INTRODUCTION
Emergency and Trauma nursing is a field in nursing that deals with traumatic events that need immediate attention of the health care professionals. Nurses are the first to be exposed to the trauma and have to act as quickly as possible to save the patient’s life. These traumatic events also pose a threat to the nurse’s mental, physical and emotional well-being. There are still gap in the existing knowledge of this research.
This literature review consists of the research problem, research aims and objectives, the body – which includes the 3 common themes from the literatures which is; expectations of trauma professional nurses, dealing with the patient’s recovery and the family and emotional challenge and coping strategies, conclusion
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and the reference list. RESEARCH PROBLEM Professional nurses need to have necessary skills and knowledge on how to manage the different traumatic events they are faced with in the emergency and trauma department (Freeman, 2014:9). There is still a gap in South Africa on researches done on lived experiences of professional nurses working in Emergency and Trauma units. Professional nurses are therefore repeatedly exposed to traumatic events for prolonged periods (Hinderer, 2014:191). According to the University of Johannesburg: Theory of Health Promotion in nursing (2010:4) “the person is seen holistically in interaction with the environment in an integrated manner” (UJ: TPHN, 2010:4). This means that the patient is nursed holistically by including their mental, physical and spiritual well-being. Trauma nurses put their patient’s well-being first, and often forget about their own health and self-care (Wentzel, 2014:95). RESEARCH AIMS The purpose of this study is to explore and gain an understanding of the lived experiences of emergency and trauma professional nurses working in public hospitals and to also make recommendations on how professional nurses can use different coping strategies in the workplace. RESEARCH OBJECTIVES The objectives of this research are to describe the nurses’ lived experiences of working in the trauma department and to make recommendations and review guidelines on how to assist nurses with coping with traumatic events. FINDINGS Reading different articles 3 common themes emerged which is; expectations of trauma professional nurses, dealing with the patient’s recovery and the family and emotional challenge and coping strategies. Expectations of trauma professional nurses This theme explores the expectations that professional nurses have before and after the have experience in the trauma unit.
According to Freeman (2014:8), professional nurses have different expectations between trauma nursing and the reality of the challenges they face in this speciality. Their expectation is working in a safe and therapeutic environment, while building trust with the patients and family to be respected and treated with dignity, instead they felt disrespected, not appreciated and they are being over-worked. In Gauteng a cross-sectional study was done in a sample of 323 Emergency workers, to study the occupational stress experienced by emergency workers (Naude, 2006:75), he stated that occupations stress leads to depersonalisation and emotional stress therefore decreasing the productivity of an individual in the …show more content…
workplace. According to Wentzel (2014:95) working in a trauma department can be very busy and dis-ordered, due to a continuous influx of patients, nursing patients in the department due to no empty bed in the wards, having to deal with the family and their concerns, and being short-staffed in the unit. Adeb-Saeedi (2002:23) supports this notion, claiming that workload in the emergency department leaves little time for the nurses to explain procedures to the patients and also provide updates to the family about the patient’s condition, which makes the nurse look incompetent. Heavy-work load, lack of resources in the department and staff-shortage also led to poor performance, exhaustion and accidents. Chase (2005:72) also supported the statements by stating that the heavy-work load and an increased influx of patients caused frustration to the nurses. Freeman (2014,9) stated that for nurses to continue to work in these situations in a productive way and experience a sense of satisfaction, they needed to face their fears and struggles and find an effective way in dealing with these situations. Dealing with the patients recovery and the family This theme explores the nurse’s role in the recovery of the patient and dealing with the complications. According to Alzghoul (2014:17), most nurses think trauma patients are difficult to nurse and manage. Working with trauma patients requires an experienced nurse with skills and knowledge in order to meet the demands of care needed by the patients. Bostrom (2012:24) supports this by stating that working in the trauma unit with no experience requires the help of other professional nurses which is time consuming. Nurses therefore believed that junior nurses are not ready to nurse trauma patients due to lack of formal education and a speciality (Alzghoul, 2014:17) According to Alzghoul (2012:16) the nurse’s challenges in dealing with a trauma patient was the unpredictability of the patient’s progress and the outcome, and the influence of having to update the family about the patient’s progress.
