New Roles for Psychologists in Medical Settings: Direct Services in a Hong Kong Accident and Emergency Department

Wo Oi Kwok, Christopher D. Tori, Timothy H. Rainer

1California School of Professional Psychology, Alliant International University, Hong Kong, China.
Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
California School of Professional Psychology, Alliant International University, Hong Kong, China.

DOI: 10.4236/ojmp.2013.22011                

Abstract

Study Aim: Descriptions of the direct services of a psychologist (i.e. clinical psychology intern) in an accident and emergency department (AED) are provided as a new and rare area of professional practice. Method: Data were collected in a large, Hong Kong, government hospital over an eighteen-month period. Recipients included 281 patients, 150 medical staff members, and 44 relatives of patients. Results: Interventions with patients and their family members centered on crisis management, diagnostic assessment, psychoeducation, and consultations regarding long-term adjustment to medical infirmities. The majority of staff members sought consultations regarding work related stress such as burnout symptoms and coping with vicarious trauma experiences. Frequency tables provide information on utilization of specific services while case vignettes contextualize psychological interventions. Conclusion: There are many potential benefits of psychological service for AED patients and staff.

Keywords

Accident and Emergency Departments; Psychological Services Utility; Patients and Staff

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. Soons and J. Denollet, “Medical Psychology Services in Dutch General Hospitals: State of the Art Developments and Recommendations for the Future,” Journal of Clinical Psychology in Medical Settings, Vol. 16, No. 2, 2009, pp. 161-168. doi:10.1007/s10880-009-9158-7
[2]	T. W. Smith, P. C. Kendall and F. J. Keefe, “Behavioral Medicine and Clinical Health Psychology: Introduction to the Special Issue, a View from the Decade of Behavior,” Journal of Consulting and Clinical Psychology, Vol. 70, No. 3, 2002, pp. 459-462. doi:10.1037/0022-006X.70.3.459
[3]	N. Tomes, “The Development of Clinical Psychology, Social Work, and Psychiatric Nursing: 1900-1980s,” In: E. R. Wallace and J. Gach, Eds., History of Psychiatry and Medical Psychology, Springer, New York, pp. 657-682.
[4]	A. S. Malik, O. Boyko, N. Atkar and W. F. Young, “A Comparative Study of MR Imaging Profile of Titanium Pedicle Screws,” Acta Radiologica, Vol. 42, No. 3, 2001, pp. 291-293. doi:10.1080/028418501127346846
[5]	S. Finger, F. Boller and K. L. Tyler, “History of Clinical Neurology,” Elsevier, Edinburgh, 2010.
[6]	T. Stancin, E. C. Perrin and L. Ramirez, “Pediatric Psychology and Primary Care,” In: M. C. Roberts and R. G. Steele, Eds., Handbook of Pediatric Psychology, 4th Edition, Guilford Press, New York, 2009, pp. 630-646.
[7]	C. Herrmann-Lingen, “Steps towards Integrated Psychosomatic Medicine—The Example of Psychocardiology,” Journal of Psychosomatic Research, Vol. 70, No. 2, 2011, pp. 111-115. doi:10.1016/j.jpsychores.2010.09.019
[8]	H. de La Ménardière, M. Reich and L. Vanlemmens, “Reperage, Clinique, et Evaluation de la Depression en Oncologie: Collaboration Psychiatre, Psychologue, et Cancérologue,” Psycho-Oncologie, Vol. 4, No. 4, 2010, pp. 250-255. doi:10.1007/s11839-010-0285-z
[9]	J. A. Morris, “The Rural Psychologist in the Hospital Emergency Room,” In: J. A. Morris Ed., Practicing Psychology in Rural Settings: Hospital Privileges and Collaborative Care, American Psychological Association, Washington DC, 1977, pp. 81-96.
