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Psychiatric emergencies in medical settings often provide great challenges to medical staff as well as other healthcare service providers such as social workers. This is because medical staff and healthcare providers rarely encounter psychiatric emergencies, thus they lack adequate exposure and experience on how to handle psychiatric emergency cases whenever they arise (Soreff, 2009).

This essay will develop various strategies and a plan that will help medical staff in broadening their understanding on psychiatric emergencies as well as acquainting them with the most appropriate approaches and ways of dealing with psychiatric emergencies that are likely to occur in medical settings. This essay uses both FOCUS and PDCA models in suggesting alternative solutions to the given scenario. The FOCUS model entails finding the process to be improved, organizing a team for facilitation of the process, clarification of current knowledge about the process, understanding possible variations in the process, and selecting the most appropriate alternative for improving the process or solving the problem. On the other hand, PDCA model concerns the development of a plan for the future, doing activities entailed in the plan, checking if the plan has worked, and taking appropriate actions.

FOCUS Model. Finding the Process to Improve. Identification of the process to improve is the first activity in solving a given problem. It involves the identification of a particular process that requires further improvement to bring about the desired change in the entire system.

Based on the incident in the given scenario, I would assert that the main process that needs to be improved is the handling of patients with psychiatric emergencies. Patients with psychiatric emergencies are those patients who develop sudden mental disorders relating to their thinking or psychology. Psychiatric emergencies may develop because of past mental disorders. According to Glick (2010), patients who have never had mental disorders may also develop psychiatric emergencies due to social factors such as change in the environment of the patients, increased anxiety, depression and excessive use of alcohol and drugs. However, patients who have suffered from mental disorder in the past are more likely to suffer from psychiatric disorders. This implies that the medical history of the patient is vital in understanding the cause of the psychiatric emergency.

According to Bridges (2008) and Gorton and Partridge (2010), psychiatric emergencies are more difficult to handle because they occur less frequently. This leads to inadequate exposure of medical staff such as nurses, therapists and doctors in handling such cases. Therefore, it is important for medical staff to develop adequate techniques, strategies and ways of handling psychiatric emergencies. In my opinion, handling of patients with psychiatric emergencies requires skillfulness, patience, tolerance and compassion.

Organizing a team that knows the process. In order to effectively handle patients of psychiatric emergencies, a team of medical and non-medical professionals shall be constituted. The medical professionals include doctors, physicians, nurses, psychiatrists and pharmacists whereas the non-medical professionals include psychologists, behaviorists and social workers among others. A senior psychiatrist who will act as the team leader and facilitator heads this team of professionals. The team leader will be responsible for ensuring that all patients of psychiatric emergencies are handled in the most appropriate manner. He or she will also ensure that all new approaches in handling of patients with psychiatric emergencies are fully implemented. In addition, the entire team of professionals will be responsible for formulation and implementation of policies, strategies, medication plans and handling of patients with psychiatric emergencies. In my view, the team of professionals should provide different services that the patients may require; for example, the doctors will prescribe medications for the patients while psychologists and behaviorists will assist in counseling of the patients during treatment. Other people who might be needed in the process include health care policy makers who would formulate policies that facilitate provision of high-quality care services to the patients.

Clarifying current knowledge of the process. From my part, the current process for handling of patients with psychiatric emergencies lacks adequate coordination between medical professionals, facilitation and proper planning. In addition, there are no well-laid procedures that should be followed by medical staff in case of such emergencies. This is why nurses in the emergency department in the given scenario were stranded on what to do when Mr. X indicated symptoms of psychiatric emergency. I would also argue that due to lack of adequate knowledge and exposure in handling of patients with psychiatric emergencies, the nurses were not able to control the behavior of Mr. X. The absence of a psychiatrist or behaviorist who would counsel, guide and advice Mr. X during the incident further complicated the situation. Therefore, I would recommend that medical staff should be given an adequate exposure during and after professional training in medical schools on cases relating to management of psychiatric emergencies.

Understanding Cause-and-Effect relationships. The diagrams below show the cause-and-effect relationships in psychiatric emergencies and process variations in handling of patients with psychiatric emergencies.

