or have experience practising in mental health settings, possess a distinctive skill set that uniquely qualifies them to intervene effectively in behavioural crisis situations, as their expertise extends to mental health and physical assessments, aggression prevention, violence management and adeptly navigating the intersection of legal and medical considerations (Dikeç et al., 2017). This proficiency underscores their central role in managing critical situations, with their insights potentially offering valuable perspectives on how behavioural crises are addressed at different stages, including the first response at a crisis scene.

1.2. The study

Examining the roles of varied MDT professionals within the context of a police‐led behavioural crisis call is not only compelling and timely but also represents a relatively unexplored field of study (Dempsey et al., 2020). Considering that MDTs are presumed to thrive through the interlacing of diverse approaches, training, and perspectives, it is equally critical to comprehend how potential disagreements and diverging viewpoints can be transformed into a collective strength rather than a hindrance (Dempsey et al., 2020; Pfefferle et al., 2019). The primary objective of this study was to better understand how forensic nurses may perceive, assess and address behavioural crisis situations. The study compared their responses to those of other distinct disciplines that are traditionally involved in first‐response behavioural crisis scenarios, exploring how the unique professional backgrounds shape and influence their perspectives, approaches and viewpoints.

2. METHODS

2.1. Study design

The present study employed a descriptive, exploratory, qualitative design, utilizing focus groups as a data collection method. The study is guided by the fundamental principles of qualitative descriptive research, focusing on in‐depth exploration, detailed descriptions and contextually grounded analysis (Miles et al., 2018). Focus groups offer a dynamic and interactive process, enabling participants to openly share their views, perspectives and personal experiences. This approach also facilitates exchanges in which statements can be elaborated upon, challenged or corroborated, thus revealing a wealth of information that might otherwise remain concealed and providing a more comprehensive understanding of the topic under investigation (Tausch & Menold, 2016). In this study, the research team devised a semi‐structured guide, which was administered across four distinct focus groups: one comprising police officers, another with co‐response clinicians, a third with sexual assault nurse examiners (SANE) and the fourth with correctional nurses.

2.2. Theoretical framework

Systems Theory provides a valuable framework for understanding how individual professionals approach a crisis scene (Cordero et al., 2017). This framework informs the examination of the complex and dynamic interactions between the various components within a multidisciplinary team (MDT). It underscores the interdependence of these professionals within the system and how their unique approaches, shaped by their training and expertise, influence the overall crisis response. In the context of our study, the MDTs represent complex systems, and our research investigates how these subsystems (individual professionals) function independently when approaching a crisis scene.

2.3. Sample, inclusion criteria and procedures

Purposive sampling was used to recruit police officers and co‐response clinicians through a state agency that oversees forensic services and jail diversion programs. Additionally, the two groups of forensic nurses (e.g. SANE and correctional nurses), who are not directly involved in jail diversion programs, but are part of the crisis response and/or law enforcement continuum, were also invited to participate in the study. A surrogate at the state agency extended the recruitment letter via email, describing the study to prospective participants. Recruitment of forensic nurses was facilitated by a surrogate who oversees forensic services. Additionally, snowball sampling was used to optimize the sample size for the study. The recruitment materials included instructions guiding potential professionals interested in participating in the study to contact the research team directly via email.

Once contact was established, participants were provided with a Qualtrics survey, which served different purposes: (1) to provide additional details about the study; (2) to obtain informed consent form; (3) to gather preliminary information (e.g. demographic and professional information); and (4) to screen and confirm eligibility. Eligible participants included the following: (1) English speaking; (2) individuals who are active in their profession; and (3) function as a police officer that is part of a jail diversion program or crisis intervention team, co‐response mental health clinicians who do joint assessments with police officers to live first‐response behavioural crisis calls, or forensic nurses who function in emergency (e.g. emergency department, rape crisis centres, etc.) or correctional settings. Participants who met the inclusion criteria and agreed to participate in the study were then invited to attend a virtual focus group via Zoom.

2.4. Participants and setting

The study took place in the United States, with focus groups spanning from December 2022 to August 2023. The four focus groups are described below:

2.4.1. Officers (law enforcement)

The group (N = 12) consisted of officers who were members of Jail Diversion Programs (JDP), with an average of 21.3 years of experience (SD = 5.6). Four of the participants in the law enforcement group were sergeants, one was a lieutenant, two were detectives and five identified their role as police officer. In total, four of the participants were Crisis Intervention Team (CIT) trained and all of them performed joint assessments with a co‐response clinician.