[10]	G. G. Bodiwala, “Emergency Medicine: A Global Specialty,” Emergency Medicine Australasia, Vol. 19, No. 4, 2007, pp. 387-388.
[11]	R. E. Suter, “The Light of Emergency Medicine: Vietnam —The Next Chapter in the Global History of Emergency Medicine?” Academic Emergency Medicine, Vol. 18, No. 4, 2011, pp. e31-e35. doi:10.1111/j.1553-2712.2011.01046.x
[12]	International Federation for Emergency Medicine (IFEM), “IFEM Definition of Emergency Medicine,” 2012. http://www.ifem.cc/About_IFEM.aspx
[13]	Hong Kong College of Emergency Medicine, “From Casualty to Emergency Medicine—Half a Century of Transformation,” Hong Kong Academic of Medicine Press, Hong Kong, 2006.
[14]	Hospital Authority of Hong Kong, “Hospital Authority Statistical Report 2010-2011,” 2012. http://www.ha.org.hk/gallery/ha_publications.asp?
[15]	R. Burns, A. Cheung, S. Leung and F. Leung, “Management of Accident and Emergency Services: Audit Report,” Hospital Authority, Hong Kong, 2010.
[16]	Y. Zhang, H. Su, L. Shang, D. Li, R. Wang, R. Zhang and Y. Xu, “Preferences and Perceived Involvement in Treatment Decision Making among Chinese Patients with Chronic Hepatitis,” An International Journal of the Society for Medical Decision Making, Vol. 31, No. 2, 2011, pp. 245-253. doi:10.1177/0272989X10375990
[17]	H. Q. Wu, Y. Zang, Y. W. Li, Y. Zhu and F. Shen, “Clinical Characteristics of Patients with Depressive Disorders at Department of Neurology in General Hospitals,” Zhonghua Yi Xue Za Zhi, Vol. 19, No. 25, 2010, pp. 1760-1763.
[18]	S. B. R. Rosser, “Working as a Psychologist in the Medical Reserve Corps: Providing Emergency Mental Health Relief Services in Hurricanes Katrina and Rita,” Professional Psychology: Research and Practice, Vol. 39, No. 1, 2008, pp. 37-44. doi:10.1037/0735-7028.39.1.37
[19]	C. T. Beck, “Secondary Traumatic Stress in Nurses: A Systematic Review,” Archives of Psychiatric Nursing, Vol. 25, No. 1, 2011, pp. 1-10. doi:10.1016/j.apnu.2010.05.005
[20]	L. M. Culver, B. L. McKinney and L. V. Paradise, “Mental Health Professionals’ Experiences of Vicarious Traumatization in Post-Hurricane Katrina New Orleans. Journal of Loss and Trauma, Vol. 16, No. 1, 2011, pp. 33-42. doi:10.1080/15325024.2010.519279
[21]	B. Kerasiotis and R. W. Motta, “Assessment of PTSD Symptoms in Emergency Room, Intensive Care Unit, and General Floor Nurses,” International Journal of Emergency Mental Health, Vol. 6, No. 3, 2004, pp. 121-133.
[22]	M. Folstein, S. Folstein and P. McHugh, “Mini-Mental State: A Practical Method for Grading the Cognitive State of Patientsfor the Clinician,” Journal of Psychiatric Research, Vol. 12, No. 3, 1975, pp. 189-198. doi:10.1016/0022-3956(75)90026-6
[23]	H. F. K. Chiu, H. C. Lee, W. S. Chung and P. K. Kwong, “Reliability and Validity of the Cantonese Version of the Mini-Mental State Examination—A Preliminary Study,” Journal of Hong Kong College of Psychiatry, Vol. 4, No. 1, 1994, pp. 25-28.
[24]	Z. Nasreddine, N. A. Phillips, V. Bedirian, S. Charbonneau, V. Whitehead, I. Collin and H. Chertkow, “The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment,” Journal of the American Geriatric Society, Vol. 53, No. 4, 2005, pp. 695-699. doi:10.1111/j.1532-5415.2005.53221.x
[25]	C. F. Tsai, W. J. Lee, S. J. Wang, B. C Shia, Z. Nasredine and J. L. Fuh, “Psychometrics of the Montreal Cognitive Assessment (MoCA) and its Subscales: Validation of the Taiwanese Version of the MoCA and an Item Response Theory Analysis,” International Psychogeriatrics, Vol. 24, No. 4, 2012, pp. 651-658. doi:10.1017/S1041610211002298
