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Title: A grounded theory approach to emergency nurses' engagement in managing emerging infectious diseases : persevering through collapse vulnerability
Authors: Lam, Kam Ki
Degree: Ph.D.
Issue Date: 2018
Abstract: Background: Emerging infectious diseases (EIDs) have been a major challenge for global public health authorities, creating an impetus for enhanced management planning. In EID management, hospital accident and emergency departments constitute pivotal public health organizations that on top of providing emergency care, are particularly relevant for initial screening, rapid detection of disease, and prompt isolation of suspected yet undifferentiated patients. During an epidemic, this extended role for emergency services gives prominence to their expanded role as an important part of the public health response, due to emergency nurses' close and frequent contact with emergency healthcare service users. Accomplishing this extended role requires emergency nurses to demonstrate their competence in responding to EID situations, with skills and knowledge in the areas of infection control and disease management. While several studies have been conducted on nurses' experience in an epidemic response, previous studies have not explicated the role of emergency nurses in EID management. This study serves as an avenue to provide empirical evidence on emergency nurses' involvement in the management of EIDs. Aim: This study intends to develop a substantive theory to explicate the role of emergency nurses and the underlying processes involved in EID management in a clinical context. Design: This study adopted a Straussian grounded theory approach to explicate emergency nurses' involvement in EID management. This research approach offers an effective way to understand the process of how emergency nurses engage in an epidemic response. Registered nurses who worked on a fulltime basis in an accident and emergency department in Hong Kong were invited to participate. Part-time emergency nurses were excluded because their work during epidemics was not on a mandatory basis. A total of 26 emergency nurses from 12 accident and emergency departments were recruited through purposive sampling and theoretical sampling. Semi-structured, face-to-face, individual interviews were conducted. The transcribed interview data were analyzed through a series of coding procedures, which included open, axial, and selective coding. Various analytic strategies were adopted in the interpretation of data, such as the constant comparative method and memoing. A variety of techniques, such as member checks, audit trail, and frequent debriefing sessions, were adopted to establish the trustworthiness in the research process.
Findings: The grounded theory persevering through the vulnerability of collapse emerged from the data, which elucidates the process of emergency nurses' engagement in EID management, and interrelates the corresponding conditions, actions and interactions, and consequences within the phenomenon. The theory emphasizes the dynamic and interactive interplay between emergency nurses' practice and the context they are situated in during EID management. This theory is a composite of five major categories that provide details on the corresponding activities and interactions of emergency nurses: (1) encountering situations fraught with obstacles and challenges, (2) rehearsing for improvisation, (3) preserving professional duties and integrity, (4) withstanding the collapse of service provision, and (5) enhancing preparedness for imminent threats. Each of these categories represents a facet of the engagement process in the theory, identified as the facet of encounter, facet of navigation, facet of striving, facet of resolution, and facet of learning respectively. The major notions of the theory are discussed, indicating the importance of decision-making and clinical judgment for emergency nurses engaging in EID management. In addition, adaptive capacity is another imperative attribute that empowers nurses as they engage in EID response. Nurses should be capable of adapting and adjusting their attitudes, behaviors, and work practices to handle unpredictable and evolving EID situations. Conclusion: This theory advances the existing understanding of EID response from the perspective of emergency nurses. The findings have significant implications for possible strategies to renew and reinforce emergency nurses' competence and readiness to face future epidemic events. These implications not only indicate recommendations for nursing practice, education and policy, but also highlight that a collaborative effort should be made among emergency nurses, hospital administrators and policy-makers, to strengthen their capacity for EID preparedness and response.
Subjects: Hong Kong Polytechnic University -- Dissertations
Emergency nursing
Emerging infectious diseases -- Nursing
Pages: xvi, 303 pages
Appears in Collections:Thesis

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