Improving Psychiatric Care: One Nurse-Led Idea
According to the American Psychiatric Nurses Association (APNA), approximately 1 in 5 adults in the U.S. (43.8 million) experience mental illness in a given year. What’s more, with greater access to care and an aging population, the APNA estimates that half of American medical-surgical patients will face cognitive, behavioral and emotional challenges.
“People with mental health needs enter the healthcare system from a variety of access points, and many often have comorbid medical illnesses,” said Mary Ann Nihart, MA, APRN, PMHCNS-BC, PMHNP-BC, president of the APNA. “This means that it’s common for healthcare providers who are not mental health specialists to encounter people with mental health needs in daily practice.”
All too often, however, non-psychiatric staff are not prepared to recognize or resolve mental health issues due to limited training and education in this area. For Angela Mackay, MSN, BSN, PHN, RN, a psychiatric resource nurse at Regions Hospital in Saint Paul, Minn., the gap in knowledge about mental healthcare at her hospital was an opportunity to create a better solution for improved patient and staff safety. According to Mackay, when a patient was having a mental health crisis in a non-mental health unit, the typical response at Regions was to call security officers, who had little knowledge or understanding of how to respond to a psychiatric issue.
Mackay saw the need for a team of quality mental health staff to assist with crisis situations on non-mental health units, and as a result, pioneered the Psychiatric Emergency Response Team (PERT) at Regions Hospital in 2014. Through a collaborative approach, Mackay’s PERT program encourages patient-centered interventions and reduces the use of unnecessary restraints or medication.
The PERT program trains staff in non-violent intervention and includes nurses, mental health associates and security staff. It helps maintain a safe environment and the use of therapeutic communication – which results in better outcomes for the patient and healthcare team. Since the program began 26 months ago, Mackay and her team have trained 190 healthcare workers on how to respond to mental health crisis situations on the non-mental health units.
“What particularly impresses me about Mackay’s program was the way in which she initiated it by first asking the nurses themselves about their needs and then using her ability to bring people together across the entire hospital system to work toward solutions to improve outcomes,” said Nihart.
Mackay worked closely with a mental health educator to compile the education training, expectations and competency required to be a PERT team member. She also worked with the simulation center manager to plan the simulation training for staff.
“A de-escalation and restraint scenario was written based on situations that I had experienced in my role as a mental health resource nurse,” she said. “Staff went through a two-hour training in the simulation center to learn about the skills and awareness needed when responding to a crisis situation on the medical units.”
The PERT program was adopted as a nursing practice at Regions Hospital, already showing improved outcomes for reductions in use of restraints, patient injuries and staff injuries, which Nihart notes is likely to decrease cost as well.
“Knowing that I have a team of trained cross-functional professionals has empowered me and my staff to respond more efficiently and effectively to crisis calls,” said Mackay. “Staff on the non-mental health units have expressed how much safer they feel working with patients that have the potential to be violent, knowing that they have the resources available to call for assistance before situations potentially get out of control."
Through the APNA Annual Award for Innovation, the PERT project has been shared with the psychiatric-mental health nursing community as a best practice.
“It is vital for all providers to understand that there are simple steps anyone can take that will make all the difference in creating a therapeutic and safe environment, while also providing the best possible care,” said Nihart. “Our patients are people first and foremost, and it is important for us to understand how to meet their needs in a way that preserves their human dignity while also keeping providers and patients safe, even in moments of crisis.”
For more information about Mackay’s PERT program, visit www.apna.org.