Barriers Faced by Nurses in Emergency Departments: Suicide Risk

This report investigates the barriers faced by nurses in emergency departments (EDs) when assessing patients at risk of suicide. The introduction highlights the increasing demand for nurses in suicidal risk assessment and the social, physical, and emotional barriers they face. The search strategies section details the electronic databases (Cochrane Library, Science Direct, BioMed Central) and keywords used for literature review. The overview of the literature synthesizes findings from studies examining nurses' knowledge, attitudes, and practices in caring for suicidal patients, including the impact of training and support. The discussion section analyzes the identified barriers, such as lack of counselling skills, time constraints, and privacy concerns, and proposes solutions like improved communication and structured follow-up. The report emphasizes the need for multidisciplinary approaches, education, and clinical care improvements to support nurses in providing effective suicidal risk assessments within the demanding ED environment. The conclusion reiterates the importance of addressing these barriers to enhance patient care and nurse well-being.

“Barriers for nurses in
Emergency department
and suicidal” risk
assessment

Table of Contents
INTRODUCTION...........................................................................................................................1
SEARCH STRATEGIES.................................................................................................................1
Electronic research: ...............................................................................................................1
Search terminologies: ............................................................................................................2
Inclusion and exclusion criteria:.............................................................................................2
OVERVIEW OF THE LITERATURE SUPPORTING THIS ISSUE............................................3
DISCUSSION..................................................................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

Index of Tables
Table 1: List of Keywords...............................................................................................................2
Table 2: Inclusion and Exclusion criteria........................................................................................2

