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

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.