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Ice epidemic strain on emergency department staff

Professor Kim Usher
Photo: Professor Kim Usher
The ice epidemic is taking a toll on the nurses, doctors and other staff working in Australia’s hospital emergency departments, new research shows.

Professor Kim Usher AM, a mental health nurse researcher and Head of the School of Health at the University of New England, says targeted training for staff and injecting more mental health nurses into emergency departments will help combat the impact of the escalating increase in ice presentations.

Professor Usher, who will present her research at the Australian College of Mental Health Nurses’ (ACHMN) 42nd annual conference from October 25-27, says New South Wales data shows a dramatic rise in the number of ED presentations and hospitalisations for people using the drug crystal methamphetamine, from 340 people in 2009 to 2,904 in 2015 - with 11,869 methamphetamine-related hospitalisations in the past 16 years.
Ice-affected patients are often aggressive, agitated, violent and unpredictable. Ice is linked to mental health problems such as psychosis, anxiety, depression and increases the risk of stroke, heart, kidney and lung problems and can also cause dental issues.

As part of a qualitative study to gauge the impact of the rise in ice presentations on frontline health staff, researchers recently interviewed 10 health professionals working in emergency departments in several public and private hospitals across New South Wales and Queensland.

While researchers across the globe are examining the epidemiology of methamphetamine use, this research is believed to be the first of its kind assessing the effect of the ice epidemic on health practitioners.

Professor Usher, editor in chief of the International Journal of Mental Health Nursing, says the research shows ice-affected patients pose a range of challenges and dangers for emergency department staff.

“People who are affected by ice are often highly complex when they present because they’ve got multiple problems - they may come in with cardiac complications, which is often a major reason for death in methamphetamine use.

“We also know there’s a lot of other issues around mental health problems that go with taking methamphetamine, like depression and symptoms of psychosis, and they are often, particularly those who have chronic use of the drug, very difficult to manage when you get them into an emergency department sort of situation.

“It’s more frequent that staff are having to manage patients like this and they are confronted, they don’t feel that they’re adequately trained, they need to be able to perform substance abuse assessments and so forth, as well as other physical and mental state assessments on clients.

“From what we gleaned, they don’t always feel that they’ve got the ability to do these things. Even understanding where they might refer people for services, that information is not always readily available.”

Professor Usher says emergency department nurses, doctors and other staff also work in fear of being assaulted when treating ice-fuelled patients.

“They are fearful and there’s currently a lack of policies and procedures to actually support staff caring for these people when they present to emergency departments, so that needs to be developed. We need policies and procedures right across the health care industry.”

As part of the research, emergency department staff reported that practitioners need to be equipped with good verbal and non-verbal communication skills when engaging with not only the patient but also their family and friends.

“It’s understanding that being respectful is really important and not being critical of the person’s drug use,” Professor Usher says.

“These patients are not just complex physically and mentally but often they’re very volatile so you need to try and understand them, show empathy but build rapport with them over a quick period of time.

“Health professionals need to bring their knowledge, skills and attitudes from previous experiences which will help them to provide good effective care for these people.”

Professor Usher says only limited professional development exists in up-skilling emergency department staff to manage ice-affected patients.

It’s paramount more education and training is developed and implemented.

“We need to ensure that registered nurses when they go through a nursing program, doctors and those going through paramedicine, are made aware of the side effects of taking these drugs, the way that people present, the issues they need to deal with, how challenging they are,” she says.

“We need to ensure that health professionals are prepared - that they come out of courses prepared to manage this issue and for those who are already in the workforce, we need to look at ways of rolling out professional development.”

While research in the field is in its infancy, Professor Usher says the study results suggest more mental health nurses are needed in emergency departments across Australia.

“Some emergency departments do have mental health nurses who work there as specialists to do this sort of work,” she says.

“Mental health nurses are exactly the people who would be best equipped to manage people presenting to emergency departments after taking ice.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords