Decision-making in an emergency department: A nursing accountability model

Abstract

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen.

Accountability issues in an English emergency department: A nursing perspective

“…This study is part of a research project involving observation, interviews and policy analysis, which were triangulated together to provide a model for nursing accountability [11]. Nonetheless, this study delves deeply into nurses' experiences only, providing key information that is lost during triangulation and analysing it differently to provide different results.…”

The Initial Assessment of Nurse Knowledge to Response Time in Traffic Accident Case

“…Pada penelitian ini dapat diketahui bahwa jenis kelamin responden paling banyak adalah laki-laki. Hasil ini sejalan dengan penelitianpenelitian sebelumnya yang menjelaskan bahwa Perawat IGD dengan jenis kelamin laki-laki sangat dibutuhkan dan sangat krusial fungsinya karena perawat laki-laki lebih cekatan dan sigap dalam tindakan, cepat dalam pengambilan keputusan, dan lebih tinggi dalam harapan karirnya sehingga kinerja laki-laki lebih baik di bandingkan dengan perempuan [11][12][13][14]. Selain karena hal tersebut, tindakantindakan keperawatan yang dilakukan oleh perawat di IGD juga membutuhkan banyak tenaga seperti resusitasi jantung paru (RJP), mobilitas penuh siaga, dimana tindakantindakan tersebut membutuhkan tenaga ekstra yang dimiliki oleh perawat laki-laki [15].…”

Possible advantages of the clinical policy ethics assessment tool: institutional support or unnecessary bureaucracy?

“…The lack of tools to support structured ethical assessment of clinical policies was apparent went we decided to analyse the protocols and policies to triangulate them with other sources of nursing accountability and we could not find a tool appropriate to inspect the ethical validity of those policies. 19 That was the main reason to create CliPEAT, but after serving its purpose as a tool to facilitate data analysis and triangulation we realised of its possible advantages covering the gap between limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals.…”