INTRODUCTION
Emergency department which is also known as accident and emergency department is a
medical facility given by all hospitals which provide treatment with emergency medicines and
procedures to the patients without any prior appointment. This department is mainly found in
hospitals and in some primary care centres (arke, Hunter, Strain, Marck, Waugh & McClelland,
2013). The main aim of this research paper is to identify the barriers for nurses those are working
the emergency department and involved in suicidal risk assessment. In today's world many
suicidal cases are coming forward that increase the demand of nurses working in suicidal risk
assessment. But there are many organisations and care centres where nurses are facing many
social, physical and emotional barriers in provision of care to patients in emergency department
and those who need suicidal risk assessment. Despite of ample advancement in the nursing
practices in many are nurses are facing barriers and problems that hinder their main objective of
nursing i.e. provision of excellent care to the patients (Bolster, Holliday, Oneal & Shaw, 2015).
SEARCH STRATEGIES
With the advancement in field of nursing many systematic and standard approaches are
adopted for the effective research of reliable literatures to conducting a research study. This also
depict that focused research is done to come up with the result of this study (Pretorius, Searle &
Marshall, 2015). There are several research strategies available to carry out the effective research
on the selected problem such as:
Electronic research:
There are various computerized databases available that provide researchers with latest
and updated information regarding the subject of their research. This information is available in
the form of journals, articles and e-books and a good deal of other literature through many online
libraries that are easily accessible. Following database were used to conduct this research study:
 The Cochrane Library: It is an online collection of number of databases that contain
high quality evidences regarding decision making in healthcare setting. This library of
database is provided by Cochrane collaboration, that contain database related to speciality
in healthcare and medical. It contains the full length research articles that tends to provide
detailed information regarding particular subject (Cochrane Library, 2017).
 Science Direct: Science direct is the database that provide access to full length article and
journals mainly on the scientific nature but on the basis of online subscription. This
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database contain more than 12 million literature ranging from 3500 academic journals
and 34,000 e-books.
 BioMed central: BioMed central is the online portfolio having 300 peer reviewed
journals and have open excess for these journals. The articles are mainly based on
biomedicine, science and technology. Along with this BMC is also an integral part of
springer nature (BioMed Central, 2017).
Search terminologies:
For conducting a specific research there is a need of certain words or variables. These
specifics words and variables are known as keywords (Grudzen, Richardson, Major-Monfried,
Kandarian, Ortiz, & Morrison, 2013). The keywords are identified before starting search for
journals and articles. The keywords that are used in the particular research study are:
Table 1: List of Keywords
No. Of Terms Keywords & Synonyms
Term 1 Barrier, Barricade and Hurdle
Term 2 Emergency, Crises and Extremity
Term 3 Department, Sector and Division
Term 4 Suicide and Self killing
Term 5 Risk, Possibility and Chance
Term 6 Assessment, Evaluation and Judgement
Term 7 Nurse, Carer and Attendant
Term 8 Professional, Executive and Expert
Term 9 Training, Instruction and Teaching
Term 10 Skills, Mastery and Adroitness
Inclusion and exclusion criteria:
Inclusion and exclusion criteria help in selection of literature specific to research subject.
With the help of these criteria relevant literature can be identified that is important for the
research study. Following are the inclusion and exclusion criteria for this research paper:
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Table 2: Inclusion and Exclusion criteria
Inclusion criteria Exclusion criteria
Research is conducted in the English language. Research conducted in language other than
English.
Research conducted from 2008-2017. Study done prior to 2008.
Research is done on Barriers for nurses in
Emergency department and suicidal risk
assessment.
Research done on Barriers for nurses in
Maternity department.
OVERVIEW OF THE LITERATURE SUPPORTING THIS ISSUE
Knowledge, attitudes, and practices of emergency department providers in the care of
suicidal patients.
According to the research conducted by Betz et.al (2013) it requires for the nurses to have
proper understanding of the steps that has to be conducted at the time of emergency situation. In
other words, the research was conducted on examining the knowledge, attitudes and practices of
emergency department providers. To carry out the research in effective manner, there are about
631 participants at eight emergency departments evaluated. From the findings, it was identified
that age of median participants was 35 among which more than half of them were females.
Further, there were 48 % were nurses, 22 % were resident and physicians (30 %). From the
analysis made, it was identified that majority of the people involved in ED had confidence but
they lack proper skills for counselling, and assessment of the situation in effective manner. It
requires to have better efforts to be made in identifying suicidal patients with the help of
commensurate efforts to improve the risk assessment and their management skills.
Emergency Room Psychiatric Services: A Qualitative Study of Nurses’ Experiences
As per the research conducted by Plant and White, (2013) is focused on the nurses who
work at general emergency divisions (EDs). From this research, it is identified that they are
provided with proper training and are given acute physical problems. There are different type of
experiences during the process of providing care for psychiatric patients. However, the
experiences they face are not been properly studied. Invest orators have made Qualitative
research in which focus groups are selected. Main aim for this study was to understand the
experience of nurses and their feelings for patients with mental illness. Krueger and Casey’s
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qualitative analysis was used for focused groups so as to categorize phrases and code and to
determine the themes from transcribed interviews. There were four themes identified, these were
helpful to capture the overarching and subjective experience of the participants. From the
findings, it is identified that implications of emergency room care of psychiatric patients are
described.
Rationale and study protocol for a two-part intervention: Safety planning and structured
follow-up among veterans at risk for suicide and discharged from the emergency
department
Currier et.al., (2015) it is important for the nurses to have proper knowledge and
understanding about the competence on suicide prevention and proper management of people.
Further, there are no proper evidence based or brief interventions so as to reduce risk of suicide
in Veterans. Further, suicides can be determined to be the major public health problem. In
accordance with this article, it describes protocol, (SAFEVET) Suicide Assessment and Follow
up Engagement: Veteran Emergency Treatment. This was developed in order to test the
effectiveness of brief intervention used for combining safety planning intervention with
structured follow up. It was focused on reducing the rate of suicides and in increasing outpatient
behavioural health treatment engagement. The rate of suicides can be reduced when nurses are
provided with proper training in which they can understand the needs and the issue that are faced
by them.
Emergency Nursing Experiences in Assisting People With Suicidal Behavior: A Grounded
Theory Study
According to Vedana et.al., (2017) the research was conducted to identify the experience
of emergency nurses in order to assess people with suicidal behaviour. To carry out the research,
the investigator has made use of grounded theory study with symbolic interactionism that was
conducted from the year 2015 to 2016 in Brazil and the research was conducted from 19 nurses.
As per the findings, it is identified that to assess people with suicidal behaviour is critical, evokes
