Emergency department nurses' experiences of occupational stress: A qualitative study from a public hospital in Bangkok, Thailand

Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia

BACKGROUND

Emergency nurses play a pivotal role in delivering efficient emergency healthcare, yet they often encounter numerous challenges, especially while managing life-threatening cases, impacting both their well-being and patient satisfaction. This study seeks to identify the prevalent challenges faced by these nurses in Saudi hospitals when handling Canadian Triage and Acuity Scale (CTAS1 and CTAS2) cases, with the aim of mitigating or managing these issues in the future.

METHODS

This study incorporated a mixed-method approach to identify obstacles in Emergency Department (ED) nursing treatment of CTAS1 and CTAS2 cases in two major Saudi Arabian hospitals. The research began with qualitative focus group interviews with expert ED nurses, followed by a quantitative survey to measure and explore relationships among the qualitative findings. Data analysis leveraged qualitative thematic analysis and principal component analysis, ensuring rigorous examination and validation of data to drive meaningful conclusions.

FINDINGS

From expert interviews, key challenges for emergency nurses were identified, including resource management, communication, training compliance, and psychological factors. A survey of 172 nurses further distilled these into five major issues: patient care management, handling critical cases, administration support, patient care delay, and stress from patients' families.

CONCLUSION

Through a mixed-method approach, this study pinpoints five pivotal challenges confronting emergency nurses in Saudi hospitals. These encompass difficulties in patient care management, the psychological toll of handling critical cases, inadequate administrative support, delays due to extended patient stays, and the stress induced by the presence of patients' families, all of which significantly impede emergency department efficiency and compromise nurse well-being.

Conflict in emergency medicine: A systematic review

BACKGROUND

The emergency department (ED) is a demanding and time-pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings. We aim to synthesize the individual-, team-, and systemic-level factors that contribute to conflict between clinicians within the ED and explore strategies and opportunities for future research.

METHODS

Online databases PubMed and Web of Science were systematically searched for relevant peer-reviewed journal articles in English with keywords relating to "conflict" and "emergency department," yielding a total of 29 articles.

RESULTS

Narrative analysis showed that conflict often occurred during referrals or admissions from ED to inpatient or admitting units. Individual-level contributors to conflict include a lack of trust in ED workup and staff inexperience. Team-level contributors include perceptions of bias between groups, patient complexity, communication errors, and difference in practice. Systems-level contributors include high workload/time pressures, ambiguities around patient responsibility, power imbalances, and workplace culture. Among identified solutions to mitigate conflict are better communication training, standardizing admission guidelines, and improving interdepartmental relationships.

CONCLUSIONS

In emergency medicine, conflict is common and occurs at multiple levels, reflecting the complex interface of tasks and relationships within ED.

Emergency department Nurses' narratives of burnout: Changing roles and boundaries

PURPOSE

Emergency department nurses work in rapidly changing environments, which can contribute to occupational stress. Emergency department nurses utilise diverse strategies to mediate the impact of stress on their daily lives. There is a paucity of qualitative research which explores emergency department nurses' experiences and perspectives of burnout. This study aimed to explore emergency department nurses' experiences of burnout. Further, the study considered how emergency nurses conceptualised burnout and the strategies they used to manage the professional and personal effects of burnout.

PROCEDURES

The COREQ research guidelines were used throughout the study from the design stage through to dissemination. Narrative inquiry was used as the underpinning theoretical framework. The researcher met individually with eight emergency department nurses from NSW hospitals to undertake a face-to-face semi-structured interview. An inductive approach was used to establish major themes within the narrative.

FINDINGS

Two major themes were established: experiencing conflicting emotions and trying to establish a personal sense of control. Emergency nurses felt passionate about their professional roles, yet encountered difficulties due to management structures, time constraints and a sense of underappreciation. The misalignment between their expectations and the reality of emergency department nursing, resulted in experiences of burnout such as dissatisfaction and frustrations at work. Consequently, these nurses adopted diverse strategies within both their professional and personal domains.

PRINCIPAL CONCLUSIONS

The conclusions of this study are transferable to a variety of acute health services. Health service management have a role to promote a positive workplace culture for nurses, which advocates for home life balance. This will support nurses to construct clear boundaries between professional identity and their personal lives.

Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study

BACKGROUND

The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters.

METHODS

This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data.

RESULTS

After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems.

