The Lived Experiences of Emergency Department Personnel in Working with Individuals with

205 Pages·2017·2.06 MB·English

University of Arkansas, Fayeteville
The Lived Experiences of Emergency Department Personnel in Working with Individuals with
Mental Health Needs

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy in Counselor Education

by

Sarah Wohlford-Neubauer
Baylor University
Bachelor of Science in Neuroscience, 2009
University of Texas at Southwestern Medical Cente r
Master of Rehabilitation Counseling, 2012

December 2016
University of Arkansas

This dissertation is approved for recommendation to the Graduate Council .

_________________________________
Dr. Roy Farley
Dissertation Director

_________________________________
Dr. Mary Ramey
Committee Member

_________________________________ __________________________
Dr. Kristin Higgins Dr. Stephanie Lusk
Committee Member Committee Member
Abstract
Individuals who work in emergency departments and emergency services in the United
States have daunting, overwhelming, and difficult tasks to perform. In addition to medical
emergencies that include physical trauma and illnesses, emergency personnel treat individuals
with psychiatric emergencies. This qualitative research study explored the lived experiences of
ten emergency department personnel that had experienced working with individuals with mental
health needs. The ultimate purpose of the study was to break down individuals’ experiences into a
shared description of a universal phenomenon. The study utilized a phenomenological, qualitative
research design to capture the essence of this phenomenon. Participants’ responses to semi-
structured, open-ended interview questions generated the study’s results. The utilization of
phenomenological questions in this study may afford insights into the roles of emergency
department and their treatment of individuals with mental health issues.
Keywords: emergency department personnel, emergency service workers, mental health issues,
mental health treatment, phenomenology, qualitative research
©2016 by Sarah Wohlford
All Rights Reserved
Acknowledgments
The opportunities that I have had at the University of Arkansas have gone beyond my
expectations. A significant part of the learning has been in conjunction with Dr. Roy Farley, Dr.
Kristin Higgins, Dr. Stephanie Lusk, and Dr. Mary Ramey. During these past three years, they
have taught me to become a better researcher, evaluator, writer, and practitioner. I will always be
grateful for their support and wisdom that they have imparted upon me during my studies.
Dedication

