Table 2.
Perceived knowledge gaps in the assessment and management of mental health related presentations reported by study participants
| Themes | Quotes | ||
|---|---|---|---|
|
Theme |
Sub-theme |
Doctors |
Nurses |
| Assessment |
Risk assessment |
Making the suicide risk safety assessment [is a knowledge gap] if this person has come in saying they’re trying to kill themselves and I want to send them home. (M39) |
I think the biggest knowledge deficit is that decision making on ‘are they safe to be discharged or are they not? (N4) |
| |
Mental status /describing symptoms |
Ability to perform a thorough mental state assessment is wanting… (M13) |
It’s just the lack of knowledge on the types of illnesses, like what’s the real … difference between delusions and hallucinations and stuff, we get a bit stuck on. (N24) |
| Diagnosis |
|
…to formulate a diagnosis or differential diagnosis can be problematic… (M13) |
I think we didn't understand all the diagnoses. I think we would have loved a bit more training on different illnesses with mental health… (N10) |
| Management |
Psycho-therapeutic skills |
…the kind of brief intervention, for people who are not acutely disturbed, but need some counselling… (M29) |
…[some staff] ignore problems and things will escalate and then all of a sudden you’ve got a violent patient on your hands… (N6) |
| |
Ongoing management |
…more to do with the ongoing management and medications and chronic effects of the illness rather than the acute presentation… (M31) |
I acknowledge my level of knowledge is not high in terms of routine treatment and ongoing care plans.(N16) |
| |
Medications/Sedation |
….more info on the long-term side effects of medication.(M9) |
…there’s a lot of debate over which is the best sedation agent to use. (N2) |
| |
Behaviour |
I feel pretty comfortable assessing mental health patients, but if they’re like really aggressive and hostile and distressed I find that difficult (M35) |
…the immediate response to how you manage someone, to de-escalate the situation… (N20) |
| Training |
Curriculum |
Making sure that junior staff are up to date and know their stuff is actually very difficult. (M11) |
Training in drug and alcohol issues would be good. (N8) |
| |
Rotations |
I think that ED registrars would also benefit from more psychiatric training. I did quite a bit of psych in my ED training. I think it’s something that people working in the ED probably could do with more training, particularly in the registrar phase when they are learning new skills anyway. (M7) |
…mental health seems to get forgotten about yet we still have an expectation about staff that they’re competent and that they work in this mental health area. (N22) |
| Legislation | I think that we are not really formerly taught about the legal requirements about forms and transport issues (M33) | ||