CONCLUSION

Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

The psychometric properties of the Chinese version of the stressor scale for emergency nurses

BACKGROUND

Emergency nurses are experienced specific stress factors. To evaluate stressors of emergency nurses effectively is useful to improve quality of nursing care. This study aimed to translate the stressor scale for emergency nurses into Chinese (C-SSEN) and carry out the reliability and validity test among Chinese emergency nurses.

METHODS

A total of 358 emergency nurses from four hospitals in Tianjin, Henan, and Shandong province of China are recruited through a convenience sampling. The C-SSEN was translated into Chinese applying a classic 'forward-backward' translation method. Reliability (internal consistency, test-retest reliability) and validity (content validity, construct validity) were assessed.

RESULTS

The final version of C-SSEN was rated by the expert panel, indicating good content validity (I-CVI ≥ 0.83, S-CVI = 0.96). The scale had satisfactory content validity, internal consistency (Cronbach's α coefficient = 0.958), and test-retest reliability (intra-class correlation coefficient = 0.824).

CONCLUSION

The C-SSEN is a useful and reliable scale to evaluate stressors among emergency nurses.

Qualitative study of challenges facing emergency departments nurses in Jordan

Worldwide, nurses employed in the Emergency Department (ED) face many challenges that negatively influence their well-being and ability to provide high-quality patient care. Previous researchers have investigated these challenges regarding their causes, consequences, and how to deal with them. However, most of the previous research addressed these challenges using quantitative research. The current study is the first qualitative study that examined these challenges in the Jordanian context. A descriptive naturalistic qualitative design was used to explore the most critical challenges facing nurses employed in the ED and described the suggested solutions for these challenges from nurses' perspectives. Ten registered nurses employed in the most prominent ED in Jordan were selected through purposive sampling. Semi-structured interviews were used to collect data. Thematic analysis technique was used to analyze data. Six main themes emerged: the definition of challenge, challenges facing registered nurses in the emergency department (five sub-themes), preventive measurements, possible solutions (five sub-themes), effects of the challenges (two sub-themes), and future challenges. The outcomes of this study could be integrated into the educational curricula to prepare new nurses to deal with these challenges in the future after graduation and contribute to finding solutions and solving some significant problems facing registered nurses in the ED. The hospital administrators and the policymakers should develop effective interventions to overcome the challenges facing nurses in the ED to ensure a better work environment and high-quality patient care.

Incidence of stress among emergency nurses: A systematic review and meta-analysis

BACKGROUND

This study's main purpose is to evaluate the stress level among emergency nurses systematically.

METHODS

Adhering to the preferred reporting items for systematic reviews and meta-analyses guidelines, nine databases, including PubMed, Cochrane, web of science, Scopus, ScienceDirect, Embase, China National Knowledge Infrastructure, Wanfang, and China biomedical literature service system, were searched to collect cross-sectional studies on emergency nurses. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies.

RESULTS

From 2655 studies, 21 cross-sectional studies were included, including 4293 subjects. Meta-analysis showed that the incidence of low-level stress was 0.21% (95% CI [0.18-0.24]), the incidence of middle-level stress was 0.46% (95% CI [0.33-0.58]), and the incidence of high-level stress was 0.32% (95% CI [0.22-0.41]), which is mainly at the medium level.

CONCLUSION

This review identified the stress level of emergency nurses mainly at the medium level. This result makes nursing administrators pay more attention to the mental health problems of emergency nurses and actively take measures to promote the physical and mental health of emergency nurses and further promote the development of the nursing profession.

Factors related to work ability among nursing professionals from urgent and emergency care units: A cross-sectional study

BACKGROUND

Nursing professionals are on the front line of health systems in Brazil as well as worldwide. Studies on the work ability of nursing professionals are especially relevant as care demands increase and health care workforce shortages are expected. As the population of Brazil ages, the need for nursing care will increase.

OBJECTIVE

To identify levels and predictors of work ability among Brazilian nursing professionals.

METHODS

A cross-sectional study with 267 nursing professionals (72 nurses and 195 nursing technicians and nursing auxiliary) from public emergency and urgent care units was conducted. Measures included the following: Work Ability Index; Questionnaire of Socio-demographics, Lifestyle and Work and Health Aspects; and Violence at Work questionnaire. Generalized linear regression and Poisson models were used for data analysis.

