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Boarding refers to the practice of holding patients in the emergency department (ED) for extended periods, often beyond the recommended timeframe, due to a lack of available mental health treatment options or appropriate placement. In this scenario, the nurse is notifying the manager about the presence of clients with mental health disorders who have been in the ED for more than 48 hours. This situation suggests that the hospital is likely practicing boarding for these clients.

Boarding of mental health patients in the ED can have significant negative consequences. It can contribute to overcrowding in the ED, leading to delays in care for other patients. It can also compromise the quality of care and exacerbate the distress and discomfort experienced by individuals with mental health disorders. Additionally, it is not an optimal environment for mental health treatment and recovery.

By discussing the issue of boarding with the manager, the nurse is addressing the need for timely and appropriate placement for clients with mental health disorders. This conversation may involve exploring solutions such as improving access to mental health services, establishing dedicated mental health units or crisis stabilization centers, and collaborating with community resources to ensure a smooth transition of care for these clients.

The other options mentioned are not directly related to the issue of clients with mental health disorders being present in the ED for over 48 hours:

● Temporary detaining orders for clients: This refers to legal mechanisms that allow for the temporary detention of individuals with mental health disorders who may pose a risk to themselves or others. While it may be related to the care of these clients, it does not address the issue of prolonged stays in the ED.

● The revolving door for clients: This concept refers to the frequent readmission or return of clients to the ED or hospital due to ongoing mental health issues. While it is a concern in mental health care, it does not specifically pertain to the issue of clients remaining in the ED for an extended period.

● The cost of holding clients in the ED for over 48 hours: While the cost implications of extended stays in the ED are relevant, the primary concern in this scenario is the quality of care, appropriate placement, and the impact on both the clients and the ED's functioning.

While all members of the interdisciplinary team play important roles in the care of a client started on antidepressant medication, the psychiatric nurse typically takes a leading role in monitoring the medication's effectiveness and side effects.

1. Pharmacist: The pharmacist plays a crucial role in ensuring the safe and accurate dispensing of medications. They provide important information about the medication, its dosing, and potential drug interactions. However, they may not be directly involved in monitoring the client's response to the medication or assessing for specific side effects.

2. Psychiatrist: The psychiatrist is responsible for prescribing the antidepressant medication and determining the appropriate treatment plan for the client. While they may periodically review the client's progress and adjust the medication as needed, their role may focus more on the overall management of the client's mental health condition rather than continuous monitoring of the medication's effectiveness and side effects.

3. Psychologist: The psychologist typically focuses on providing therapy and counseling services to the client. While they may have knowledge about the effects of antidepressant medication, their primary role is not to monitor its effectiveness or side effects.

4. Psychiatric nurse: The psychiatric nurse is often at the forefront of medication monitoring and management. They closely observe the client for changes in symptoms, assess the client's response to the antidepressant medication, and monitor for any potential side effects or adverse reactions. The psychiatric nurse may collaborate with the psychiatrist and other team members to adjust the medication regimen and provide ongoing support and education to the client about their medication.