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Smith LH, Warren E, Hendrickson N, Joshua K. An Empty Scoping Review of Emergency Department to School Transition for Youth with Mental Health Concerns. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.23.24301673. [PMID: 38343854 PMCID: PMC10854341 DOI: 10.1101/2024.01.23.24301673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The number of youth Emergency Department (ED) visits due to mental health concerns has been steadily increasing with a large number of youth being referred from school. Despite the increase in ED visits, there has not been an increase in the number of students who are actually admitted to the hospital. Further, youth referred from school are more likely to be discharged from the ED. Given the unique relationship between school and ED referrals and the large number of youth who do not require hospitalization, this study sought to understand how schools are supporting students who return to school after an ED visit. We conducted a scoping review to identify programs and practices to support ED to school transition. Two reviewers screened 907 manuscripts, but none of the manuscripts met the inclusion criteria. We discuss the importance of supporting students returning to school from the ED and draw from the literature on hospital to school transition to make recommendations for educators.
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Affiliation(s)
| | - Emily Warren
- University of Virginia, School of Education & Human Development
| | | | - Kate Joshua
- University of Virginia, Claude Moore Health Sciences Library
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Fisher BW, Petrosino A, Persson H, Guckenburg S, Fronius T, Benitez I, Earl K. School-based law enforcement strategies to reduce crime, increase perceptions of safety, and improve learning outcomes in primary and secondary schools: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1360. [PMID: 38024781 PMCID: PMC10630714 DOI: 10.1002/cl2.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background School-based law enforcement (SBLE) has become a common intervention. Although SBLE is meant to make schools safer, critics suggest it may not accomplish this purpose, and may have unintended negative consequences such as increasing students' exclusionary discipline or contact with the criminal justice system. There may also be secondary effects related to perceptions of the school or student learning. Objectives The purpose of this review is to synthesize the literature evaluating the use of SBLE, including outcomes related to (a) crime and behavior problems; (b) perceptions of safety; and (c) learning. Methods We conducted a systematic literature search to identify studies that examined outcomes associated with SBLE use. Eligible studies used experimental or quasi-experimental designs; included samples of students, teachers/staff, schools, or school districts; reported on a policing strategy focused on crime prevention or school safety that did not involve officers teaching a curriculum; included a measure that reflects crime and behavior problems, perceptions of safety, or learning; and were in a primary or secondary school. Following a multi-stage screening process to identify studies eligible for inclusion, we estimated a series of meta-analytic models with robust variance estimation to calculate weighted mean effect sizes for each of three main categories of outcomes and commonly occurring subsets of these categories. We examined heterogeneity in these estimates across features of the primary studies' design. Results The search and screening process yielded 1002 effect sizes from 32 reports. There were no true experiments, and the quasi-experiments ranged from strictly correlational to permitting stronger causal inferences. SBLE use was associated with greater crime and behavior problems in studies that used schools as the unit of analysis. Within this category, SBLE use was associated with increased exclusionary discipline among studies that used both schools (g = 0.15, 95% confidence interval [CI] [0.02, 0.27]) and students (g = 0.003, 95% CI [0.002, 0.003]) as the unit of analysis. SBLE use was not associated with any measures of crime or violence in schools. SBLE use was associated with greater feelings of safety among studies that used schools as the unit of analysis (g = 0.18, 95% CI [0.13, 0.24]), although this estimate was based on only seven effect sizes from two correlational studies. All the other models, including those examining learning outcomes, yielded null results. None of the moderators tested showed meaningful relationships, indicating the findings were consistent across a variety of study design features. Authors’ Conclusions This study's findings provide no evidence that there is a safety-promoting component of SBLE, and support the criticism that SBLE criminalizes students and schools. Although we found no evidence of differences across methodological features, risk of bias in the primary studies limits our confidence in making causal inferences. To the extent that the findings are causal, schools that invest in strategies to improve safety will likely benefit from divesting from SBLE and instead investing in evidence-based strategies for enhancing school safety. Schools that continue to use SBLE should ensure that their model has no harmful effects and is providing safety benefits.