RESULTS

The mean work ability was 40.4 (range: 22 to 49). Almost 79.6% (n = 211) of participants reported good or excellent work ability, and 20.4% (n = 54) reported moderate or poor work ability. Better perceptions of health and job satisfaction, absence of health issues (past 15 days), lower stress levels, and having a partner were associated with better work ability. Victims of workplace violence were less likely to have good or excellent work ability than non-victims (prevalence ratio = 0.80; 95% CI 0.72 to 0.90). Professionals with cumulative experiences of workplace violence were less likely to report better work ability.

CONCLUSIONS

The prevalence of good or excellent work ability was 79.6%. Our findings indicate that the following factors are predictors of work ability: self-reported perception of health, health issues in the last 15 days, workplace violence, job satisfaction, stress, and marital status.

Triage Knowledge and Practice and Associated Factors Among Emergency Department Nurses

Objective

The study aims at assessing the triage knowledge and practices and their associated factors among emergency department nurses employed in King Fahad Medical City (KFMC), Saudi Arabia.

Method

The study employed a cross-sectional, descriptive, and correlational design. Data collection was carried out from February 11, 2021, until April 27, 2021. The study included all emergency department nurses who were working in the KFMC during the data collection period and excluded those who were on leave at the time of data collection. A self-reported questionnaire with adequate validity and reliability was used. Statistical analysis was performed using the IBM SPSS Version 25 employing descriptive statistics, independent t-test, one-way ANOVA, and Pearson correlation test.

Results

A total of 147 emergency department nurses completed the study. Participants demonstrated generally high levels of triage knowledge and triage practice. However, knowledge deficit and incorrect practice related to some aspects were noted. There were no significant differences in triage knowledge and practice according to participants’ demographics including gender, job title, qualification, emergency nursing training, and previous training in triage (P > 0.05). Most participants (n = 141, 95.9%) had access to their triage systems and the majority (n = 79, 53.7%) utilize triage systems on a daily basis. Half said that only professional nurses performed the triage role (n = 69, 46.9%). There was a significant positive relationship between triage knowledge and practice (r = 0.486, P < 0.01).

Conclusion

The respondents had a high level of triage knowledge and practice. However, they have some areas of knowledge deficit and some deficiencies in the conversion of their knowledge into practice. The study recommends the development of further training and education in emergency nursing to address knowledge deficits and incorrect triage practices.

Late-onset PTSD and coping strategies for frontline nurses during the COVID-19 epidemic in China

Aim

To evaluate the late‐onset post‐traumatic stress disorder (PTSD) situation, coping strategies and social supports for frontline clinical nurses 6 months after involvement in fighting against coronavirus disease 2019 (COVID–19) outbreak in China.

Design

A cross‐sectional design.

Methods

We recently randomly distributed a questionnaire online to Chinese nurses who had taken care of COVID‐19 patients since the end of January 2020. The questionnaire was made up of three professional scales, the impact of event scale‐revised, simplified coping style questionnaire and social support rating scale included.

Results

The general prevalence of late‐onset PTSD among frontline nurses was 88.19%. Nurses who worked in Hubei Province (the kindle place of the COVID‐19 outbreak) showed lower risk of late‐onset PTSD symptoms than those who did not. We also found that positive coping strategies were correlated with less late‐onset PTSD symptoms. Meanwhile, getting more social supports could help these nurses to obtain positive coping strategies.

Job demands, work engagement and job turnover intentions among registered nurses: Explained by work-family private life inference

BACKGROUND

The job demands on nurses have increased. Conflict between work life and family life may lead to stress and lower work engagement. Consequently, nurses may choose a different career path or leave the profession.

OBJECTIVE

Examine the extent to which perceived job demands (interpersonal conflicts at work and workload), work engagement, work-family conflict and family-work conflict are associated with turnover intentions, and examine a possible moderating effect of work-family conflict on the relationship between the intention to leave the nursing profession, job demands and work engagement.

METHODS

Cross-sectional study using Hobfoll's Conservation of Resources theory. Data were collected from a sample of 807 registered nurses (RNs) from western Sweden. Tests of moderation were conducted using the PROCESS software macro developed by Andrew F. Hayes.

RESULTS

Work-family conflict was a significant moderator in the relationship between the intentions to leave the nursing profession and work engagement as well as interpersonal conflicts at work. Low work engagement, high work-family conflict and high job demands intensify turnover intentions in well-educated and well-experienced nurses.