This dissertation is dedicated to my family:
To my father, Charles Wohlford, who taught me to never give up.
To my mother, Kim Wohlford, who taught me how to be confident and believe in
myself.
To my grandmother, Bobbie Wohlford who taught me what it means to be brave.
To my grandmother, Linda Wells, who provided me with encouragement to go
above and beyond.
To my grandfather, John Wells who encouraged me to pursue higher education.
To my brother, John Wohlford, who taught me humility and how to laugh in tough
times.
To my sister, Rachel Wohlford, who showed me compassion when I needed it the
most.
To my husband, Joseph Neubauer, who encouraged me to be persistent and
resilient.
Table of Contents
CHAPTER ONE: INTRODUCTION AND OVERVIEW ................................ 1
Organization of the Chapter .................................................................................... 1
Background ............................................................................................................. 1
Purpose of the Study ............................................................................................ .3
Research Question ............................................................................................... 3
Research Sub-questions ........................................................................................ 4
Significance of the Study ...................................................................................... 4
Conceptual Design ............................................................................................... 5
Theoretical Sensitivity ......................................................................................... .8
Personal Experience ............................................................................................. .7
Professional Experience ........................................................................................ 8
Knowledge of Literature ....................................................................................... 8
Analytic Rigor ...................................................................................................... 9
Parameters of the Study ...................................................................................... 10
Assumptions ....................................................................................................... 11
Limitations ......................................................................................................... 12
Definition of Terms............................................................................................ .12
Summary ............................................................................................................ 14
Organization of the Dissertation ......................................................................... 15
CHAPTER TWO: LITERATURE REVIEW ................................................. 17
Organization of the Chapter ................................................................................ 17
Introduction ........................................................................................................ 17
Search Strategy .................................................................................................. 18
Emergency Departments ..................................................................................... 19
Current Emergency Department Protocols ......................................................... .23
Emergency Department Personne l...................................................................... 24
Emergency Services Personnel ........................................................................... 26
Police Officers ................................................................................................... 24
EMS Personnel................................................................................................... 25
Mental Health Issues in Emergency Settings........................................................ 29
Psychiatric Emergency Prevalence ....................................................................... 37
Emergency Department Treatment of Suicidal Ideations and Suicide Attempts . 38
Treatment of Individuals Experiencing Acute Psychosis ..................................... 41
Psychiatric Conditoins Co-Morbid with Medical Conditions .............................. 40
Bereavement. ........................................................................................................ 45
Crisis Counseling .................................................................................................. 47
Existing Treatment Models Including Counselors ............................................... 50
Need for Multidisciplinary Approaches in Emergency Rooms ............................ 52
Summary ............................................................................................................... 53
CHAPTER THREE: RESEARCH DESIGN ................................................... 55
Organization of the Chapter .................................................................................. 55
Introduction ........................................................................................................... 55
Statement of the problem ...................................................................................... 56
Focus of the Study ................................................................................................ 56
Research Question ................................................................................................ 57
Research Sub-questions ........................................................................................ 57
Research Design and Timeline ............................................................................. 57
Site and Sample Selection ..................................................................................... 59
Participants ............................................................................................................ 59
Research Ethics ..................................................................................................... 60
Depth vs Breadth................................................................................................... 62
Data Collection Protocol ....................................................................................... 62
Interviews .............................................................................................................. 64
Round I interview protocol. .................................................................................. 66
Round II interview protocol. ................................................................................ 68
Observations ......................................................................................................... 70
Document collection. ............................................................................................ 72
Process notes……......……………………………………………………………66
Managing and Recording Data ............................................................................. 73
Researcher’s Role Management ........................................................................... 74
Theoretical Position .............................................................................................. 74
Trustworthiness ..................................................................................................... 77
Prolonged engagement. ......................................................................................... 78
Persistent engagement. .......................................................................................... 78
Triangulation. ........................................................................................................ 78
Peer debriefing. ..................................................................................................... 79
Member checks. .................................................................................................... 79
Audit trail. ............................................................................................................. 80
Evidentiary Inadequacies ...................................................................................... 81
Summary ............................................................................................................... 82
CHAPTER IV: PRESENTATION OF THE DATA ....................................... 83
Organization of the Chapter .................................................................................. 83
Introduction ........................................................................................................... 84
Transcribed Interviews.......................................................................................... 85
Description of the Sample ..................................................................................... 85
Sample Demographics .......................................................................................... 86
Data Analysis ........................................................................................................ 89
Open Coding ......................................................................................................... 91
Axial Coding ......................................................................................................... 92
Presentation of the Axial Codes ............................................................................ 93
Personal History .................................................................................................... 96
Summary of Personal History ............................................................................... 97
Training ................................................................................................................. 97
Summary of Training .......................................................................................... 100
Chief Complaint .................................................................................................. 100
Summary of Chief Complaint ............................................................................. 106
Interventions ....................................................................................................... 107
Medical ............................................................................................................... 107
Summary of Medical........................................................................................... 107
Psychiatric ......................................................................................................... 1071
Internal Emotional Experiences .......................................................................... 114
Summary of Internal Emotional Experiences ..................................................... 116
Perceptions of Patients ........................................................................................ 117
Summary of Perceptions of Patients ................................................................... 119
Post-Incident Coping .......................................................................................... 119
Summary of Post-Incident Coping...................................................................... 122
Post-Incident Reflections .................................................................................... 122
Summary of Post-Incident Reflections ............................................................... 123
Summary ............................................................................................................. 124
CHAPTER V: CONCLUSIONS AND RECOMMENDATIONS ................ 126
Organization of the Chapter ................................................................................ 126
Introduction ......................................................................................................... 126
Codes................................................................................................................... 127
Open Codes ......................................................................................................... 129
Axial Codes ......................................................................................................... 129
Selective Codes ................................................................................................... 129
Discussion of Theory 1: Pre-Incident Experiences ............................................. 130
Discussion of Theory 2: In-Vivo Experiences .................................................... 132
Discussion of Theory 3: Post-Incident Experiences ........................................... 135
Answering the Research Question and Sub-questions........................................ 136
Summary of Findings .......................................................................................... 140
Implications of Results to Counseling Field ....................................................... 140
Recommendations for the Counseling Field ....................................................... 142
Recommendations for Counselor Educators ....................................................... 143
Recommendations for Future Research Endeavors ............................................ 144
Researcher’s Reflections ..................................................................................... 145
Conclusion .......................................................................................................... 146
References ........................................................................................................... 147