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Affiliation(s)
- Benjamin W. Fisher
- Department of Civil Society and Community Studies, School of Human EcologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | | | | | | | | | - Ivan Benitez
- Office for Safe and Healthy NeighborhoodsLouisvileKYUSA
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Kline CL, Hurst L, Marcus S, Malas N. A Review of Telepsychiatry for Pediatric Patients in the Emergency Setting. Curr Psychiatry Rep 2023; 25:429-436. [PMID: 37526863 DOI: 10.1007/s11920-023-01442-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize factors contributing to the current state of pediatric mental health access in ED settings and synthesize the existing literature on the use of telepsychiatry to extend access to care, with particular focus on feasibility and sustainability. RECENT FINDINGS Children are presenting to emergency departments (EDs) with mental health concerns at an increasing rate, while ED capacity to treat psychiatric needs in children remains insufficient. This growing problem is compounded by decreased access to outpatient care and inpatient psychiatric beds, resulting in exorbitantly long waiting times, or "boarding," of children in crisis. Telepsychiatry has emerged as a strategy to decrease boarding of pediatric patients in ED settings by utilizing remote psychiatric professionals to provide consultation and assessment. Telepsychiatry in ED settings is an effective strategy to increase access to care and decrease length of stay for pediatric patients.
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Affiliation(s)
- Christopher L Kline
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Laura Hurst
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sheila Marcus
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
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Bommersbach TJ, McKean AJ, Olfson M, Rhee TG. National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. JAMA 2023; 329:1469-1477. [PMID: 37129655 PMCID: PMC10155071 DOI: 10.1001/jama.2023.4809] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
Importance There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. Objective To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Design, Setting, and Participants Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Main Outcomes and Measures Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. Results From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Conclusions and Relevance Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.
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Affiliation(s)
| | - Alastair J McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Shattuck D, Sebastian R, Zamarin K, Acosta S, Ramos MM. School Nurse Management of Behavioral Health, Violence, and Trauma-Related Emergencies: Findings from a Statewide Survey. J Sch Nurs 2022:10598405221120437. [PMID: 35979606 DOI: 10.1177/10598405221120437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities.
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Affiliation(s)
- Daniel Shattuck
- 11209Pacific Institute for Research and Evaluation-Southwest, 851 University Boulevard, Albuquerque, NM, USA
| | - Rachel Sebastian
- 11209Pacific Institute for Research and Evaluation-Southwest, 851 University Boulevard, Albuquerque, NM, USA
| | - Kim Zamarin
- 11209Pacific Institute for Research and Evaluation-Southwest, 851 University Boulevard, Albuquerque, NM, USA
| | - Susan Acosta
- 1107New Mexico Department of Health, Office of School and Adolescent Health, Albuquerque, NM, USA
| | - Mary M Ramos
- Department of Pediatrics, University of New Mexico, MSC11-6145, 1 University of New Mexico, Albuquerque, NM, USA
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Tolliver DG, Lee LK, Patterson EE, Monuteaux MC, Kistin CJ. Disparities in School Referrals for Agitation and Aggression to the Emergency Department. Acad Pediatr 2022; 22:598-605. [PMID: 34780998 DOI: 10.1016/j.acap.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Describe the demographic and clinical characteristics of children presenting to the emergency department (ED) for agitation and aggression from school versus other sites. METHODS We performed a retrospective cross-sectional study of children 5 to 18 years old who were evaluated in an urban tertiary care pediatric ED with a chief complaint of agitation or aggression. We examined demographics, disposition, and payments for children presenting from school versus other sites. We conducted multivariable logistic regression to identify predictors of referral site (school versus all other sites, school versus home) and discharge status (home versus higher level of psychiatric care). RESULTS Of the 513 included children, 147 (29%) presented from school. Children were more likely to present from school versus other sites if they were Black (adjusted odds ratio [aOR] 2.26, 95% confidence interval [CI] 1.32, 3.88), Latinx (aOR 2.91, 95% CI 1.42, 5.97), or had special educational needs (aOR 2.55, 95% CI 1.64, 3.97). These associations persisted in the analysis of school versus home referrals. Children presenting from school versus all other sites were more likely to be discharged home (aOR 1.60, 95% CI 1.05, 2.44), although this difference did not persist when comparing school versus only home referral. A total of $154,269 (median $367 per encounter) was paid for school referrals to the ED. CONCLUSIONS Children with agitation and aggression referred from school were more likely to be Black, Latinx, or have special educational needs. Future efforts should identify and address root causes of this disparity to decrease ED referrals, reduce healthcare spending, and address inequities.
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Affiliation(s)
- Destiny G Tolliver
- Department of Pediatrics (DG Tolliver), Boston Children's Hospital, Boston, Mass.