[26]	A. J. Raphael and C. J. Golden, “Relationships of Objectively Scored Bender Variables with MMPI Score in an Outpatient Psychiatric Population,” Perceptual and Motor Skills, Vol. 95, No. 3, 2002, pp. 1217-1232. doi:10.2466/pms.2002.95.3f.1217
[27]	L. Handler, “The Clinical Use of Figure Drawings,” In: C. S. Newmark, Ed., Major Psychological Assessment Instruments, 2nd Edition, Simon & Schuster, Needham Heights, 1996, pp. 206-299.
[28]	W. M. Patterson, H. H. Dohn, J. Bird and G. A. Patterson, “Evaluation of Suicidal Patients: The SAD PERSONS Scale,” Psychometrics: Journal of Consultation Liaison Psychiatry, Vol. 24, No. 4, 1983, pp. 343-349.
[29]	S. S. Khan and J. Benger, “SAD PERSONS Scale in Assessing Self-Harm Risk,” Emergency Medicine Journal, Vol. 28, No. 4, 2011, pp. 335-336.
[30]	Y. Li, Y. Yang and C. Jiang, “A Study of the Reliability and Vlidity of Millon Clinical Multiaxial Inventory III (MCMI-III),” Chinese Journal of Clinical Psychology, Vol. 18, No. 1, 2010, pp. 11-14.
[31]	M. Boulton, M. Boudioni, M. J. Mossman, G. Moynihan, G. Leydon and G. A. Ramirez, “Dividing the Desolation: Clients Views on the Benefits of a Cancer Counseling Service,” Psychooncology, Vol. 10, No. 2, 2001, pp. 124-136. doi:10.1002/pon.494
[32]	J. Pimm, “The Psychological Care of Medical Patients,” Clinical Medicine, Vol. 3, No. 2, 2003, pp. 171-172.
[33]	J. Skelton, “Narrative Medicine: Stories to Some Purpose,” In: B. D. Kirkcaldy, Ed., The Art and Science of Health Care: Psychology and Human Factors for Practitioners, Hogrefe Publishing, Cambridge, 2011, pp. 313-327.
[34]	A. P. A. Margalit and A. El-Ad, “Costly Patients with Unexplained Medical Symptoms: A High-Risk Population,” Patient Education and Counseling, Vol. 70, No. 2, 2008, pp. 173-178. doi:10.1016/j.pec.2007.09.020
[35]	E. D. Peselow, “Adherence with Respect to Medication Management,” Primary Psychiatry, Vol. 14, No. 7, 2007, pp. 83-89.
[36]	E. L. Y. Wong, M. C. M. Leung, A. W. L. Cheung, C. H. K. Yam, E. K. Yeoh and S. Griffith, “A Population-Based Survey Using PPE-15: Relationship of Care Aspects to Patient Satisfaction in Hong Kong,” International Journal for Quality in Health Care, Vol. 23, No. 4, 2011, pp. 390-396. doi:10.1093/intqhc/mzr037
[37]	W. O. Kwok, “The Effects of an Intervention Program (MEDI) on Reducing Occupational Stress in Emergency Department Nurses,” PsyD (Clinical), Dissertation, Alliant International University, Los Angeles, 2011.
[38]	S. Y. Lee, “Job Burnout among Nurses in Hong Kong: Implications for Human Resource Practices and Interventions,” Asia Pacific Journal of Human Resources, Vol. 45, No. 1, 2007, pp. 63-84. doi:10.1177/1038411107073604
[39]	B. S. Oken, “Placebo Effects: Clinical Aspects and Neurobiology,” Brain: A Journal of Neurology, Vol. 131, No. 11, 2008, pp. 2812-2823. doi:10.1093/brain/awn116
[40]	J. W. Pennebaker, J. K. Kiecolt-Glaser and R. Glaser, “Disclosure of Traumas and Immune Function: Health Implications for Psychotherapy,” In: R. M. Kowalski and M. R. Leary, Eds., The Interface of Social and Clinical Psychology: Key Readings, Psychology Press, New York, 2004, pp. 301-312.
[41]	M. H. Antoni, “Stress Management Effects of Psychological, Endocrinological, and Immune Functioning in Men with HIV Infection: Empirical Support for a Sychoneuroimmunological Model,” Stress, Vol. 6, No. 3, 2003, pp. 173-188. doi:10.1080/1025389031000156727