1
|
Hetherington D, Wilson NJ, Dixon K, Murphy G. Emergency department Nurses' narratives of burnout: Changing roles and boundaries. Int Emerg Nurs 2024; 74:101439. [PMID: 38581856 DOI: 10.1016/j.ienj.2024.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
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.
Collapse
Affiliation(s)
- Debbie Hetherington
- Master of Research (MRes), School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Kathleen Dixon
- School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Gillian Murphy
- School of Nursing and Midwifery, Western Sydney University, Australia.
| |
Collapse
|
2
|
Alhaidari F, Almuhaideb A, Alsunaidi S, Ibrahim N, Aslam N, Khan IU, Shaikh F, Alshahrani M, Alharthi H, Alsenbel Y, Alalharith D. E-Triage Systems for COVID-19 Outbreak: Review and Recommendations. SENSORS (BASEL, SWITZERLAND) 2021; 21:2845. [PMID: 33920744 PMCID: PMC8072881 DOI: 10.3390/s21082845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
With population growth and aging, the emergence of new diseases and immunodeficiency, the demand for emergency departments (EDs) increases, making overcrowding in these departments a global problem. Due to the disease severity and transmission rate of COVID-19, it is necessary to provide an accurate and automated triage system to classify and isolate the suspected cases. Different triage methods for COVID-19 patients have been proposed as disease symptoms vary by country. Still, several problems with triage systems remain unresolved, most notably overcrowding in EDs, lengthy waiting times and difficulty adjusting static triage systems when the nature and symptoms of a disease changes. In this paper, we conduct a comprehensive review of general ED triage systems as well as COVID-19 triage systems. We identified important parameters that we recommend considering when designing an e-Triage (electronic triage) system for EDs, namely waiting time, simplicity, reliability, validity, scalability, and adaptability. Moreover, the study proposes a scoring-based e-Triage system for COVID-19 along with several recommended solutions to enhance the overall outcome of e-Triage systems during the outbreak. The recommended solutions aim to reduce overcrowding and overheads in EDs by remotely assessing patients' conditions and identifying their severity levels.
Collapse
Affiliation(s)
- Fahd Alhaidari
- Department of Networks and Communications, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Abdullah Almuhaideb
- Department of Networks and Communications, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Shikah Alsunaidi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Nehad Ibrahim
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Nida Aslam
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Irfan Ullah Khan
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Fatema Shaikh
- Department of Computer Information Systems, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Mohammed Alshahrani
- Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Hajar Alharthi
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Yasmine Alsenbel
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| | - Dima Alalharith
- Department of Computer Science, College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (S.A.); (N.I.); (N.A.); (I.U.K.); (H.A.); (Y.A.); (D.A.)
| |
Collapse
|
3
|
Man NWY, Forero R, Ngo H, Mountain D, FitzGerald G, Toloo GS, McCarthy S, Mohsin M, Fatovich DM, Bailey P, Bosley E, Carney R, Lai HMX, Hillman K. Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study. Emerg Med J 2020; 37:793-800. [PMID: 32669320 DOI: 10.1136/emermed-2019-208958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Delayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays. METHODS EMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series 'Before-and-After' trend analysis was used for assessing the Policy's impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes. RESULTS Before the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia's increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall. CONCLUSION The Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.
Collapse
Affiliation(s)
- Nicola Wing Young Man
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Roberto Forero
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia .,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Hanh Ngo
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia
| | - David Mountain
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Ghasem Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sally McCarthy
- Emergency Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, Liverpool Hospital, Liverpool, New South Wales, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Daniel M Fatovich
- Division of Emergency Medicine, Faculty of Health and Medical Services, University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Royal Perth Hospital, Centre for Clinical Research in Emergency Medicine, Perth, Western Australia, Australia
| | - Paul Bailey
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Rosemary Carney
- New South Wales Ambulance Service, Rozelle, New South Wales, Australia
| | - Harry Man Xiong Lai
- New South Wales Ambulance Service, Rozelle, New South Wales, Australia.,Discipline of Psychiatry, University Of Sydney, Sydney, New South Wales, Australia
| | - Ken Hillman
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| |
Collapse
|
4
|
Comparison of Reliability and Validity of the Chinese Four-Level and Three-District Triage Standard and the Australasian Triage Scale. Emerg Med Int 2019; 2019:8490152. [PMID: 31827931 PMCID: PMC6885288 DOI: 10.1155/2019/8490152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/22/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Abstract
Emergency triage is an important tool for prioritizing urgent or critical patients, and its effect needs to be investigated and evaluated. This observational study aimed to compare the reliability and validity of the Chinese four-level and three-district triage standard (CHT) and the Australasian Triage Scale (ATS) in an adult emergency department of a general hospital in China. From 2016-01 to 2017-01, twelve nurses independently performed on-site triage of 254 patients and 1552 patients to assess the scales' reliability and validity, respectively. The interrater reliability, as assessed by the weighted k scores, was 0.686 (95% CI 0.608–0.757) for the CHT and 0.731 (95% CI 0.663–0.790) for the ATS, and the k scores between the CHT and the ATS were 0.630 (95% CI 0.594–0.669). Temperature, respiration, pulse, blood oxygen saturation, waiting time, treatment time, emergency disposition, hospitalization rate, and mortality were significantly associated with the triage levels of the CHT and ATS (p < 0.001). The area under the receiver operating characteristic (AUROC) curve values of the CHT and ATS for predicting intensive care treatment were 0.845 (95% CI: 0.825–0.866) and 0.740 (95% CI: 0.715–0.765), respectively. The reliability and validity of the CHT and ATS were moderate, and both of them can be used to identify critical patients in emergency departments. It is necessary to further improve the triage system in terms of structure and content.
Collapse
|
5
|
Aboagye-Sarfo P, Mai Q. Seasonal analysis of emergency department presentations in Western Australia, 2009/10–2014/15. J Appl Stat 2018. [DOI: 10.1080/02664763.2018.1441384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Patrick Aboagye-Sarfo
- Clinical Support Directorate, Clinical Analytics and Modelling, Department of Health, Government of Western Australia, East Perth, Western Australia
- School of Science, Edith Cowan University, Joondalup, Western Australia
| | - Qun Mai
- Clinical Support Directorate, Clinical Analytics and Modelling, Department of Health, Government of Western Australia, East Perth, Western Australia
| |
Collapse
|