Evaluating psychiatric nursing competencies applied to emergency settings: A pilot role delineation study

Abstract

<p><strong>Aims:</strong> 1) To examine emergency department (ED) nurses&rsquo; reports of a) frequency b) importance and c) self-efficacy related to the application of recommended psychiatric nursing competencies in three domains (i.e., assessment, tasks, knowledge). 2) To test the extent to which frequency and importance independently predict ED nurses&rsquo; self-efficacy related to the application of the competencies in their daily work.</p> <p><strong>Background:</strong> In the past 10 years, ED use has increased by 26% marked by a concomitant increase in the number of persons with psychiatric illness seeking ED services with ED nurses often the first-line care providers. Yet, studies suggest that ED nurses believe they lack the skills and knowledge to provide effective care to psychiatric patients, leading to a lack of confidence and negative attitudes that may affect the quality of patient care. At the same time, limited evidence exists to clearly identify the competencies required of ED nurses to care for this population.</p> <p><strong>Methods: </strong>ED nurses from a large tertiary care center (n=75) completed an online survey. Nurses were asked to rank, using Likert scales ranging from 0 to 4, the frequency, importance and self-efficacy of 15 recommended psychiatric nursing competencies across three domains: Assessment, Tasks and Knowledge. Survey responses to items in each of the three domains were summarized with descriptive statistics. Regression analysis was used to model each self-efficacy item with the corresponding frequency and importance rankings included as predictors and important socio-demographic factors (e.g., age, race/ethnicity, education, time in position) included as control variables.</p> <p><strong>Results: </strong>ED nurses rankings of importance and frequency of performing the competencies were higher than their rankings of self-efficacy for the same competencies. Scores ranged from means of 1.81 (SD=1.29) for ranking of importance and 0.64 (SD=1.06) for the ranking of frequency related to performing psychiatric tests to 3.67 (SD=0.60) for ranking of importance and 3.04 (SD=0.75) for ranking of frequency related to applying strategies to reduce patient harm to self and others. Scores were lowest for competencies in the knowledge domain, followed by those in the assessment domain and were highestin the task domain. Greater frequency of performing competencies predicted higher self-efficacy scores in almost every domain. The importance ranking was associated with higher self-efficacy scores in most, but not all, models. Younger nurses (18 to 34 years of age) had lower self-efficacy scores for many competencies relative to older nurse (45 years and above). Those with less than 5 years of experience as an ED nurse had lower self-efficacy scores for performing psychiatric tests.</p> <p><strong>Implications:</strong> Although ED nurses perform recommended competencies frequently and rank them as important, their reports of self-efficacy related to these competencies are comparably low. We find performance frequency and perceived importance of psychiatric nursing competencies are associated with their self-efficacy; therefore, opportunities for practice as well as interventions to underscore the importance of specific competencies may improve self-efficacy. Younger and less experienced ED nurses might require more support and teaching in these competencies. Research in other samples and settings is needed to corroborate these results.</p>