different feelings, it is challenging, requires emotional control, skills and knowledge. At the
initial stage, nurses do not feel prepared or supported but they analyse the situation and aim at
understanding the main cause of the problem. Further, nurses are restricted to attend physical
need and so the roles that they have to play is also limited. In addition to this, they predominantly
manifest opposition, incomprehension and judgements about patients. this study concludes that
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there are key elements to address in investigations and interventions for nurses support,
supervision and their training.
Barriers and facilitators of suicide risk assessment in emergency departments: a qualitative
study of provider perspectives
As per Petrik et.al., (2015) is focused on understanding the barriers and facilitators of
suicide risk assessment by emergency department providers perspective to carry out the research
in effective manner, there are about 92 ED providers from 2 hospitals considered. There are
asked open ended questions that was conducted through online survey. This way, it was helpful
to know the barriers and facilitators to assess the risk of suicide. From the findings, it was
identified there were six themes that has impact over the suicide risk assessment. in this context,
included consultation, collaboration, privacy, integration of standard screening protocol, other
professional and time. Apart from this, it includes effective communication with patients and
also requires to have participation so that they are able to develop strong relationship. From this,
it can be concluded that it requires to have multidisciplinary approach so as to make proper
assessment of suicides. It is recommended that education, clinical care and quality improved is
important to be maintained and to be provided to patients.
DISCUSSION
On the basis of research conducted on evaluation of 631 participants the literature (Betz
et.al., 2013) suggest that nurses that are working in emergency department have enough
confidence regarding treatment procedure they provide to patients but lack proper counselling
skills and the effective assessment of the situation. Nurses are not able to effectively cooperate
with patients and their family this hinders the nursing practice in this department. Along with this
there is need of efforts to identify the problems associated with suicidal patients. Thus, this
article completely relate with research subject and with the help of commensurate efforts and
effective training nurses can improve their risk assessment strategies.
The research conducted by Petrik et.al., (2015) focused mainly on understanding the
emergency department perspectives on the barrier and facilitators of suicide risk management. In
his survey 92 emergency department services providers from two different hospitals responded
to open ended question through online survey. The outcome of this survey came up with six
reasons that affect the suicidal risk assessment in the emergency department which includes:
time, privacy, consultation and collaboration with other professionals. Thus, this literature is
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completely related to present subject as it helps in identification of the barrier that nurses face in
suicidal risk assessment. But this issue can be resolved in effective manner by emphasizing
more on communication that results in good interpersonal relation with other professionals.
Currier et.al., (2015) conducted study in which he described about intervention that help
in reducing the risk related to suicide in Veterans. This particular articles describe that structured
follow up of patients is necessary after providing them with treatment regarding suicidal attempt,
in order to reduce the near term suicide risk. Thus, in this article author addressed the lack of
follow up which is important for the behavioral treatment and this act as barrier in emergency
department in the efficient suicidal risk assessment. But this issue can be resolved by combining
the safety planning intervention with structured follow to reduce the risks related to suicides.
Similarly, the research study done by Plant and White, (2013), mainly focused to study
and explore the experience of nurses dealing with psychiatric patients having acute mental illness
in the emergency department. As nurses are trained to treat and provide care to patients having
acute physical problems and in case of psychiatric patients due to lack of information and
education regarding specific treatment procedures nurses are not able to provide effective care to
those patients. Thus, this lack of education act as barrier for nurses in emergency department to
provide efficient care to patients. But it can be resolved by providing education and training to
nurses regarding treatment of psychiatric patients.
On the basis of research conducted by Vedana et.al., (2017) it was identified that
assessing the people with suicidal behaviour is critical, which evokes different feeling and
requires the emotional control, skills and knowledge. At the initial stages the nurses are not
prepared and lack support of professionals that help them in analyzing the conditions of patients.
Thus, this act as barrier for them in order to provide effective care to patients. But this issue can
be resolved by providing nurses with support, supervision and training that help in improving the
key elements of investigation and intervention in them.
CONCLUSION
Form the above done research it can be concluded that due to lack various elements many
nurses tends to face barriers in the emergency department and suicidal risk assessment. The
major elements that were identified are lack of effective communication, professional skills,
critical thinking and attitude towards patients (Hockenberry & Wilson, 2014). These issue can be
efficiently resolved by providing nurses with intense training in order to increase the adaptability
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and to make them aware regarding loopholes in practice patterns (Dougherty & Lister, 2015). By
proper identification of the problems nurses can be able to overcome the barriers in the effective
way.
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REFERENCES
Books and journals
Betz, M. E., Sullivan, A. F., Manton, A. P., Espinola, J. A., Miller, I., Camargo, C. A., &
Boudreaux, E. D. (2013). Knowledge, attitudes, and practices of emergency department
providers in the care of suicidal patients. Depression and anxiety, 30(10), 1005-1012.
Bolster, C., Holliday, C., Oneal, G., & Shaw, M. (2015). Suicide assessment and nurses: What
does the evidence show. The Online Journal of Issues in Nursing. 20 (1).
Currier, G. W., Brown, G. K., Brenner, L. A., Chesin, M., Knox, K. L., Ghahramanlou-
Holloway, M., & Stanley, B. (2015). Rationale and study protocol for a two-part
intervention: safety planning and structured follow-up among veterans at risk for suicide and
discharged from the emergency department. Contemporary clinical trials, 43, 179-184.
Dougherty, L., & Lister, S. (2015). The Royal Marsden manual of clinical nursing procedures.
John Wiley & Sons.
Grudzen, C. R., Richardson, L. D., Major-Monfried, H., Kandarian, B., Ortiz, J. M., & Morrison,
R. S. (2013). Hospital administrators' views on barriers and opportunities to delivering
palliative care in the emergency department. Annals of emergency medicine, 61(6), 654-660.
Hockenberry, M. J., & Wilson, D. (2014). Wong's Nursing Care of Infants and Children-E-Book.
Elsevier Health Sciences.
Parke, B., Hunter, K. F., Strain, L. A., Marck, P. B., Waugh, E. H., & McClelland, A. J. (2013).
Facilitators and barriers to safe emergency department transitions for community dwelling
older people with dementia and their caregivers: a social ecological study. International
Journal of Nursing Studies, 50(9), 1206-1218.
Petrik, M. L., Gutierrez, P. M., Berlin, J. S., & Saunders, S. M. (2015). Barriers and facilitators
of suicide risk assessment in emergency departments: a qualitative study of provider
perspectives. General hospital psychiatry, 37(6), 581-586.
Plant, L. D., & White, J. H. (2013). Emergency room psychiatric services: a qualitative study of
nurses’ experiences. Issues in Mental Health Nursing, 34(4), 240-248.
Pretorius, A., Searle, J., & Marshall, B. (2015). Barriers and enablers to emergency department
nurses' management of patients' pain. Pain Management Nursing, 16(3), 372-379.
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