2.4.2. Co‐response clinicians

The co‐response clinicians taking part in the focus group were recruited through the state agency that funds and oversees jail diversion programs (N = 13). All co‐response clinicians were actively engaged in JDP teams, with an average of 13.8 years (SD = 8.74) of experience. Their educational and training backgrounds included graduate studies, including four participants (31%) who completed education and supervised clinical hours in social work and seven (54%) who had a degree in mental health counselling. Two of the individuals who were hired and acting as co‐response clinicians did not have formal education in a clinical discipline and received only on the job training.

2.4.3. Sexual assault nurse examiners (SANE)

The group consisted of nurses who were trained and certified as sexual assault nurse examiners (N = 6). They had an average length of SANE work experience of 24.8 years (SD = 12.4). They were all registered nurses (RN)—five had a bachelor's degree in nursing and one had an associate degree.

2.4.4. Correctional nurses

Correctional nurses had a history of working with charged and sentenced perpetrators in county jails (N = 4). They had an average experience of 16.8 years working in forensic settings as a nurse (SD = 7.27). In the group, three nurses were RNs with bachelor's degrees and one was a RN with a master's degree.

2.5. Data collection

The focus groups were guided by a facilitator trained by the lead author. Each focus group lasted on average 60–90 min, and audio was recorded with participants' permission. Participants first watched bodycam footage, which was publicly available, depicting the interaction between police officers and two individuals, a male and a female, who had been pulled over due to reports of a behavioural crisis and suspected domestic violence. After the video was completed, the participants were then given prompts. Based on the research question, we were specifically interested in obtaining detailed accounts of contrasting positions, in order to both increase the validity of reports and to gain insight into points of agreement and divergence among the groups. To achieve that goal, we used the following questions to guide the discussions:

• From your professional perspective, what are the key elements you noticed in the scenario that you just saw?

• Given your professional training and role, can you describe your understanding of the situation and explain how you would act if you were on the scene?

Probes were also used to facilitate in‐depth exploration and encourage open dialogue, prompting participants to expand on salient points. Specifically, participants were directed to elaborate on their professional perspectives, providing detailed insights into the rationale behind their approaches and the decision‐making processes they would employ in a first‐response behavioural crisis scenario. The formulated questions and prompts were designed to cultivate an open and insightful discourse, unveiling the nuanced strategies inherent in the diverse approaches adopted by various disciplines when addressing a behavioural crisis. The audio recordings were then transcribed verbatim using NVivo Transcription and reviewed individually by the first (VP) and senior authors (AWB).

2.6. Data analysis

The transcripts were analysed and coded by three independent team members: one research assistant, the primary investigator and one of the other co‐investigators. Inductive approaches were used for thematic analysis (Miles et al., 2018). In this process, following data collection, a comprehensive familiarization process involved multiple readings of the interview transcripts to gain a deep understanding of the content. The transcripts were read line by line and initial codes were systematically generated, capturing features and patterns within the data. Excerpts associated with a given code were collated. The codes were then organized into potential themes, and a careful review process ensued to validate and refine these identified themes against both coded extracts and the entire dataset. Each of the central themes was defined, and names were assigned to encapsulate their core meanings, contributing to the development of a clear and coherent narrative (Miles et al., 2018).

To ensure rigour in the process and to reduce bias, the codes were reviewed in periodic team meetings until consensus was reached. The individual coders also identified basic patterns and themes through open coding—initial codes were grouped under primary codes that were representative of patterns, and then as relationships were observed, they were sorted into themes (Miles et al., 2018). As themes were unveiled, those were also reviewed during the team meetings with the primary investigator and a co‐investigator (JB), who work in forensic settings and crisis response. These meetings served to ensure consistency in theme identification and provide context and an in‐depth understanding of the perspectives as they relate to the themes. The themes were reviewed for importance and for clustering by content. We used constant comparison to condense the categories and themes, and through the iterative process, the most salient themes were established.

2.7. Ethical considerations and researchers' positionality

The principal investigator, a psychiatric and mental health nurse practitioner, has over a decade of experience working with forensic populations in both correctional facilities and community settings. His practice has involved providing care to individuals involved with the legal system, pre‐trial, during incarceration and post‐release. The research team is also composed of another two forensic nurses, as well as a mental health clinician with vast experience in jail diversion, crisis response and forensic settings. All procedures, including recruitment, sampling, as well as data processing, analysis and storage, were approved by the institutional review board of Boston College.

