THE LIVED EXPERIENCES OF NURSES IN THE EMERGENCY DEPARTMENT: A STUDY IN SELECTED HOSPITALS IN THE VOLTA REGION OF GHANA

ABSTRACT
Emergency care is care that must be rendered without delay. Though today’s nurses in emergency departments (ED) are faced with many challenges, little time is spent in teaching or learning the content of emergency nursing care during the basic, master’s or doctoral level nursing education program. The purpose of this research was to explore the lived experiences of nurses working in EDs in selected hospitals in the Volta Region of Ghana. The study is a qualitative research in which a phenomenological design was used. Purposive sampling technique was applied in selecting the hospitals and participants for the study. Data were collected through a semi-structured interview of 15 professional nurses who worked in EDs of selected hospitals in the Volta Region. Demographic results revealed 73.3 percent of respondents were between 25 to 29 years. Only 6.7 percent of respondents used knowledge of critical care nursing to practice emergency care in ED. Six thematic categories emerged after content analysis: encountering challenges in ED; ED as a place of learning and increased confidence for nurses; feelings of stress and joy in ED; social and physical consequences of ED on the life of nurses working in ED; nurses taking up jobs in ED that are inconsistent with their job description; clients receiving low quality care in ED. Formal education of nurses in the advance role of emergency care nursing is necessary to improve the practice of emergency care.


CHAPTER ONE
INTRODUCTION
Background to the Study
Emergency care is defined as care that must be rendered without delay (Smelter, Bare, Hinkle & Cheever, 2008). Emergency departments (EDs) are important consideration in today’s health policy dialogue (Hines, Fraze & Stocks, 2011). The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach (Andersson., Sundström., Nilsson., & Jakobsson, 2014). The goal of an effective emergency medical system should be to provide universal emergency care; that is, emergency care should be available to all who need it (World Health Organisation [WHO], 2005). Nurses are frontline workers during situations of emergencies or crises, working in hospital settings (WHO, 2004). The care provided by nurse practitioners practicing in emergency care requires a body of knowledge relating to acute and chronic illness and injury (Emergency Nurses Association [ENA], 2008). Presently, competency in emergency nursing can be achieved through various pathways including a combination of successful completion of academic courses, and continuing education courses (Emergency Nurses Association [ENA], 2008). Due to rising patient population, emergency department nurses are facing the challenge of serving an ageing population that requires complex and lengthy evaluations (Hwang et al., 2013). Emergency department nurses are challenged to provide safe, quality care to older people; however, nurses’ perceptions of their role and experiences are seldom investigated (Gallagher, Fry, & Chenoweth, 2014). While some literature exists, none reported on the perspective of the nurses’ experiences in caring for psychiatric clients in ED (Plant, & White, 2013).

Growing admission volumes, hospital closures, financial pressures, and operational inefficiencies are the principal reasons for ED overcrowding which leads to stress among ED nurses (Institute of Medicine [IOM], (2006). The actual condition in an ED is that when the number of ED patients increases, or patients with severer conditions are admitted to an ED, individual demands for direct nursing care will increase; therefore, patients’ needs often cannot be met by the existing nursing staff (Chang, Harnod, & Shih, 2010). Nursing staff may be forced to reduce the nursing care available or contact time with the patient (Chang, Harnod, & Shih, 2010). When the supply of direct nursing care is less than the demand at the time, it may pose a threat to the health of clients (Chang, Harnod, & Shih, 2010). Other challenges faced by the emergency care nurse include inadequate basic preparation for emergency care, leadership challenges and challenges with continuous education in emergency care (Weiner, 2006). Though today’s nurses are faced with many challenges, little time is spent in teaching or learning the content of emergency nursing during the basic, master’s or doctoral level nursing education program (Weiner, 2006).

