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An Ethical Evaluation of the Boarding of Psychiatric Patients in the Emergency Department

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My thesis project, "An Ethical Evaluation of the Practice of Psychiatric Patient Boarding in the Emergency Department" sets out to address a relatively nameless problem in the healthcare system in the United States. This problem is the boarding of psychiatric patients in emergency departments nationwide. What is psychiatric patient boarding?…

My thesis project, "An Ethical Evaluation of the Practice of Psychiatric Patient Boarding in the Emergency Department" sets out to address a relatively nameless problem in the healthcare system in the United States. This problem is the boarding of psychiatric patients in emergency departments nationwide. What is psychiatric patient boarding? This term refers to the increasingly common practice of care provided to psychiatric patients upon arrival at an emergency department. When inpatient psychiatric beds or services are not available, "boarding" is performed by simply storing mentally ill patients in hallways or other emergency room areas while they wait for the availability of psychiatric treatment, which may take hours, or in more extreme cases has been cited to last for days at a time (Alakeson et. al, 2010). While any individual can expect to wait a prolonged period of time for medical care in the increasingly overcrowded emergency departments, the psychiatric patient experience is astonishingly unique. A psychiatric patient presenting, or arriving, at the ED in crisis can often times find him or herself not only waiting hours to be admitted and assessed as a medical patient would, but with a limited and ever attenuating supply of psychiatric treatment rooms and services, these patients will often times be harbored in an ED room designed for short-term medical treatment without care until psychiatric services become available. Patients can be left waiting for days for an in-patient vacancy; all the while not receiving true psychiatric treatment and in some cases being held against their will in a chaotic environment far from conducive for treatment of a mental health ailment. In this analysis, I will discuss and review aspects of psychiatric patient boarding from various literature, such as why boarding occurs from a hospital and historical standpoint, negative implications of boarding for psychiatric and medical patients, and the burden placed on the hospital when practicing psychiatric boarding. To learn further on the topic, I will share the results from 14 semi-structured, qualitative interviews performed with ED healthcare professionals, being physicians, charge nurses, nursing staff, and certified nursing assistants or patient safety advocates. This portion of my investigation is designed to offer a perspective that the literature cannot, being a first hand outlook on psychiatric boarding from those working on the front line, focusing on topics of all aspects, such as causation, consequences for all involved parties, and proposed solutions.
ContributorsChun, Tristan Eric (Author) / Brian, Jennifer (Thesis director) / Foy, Joseph (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
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How Summer Camps Can Aid Palliative Care for Cancer Patients

Description
The rate of cancer incidence is a morbid figure. Twenty years ago, 1 in 2 men and 1 in 3 women were predicted to be afflicted by cancer throughout their lifetime (Cancer Facts & Figures- 1998). In 2017, the rate remains the same ("Cancer Statistic Center"). Every year, more people…

The rate of cancer incidence is a morbid figure. Twenty years ago, 1 in 2 men and 1 in 3 women were predicted to be afflicted by cancer throughout their lifetime (Cancer Facts & Figures- 1998). In 2017, the rate remains the same ("Cancer Statistic Center"). Every year, more people are affected by cancer, which is a physiologically, psychologically, emotionally and socially devastating disease. And yet the language and metaphors we use to describe cancer focus our attention on the "fight" of the heroic individual against the brutal disease or on finding a cure. Despite this narrow rhetoric, there are many meaningful, supportive, and palliative measures designed to substantively and holistically care for cancer patients, beyond their medical treatment. Many of these interventions help the patient feel supported (and less alone in this "battle") by building robust communities. In this thesis, I argue the summer camps for children affected by cancer are meaningful interventions that offer palliative care throughout their treatment by creating support networks with peers going through similar medical procedures. Drawing on anecdotal evidence from three cancer camps and a detailed literature review of a subset of palliative interventions designed to promote well-being, this thesis proposes a new model for a summer camp that focuses on emotional processing emotional expression, positive psychology in order to improve palliative care for cancer patients.
ContributorsPearce, Spencer Taylor (Author) / Miller, April (Thesis director) / Brian, Jennifer (Committee member) / School of Molecular Sciences (Contributor) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2017-12
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Maturity and the Right to Refuse Treatment for Cancer: Considering the Societal, Biological, and Legal Implications of Allowing a Minor to Make a Complex Medical Decision

Description
Treating a minor diagnosed with cancer is a difficult situation. However, cases in which doctors and the patient's family disagree about the proper course of treatment present complex scenarios when it comes to patient care. The forced treatment of Cassandra Callender came as a result of challenging interactions between the…