Selecting what to improve in the process. In my opinion, one of the major activities that should be done to prevent subsequent occurrence of the challenges faced in handling of patients with psychiatric emergencies is proper guidance and counseling of the patients to reduce potential negative behavior such as attempts to commit suicide, increased drug abuse and stress management strategies for patients with depressions. Behaviorists would also provide counseling services to the patients in addition to monitoring behavioral changes.

Secondly, I would ensure that emergency psychiatric services are provided within closed or protected environments to ensure safety of the patients. For example, in the given scenario, Mr. X did not receive adequate protection and thus was able to exit the hospital facilities without authority from the nurses. This posed greater risks to his health and condition.

Thirdly, I would make certain that teams responsible for provision of emergency psychiatric services are highly mobilized to carry out interventions to determine the cause of the patient’s problem. Adequate resources that might be required during treatment of the patients should also be mobilized and made available. Elimination of life-threatening conditions such as locking up patients in safer environments would also be applied.

Fourthly, Hillard and Zitek (2009) also assert that early identification of psychiatric problems such as anxiety, aggression and suicide attempts and their respective causes that are vital in treatment of patients suffering from psychiatric emergencies would also help in improving handling of the patients.

Furthermore, a detailed analysis of past medical condition of the patient would also help in determining if the patient has ever suffered from mental disorders. In case the patient does not have any known psychiatric disorders, it is important for the emergency service providers to conduct a detailed analysis to determine the possible cause of the patient’s problems.

Moreover, medical staff, such as physicians and nurses in the psychiatric emergency department, should be given specialized training to enable them to adequately identify potential cases of psychiatric emergencies, as well as properly intervene in managing the situation. For example, if the nurses in the given scenario had basic knowledge on handling of patients with psychiatric disorders, they would effectively manage to calm down Mr. X as he was yelling and shouting, “I don’t know”.

Finally yet importantly, medical staff should establish good rapport with patients; for example, by asking questions and probing their experiences. In cases where the patient refuses to take medications, electroconvulsive therapy (ECT) may also be used (Hankoff, 2011; O’Neill, 2009).

PDC Model. Planning for the future. In order to effectively handle possible future problems and risks associated with psychiatric emergencies, all medical staff should undergo specialized trainings to enable them to acquire skills and knowledge on how to handle such patients. The trainings should take at least six months and at most eighteen months.

Doing the plan. Training of medical staff should be carried out both internally and externally. Internal training will entail exposing nurses to the situation involving psychiatric emergencies, coaching by senior medical staff and other on-the-job training techniques. On the other hand, external training will involve admission to medical institutions for specialized staff enhancement programs.

Checking the plan. The team leader would check the effectiveness of the plan through post evaluation techniques that involve comparing the actual results obtained from the process against the anticipated results. This would help in determining any shortfalls and deviations. Thus, appropriate corrective measures would be taken to correct deviations from the predetermined plans.

Protocol of directives for staff to follow in case of behavioral emergency in a non-psychiatric setting

  1. Medical staff should immediately intervene upon admission of a patient with psychiatric emergency. This would involve spending more time with the patient, reassuring the patient of recovery of his or her health and administration of appropriate medications such as antidepressants for stressed patients.
  2. Guidance and counseling of depressed patients. In my opinion, this would help in elimination of destructive thoughts and behavior such as suicidal thoughts.
  3. Patients who have stopped eating voluntarily should be given steroid drugs to induce hunger. This would help in increasing their appetite.
  4. Patients who develop complications due to exposure to particular environments such as cold, noise or crowded places, should be removed and placed in better or conducive environments.
  5. The medical staff should provide passionate care services to the clients irrespective of their intolerable behavior or conduct. For example, in the given scenario, the nurses were not supposed to shy away from helping Mr. X on the second day when he returned to seek medical assistance.


Caring for patients with psychiatric emergencies poses numerous challenges to medical professionals and other healthcare providers. Therefore, it is important for medical staff such as emergency nurses, doctors and psychiatrics to develop appropriate strategies and plans for dealing with such situations. Similarly, adequate research and surveys should be carried out to determine the most appropriate approaches that should be deployed in handling clients with psychiatric emergencies.

It is also important for team leaders of emergency departments to identify various obstacles and burdens that are likely to undermine efforts of the medical staff in providing high-quality services to patients with psychiatric emergencies. I would also argue that it is important for all the medical staff to have basic knowledge of psychiatric nursing, irrespective of the setting in which they work.

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