Emergency Nurses’ Barriers to Caring for Psychiatric Boarders: A Theory of Planned Behavior Approach
Abstract
In 2021 around 2.5 million patients sought psychiatric care through the emergency department.1 However, emergency department based psychiatric care has challenges including overcrowded hectic environments 2–5 and prevalent patient violence.2,4,5 This includes the practice of boarding where medically cleared patients cannot be dispositioned due to inadequate non-emergency department services6 and wait in the emergency department for hours, days, or longer.7 This leads to negative patient effects including increased vulnerability,3 distress,5 and violence.8 The purpose of this presentation is to show how the Theory of Planned Behavior was used to identify practice barriers in caring for psychiatric boarders according to emergency nurses. In this qualitative descriptive research study, the author investigated emergency nurses’ perspectives on caring for psychiatric boarders to identify areas for improvement. The Theory of Planned Behavior informed the semi-structured interview guide as it addresses the influence of people’s attitudes and beliefs, whether they or others thought of certain behaviors as good or bad, and people’s beliefs they can accomplish the behavior in question which for this study was caring for psychiatric boarders.9
Eighteen emergency nurses from a variety of emergency departments participated in this study. Five themes were identified including the emergency department environment, emergency department psychiatric treatment, challenging patient situations, nurse attitudes, and systemic issues.
Comparing these findings to the Theory of Planned Behavior showed they intersected. The researcher identified several separate aspects of psychiatric boarder care that can be targets for improvement. Nurses described many beliefs regarding psychiatric boarder care, both good, bad, and influences from experiencing challenging patient events like violence. There was considerable overlap between resource availability and nurse attitudes suggesting that these are related and providing adequate resources may improve nurse attitudes.
Findings suggest leaders can play a role in advocating for and providing adequate resources for psychiatric boarders. Opportunities to consider include boarding psychiatric patients outside of traditional emergency department environments to improve patient care. Emergency department teams may be good partners in advocating for adequate psychiatric resources and policy both in and outside of the emergency department.
Notes
1. Cairns C, Kang K. National Hospital Ambulatory Medical Care Survey: 2021 Emergency Department Summary Tables.; 2021. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc21-ed-508.pdf
2. Mulhearne P, Cotter P, O’Shea M, Leahy-Warren P. Experiences of registered general nurses who care for patients presenting with self-harm to the emergency department in Ireland. International Emergency Nursing. 2021;58. doi:10.1016/j.ienj.2021.101047
3. McGough S, Wynaden D, Ngune I, Janerka C, Hasking P, Rees C. Emergency nurses’ perceptions of the health care system and how it impacts provision of care to people who self-harm. Collegian. 2022;29(1):38-43. doi:10.1016/j.colegn.2021.04.004
4. Derblom K, Molin J, Gabrielsson S, Lindgren BM. Nursing staff’s experiences of caring for people with mental ill-health in general emergency departments: a qualitative descriptive study. Issues in Mental Health Nursing. 2022;43(12):1145-1154. doi:10.1080/01612840.2022.2138653
5. Pawaskar R, Mahajan N, Wangoo E, Khan W, Bailey J, Vines R. Staff perceptions of the management of mental health presentations to the emergency department of a rural Australian hospital: qualitative study. BMC Health Serv Res. 2022;22(1). doi:10.1186/s12913-022-07476-7
6. American College of Emergency Physicians. Definition of boarded patient. Published online September 1, 2018. Accessed November 30, 2023. https://www.acep.org/patient-care/policy-statements/definition-of-boarded-patient
7. Kraft CM, Morea P, Teresi B, et al. Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department. The American Journal of Emergency Medicine. 2021;46:550-555. doi:10.1016/j.ajem.2020.11.021
8. Bowden CF, True G, Cullen SW, et al. Treating pediatric and geriatric patients at risk of suicide in general emergency departments: perspectives from emergency department clinical leaders. Annals of Emergency Medicine. 2021;78(5):628-636. doi:10.1016/j.annemergmed.2021.04.025
9. Fishbein M, Ajzen I. Predicting and Changing Behavior: The Reasoned Action Approach. Routledge; 2010
Sigma Membership
Gamma Zeta
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Theory, Policy/Advocacy, Acute Care
Recommended Citation
Keslar, Rachel and Bacon, Cindy, "Emergency Nurses’ Barriers to Caring for Psychiatric Boarders: A Theory of Planned Behavior Approach" (2025). Creating Healthy Work Environments (CHWE). 27.
https://www.sigmarepository.org/chwe/2025/presentations_2025/27
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Phoenix, Arizona, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Emergency Nurses’ Barriers to Caring for Psychiatric Boarders: A Theory of Planned Behavior Approach
Phoenix, Arizona, USA
In 2021 around 2.5 million patients sought psychiatric care through the emergency department.1 However, emergency department based psychiatric care has challenges including overcrowded hectic environments 2–5 and prevalent patient violence.2,4,5 This includes the practice of boarding where medically cleared patients cannot be dispositioned due to inadequate non-emergency department services6 and wait in the emergency department for hours, days, or longer.7 This leads to negative patient effects including increased vulnerability,3 distress,5 and violence.8 The purpose of this presentation is to show how the Theory of Planned Behavior was used to identify practice barriers in caring for psychiatric boarders according to emergency nurses. In this qualitative descriptive research study, the author investigated emergency nurses’ perspectives on caring for psychiatric boarders to identify areas for improvement. The Theory of Planned Behavior informed the semi-structured interview guide as it addresses the influence of people’s attitudes and beliefs, whether they or others thought of certain behaviors as good or bad, and people’s beliefs they can accomplish the behavior in question which for this study was caring for psychiatric boarders.9
Eighteen emergency nurses from a variety of emergency departments participated in this study. Five themes were identified including the emergency department environment, emergency department psychiatric treatment, challenging patient situations, nurse attitudes, and systemic issues.
Comparing these findings to the Theory of Planned Behavior showed they intersected. The researcher identified several separate aspects of psychiatric boarder care that can be targets for improvement. Nurses described many beliefs regarding psychiatric boarder care, both good, bad, and influences from experiencing challenging patient events like violence. There was considerable overlap between resource availability and nurse attitudes suggesting that these are related and providing adequate resources may improve nurse attitudes.
Findings suggest leaders can play a role in advocating for and providing adequate resources for psychiatric boarders. Opportunities to consider include boarding psychiatric patients outside of traditional emergency department environments to improve patient care. Emergency department teams may be good partners in advocating for adequate psychiatric resources and policy both in and outside of the emergency department.
Description
Many patients seek psychiatric care through emergency departments; however, there are challenges, including waits for placement. A qualitative descriptive study used the Theory of Planned Behavior to identify emergency nurses’ barriers to caring for psychiatric boarders. This method revealed insights into this issue including several potential action items. Nursing leaders can improve these patients’ care through adequate resourcing, trying novel solutions, and advocating for policy change.