Treating a minor diagnosed with cancer is a difficult situation. However, cases in which doctors and the patient's family disagree about the proper course of treatment present complex scenarios when it comes to patient care. The forced treatment of Cassandra Callender came as a result of challenging interactions between the patient, the medical establishment, and the state. While the Connecticut Supreme Court mainly considered Cassandra's maturity and her mother's actions when deciding this case, there were more factors contributing to Cassandra's quality of care than her ability to make decisions. An evaluation of these factors demonstrates important implications for ensuring a minor receives the best care. Cassandra wished to pursue a means of treatment that would have fewer serious side effects than chemotherapy, but her assessment of her prognosis was markedly different than that of her doctors. While it is clear that Cassandra did not fully grasp the likelihood of death without chemotherapy treatment, her perspective should not have been fully ignored. The forced treatment inflicted serious (though short term) harm. To understand the full context of this case, this paper considers relevant legal doctrine, decision-making capabilities of minors, the problems and perils of chemotherapy, the role of the media, and the doctor-patient relationship. Developing a perspective based on these facets of Cassandra's case is important in determining how to facilitate the best interaction between doctor and patient and to make sure that future cases aid the patient and his or her family to make the best decision given the situation. Even when there is no consensus about what is best for a patient, more consideration must be given to the patient's perspective, beyond attempting to solely extend life.
ContributorsStoffer, Sidney Rae (Author) / Brian, Jennifer (Thesis director) / Cook-Deegan, Robert (Committee member) / School of Criminology and Criminal Justice (Contributor) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2016-05
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Meditation and Sleep Applications: Testing Piano Music Modality to Reduce Anxiety and Stress in College Students

Description

My research aims to determine the effectiveness of meditation and sleep applications (apps) on the reduction of anxiety and stress in college students, with a focus on sedative piano music. Results showed a significant reduction of stress and anxiety levels in college students when listening to sedative piano music versus…

My research aims to determine the effectiveness of meditation and sleep applications (apps) on the reduction of anxiety and stress in college students, with a focus on sedative piano music. Results showed a significant reduction of stress and anxiety levels in college students when listening to sedative piano music versus non-sedative piano music. Music along with other therapy modalities in meditation and sleep apps show promise in reducing students’ anxiety and stress and promoting their successes.
ContributorsPantha, Bidur (Author) / Brian, Jennifer (Thesis director) / Patten, Kristopher (Committee member) / School of Molecular Sciences (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
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Nanomedical Treatments for Cancer: Breakthroughs and Challenges

Description

The purpose of this project is to analyze the current state of cancer nanomedicine and its challenges. Cancer is the second most deadly illness in the United States after heart disease. Nanomedicine, the use of materials between 1 and 100 nm to for the purpose of addressing healthcare-related problems, is…

The purpose of this project is to analyze the current state of cancer nanomedicine and its challenges. Cancer is the second most deadly illness in the United States after heart disease. Nanomedicine, the use of materials between 1 and 100 nm to for the purpose of addressing healthcare-related problems, is particularly suited for treating it since nanoparticles have properties such as high surface area-to-volume ratios and favorable drug release profiles that make them more suitable for tasks such as consistent drug delivery to tumor tissue. The questions posed are: What are the current nanomedical treatments for cancer? What are the technical, social, and legal challenges related to nanomedical treatments and how can they be overcome? To answer the questions mentioned above, information from several scientific papers on nanomedical treatments for cancer as well as from social science journals was synthesized. Based on the findings, nanomedicine has a wide range of applications for cancer drug delivery, detection, and immunotherapy. The main technical challenge related to nanomedical treatments is navigating through biological barriers such as the mononuclear phagocyte system, the kidney, the blood-brain barrier, and the tumor microenvironment. Current approaches to meeting this challenge include altering the size, shape, and charge of nanoparticles for easier passage. The main social and legal challenge related to nanomedical treatments is the difficulty of regulating them due to factors such as the near impossibility of detecting nanowaste. Current approaches to meeting this challenge include the use of techniques such as scanning tunneling microscopy and atomic force microscopy to help distinguish nanowaste from the surroundings. More research will have to be done in these and other areas to enhance a major cancer-fighting tool.
ContributorsAbraham, Alfred Francy (Author) / Brian, Jennifer (Thesis director) / Liu, Yan (Committee member) / Materials Science and Engineering Program (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05