The condition of trauma patient changes suddenly depending on the severity of the injury or the illness, which becomes even more traumatic for the health-care staff and family in dealing with these changes. According to Freeman (2012:10), nurses help the family get through difficult times, by being open to promote trust, providing education and information to the family and also referring them to relevant people such as psychologists. When the family receives bad news they also give the family member time and space to ventilate their feelings, which most of the time they get positive feed-back from the family which boosts their
confidence. Freeman (2012:10) stated that seeing a patient recover is the nurses most rewarding and meaningful aspects of being a trauma nurse. The nurses feel like they had played a huge role in the patient’s life and also made a difference in the patient’s life. Emotional challenge and coping strategies Traumatic events occur on a daily basis in the emergency and trauma department (Chase, 2005:2). The nurses need to deal with these traumatic events since they need to recognise and prioritise the patient according to the emergency (Crabbe, 2004). In a qualitative research that was done by Chase (2005) with a sample of 18 professional nurses working at urban hospital in Southwest Georgia, the nurses discussed about the work-related stressors which led to frustration and lack of support. There is lack of support for the nurses to debrief after any traumatic event (Chase, 2005:75) and Naude and Rothmann (2003:97) supported this statement and added that there is also lack of support from the supervisors or managers. Crabbe (2004) disagreed with Chase (2005:75) and Naude and Rothmann (2003:97), by claiming that trauma professional nurses got support from their colleagues after any traumatic events occurring in the unit. Moghaddam (2014:3) stated that it’s not that nurses do not have any support systems, but it’s because they do not know how to deal with patient stress. Chase (2005:81) stated that there is a lack of formal coping strategies for the nurses, but there are informal strategies such as talking to a peer, colleague, or a family member. CONCLUSION The existing literature revealed that much was researched on burn-out, compassion fatigue, occupation stress, post-traumatic stress disorder and less on the lived experiences of professional nurses working in emergency and trauma unit. Majority of the researches on trauma and emergency were done in other continents, and less was done in South Africa which leaves a gap in the existing knowledge. In the review it was discovered that nurses did actually voice-out their experiences even though it was different topic, which were related to trauma and emergency nursing. More research needs to be done on trauma and emergency in nursing especially in South Africa, with the existing researches a lot of research proposals needs to be reviewed regarding the sample populations and the research approaches that were used to give more accurate results. REFERENCES Adeb-Saeedi, J. (2002). Australian Emergency Nursing Journal. Stress amongst Emergency Nurses, vol. 5, no. 2, Aug, pp. 19-24. Alzghoul, M. (2014). International Journal of Orthopaedic & Trauma Nursing. The experiences of nurses working with trauma patients in critical care and emergency settings: A qualitative study from Scottish nurses perspectives, vol.18, no. 1, Feb, pp. 13-22. Boström, M. et al. (2012). International Journal of Orthopaedic and Trauma Nursing. Nursing patients suffering from trauma: Critical care nurses narrate their experiences, vol. 16, no. 1, Feb, pp. 21–29 Chase, M. (2005). Emergency Department Nurses' Lived Experience with Compassion Fatigue. Accessed from http://diginole.lib.fsu.edu/etd [11 August 2015] Crabbe, J. (2004). Emergency medical journal. Are health professionals getting caught in the crossfire? The personal implications of caring for trauma victims, vol. 21, no. 5, Aug, pp. 568-572. Freeman, L. (2014). Being a trauma nurse. The experience of being a trauma nurse: A phenomenological study, vol. 30, no. 1, Feb, pp. 6-12. Hinderer, A. (2014). Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. Accessed from http://www.researchgate.net/publication/263934476_Burnout_compassion_fatigue_compassion_satisfaction_and_secondary_traumatic_stress_in_trauma_nurses [10 August 2015] Moghaddam, M.N. (2014). Nurses’ Requirements for Relief and Casualty Support in Disasters: A Qualitative Study, vol. 3, no. 1, April, pp. 1-8. Naude, J.L.P and Rothmann, S. (2006). South African Journal of Psychology. Work-related well-being of emergency workers in Gauteng, vol. 36, no. 1, pp. 63–81. Naude, J.L.P and Rothmann, S. (2003). SA Journal of Industrial Psychology Occupational Stress of Emergency workers in Gauteng, vol. 29, no. 4, pp. 92-100. University of Johannesburg. (2010). University of Johannesburg Department of Nursing Science Paradigm: Theory of Health Promotion in Nursing. Wentzel, D. and Brysiewicz, P. (2014). The Consequence of Caring Too Much: Compassion Fatigue and the Trauma Nurse, vol. 40, no. 1, Jan, pp. 95–97.
Every person’s needs must be recognized, respected, and filled if he or she must attain wholeness. The environment must attuned to that wholeness for healing to occur. Healing must be total or holistic if health must be restored or maintained. And a nurse-patient relationship is the very foundation of nursing (Conway et al 2011; Johnson, 2011). The Theory recognizes a person’s needs above all. It sets up the conducive environment to healing. It addresses and works on the restoration and maintenance of total health rather than only specific parts or aspect of the patient’s body or personality. And these are possible only through a positive healing relationship between the patient and the nurse (Conway et al, Johnson).
