Seeking Status: The Process of Becoming and Remaining an Emergency Nurse

The Application of Classic Grounded Theory in Nursing Studies: A Qualitative Systematic Review

AIM(S)

To explore the application of Classic Grounded Theory (GT) methodology in nursing research and critically appraise studies employing Classic GT against the validated framework Guideline for Reporting and Evaluating Grounded Theory (GUREGT) research studies.

DESIGN

Systematic review without meta-analysis METHODS: The review followed the PRISMA statement and used the Synthesis Without Meta-analysis (SWiM) guideline for data analysis. The quality of included articles was assessed using the CASP qualitative research appraisal tool, and the GUREGT framework was applied to evaluate adherence to Classic GT guiding principles.

DATA SOURCES

Databases were PUBMED, CINAHL, Nursing and Allied Health Database (ProQuest).

RESULTS

Twenty-nine studies from 2010 to 2024 met the inclusion criteria. Findings revealed inconsistencies in the reporting of Classic GT methodology in nursing research, with frequent omissions of key methodological elements. The GUREGT tool, while user-friendly and practical, highlights gaps in areas such as identifying the main concern, philosophical positioning, and engagement with the literature. These omissions can compromise methodological rigour, suggesting that further refinement of the GUREGT tool is necessary.

CONCLUSION

The GUREGT tool provides a promising framework for improving the reporting and evaluation of Classic GT studies. However, its current version requires enhancement to fully address the unique demands of Classic GT and ensure rigorous application and reporting of the methodology. Development of a dedicated reporting guideline tailored to Classic GT is critical for advancing the quality of nursing research and supporting researchers in generating robust, theory-driven insights.

IMPACT

Few studies critically appraise Classic GT methodology in health research. This review highlights the need for dedicated reporting guidelines to support methodological rigour and transparency in Classic GT studies.

REPORTING METHOD

This review adhered to EQUATOR reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Post-traumatic growth experiences of emergency and critical care nurses after the COVID-19 pandemic: A qualitative meta-synthesis

Objective

The previous coronavirus disease 2019(COVID-19) epidemic inflicted significant psychological trauma on emergency and critical care nurses due to various factors, potentially leading to job burnout. Despite the rise of positive psychology, little is known about the post-traumatic growth experience of these nurses after the pandemic. The aim of this study was to assess the experience of post-traumatic growth among emergency and critical care nurses, in order to provide managerial insights for developing effective strategies and facilitating the transformation of nurses' negative emotions into positive ones.

Design

A qualitative review.

Data sources

PubMed, EBSCO, Medline, Elsvier, Cochrane Library, CINAHL, Web of Science, Embase, and Ovid and Chinese databases include the following: Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database and China Biomedical Database (CBM).

Review methods

All articles about emergency and critical care nurses' post-traumatic growth after the COVID-19 pandemic were included after searching and screening 13 databases. The meta-synthesis method was used to integrate and evaluate the included literature in qualitative research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used as a basis for reporting the review. The literature was selected and evaluated by two researchers, and then meta-integration was used for analysis.

Results

From a total of 11 articles, 90 main results were presented, eight new categories were integrated, and three themes were formed: stress period, adjustment period and growth period. These three themes include eight sub-themes: negative emotion, psychological gap, self adjusting, social support, improvement of personal ability, increased sense of professional belonging, spiritual awakening and extended thinking, look ahead.

Conclusion

Post-traumatic growth in emergency and critical care nurses is dynamic. Managers should monitor the psychological changes experienced by emergency and critical care nurses following traumatic events, offering targeted support at different stages, providing enhanced professional development opportunities, refining management strategies, guiding nurses in self-adjustment and active coping with trauma, and promoting their physical and mental well-being to ensure a positive mindset for effectively addressing future public health crises.

Does moral distress in emergency department nurses contribute to intentions to leave their post, specialisation, or profession: A systematic review

BACKGROUND

There is a global shortfall of nurses. Despite national targets to increase nurse training and retention, the numbers leaving the profession continue to rise. Emergency departments (EDs) consistently record above average staff-turnover. Meanwhile descriptions of moral distress amongst emergency nurses are increasing. It is vital to consider the long-term emotional and psychological impact of moral distress on the emergency nursing workforce. However, the events which trigger moral distress in the emergency department may differ from those described in other clinical areas. A clearer understanding of the effects of moral distress on intention to leave could help identify those at risk and inform decisions on interventions designed to mitigate moral distress, aiding nurse retention and the organisational stability of health services.