CONCLUSIONS

The results imply that work-family conflict has a greater impact when RNs experience lower work engagement. In other words, higher motivation implies a lower moderation effect of work-family conflict. Managers should promote a positive working climate by listening to and providing nurses with opportunities to develop their skills. By so doing, managers can gain better understanding of nurses' resources, knowledge and work situation, thus strengthening nurses' confidence and ability to practice their profession.

Investigation of usability problems of electronic medical record systems in the emergency department

BACKGROUND

Despite the benefits of using electronic medical record (EMR) systems, existing studies show that many healthcare providers are uncertain regarding their usability. The usability issues of these systems decrease their efficiency, discourage clinicians, and cause dissatisfaction among patients, which may result in safety risks and harm.

OBJECTIVE

The aim of this study was to collect and analyze EMR system usability problems from actual users. Practical user interface guidelines were presented based on the medical practices of these users.

METHODS

Employing an online questionnaire with a seven-point Likert scale, usability issues of EMR systems were collected from 200 emergency department healthcare providers (103 physicians (medical doctors) and 97 nurses) from South Korea.

RESULTS

The most common usability problem among the physicians and nurses was generating in-patient selection. This pertained to the difficulty in finding the required information on-screen because of poor visibility and a lack of distinctiveness.

CONCLUSIONS

The major problems of EMR systems and their causes were identified. It is recommended that intensive visual enhancement of EMR system interfaces should be implemented to support user tasks. By providing a better understanding of the current usability problems among medical practitioners, the results of this study can be useful for developing EMR systems with increased effectiveness and efficiency.

Work-based strategies/interventions to ameliorate stressors and foster coping for clinical staff working in emergency departments: a scoping review of the literature

BACKGROUND

Exposure to occupational stressors is an issue for staff working in emergency departments, managers and health services. The aim of this review was to identify, map, and synthesise the range and scope of current evidence for work-based strategies or interventions used in emergency departments to reduce occupational stressors and/or improve staff coping.

METHODS

The framework proposed by Arksey and O'Malley guided this review. A search of CINAHL, MEDLINE, Scopus, Cochrane and PsycINFO databases from January 2007 to June 2019 was applied. A total of thirty-one articles were included in this review. Quality appraisal was undertaken.

RESULTS

Exposure to or impact of occupational stress and workplace violence were common foci. A range of outcomes (such as burnout levels, stress levels and quality of life) were measured in the included studies. All studies demonstrated some improvement in outcomes measured although most were evaluated for relatively short duration. Quality of evidence varied.

CONCLUSION

Strategies ranging from mindfulness to organisational redesign have been trialed to diminish stress and enhance coping of emergency department staff. Understanding the effectiveness of strategies is an important early step in improving the working environment for emergency department clinicians in an evidence-informed manner. Such information may be of use to managers to inform decision making regarding the most appropriate strategy to implement in their emergency department.

A comparative study on patient safety culture among emergency nurses in the public and private hospitals of Tabriz, Iran

Aim

To appraise patient safety culture in emergency departments of Iranian public and private hospitals.

Design

A comparative cross-sectional survey design was used.

Methods

This cross-sectional study was conducted from January-March 2019. For data collection, the Hospital Patient Safety Culture (HSOPSC) questionnaire was employed. The study sample comprised 256 participants. Independent t test and analysis of variance were performed to report the mean differences in total patient safety culture perception according to the participants' characteristics and according to hospital ownership.

Results

There was no significant difference in overall perceptions of patient safety culture in public and private sectors (2.94 vs. 2.84, p > .05). There are no solid areas regarding patient safety found neither in public nor in private sectors. Out of 12 dimensions of patient safety culture, different perceptions of nurses working in public and private hospitals belonged to "Organizational learning" (t = 2.13, p = .034) and "Handoffs and transitions" (t = 2.91, p = .004). Regarding the participants' characteristics, no significant difference was observed as to the perspectives of nurses on patient safety culture. However, there was a meaningful difference in the attitudes of nurses working in public hospitals according to their employment status (t = 2.07, p = .039).

Top ten: A model of dominating factors influencing job satisfaction of emergency nurses

BACKGROUND

Increasing emergency department (ED) visits per capita, combined with an aging population and ongoing budgetary constraints in Canada's health care system necessitate continuous improvements to ensure that patients remain safe and continue to receive high quality care. Addressing ED nursing job satisfaction is a cost-effective way of improving safety and quality of hospital care.

