Singhal Shreya, Hosking Ian, Ward James, Boyle Adrian A
Emergency Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Engineering Design Centre, Cambridge University Department of Engineering, Cambridge, GBR.
Cureus. 2021 Sep 12;13(9):e17912. doi: 10.7759/cureus.17912. eCollection 2021 Sep.
Background 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). This work aims to describe the problem-solving approaches used by NICs and the coordination of their role with other team members. Methods Observations and semi-structured interviews were performed with NICs in a single centre, where NICs were purposively sampled for a variety of experience levels. 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. Constant comparative analysis based on grounded theory methodology was used for this qualitative study. Results Eight different problem-solving approaches were identified. These are placing, targeting, guiding, juggling, chasing, team-leading, escalating and de-escalating. The last three were exclusive to NICs, whereas the others were shared to some degree with the EPIC. 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. 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. Conclusions Emergency 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. Shared awareness between the NIC and other ED team members facilitate decision-making and smooth coordination. These findings provide a better understanding of the role of the NIC and are useful for describing solutions for patient flow.
许多急诊科已实施主管护士（NIC）这一角色，以协助急诊科实现平稳运作与协调，与负责的急诊医师（EPIC）共同开展工作。本研究旨在描述主管护士所采用的解决问题的方法，以及其角色与其他团队成员之间的协调情况。方法：在一个单一中心对主管护士进行观察和半结构化访谈，有目的地选取了不同经验水平的主管护士作为样本。在观察过程中，记录主管护士在急诊科采取的每一项行动；半结构化访谈结合了问题提示以及要求主管护士进行标注的急诊科空白示意图。本定性研究采用基于扎根理论方法的持续比较分析。结果：确定了八种不同的解决问题的方法。分别是安置、定位、引导、兼顾、追踪、团队领导、升级和降级。最后三种方法是主管护士所特有的，而其他方法在一定程度上与负责的急诊医师相同。确定了主管护士用于与其他团队成员协调的七种团队态势感知过程，引发了关于团队同步和共享意识机制的讨论。特别是，主管护士以及其他团队成员之间共享的内部模型为分析团队成员在医疗环境中如何协同工作提供了一个框架。结论：急诊科主管护士有多种已明确的解决问题的方法，且已表明与负责的急诊医师有一定程度的重叠。主管护士与急诊科其他团队成员之间的共享意识有助于决策制定和顺畅协调。这些研究结果有助于更好地理解主管护士的角色，对于描述患者流程的解决方案很有用。