AIM

This systematic review aims to synthesise the available evidence on the association between moral distress and intention to leave in emergency nurses.

METHODS

A systematic search of studies was performed on MEDLINE, CINAHL, PsychINFO, Web of Science and Cochrane databases (8th -10th June 2022). Results were screened and quality-assessed with cross-checks. The heterogeneity of samples and insufficient data precluded statistical pooling and meta-analysis. Consequently, narrative synthesis was performed.

RESULTS

Five studies reported quantitative results eligible for synthesis. Low to moderate levels of moral distress were reported in emergency nurses; contrasting starkly with the significant proportion who reported having left or considered leaving due to moral distress (up to 51%). Sparse, mostly low-quality evidence was identified, highlighting a need for more robust research. Current tools for measuring moral distress appear not to capture the unique pressures which contribute to moral distress in emergency nurses.

CONCLUSIONS

Emergency nurses cite moral distress as a reason for leaving. Further study is required to determine the levels of moral distress associated with intentions to leave and the strength of that association. This is fundamental to the design of effective retention policies. Future research should also explore the applicability of current moral distress measures to the emergency department, with consideration given to developing emergency department specific tools.

PROSPERO REGISTRATION NUMBER

CRD42022336241 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336241.

GridlockED as an Intervention for Nurses (GAAIN) Study

BACKGROUND

GridlockED (The Game Crafter, LLC) is a serious game that was developed to teach challenges that face nursing and medical professionals in the emergency department (ED). However, few studies have explored nurses' perceptions of the utility, fidelity, acceptability, and applicability of the serious game modality. This study examined how ED nurses view GridlockED as a continuing education platform.

METHOD

This single-center observational study explored how nurses engage with and respond to Grid-lockED. The convenience sample included participants recruited from a local continuing nursing education day. Participants completed a presurvey, engaged in a full game play session with the GridlockED game for approximately 45 minutes, and immediately completed a post-game play survey.

RESULTS

Of the 48 participants (11 male, 37 female; 44 of 48 were RNs), most (91%) agreed that the workflow reflected in the game was equivalent to the flow in a typical ED. Almost all (96%) found the cases in the game reflective of real ED patients, and most (92%) found the game a useful educational tool to prepare new nurses to transition into the ED environment.

CONCLUSION

The GridlockED game shows potential as a serious game to support nursing education, particularly for new ED nurse orientation and transition to ED practice. [J Contin Educ Nurs. 2024;55(5):231-238.].

From registered nurse to nursing student - Exploring registered nurses' transition to nursing student during a post-registration children's nurse programme: A qualitative descriptive research study

BACKGROUND

Registration as a children's nurse in Ireland occurs via two routes, an undergraduate degree in children's and general nursing and a twelve-month post-registration children's nurse programme. Candidates undertaking the latter are experienced nurses on the register for either general, intellectual disability or mental health nursing yet they are required to become a nursing student for the duration of the programme. Although anecdotal evidence indicates that this presents unique challenges for these students the experiences of transitioning from registered nurse to nursing student has not been explored since inception of the programme in 2006.

OBJECTIVES

The study aimed to explore the experiences of the registered nurse that transitioned to nursing student during the Post-registration Children's Nurse Programme, to identify the previous experience of the registered nurse and to identify what challenged and supported successful transition.

DESIGN

A qualitative descriptive research design was used.

SETTING

The study was carried out in a large teaching children's hospital in Dublin, Ireland.

PARTICIPANTS

A purposeful sample of six registered nurses that completed the programme within the last 12 months was interviewed about their experiences of being a post-registration nursing student.

METHODS

Face-to-face, semi-structured, conversation-style interviews were conducted.

RESULTS

Four main themes were identified from the data: 'Feelings related to returning to student status', 'Supports throughout the transition', 'Differences between disciplines' and 'Knowing your place'. Registered General Nurses (RGN) had different learning needs in comparison to registered nurses in intellectual disability (RNID) and expressed difficulty adapting to the role of nursing student as they felt that their previous knowledge and experience was being overlooked. In contrast, RNIDs were more challenged on clinical placement by unfamiliarity with clinical equipment and terminology. Both RNIDs and RGNs found that the nursing staff on their placements were a source of support despite reporting that they rarely worked with their designated preceptor.

