We performed the study in ED in Addenbrooke’s Hospital, Cambridge, England in February 2020. Grounded methodology has been used effectively in other studies in a healthcare setting. Grounded theory was considered suitable to use for this study for its methodology in exploring little-researched areas to act as a landscape for understanding individuals’ views and interactions Charmazian theory was used in particular for its subtlety of reflecting the story of participants, which was felt to be particularly relevant in this study involving analysis of the role of the NIC which is carried out in a high-pressure inter-personal environment . Grounded theory is a methodology that aims to discover theories from systematically gathered data, where ideas and concepts are said to emerge from the data through structured analysis. This was a qualitative explorative study using the grounded theory approach. These findings provide a better understanding of the role of the NIC and are useful for describing solutions for patient flow. Shared awareness between the NIC and other ED team members facilitate decision-making and smooth coordination. In particular, shared internal models amongst the NICs and also other team members provide a framework for analysing how team members function together in a healthcare setting.Įmergency department NICs have a number of problem-solving approaches that have been defined and shown to have a degree of overlap with the emergency physician in charge. Seven team situational awareness processes used by NICs for coordination with other team members were identified, leading to a discussion on team synchronisation and shared awareness mechanisms. The last three were exclusive to NICs, whereas the others were shared to some degree with the EPIC. These are placing, targeting, guiding, juggling, chasing, team-leading, escalating and de-escalating. Constant comparative analysis based on grounded theory methodology was used for this qualitative study.Įight different problem-solving approaches were identified. During the observations, field notes were taken for every action conducted by the NIC in ED the semi-structured interviews involved a combination of question prompts and a blank diagram of the ED that the NICs were asked to annotate. Observations and semi-structured interviews were performed with NICs in a single centre, where NICs were purposively sampled for a variety of experience levels. This work aims to describe the problem-solving approaches used by NICs and the coordination of their role with other team members. The nurse-in-charge (NIC) role has been implemented in many emergency departments (EDs) to assist with smooth operations and coordination across the ED, together with the emergency physician in charge (EPIC).
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