METHODS

A scoping literature review was conducted to examine the breadth of job satisfaction literature and identify the factors that specifically influence the job satisfaction of ED nurses.

RESULTS AND DISCUSSION

A review of 161 journal articles revealed 34 articles fitting the inclusion criteria, which were included in the final analysis. There were ten predominant factors that allowed for workplace interventions, including six that did not achieve consensus. The ten factors are presented in the form of a practical model for implementation based on the Herzberg two-factor theory and the Maslow hierarchy of needs theory.

CONCLUSION

The model informs healthcare leaders how to pragmatically understand job satisfaction specific to ED nurses. This information in turn can be used to design interventions that increase job satisfaction while maintaining safety and quality of care.

Future Emergency Nursing Workforce: What the Evidence Is Telling Us

INTRODUCTION

In Australia, on any given day, there are more than 300 advertised emergency nursing positions, and this situation can be replicated in nearly every country internationally. The nursing shortage globally is known. The importance of not only why nurses specialize in the field of emergency nursing but also why they remain in the field requires an understanding of the evidence and research into nursing recruitment and retention. Leadership within the emergency department has a strong correlation to staff retention. It is hoped that, by gaining a greater understanding of the elements that influence staff retention, we will be able to lay down a strong foundation for the future of emergency nursing.

METHODS

This literature review used a bibliographic search as well as the author's own experience.

RESULTS

This article presents the key factors that have impact on emergency nursing retention: workplace environment, demands on emergency nurses, resilience, and education and training.

DISCUSSION

Emergency nursing recruitment and retention is a multifaceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This literature review has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.

Development and psychometric properties of the stressor scale for emergency nurses

INTRODUCTION

Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses.

METHODS

The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated.

RESULTS

The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and families' actions and reactions, Technical and formal support, and Conflicts. The Cronbach's alpha values ranged from 0.89 to 0.93 per factor, and the intra-class correlation coefficient was 0.89, indicating good homogeneity and stability.

CONCLUSIONS

The instrument's content, face, and construct validities were satisfactory, and the internal consistency and test-retest reliability were good. This instrument can be useful in the management of emergency departments.

Emergency department nurses' experience of performing CPR in South Korea

BACKGROUND

Emergency Department (ED) nurses often confront unexpected cardiopulmonary resuscitation (CPR) with little information about the patients.

METHODS

This qualitative study explored the experience of performing CPR among ED nurses. Data collection took place between May and June 2016 using an online advertisement to recruit 17 ED nurses. Each participant was interviewed for 40-90min. Interviews were recorded and transcribed verbatim. Data analysis was conducted using a conventional content-analysis method.

RESULTS

Four themes emerged: Pressure from the urgency of the CPR, becoming sharp tempered in addressing personnel during CPR, keeping psychological conflicts of CPR patient care to oneself, and growing as an ED nurse through CPR.

CONCLUSION

ED nurses had anxiety about CPR, regardless of their ability to perform CPR. They also suffered psychologically afterward. ED nurses could benefit from education that promotes their competencies for CPR and support systems to alleviate their psychological distress.

Improving work conditions through strike: Examination of nurses' attitudes through perceptions of two physician strikes in Israel

BACKGROUND

Strikes are means to influence policies related to working conditions, yet raise ethical dilemmas for healthcare workers. Nurse strikes have become more prominent around the world.

OBJECTIVE

To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike.

METHODS

An anonymous survey was administered once in 2000 (N = 106) and again in 2011 (n = 175) following 110 days of a physician strike, to assess nurses' attitudes towards the strike and resulting ethical issues.

RESULTS

A statistically significant change (p < 0.05) between administrations revealed that in 2011 more nurses identified striking as a legitimate mechanism, would strike under the same circumstances, and felt that collaboration with physicians persisted despite the strike. Additionally, an increasing number of nurses said that the suffering of patients due to the strike is somewhat or entirely justified, although they were faced with a difficult dilemma of loyalty to physician colleagues vs.

PATIENTS

Nurses reported finding ways to mitigate the suffering of patients resulting from the strike.

CONCLUSIONS

While patient-centered care remains nurses' first and foremost priority, findings indicate an increasing support of collective bargaining and strike to promote working conditions related to professional and public health agendas.