CONCLUSIONS

The challenges experienced by nursing students from different nursing disciplines sharing the same post-registration programme needs to be considered in the planning and implementation of all aspects of the programme. Healthcare staff should become more aware of the challenges experienced by the postgraduate nursing student when educating and supporting their learning within the preceptor-student relationship.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review

AIMS AND OBJECTIVES

The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work.

BACKGROUND

The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses' motivations, how they cope and sustain themselves for caring work.

DESIGN AND METHODS

The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008-2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed.

RESULTS

No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses' motivations to sustain their work, (2) emergency nurses' coping strategies and (3) sustaining care as emergency nurses.

CONCLUSION

To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work.

RELEVANCE TO CLINICAL PRACTICE

To ensure the sustainability of emergency nurses' work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.

The Impact of Burnout on Emergency Nurses' Intent to Leave: A Cross-Sectional Survey

INTRODUCTION

Emergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave.

METHODS

A cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses' intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale.

RESULTS

The findings revealed that a formal orientation enhanced emergency nurses' sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment.

DISCUSSION

Emotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses' intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work-life balance and staff retention.

An Interprofessional Simulation-Based Orientation Program for Transitioning Novice Nurses to Critical Care Roles in the Emergency Department: Pilot Implementation and Evaluation

BACKGROUND

The emergency department (ED) relies on high-functioning teams to deliver consistent and safe patient care. Experts recommend that both emergency physicians and ED nurses participate in team training. However, there are currently no nationally accepted curricula for either profession to embed this training in their professional development, particularly for health workers who are novice or transitioning into critical care roles.

METHODS

An interprofessional educator team designed and embedded a series of simulation scenarios within a novel orientation program for novice nurses transitioning to critical care roles in the ED to teach clinical and teamwork skills for conjoint groups of resident physician and novice nurse learners. The team created four interprofessional simulations to represent the acuity and breadth of patient populations in the ED critical care bays.

INTERVENTION/REFINEMENT

To date, the team has conducted 24 two-week orientation sessions for 48 nurses and 51 resident physicians. Overall mean scores for the Debriefing Assessment for Simulation in Healthcare (DASH) instrument from nursing participants in the first 18 sessions were high. Qualitative evaluation data from both nurses and physicians demonstrated a positive impact of the simulations and provided insight into respective roles, identities, and priorities across professions. Participant feedback led to iterative steps in refinement of the simulations, including adjustments in debriefings and logistics of the orientation program.

IMPLICATIONS FOR PRACTICE

A team-based interprofessional simulation program was found to be feasible and acceptable for practicing novice physicians and nurses as part of a nursing critical care orientation program in the ED. Future work will assess the program's long-term impact on teamwork and safety in the actual clinical environment.

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.

A METODOLOGIA DA TEORIA FUNDAMENTADA NOS DADOS CLÁSSICA: CONSIDERAÇÕES SOBRE SUA APLICAÇÃO NA PESQUISA EM ENFERMAGEM

RESUMO Objetivo: discutir o papel dos orientadores e estudantes que usam a Teoria Fundamentada dos dados no contexto da pós-graduação em enfermagem, como mestrado, doutorado ou doutorado profissional. Método: utilizou-se análise reflexiva, organizada em três seções: 1) Visão geral da Teoria Fundamentada nos dados; 2) Papel dos orientadores; e 3) Papel dos estudantes. Resultados: a Teoria Fundamentada nos dados é uma das metodologias de pesquisa qualitativa mais utilizadas na enfermagem. No entanto, na prática, diferentes abordagens são empregadas, gerando confusão. A metodologia Teoria Fundamentada nos dados, desenvolvida por Glaser e Strauss, busca compreender o que está acontecendo em uma área substantiva, e seus procedimentos orientam os pesquisadores na descoberta da principal preocupação dos participantes com base em dados emergentes, não em dados pré-concebidos. Conclusão: a Teoria Fundamentada nos Dados incentiva a autonomia de pesquisadores, e os orientadores precisam adotar um estilo de supervisão que maximize o desenvolvimento da teoria, sabendo que a Teoria fundamentada dos Dados é melhor aprendida por meio de experiências. Os pesquisadores devem confiar que a metodologia permitirá que eles desenvolvam uma teoria significativa, contando a forma utilizada pelos participantes para resolverem suas principais preocupações.