| | - Lois K Lee
- Division of Emergency Medicine (LK Lee, EE Patterson, and MC Monuteaux), Boston Children's Hospital, Boston, Mass
| | - Emma E Patterson
- Division of Emergency Medicine (LK Lee, EE Patterson, and MC Monuteaux), Boston Children's Hospital, Boston, Mass
| | - Michael C Monuteaux
- Division of Emergency Medicine (LK Lee, EE Patterson, and MC Monuteaux), Boston Children's Hospital, Boston, Mass
| | - Caroline J Kistin
- Division of General Pediatrics (CJ Kistin), Boston Medical Center, Boston, Mass
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Dubuque-Gallo C, Kurz B, Becker J, Fendrich M, Vanderploeg J. Providers’ Perspectives on Implementing Mobile Crisis Services for Children and Youth in Connecticut. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-021-09670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Fendrich M, Ives M, Kurz B, Becker J, Vanderploeg J, Bory C, Lin HJ, Plant R. Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs. Psychiatr Serv 2019; 70:881-887. [PMID: 31215355 DOI: 10.1176/appi.ps.201800450] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services. METHODS The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year. Propensity scores were created to balance the two groups, and outcome analyses were used to examine subsequent ED use (any behavioral health ED admissions and number of behavioral health ED admissions) in an 18-month follow-up period. RESULTS A pooled odds ratio of 0.75 (95% confidence interval [CI]=0.66-0.84) indicated that youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with youths in the comparison sample. The comparable result for the continuous outcome of number of behavioral health ED visits yielded an incidence risk ratio of 0.78 (95% CI=0.71-0.87). CONCLUSIONS Using comparison groups, the authors provided evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs. Replication in other years and locations is needed. Nevertheless, these results are quite promising in light of current trends in ED use.
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Affiliation(s)
- Michael Fendrich
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Melissa Ives
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Brenda Kurz
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Jessica Becker
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Jeffrey Vanderploeg
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Christopher Bory
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Hsiu-Ju Lin
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Robert Plant
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
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Baldaçara L, Ismael F, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VDP, Calfat ELB, Diaz AP, Périco CAM, Porto DM, Zacharias CE, Cordeiro Q, da Silva AG, Tung TC. Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. ACTA ACUST UNITED AC 2018; 41:153-167. [PMID: 30540028 PMCID: PMC6781680 DOI: 10.1590/1516-4446-2018-0163] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022]
Abstract
Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient’s appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number: CRD42017054440.
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Affiliation(s)
- Leonardo Baldaçara
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil
| | - Flávia Ismael
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Coordenadoria de Saúde Mental, São Caetano do Sul, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Universidade de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | - Verônica Leite
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil.,Secretaria de Saúde do Município de Palmas, Palmas, TO, Brazil
| | - Lucas A Pereira
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Tecnologia e Ciências (FTC), Salvador, BA.,Universidade Salvador (UNIFACS), Salvador, BA, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brazil
| | - Roberto M Dos Santos
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.,Pronto Atendimento de Saúde Mental, João Pessoa, PB, Brazil
| | - Vicente de P Gomes Júnior
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Psiquiátrica do Piauí (APPI), Teresina, PI, Brazil
| | - Elie L B Calfat
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Centro de Atenção Integrada à Saúde Mental, Franco da Rocha, SP, Brazil
| | - Alexandre P Diaz
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC, Brazil
| | - Cintia A M Périco
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Coordenadoria de Saúde Mental, São Bernardo do Campo, SP, Brazil
| | - Deisy M Porto
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria de Santa Catarina, São José, SC, Brazil.,Coordenação Estadual de Saúde Mental, Florianópolis, SC, Brazil
| | - Carlos E Zacharias
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil.,Secretaria de Saúde do Município de Sorocaba, Sorocaba, SP, Brazil
| | - Quirino Cordeiro
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Coordenação-Geral de Saúde Mental, Álcool e Outras Drogas, Ministério da Saúde, Brazil
| | - Antônio Geraldo da Silva
- Asociación Psiquiátrica de América Latina (APAL).,ABP, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina, Universidade do Porto/Conselho Federal de Medicina (CFM), Porto, Portugal
| | - Teng C Tung
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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11
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Best NC, Oppewal S, Travers D. Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review. J Sch Nurs 2017; 34:14-27. [PMID: 29207914 DOI: 10.1177/1059840517745359] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
School nurses intervene with students, parents, and school staff to advance the health and academic success of students. We conducted an integrative literature review of published research to describe the types of school nurse interventions and health and education outcome measures and to examine how school nurse interventions were linked to student outcomes. Sixty-five studies met the inclusion criteria. We used the National Association of School Nurses' Framework for 21st Century School Nursing Practice to categorize school nurse interventions and health and education outcome measures. The majority of interventions were categorized under the care coordination principle, most commonly, motivational interviewing and counseling. In 17 studies, school nurse interventions were linked to improved student outcomes. Most studies (80%) were descriptive. To advance school nursing science, researchers can build on this foundation with more rigorous research methods to evaluate the impact of school nurse interventions and activities on student health and education outcomes.
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Affiliation(s)
- Nakia C Best
- 1 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Sonda Oppewal
- 1 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Debbie Travers
- 1 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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