2.8. Rigour and reflexivity

The study rigorously adhered to qualitative research standards by prioritizing self‐awareness and bias reduction. To ensure objectivity, the research team conducted peer debriefing sessions, fostering open dialogue to address varying viewpoints and potential biases. Reflexive notes were diligently kept to capture personal thoughts and emotions, aiding in the identification and mitigation of subjectivity. Additionally, a strategy of co‐researcher triangulation was employed, involving a fellow researcher not directly involved in data collection or analysis to review and challenge interpretations, thus bolstering the research's methodological rigour. Member‐checking further enhanced credibility, as preliminary findings were shared with participants for validation. These comprehensive measures collectively upheld rigour and reflexivity, reinforcing the trustworthiness of the study's outcomes (Miles et al., 2018).

3. RESULTS

In examining the data derived from the focus groups, this study adopted a system theory lens to explore the overarching themes, particularly regarding how forensic nurses' perspectives compare to those of other disciplines involved in first response. The investigation centred on exploring how training and professional roles influence approaches and perspectives in a behavioural crisis scenes (Table 1). This emphasis aligns with the principles of systems theory, which underscores the interconnectedness of elements within a system. The resulting thematic analysis identified three distinct themes, primarily categorized by their temporal orientation: (1) Searching for Historical Information, (2) Safety and Acting at the Present Scene, and (3) Future Strategies and Interventions. This categorization reflects the acknowledgement that professionals, informed by systems theory, recognize the dynamic interplay of past events, present actions, and future implications within the complex system of behavioural crisis response.

TABLE 1.

Identified themes and differences/overlap across groups.

	Officers	Co‐response clinicians	SANE nurses	Correctional nurses
Themes
Actions, assessment and influence of training/professional role on actions
Searching for Historical Information
Dimensions considered during evaluation
Physical			X	X
Mental health		X	X	X
Criminal	X
Past treatment		X		X
Past abuse		X	X	X
Interpersonal dynamics	X	X	X	X
Obtaining collateral information	X	X	X	X
Acting at the Present Scene
De‐escalation	X	X	X	X
Separating the truth from deception	X
Therapeutic support		X	X	X
Assessment at the scene
Safety	X	X	X	X
Emotional wellbeing		X	X	X
Physical wellness			X	X
Presence of potential criminal behaviour	X
Trauma‐informed approach			X
Future strategies and interventions
Ensuring safety
Towards self		X		X
Concerns about risk for violence			X	X
Physical separation	X	X	X	X
Additional information gathering				X
Referral to additional resources
Further evaluation	X	X	X	X
Treatment			X	X

3.1. Searching for historical information

In the context of assessing a behavioural crisis scene in which domestic violence was suspected, all groups highlighted the importance of obtaining historical information from the parties involved. Given the context of possible intimate partner violence, professionals from all backgrounds highlighted the need to inquire about the prior interpersonal dynamics of the individuals involved in the incident.

Officer: So there was obviously problems with the relationship, which we see all the time in domestics, and sometimes we're put in tough positions. We have to figure out…his story, her story and somewhere in the middle is the truth.

Co‐response clinician: I would try to explore deeper in terms of what their relationship was like as a whole. Really try to connect the dots because there was definitely some red flags in that scene, although probably not an arrestable offense per se.

SANE: Her blaming herself, basically for everything, that to me was a lot of red flags… like trauma and history of possibly DV [domestic violence].

Correctional nurse: … it seemed like there was a history of it [abuse]…so, it seems like there were other instances, maybe not of the aggressive, like the level of this one…but it seems like there was a history of unsettled business with them.

Although all the groups recognized historical information pertaining to possible past abuse as an area that needs to be addressed, so one could determine if there is a pattern of victimization, nurses emphasized that this information is particularly concerning as violence in these scenarios are likely to escalate, which may later inform psychosocial interventions.

Correctional nurse: If there is abuse or some sort of physical violence in the relationship, it's perhaps not going to get any better unless people get help.

SANE: Any time you see something like that, you should think about that this will eventually escalate, because we all know there's usually just two possible outcomes in a situation like this with a domestic—either one of them leaves the relationship, or somebody gets killed.