The focus of this model is for leadership to empower staff members with opportunities, information, support, and resources to facilitate engaged relationships that, in the long run, will facilitate staff in empowering patients by providing opportunities, support, information, and resources to reflect on their well-being. Opportunities being referred to in this model are training opportunities; training trauma-informed care. The model also requires that information be provided to increase understanding that behaviours such as self-harm in patients, can be as a result of a neurobiological response to trauma. In this way, the model follows patient centred care since it looks at the patients’ needs for effective treatment. Information about patient preferences is utilized to come up with a comprehensive list of physical, emotional, and cognitive responses to stress. The list focuses on triggers that can cause stress, calming activities and past experiences with restraint and seclusion. This follows quality improvement competency since patient data analysis enables the staff to come up with a better way to treat them. The model also emphasizes on teamwork by enhancing support. The theme of support refers to a collaboration between the staff and the leadership. Collaboration is achieved in schedule meeting and during shifts. There’s also the need for availability of patient’s
Nursing is a demanding career where we often work with patients who have experienced severe trauma and are in a state of crisis. We are taught to care for these individuals and we often forget to care for ourselves. Nurses are at risk for developing vicarious trauma or secondary trauma. Self-care is vital to personal health, to sustenance to continue to care for our patients, and professional development. Nurses are often reluctant to take the time required to care for themselves or they might have trouble finding appropriate self-care activities that are easily assimilated into their lives. Self-care benefits both nurses and patients, by practising self-care nurses can better embody their role as exemplars for health promotion (Fraser, Mills, & Wand, 2015). This paper defines secondary trauma stress and the importance of self-care. The purpose of the paper is to deepen the author’s understanding of effective self-care planning and identify strategies to promote wellbeing and self-care.
Painter, L. M., & Dudjak, L. A. (2010). Actions, Behaviors, and Characteristics of RNs Involved in Compensable Injury. Journal of Nursing Administration, 40(12), 534-539. http://dx.doi.org/10.1097/NNA.0b013e3181fc19eb
Still, the previous advantages discussed should influence the nurse to improve in identifying patient vulnerability. This is evident by this patient where I utilized my interpersonal skills to communicate to this patient so that he/she is aware that he/she is not alone in this journey. Nurses need to utilize models and theories to guide nursing practice. For instance, McCormack’s framework focuses on patient-centered care which influences nurses to understand the patient as a whole and their values (Abley, 2012, p. 42). Being able to identify values will give nurses and myself a better comprehension about the patients resulting in worthiness and belonging expressed. As a result, informing nurses about patient’s subjective vulnerability because a trust and understanding relationship is established. This is supported in a clinical experience where a patient “felt understood and opened up for further interactions based on trust” through an honest, supportive relationship with a nurse (Gjengedal, 2013, p. 134). Nurses should provide patient-focused provision of service, and assist this patient in overcoming his/her obstacle as a way of encouragement. Furthermore, Sellman (2005) explains how encouragement may compromise human flourish (p. 7), it is dependent on the situation and it cannot be assumed all encouragement will lead to harm. This informs nurses to be aware of the consequences that prevent the
A study conducted in Croatia focused on determining the symptoms of secondary trauma and if family can develop secondary trauma. This study analyzed fifty-six wives of war veterans that were diagnosed with posttraumatic stress disorder. The wives were chosen based on their husband being in the psychotherapy program at the Center for Psychotrauma in Rijeka. Those who agreed to participate in the study began with a short interview that supplied demographic and socioeconomic data. This is to determine if developing secondary trauma is impacted by one’s living status. Then, the women filled out a questionnaire that analyzes the symptoms of secondary trauma (Franciskovic 179). This study found that out of the fifty-six women only three of them did not have any symptoms of secondary trauma (Franciskovic 180). Overall, the study found that living with a traumatized person impacts family members (Franciskovic
Resilience currently a hot topic in many disciplines. Resilience is the ability to adapt or recover quickly during times of stress. Emergency room (ER) nurses deal with extremely busy, constantly changing and unpredictable work environments. Exposure to death, trauma, violence, and overcrowding contribute to the stressful environment. Resilience allows ER nurses to cope with a high stress work environment. ER nurses deal with intense situations that are physically and emotionally taxing. The occupational stress (OS) experienced by ER nurses often leads to burnout (BO) or posttraumatic stress disorder (PTSD). Resilience protects ER nurses from burnout and posttraumatic stress disorder. OS contributes to the high turnover rate for emergency
Including family members in the care of the patient helps them cope better with the patient’s illness and helps them plan ongoing care when the patient goes home. Gaining both the trust of the patient and family can help the health care team get any details that may have been missed on admission, such as medications the patient takes, or special diet, or spiritual needs. Also, the family may provide pertinent information that the patient may not have divulged to the nurse. Encouraging the patient and family to voice their concerns will help implement a safe plan of action.
