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    Nursing Assessment and Treatment of Panic Disorder in the Emergency Department: An Evaluation of Protocols and Processes

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    Author
    Blanchard, Jodi Lynn
    Issue Date
    2017
    Advisor
    Sheppard, Kate
    
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    Publisher
    The University of Arizona.
    Rights
    Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Abstract
    The purpose of this project was to conduct a program evaluation of a cardiac workup for patients who present to an emergency department (ED) with chest pain, in order to determine if and how nursing protocols and processes are implemented to identify and treat patients with panic disorder. Aims for the project were to (1) identify and describe commonalities related to activities, attitudes, and knowledge among registered nurses (RNs) who implement such protocols and processes; (2) describe how current processes fit within evidence based recommendations for evaluation and treatment of chest pain in the ED, and (3) generate evidence based practice recommendations for the evaluation and treatment of patients who present to the ED with complaints of chest pain, are diagnosed with non-cardiac chest pain (NCCP), and who may meet criteria for a diagnosis of panic disorder. Participants included ED RNs with experience evaluating patients with chest pain, and psychiatric mental health nurse practitioners (PMHNPs) with experience treating patients for anxiety. Data were collected through focus group interviews, and summarized into categories using the W.K. Kellogg Foundation (2004) logic model template. Five commonalities were identified from ED RNs, including: protocol based interventions, assessments and interventions based on nursing judgment, risk associated discharge planning, standardized discharge education, and inpatient psychiatric evaluation for suicidal ideation/homicidal ideation. Three common concerns were identified from PMHNPs, including: panic disorder as a differential diagnosis, patient expectations of benzodiazepine treatment, and education about panic disorder and evidence based treatments. Results revealed gaps in care for patients who present to the ED with chest pain who may have an undiagnosed panic disorder, including lack of assessment, diagnosis, treatment, education, or referral to a mental health provider. Recommendations include providing standardized education for patients discharged from the ED with a diagnosis of NCCP, with information about panic disorder, evidence-based treatments, and a list of available mental health providers in the area. Considerations for future research include development and implementation of a feasible, effective, and validated screening tool for panic disorder in the ED setting, and the development and implementation of an inter-professional education program for ED providers and PMHNPs.
    Type
    text
    Electronic Dissertation
    Degree Name
    D.N.P.
    Degree Level
    doctoral
    Degree Program
    Graduate College
    Nursing
    Degree Grantor
    University of Arizona
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