While all groups emphasized the importance of obtaining collateral information to triangulate and/or confirm historical data, officers highlighted their commitment to ensuring safety and focused on assessing prior criminal history, while only the clinician and correctional nurse groups discussed how from their perspective, it is important to gather information regarding prior health history and treatment.

Co‐response clinician: As a clinician I would ask more questions…asking about other family or friends that could be available to pick her up. Somewhere to take her. Medications or past treatment or services too.

Correctional nurse: I feel like they both needed to give a past medical history, to see if there's anything else going on… or any medications.

Although clinicians had a particular focus on medications and treatment pertaining to mental health, nurses had a more holistic perspective, in which they emphasized the importance of exploring the individuals' physical health, including the use of substances. This approach was described by the nursing groups.

SANE: His body language was just awkward. They felt like he might have been on drugs. To me, I just got the impression he wasn't being truthful.

Correctional nurse: Have drugs ever been involved in this? She said they don't drink. So, is there a reason they don't drink? When they were drunk, did they beat each other up? I would have gone a little bit deeper with those questions.

3.2. Safety and acting at the present scene

The second prominent theme captures the nuanced strategies and interventions deployed by the professionals as they respond to the unfolding situation. All groups readily spoke about ensuring that the scene was safe as one of their priorities. In addition to establishing their own safety, they discussed evaluating the safety status of all parties involved, including the male and female being assessed and/or investigated at the scene. From their own professional perspectives, they described:

Co‐response clinician: The first question I would ask her is if she felt safe and then I would try to explore deeper in terms of what their relationship was like as a whole.

Correctional nurse: I would have asked the female if she felt safe and probably would have asked him the same thing. If she was safe, if he was safe, you know, any altercations like this previously? Has there ever been physical violence? I would have just maybe gone down that route a little more.

SANE: Are you okay? Are you safe? You know, and just asking, is there anything that I can do for you? How can I help you?

Officer: I'd ask ‘are you safe with him? How do you feel?’ She's giving the classic “I don't want to tell on my boyfriend.”

The groups all agreed that de‐escalation was a primary goal in their intervention and that both parties would need to be separated for the assessment. However, the purpose of doing so varied between the officers and the clinical disciplines. The officers emphasized the need to create a safe environment to obtain information regarding potential victimization and/or threat, while clinicians and nurses felt that the separation would allow the individuals, particularly the suspected victim, to provide both safety and more clinically relevant information. Representing this idea, the different groups stated the following:

Officer: It's good to have that separation. I think I think it definitely would help in easing her and maybe she breaks down and says, “hey, you know what, he's not right…he hasn't been acting like this, but he's acting like this all week now, and he's got a gun in the car”…God knows what.

Co‐response clinician: I'd separate the individuals. I would have latched on to the female, really tried to explore how she feels.

SANE: I definitely think it would have been helpful to have them removed from each other and out of sight so that she couldn't see him and he couldn't see her.

Correctional nurse: I don't even want them to be able to see each other or hear each other. More time is something that I would want and to really adequately separate so that I could meet each person at their level.

Although there was acknowledgement across all groups that it is necessary to consider potential victimization and trauma among the parties involved, only SANE nurses explicitly discussed the need to use a trauma‐informed approach when engaging with the individuals at the scene.

SANE: …when I'm talking to a patient I feel like I'm letting them know immediately up front—this is what is available, these are what your options are, you are in control.

Officers were the only discipline to focus on identifying possible criminality at the scene in order to determine if charges were appropriate, co‐response clinicians acknowledged that part of their assessment would be geared towards supporting law enforcement to determine if diversion from arrest is appropriate. While nurses and clinicians highlighted that assessing the involved parties' emotional state was essential, only nurses, both correctional and sexual assault nurse examiners, noted the physical markings on the individuals and emphasized the importance of completing a physical assessment as part of the data gathering process.

Correctional nurse: I feel like they both needed a physical assessment…past medical history, to see if there's anything else going on…and the medications. But, obviously he had bruises and scratches and stuff on his face that I couldn't really see clearly, but I think those would need to be addressed. And then see if she has any other physical markings on her.

SANE: In forensic exams rarely on non‐fatal strangulation exams do we see injuries. And it's not often that we do. They're very well‐hidden. We'd have to really do a thorough exam to find very minor…the fact that both of them had even minor injuries, to me, it's always serious.