According to the American College of Preventative Medicine (2011), non-adherence to medications is estimated to cause 125,000 deaths annually and overall, about 20% to 50% of patients are non-adherent to medical therapy. Through my personal experience working in the healthcare field, I have observed an increasing number of patients seemingly detached from the seriousness of their medical diagnoses, as the majority of my patients have taken very little personal responsibility in their own healing and overall health. While these patients have a variety of medical issues, they do share similar characteristics: disengagement from their medical diagnoses and taking the necessary steps towards healing, health and vitality. In my work or in my clinical experiences, I get frustrated when patients are
Nurses encounter various challenges in the workplace. One of the most alarming trends is that they often become the victims of physical violence. It should be kept in mind that healthcare settings account for about 60 percent of all violent assaults that occur in various American workplaces (Gates, Gillespie, & Succop, 2011, p. 59). Additionally, more than 50 percent of nurses report that they suffered from physical abuse, at least once (Gates et al., 2011, p. 60). In turn, this tendency makes nurses even more vulnerable to the effects of stress. Moreover, they are likely to feel dissatisfied with their jobs. This paper is aimed at reviewing the scholarly articles that can illustrate the origins of this problem and its impacts on the experiences
As defined as a discipline, profession, and area of practice, nursing is based upon the maintenance of a patient’s health and recovery, from mental or physical illness or injury. Nurses aid an individual or individuals sick or well. There are four major principal characteristics that further define nursing care: phenomena that concern nurses, theories for nursing intervention, nursing action taken, evaluation of the effects about phenomena. This research paper will help me to learn more about this perspective field of healthcare. Throughout this research paper, I will discuss their education, duties, work environments, job outlooks, and their pay.
Following a study published by the Bureau of Labor Statistics (2016), workers in health care and social assistance settings are five times more likely to be victims of nonfatal assaults or violent attacks compared to the average worker in other occupations. Examples of healthcare violence can include verbal or physical threats and physical attacks by patients (U.S. Bureau of Labor Statistics, 2016). A report done by the American Nurses Association (ANA) found that 43% of nurses and nursing students had been verbally or physically threatened by a patient or a patient’s family member, and 24% had been assaulted (Potera, 2016). These numbers are only taking into consideration for the nurses who do decide to report an assault. Violence is extremely under reported due to lack of a reporting policy, lack of faith in the reporting system, and fear of retaliation (Workplace Violence in Healthcare, 2016). Cultural factors are also a reason as to why underreporting occurs. “Caregivers feel a professional and ethical duty to do no harm to their patients, sometimes putting their own safety and health at risk to help a patient” (Workplace Violence in Healthcare, 2016). The nurse has a responsibility to the patient and will sometimes allow the patient’s bad
In health care, there are many different approaches throughout the field of nursing. When considering the field of family nursing, there are four different approaches to caring for patients. This paper will discuss the different approaches along with a scenario that covers that approach. The approaches that will be discussed include family as a context, family as a client, family as a system, and family as a component to society. Each of these scenarios are approach differently within the field of nursing.
Eisenstark, Lam, McDermott, Quanbeck, Scott and Sokolov (2007) reported that twenty five percent of mental health nurses working in public sector hospitals take the major risk in violent attacks from patients resulting a series injury: the prevalence rate being as high as three times that of any vocational group (Del Bel,2003).this number implies that nurses physical as well as emotional health is being compromised largely each day (Lanza, 1992). Another study done from five mental health inpatient units over a period of seven months, indicated that seventy-eight percent of violent incidences came from nurses (Jones, Owen, Tarantello, and Tennant,1998).Nurses are not the only ones being challenged by violence. A study done by Albert Banerjee et.al (2008) in long term care facilities, a shocking number of personal support workers have been a victim of workplace violence. Almost half (43%) of support workers reported they experience violence in everyday work activities. 16.8% of registered nurses and one quarter (24.6%) of licensed practical nurses, registered practical nurses, and registered nursing assistants experience violence on a daily basis. In 2000, social service workers incidence injuries also rose by 9.3 from work related assaults and injuries. As significant as this numbers could be, the numbers could go higher if those underreported cases are reflected that’s comes with the employees belief, “reporting won’t change
According to Tabor 2011, vicarious trauma is one of the leading contributor of burnout within forensic health care professionals. The term vicarious trauma was first utilized by McCann and Pearlman in 1990, when they used it to describe “the therapist’s reaction to a client’s traumatic events” (Tabor, 2011, p. 203). The study also suggests that nurse’s are at a risk of suffering from vicarious trauma due to the increased levels of mental exhaustion from prolonged exposure to high levels of traumatic stressor (2011). This is in turn may result in changes in the nurse’s beliefs, cognition, memory, sense of safety, trust and self-esteem (2011). The combination of the above mentioned effect and vicarious trauma may potentially result in the nurse developing post traumatic stress disorder (2011). The consequences for this would not only be detrimental to the health of the nurses but also for their family and