Emergency Psychiatric Assessment: The Nurse, Psychiatrist, and Counselor Roles During the Process

How does a psychiatric nurse respond to patients in a crisis situation? How connected are the counselor and the patient during an emergency assessment? How important is the teamwork concept to the psychiatrist? Although all clinicians described common elements of empathy and the importance of clinical experience, significant differences did emerge in this study. Psychiatric nurses differed from the psychiatrists and counselors in the way they described valuing the interdisciplinary team, the meaning of responsibility, and the importance of connecting with the client.

In today's health care arena, psychiatric nurses find themselves functioning in dependent, independent, and interdependent roles. In the dependent role, nurses find themselves carrying out physicians' prescriptive orders and following policies and procedures established by employers and other regulatory bodies. In the independent role, nurses assess, diagnose, and prescribe nursing interventions. Advance practice nurses find more independence in their roles with some having diagnostic and prescriptive authority once limited to physicians. As health care settings become increasingly complex and sophisticated, the need for the psychiatric nurse also to function interdependently has become essential. No one individual or any one discipline can meet all of the intricate demands in today's health care setting.

How do psychiatric nurses view their interdependent role function? How do other members on the mental health team view their roles? What similarities and differences can be found between psychiatric nurses and other mental health clinicians functioning on an interdisciplinary team?

Few studies have been published that compare clinicians working within interdisciplinary settings. Aspects of the nurse-client, healer-client, and therapist-client relationship have been researched or studied (Heifner, 1993; Jackson, 1992; Leners, 1992; Marziali & Alexander, 1991). Gallop, Lance, and Shugar (1993) compared nurses' and psychiatric residents' perceptions regarding difficult-to-treat inpatients. Studies that compare interdisciplinary views regarding individual roles, relationships within the team, and relationships with clients are lacking. This study offers a comparison of nurse, psychiatrist, and counselor characteristics during decision making in an emergency psychiatric setting.

Data were obtained from a study (Anderson & Eppard, 1995) that defined the process used by these clinicians during their assessments of clients referred for emergency psychiatric admissions. In grouping the data according to discipline, common elements were identified among all clinician-informants. Differences also emerged in how these nurses, psychiatrists, and counselors viewed...