3.3. Future strategies and interventions

The third predominant theme exhibited a future‐oriented perspective, elucidating the aftermath of the encounters and the distinctive approaches of the groups in addressing behavioural crises from their respective viewpoints. Given that all groups described the importance of obtaining collateral information as a key part of their historical assessment, it is not surprising that they recommended physical separation and further evaluation beyond the present scene. Different forms of further assessment were suggested:

Co‐response clinician: We could have diverted her into like a hospital setting for a full crisis evaluation and maybe summoned on some of those charges.

Officer: This is somebody who probably needs to speak to a professional on some level or that some further evaluation… that aspect of it needs to be delved into.

Correctional nurse: I like the idea of maybe taking them both to some place where they can be in separate rooms and not in view of each other…and really kind of just dig a little deeper with her and maybe get her a crisis referral. I think that, as a nurse on scene, I probably would have done that.

The SANE group emphasized the importance of accounting for potential escalation.

SANE: …once you see the physical injury, which we don't always see, t's a really bad sign, potentially pointing toward something more fatal on the horizon.

While officers largely focused on establishing safety at the scene and determining if an arrest was warranted, the other groups identified the importance of completing an assessment that estimates risks towards oneself (i.e. self‐harm). However, only correctional nurses and SANE specifically focused on the risks of escalating violence in intimate partnerships in which victimization may take place. They highlighted how this specific aspect would be a crucial consideration in their assessment and disposition planning.

SANE: A lot of domestic violence is not visible. It's the coercion, it's the manipulation, it's the degradation and for it to become physical is extremely dangerous. It's just going to continue to escalate unless there's intervention…I feel like there might be a honeymoon phase after the police leave them, but it's the cycle—it is going to happen again.

Correctional nurse: If there is abuse in a relationship or if there's some sort of physical violence in the relationship, it's not going to stop. It's perhaps not going to get any better unless perhaps people get help…I just don't think there's really anywhere to go from there and that I'm almost certain that things just would progress and get worse.

4. DISCUSSION

In this study, we have provided insights into the distinct approaches of various professional groups—police officers, co‐response clinicians, SANE nurses and correctional nurses—towards crisis intervention. Our primary focus was to understand the individual perspectives and approaches of forensic nurses' behavioural crisis response, comparing them to the approaches and viewpoints of other disciplines typically involved in first response to behavioural crises. In the study, we also considered the broader systemic context in which these professionals operate.

Moreover, the present research contributes to the nursing and crisis response literature, particularly considering the increased push to enhance patient safety in police‐led joint responses, decriminalize mental illness and optimize jail diversion strategies for cases involving behavioural crises in which alternatives to arrest are a viable option (Kane et al., 2017). These system‐level considerations highlight the intricate web of professionals, policies, stakeholders, and societal forces that shape crisis intervention strategies.

There was a notable consistency across all the focus groups, particularly during the historical data collection stage and their prioritization of ensuring safety during the contact. Still, significant differences were observed among the groups. For instance, even though officers, co‐response clinicians, SANE and correctional nurses described the importance of assessing for a prior history of domestic violence, officers were the only ones to consider general aspects of past and current criminality. It is important to note that officers agreed that de‐escalation of the scene is an essential part of their role, but also recognized that behavioural crises may require a more nuanced approach. This is consistent with reports that indicate that the expectations and scope of law enforcement have drastically changed in the last few decades, in order to adjust and meet the needs of an evolving society. Whereas policing previously focused primarily on enforcing the law and controlling crime, the ongoing cultural changing landscape, emerging societal challenges, public opinion and unmet community needs have influenced the expansion, specialization and diversification of the role of the police (Kurtz & Tucker, 2023). This systemic shift emphasizes the evolving expectations society places on law enforcement and highlights opportunities for other disciplines, such as nursing, to broaden their roles and collaborate with law enforcement.

The co‐response clinician group, similar to both nursing groups, had a primary focus on establishing rapport, ensuring safety, providing emotional support and assessing risk of self‐harm. However, there was a marked separation between the views of SANE and correctional nurses and the co‐response clinicians, as the nursing groups both emphasized the importance of collecting history pertaining to physical health, including potential substance use and medications, and performing a physical assessment. Considering the diagnostic differential in mental and behavioural disorders, which includes the rule out of presentations due to a substance or an underlying medical condition, a physical evaluation proves essential to accurately establish aetiology (Lee et al., 2015).

