Write an essay (suggested length of 5-10 pages) in which you develop a plan to help this
staff become proficient in handling behavioral emergencies on a non-psychiatric unit by
doing the following:
A. Analyze the situation using the FOCUS and PDCA models by doing the following:
- Use the FOCUS model to identify possible causes of the staff’s problem.
a. Find a Process to Improve (What needs to be improved based on the incident in the
b. Organize a Team That Knows the Process (Who is the leader, the facilitator, the
recorder, the time keeper, team member? Do you need all these people? Do you need
c. Clarify Current Knowledge of the Process (What is being done now that might have
added to or allowed the incident?)
d. Understand Causes of Process Variation (Use cause-effect diagrams, concept maps or
other diagrams to show how you would understand the cause)
e. Select the Process Improvement (What would you do to improve the situation so that you
decrease the risk of it occurring again?)
- Develop an improvement plan that will ensure appropriate response times and
appropriate clinical interventions in this situation, using a modified version of the PDCA
a. Plan (develop a plan to address the situation and possible risk in the future)
b. Do (You are not expected to actually do the plan but tell how it would be done)
c. Check (How would you check if the plan worked?)
d. Act (Note: Act has been omitted in the modified version since you are not expected to
carry out this plan so you cannot periodically review the change to ensure that it is
B. Write a unit protocol containing at least five directives for staff to follow in case of a
behavioral emergency in a non-psychiatric setting.
C. When you use sources, include all in-text citations and references in APA format.
Summary of the challenge at hand
The medical staff in this hospital encounter a man who is rushed in by the staff of a Rapid
Response Unit. It is suspected that he has experienced a stroke but scans revealed nothing of this
nature. It is then thought that the cause of his sickness is the use of injectable drugs based on
opiates detected in his urine. When the staff attempt to take his vitals once again, the find that he
has turned manic again and this makes it difficult and even impossible for them to attach
monitoring equipment to him. They are all perturbed considering he was just talking normally
without any sign of his brain being damaged. When one of the senior attendants manages to calm
him down it works but only for a brief moment before he escapes the facility. When he is finally
found at his home they find that everything is ok with him only for him to be brought back the
following day with severe pain in his chest and head. The reaction of the nurses who attended to
him the previous day shows discomfort and this suggests that they are most likely unwilling to
attend to him given the nasty experience they had the previous day.
From this it emerges that the medical personnel in this facility are scarcely equipped with
adequate skills and expertise to handle patients with psychiatric problems that fall out of the
scope of the everyday medical conditions they handle. This essay therefore seeks to analyse this
gap in skills and also propose a plan of action that can be used to avert such situations in the
future. The logical models that will be applied to this exercise are the FOCUS model and the
PDCA cycle which will then aid the medical staff in handling such non-medical emergencies in
the event they arise again in the future. This will not only aid the doctors and nurses in handling
such cases but also improve on the overall quality of the healthcare services provided by this
hospital. The quality of personnel will also benefit from additional problem solving skills that
can be of assistance to them both in the workplace and outside the workplace. This in effect
implies that the additional knowledge will serve to diversify the professional attributes of the
targeted doctors and nurses.
Application of the FOCUS model
To get to the root issues that make up the staff’s problem, the FOCUS model shall be applied to
the facts about the case. The focus model is based on an acronym derived from the words Find a
problem, Organize the team, Clarify the problem, understand the problem and Select a viable
intervention. The process follows the order in which the statements follow each other for
effective problem solving (Park et al, 2013).
Step 1: Find the Problem
The main problem that has been identified in this hospital is the lack of adequate skills to handle
patients who have psychiatric emergencies. This is seen in the helplessness with which the
attending personnel looked at Mr X when he was having an episode. The fact that this came
suddenly without any warning signs such as impaired speech or other tell-tale signs of a mental
disorder got them unaware. The few oddities about him such as the ill-fitting boxer and his
contentment with lacking a shirt did not even strike them as peculiar. This is a clear indication
that they are so biased towards handling medical issues that they overlooked anything that fell
out of their scope of work. When they cringed at the sight of him being brought back it also
showed an unwillingness to work with such patients or psychiatric emergencies for that matter.
This is a possible attitude problem too and that goes against their work ethics since their core
duty is the alleviation of the suffering of all their patients and not just the easy to treat.
The process that therefore needs to be improved is the manner in which patients exhibiting
psychiatric problems are handled.
Step 2: Organize a Team
The main stakeholders in the hospital setting who are directly responsible for the well-being of
the patients are the doctors, nurses and security personnel (Hanskamp-Sebregts et al, 2013).