Caring for emergency patients in Africa is a challenge because nurses must often treat severely injured patients who have co-existing conditions, such as Human Immunodeficiency Virus (HIV), Acquired Immunodeficiciecy Syndrome (AIDS) or Tuberculosis (TB) (Brysiewicz, 2011). The presence of HIV, AIDS and TB complicates client care and has health implications for staff themselves (Brysiewicz, 2011). Healthcare professionals in Africa work in difficult circumstances with limited resources (Brysiewicz, 2011). The scope of practice for emergency nurses in Africa is limited and there is no clearly defined advanced nurse practitioner role and there are few institutions that offer emergency nurse training and, therefore, few emergency nurses are available to care in EDs (Brysiewicz, 2011). The formal provision of emergency health care is developing in many Sub-Saharan African countries, including Ghana (Bell et al., 2014). While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses (Bell et al., 2014).

In Ghana, as in other developing and middle-income countries, little consideration has traditionally been given to optimising the training of nursing staff for the care of acutely ill or injured patients (Osei-Ampofo et al., 2013). Existing emergency care systems in Ghana are rudimentary in comparison to those in developed countries (Osei-Ampofo et al., 2013). Nurses in Ghana are currently an underdeveloped resource for the provision of high quality emergency care (Rominski et al., 2011).

Problem Statement
Historically, emergency care had been under-represented in the advances of global health (Marsh, Rouhani, Pierre, & Farmer, 2015). Growing patient population, hospital closures, financial pressures, and operational inefficiencies are the principal reasons for ED overcrowding which usually lead to stress in ED nurses (Institute of Medicine [IOM], (2006).

The ED is a particularly vulnerable setting for workplace violence, and lack of standardized measurement and reporting mechanisms for violence in healthcare settings (Gacki-Smith et al., 2009). Violence against ED nurses is highly prevalent (Gacki-Smith et al., 2009). A study conducted in the United States of America to investigate emergency nurses' experiences and perceptions of violence from patients and visitors in emergency departments found that approximately 25 percent of respondents reported experiencing physical violence of at least 20 times in the past 3 years (Gacki-Smith et al., 2009). Similarly almost 20 percent reported experiencing verbal abuse more than 200 times during the same period (Gacki-Smith et al., 2009). Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management (Gacki-Smith et al., 2009). A similar study conducted in South Africa by Maureen and Hester (2013) concluded that the tolerance of non-physical violence and the absence of policies to deal with the violence, contributed to under-reporting

In an explorative study to explore the everyday work at an emergency department in Sweden, Andersson, Jakobsson, FurÃ¥ker, Nilsson, (2012) found that everyday work in ED was characterised by a rapid and short encounter with clients in which there was limited scope to provide individualised care, which led to a mechanical approach of care. Practitioners’ encounter with patients and relatives was rapid and of limited duration. Anderson et al. (2012) concluded that the care activities that practitioners mainly performed comprised standard medical management and were performed more mechanically than in a caring way.

Current emergency care in Ghana is sub-optimal with significant delays to definitive care with high morbidity and mortality (PEPFAR, 2011). Lack of timely access to health care in Ghana means that many medical needs present as emergencies (Osei-Ampofo et al., 2013). Patients with infectious and parasitic diseases, such as HIV/AIDS and malaria present late as emergencies, thereby adding to the strain on the already weak emergency system (Osei-Ampofo et al., 2013). In Ghana, as in other developing and middle-income countries, little consideration has traditionally been given to optimising the training of nursing staff for the care of acutely ill or injured patients (Osei-Ampofo et al., 2013). Existing emergency care systems in Ghana are rudimentary in comparison to those in developed countries (Osei-Ampofo et al., 2013). A qualitative and quantitative assessment of the Emergency Centre of the Police Hospital, a second-level hospital in Accra, Ghana revealed marked deficiencies in many essential items and services (Japiong et al.,2015). Nurses in Ghana are currently an underdeveloped resource for the provision of high quality emergency care (Rominski et al., 2011).

Available literature on experiences of nurses in ED was mostly conducted in other countries outside Ghana. Majority of research found in literature were also quantitative. There was no study available on the lived experiences of nurses in ED in Ghana. There was need therefore to explore the lived experiences of emergency care nurses in the Volta Region of Ghana that will form the basis for recommendations to improve the work of ED nurses and ultimately result in quality care to clients.

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Item Type: Ghanaian Project Material  |  Attribute: 113 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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