Moreover, both the SANE and correctional nurses noted that in scenarios in which there may be intimate partner violence, examining for physical injuries in both the potential victim and perpetrator, can provide critical information that guides interventions, from determining the need for mental health or medical treatment follow up, to ascertaining current and future danger for further victimization. This emphasizes a crucial nursing contribution to MDTs, as literature focusing on domestic violence has demonstrated that in cases of intimate partner violence, signs of certain types of injury such as asphyxiation or strangulation, are significantly associated with future intimate partner homicide (IPH), increasing the risk of death by almost eight times within a year of an incident of nonfatal strangulation (Donaldson et al., 2023).

Both cohorts of nursing professionals demonstrated a comprehensive and holistic approach to patient assessment, addressing multiple dimensions of health (Valdes et al., 2021). Their emphasis on safety and the application of a trauma‐informed approach, as recommended in crisis situations, reflects a commitment to minimizing re‐traumatization of clients (Adams et al., 2022). These assessments were characterized by careful attention to the context, including recommendations for spatial separation of the individuals involved, a thorough examination of historical health data, real‐time information from the crisis scene, and a forward‐looking consideration of patient disposition. All these aspects were designed to optimize safety and the overall well‐being of individuals involved.

4.1. Clinical and practice implications

Our findings underscore the invaluable role that forensic nurses can play in MDTs and police‐partnered behavioural crisis responses. Nurses bring a comprehensive understanding of healthcare dynamics and an array of assessment skills, encompassing physical and mental health, safety considerations, and the broader environmental context (Arkins et al., 2016). Their training and experience in managing medical and behavioural emergencies equips them with valuable insights to optimize outcomes and improve approaches within the intricate system of crisis responses. Furthermore, their adeptness in responding to situations that intersect with law enforcement or legal scenes, coupled with a focused commitment to ensuring safety and preventing escalation (Dikeç et al., 2017), underscores the potential benefits they may contribute in the context of first response.

Systems Theory further emphasizes the importance of a holistic approach to crisis intervention (Papathanasiou et al., 2013). It recognizes that crises are not isolated events but are embedded within complex systems of individual, societal and environmental factors. Moreover, it considers the temporal dimension, acknowledging that the state of a system at any given point is influenced by its history and future trajectory (Cordero et al., 2017). Nurses, with their multifaceted competencies, are well‐positioned to navigate this complexity and identify contributory factors within the larger system. This perspective aligns with the systems thinking approach, which seeks to understand how different components of a system interact and influence outcomes (Arnold & Wade, 2015).

Although joint response with mental health clinicians who accompany officers in first‐response calls has been introduced into police departments with marked success (Dempsey et al., 2020), there are notable constraints with the model and opportunities for enhancement. These considerations become especially salient when the prevalence of medical crisis cases and drug‐related incidents frequently encountered by MDTs are taken into account (Wood et al., 2020). Accurately establishing aetiology is paramount for determining the appropriate intervention (Lee et al., 2015) and existing literature underscores the importance of ruling out potential medical conditions or substance‐related presentations during mental health assessments or acute psychiatric crises (Kane et al., 2017; Roggenkamp et al., 2018). Addressing these gaps can be effectively achieved by incorporating nurses into MDTs, as they can apply their training, scope of practice and multifaceted competencies to conduct comprehensive assessments across various dimensions of health, all while promoting patient safety.

A single identified study has examined the role of nurses responding to emergency calls, through a mobile crisis team model (Scott, 2000). While the model employed in the study relied on collaborative teamwork and the nursing skillset, there are considerable limitations when it comes to the proposed approach. First, these teams solely concentrate their efforts on addressing 911 calls that are specifically categorized as psychiatric emergencies. Second, it does not serve as a first responder, as their role entails providing support by phone or in person once another police unit has already addressed the scene (Scott, 2000).

Forensic nurses have traditionally played prominent roles across various settings, exercising a range of critical skills in forensic contexts (Meera & Singh, 2017). Their responsibilities span from evaluating crime scenes and assessing cases involving drug intoxication to safeguarding the well‐being of individuals with mental health concerns. In emergency and correctional settings, they provide care to victims and perpetrators alike while working seamlessly with diverse disciplines, including law enforcement (Williams, 2022). These skills can be effectively translated to first‐line police‐led response to crisis calls.