Given that these clearly lack the skills necessary to deal with patients such as Mr X, it is essential
to bring on board experts such as psychiatrists. The purpose of this process is to ensure that there
is adequate knowledge among the hospital’s concerned stakeholders on how to best handle
psychiatric emergencies. The doctors are involved due to their leadership role in the treatment of
patients. Nurses on the other hand are the ones who spend the most time with patients while
security personnel will be necessary to avert violent episodes endangering the psychiatric
patients or any other person in the facility. The nurses, doctors and security personnel will be
briefed on the significance of this team. Doctors and senior nurses will take the leadership
position while the psychiatrist will be the facilitator. The nurses and the security staff as well as
the doctors will be participants (Pinnacle Network, 2013).
Step 3: Clarify the Problem
From our situation it is clear that those who had contact with Mr X during his psychiatric
emergency only see him as the problem. They clearly do not find anything wrong with their
inability to take care of him when he is in that state. This attitude needs to change. The
clarification that is to be carried out here is to clearly point out the gap in the skills they currently
possess. The staff has to acknowledge that they are inadequately equipped to deal with
psychiatric emergencies. This is the core reason for this whole exercise and it is only when they
understand that that the exercise will become fruitful.
Step 4: Understanding the Causes
To acquire an accurate picture of the factors that have led to the problem of medical personnel
helplessly watching a man experiencing a psychiatric emergency, we can employ a fish bone
cause-effect diagram that will aid in elaborating upon the different factors that have contributed
to the lack of skills. This is a participatory stage in which everyone will give their opinion on the
origin of this problem. This can be themed into categories such as attitude, training, equipment,
authority and other relevant factors.
A Fish-Bone diagram that can be used to understand the problem
Personnel’s inability to
attend to psychiatric
The importance of the use of the above diagram is to try and break down the problem into its
component parts so as to make the acquisition of a solution much simpler.
Step 5: Selection of the process improvement
The two areas that can be improved immediately are the attitudes of the staff as well as the
training. This latter does not necessarily mean sending the nurses back to college but rather the
retraining through role-play as well as a few visits to a facility that handles psychiatric patients
for actual demonstrations. This will provide them with both practical skills and consequently
improve their attitude. They may even gain the ability to administer preventive treatment in the
event that the patient exhibits signs of an emergency taking place (ASQ, 2013).
An Improvement Plan based on the PDCA cycle
Once the problem has been identified and understood, it is essential to execute an improvement
plan which will act as a guideline towards the understanding of this issue. The Plan, Do, Check
and Act cycle is a system that is meant to ensure continuity and effectiveness of a project
through constant evaluation of what is already being done (Shelton State, 2013). This will
continually improve the quality of healthcare in as far as the handling of psychiatric patients and
emergencies are concerned.
Step 1: Planning the Improvement
Following the formulation of a team, the improvement process will have effectively
commenced. The team will be meeting on a regular basis such as twice a week for the purpose of
addressing this problem. The first two sessions will involve familiarization and introduction.
Given that psychiatric emergencies can be a handful at times, it is essential for people to work as
a team to guarantee the patient’s well-being as well as improvement. The following session will
feature identification of and familiarization with the problem. The third and fourth sessions will
be based on cause-effect identification whereby participants will brainstorm about possible
causes of the problem. The next four sessions will be mainly instructive under the psychiatrist’s
guidance. The next two will be done in psychiatric facilities while the final one will be for
review and a recap of proceedings. For effectiveness the session will run again every six months.
Step 2: Do:
For an effective improvement, this process will be highly interactive with participation being
encouraged by compliments from the team leaders and the facilitator. Role play will be heavily
emphasized so as to ensure the skills are firmly imparted to the medical and security personnel.
The theme will be avoidance of scenarios as witnessed during Mr X’s ordeal which could easily
have been worse if he injured another person such as a doctor, a nurse or even a fellow patient.
Unit Protocol to be followed in the event of a psychiatric emergency in a non-psychiatric
- If one is alone, immediately call for assistance and also notify security personnel.
- The patient needs to be immediately reassured that everything is ok. (do not alarm the
patient by being aggressive)
- Clear the site of anything that could cause harm. These include medicines and also
medical instruments such as syringes and scalpels among others.
- If talking to the situation escalates to or toward violence, the patient needs to be
physically restrained through medical means such as the injection of a tranquillizer.
- Patients whose psychiatric conditions hamper their medical treatment need to be
immediately transferred to psychiatric hospitals first.
American Society for Quality, ASQ (2013) Plan, Do, Check, Act cycle.