Can Education and Staff-based Participatory Research Change Nursing Practice in an Era of ED Overcrowding? A Focus Group Study
published online 01 September 2008.
Introduction
In our facility an operational process intervention was implemented to decrease overcrowding. The intervention consisted of implementing criteria (developed from a series of 8 interactive workshops led by the investigators with all charge and staff nurses) describing when we should “close the waiting room.” The purpose of this study was to explore the charge nurses’ perceptions of the intervention and their experiences with implementation several months after the operational change began.
Methods
All charge nurses were invited to attend 1 of 2 focus groups that elicited participants’ knowledge of the closing criteria as well as their use and perceptions of the criteria. Participants were asked to identify how often they had been able to close the waiting room or keep it closed and to note whether they used the developed criteria. Barriers and facilitators to closing the waiting room were also discussed.
Results
Charge nurses had internalized the criteria and reported that most of the time the waiting room was often closed between the hours of 3 and 9 am. Evening charge nurses, in particular, reported feeling a positive impact from waiting room closure during these hours earlier in the day. Facilitators included charge nurses receiving positive feedback from patients and perceiving an improvement in patient safety as fewer patients were waiting. Specific barriers included negative staff attitudes and hospital overcrowding.
Discussion
Feedback from focus group analysis with charge nurses responsible for closing the ED waiting room suggests that the operational change has been positive because of the staff-based participatory research methodology used to create the intervention.
For correspondence, write: Paula Tanabe, PhD, MPH, RN, Northwestern University, Feinberg School of Medicine, Emergency Medicine & the Institute for Healthcare Research, 259 E. Erie, Suite 100, Dept. EM, Chicago, IL 60611
This study was supported by a grant from the Emergency Medicine Foundation and ENA Foundation Team Grant. Dr Tanabe was partially supported by a grant from the Illinois Department of Healthcare and Family Services to Northwestern Memorial Hospital under the Excellence in Academic Medicine Act. Dr Cameron was partially supported by a career development award from the Centers for Disease Control and Prevention.
ABSTRACT