Introducing a proposed concept of the Nurse‐Police Assistance Crisis Team (N‐PACT) as a collaborative response model, where a nurse accompanies an officer in a patrol vehicle, offers the potential to significantly broaden the scope and effectiveness of crisis interventions. With N‐PACT, a nurse is present at the initial response scene, ensuring immediate assistance and extending the model's applicability to a broader spectrum of incidents, regardless of their initial classification as behavioural crises or psychiatric emergencies. This innovation greatly enriches the depth of insights and expertise contributed by the nursing perspective.

Currently, a significant proportion of behavioural crises, which are initially addressed by police officers or multidisciplinary teams involving clinicians, culminate in referrals to emergency departments (Abreu et al., 2017; Balfour et al., 2022; McKenna et al., 2015). While it is undeniable that certain cases warrant immediate emergency department attention, a noteworthy portion could conceivably be resolved and diverted to alternative care settings through on‐scene assessments conducted by proficient nurses. There have been proposed strategies to reduce the reliance on emergency departments for addressing behavioural crises—such as the implementation of drop‐off centres and expanding mobile crisis interventions beyond outreach services—but these initiatives predominantly target individuals with mental or substance use disorders (Abreu et al., 2017). Although these programs offer benefits, their efficacy is also constrained by their dependence on the initial classification of a case by 911 as a mental health or behavioural crisis, or the on‐scene officer's request for additional support before activating mobile mental health services (Abreu et al., 2017). In this case, the prospect of a nurse‐police team in reducing the burden on emergency departments may prove significant, as they would provide a joint first response. Such an approach not only holds the promise of cost savings but also the optimization of healthcare resource allocation (Lamanna et al., 2017).

4.2. Limitations

While the findings of this study bear significant implications, it is essential to recognize and exercise prudence in light of the study's qualitative design and limited sample size. Several key considerations contribute to the need for caution when interpreting these findings.

First, the study participants, although grouped based on their training and specialized areas, may manifest variances in their approaches contingent upon the specific work settings they are situated within. Additionally, it is plausible that certain participants may draw upon their personal experiences rather than their professional training when expressing their perspectives. Additionally, the study focused on a specific scenario, and different situations might yield different insights, warranting further research that examines other behavioural crisis variants.

It is noteworthy that all the participating officers and co‐response clinicians are actively engaged in MDTs, while the two nurse groups were requested to envision themselves in a live crisis scenario. To ascertain the broader generalizability of these findings, further research is needed to assess their applicability to a more extensive cohort of officers, clinicians, and nurses. Furthermore, there is a need for subsequent research aimed at piloting the N‐PACT to test and evaluate the feasibility of this specific MDT composition.

Despite these inherent limitations, the study has yielded valuable insights into the distinct approaches of various disciplines towards crisis intervention. These findings reveal a considerable degree of convergence across different participant groups, although specific differences were observed, especially within the nursing groups.

5. CONCLUSION

This study's findings support the introduction of a novel nursing role within MDTs for crisis response, conceptualized as the Nurse‐Police Assistance Crisis Team (N‐PACT). Nurses' unique expertise and comprehensive assessment capabilities offer valuable insights into optimizing crisis responses. Addressing the limitations of current crisis response approaches, particularly in cases involving medical crises and drug‐related incidents, can be achieved by integrating nurses into MDTs. Their involvement has the potential to enhance assessments, reduce the reliance on emergency departments, and improve resource allocation. Further research into this promising concept is warranted to refine its implementation and maximize its benefits.

AUTHOR CONTRIBUTIONS

Made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: VGP, JTB, CH. Involved in drafting the manuscript or revising it critically for important intellectual content: VGP, AWB, CH. Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content: VGP, JTB, AWB, CH. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: VGP, JTB, AWB, CH.

CONFLICT OF INTEREST STATEMENT

No conflict of interest has been declared by the author(s).

Petreca, V. G. , Barros, J. T. , Hoblock, C. , & Burgess, A. W. (2025). The Nurse‐Police Assistance Crisis Team (N‐PACT): A new role for nursing. Journal of Advanced Nursing, 81, 5472–5483. 10.1111/jan.16056

DATA AVAILABILITY STATEMENT

The data are not publicly available due to privacy or ethical restrictions.