Strategies and processes emergency department nurses consider important to safely manage during an influenza pandemic: A qualitative descriptive study

Abstract

The influenza virus is responsible for significant morbidity and mortality worldwide each year, with influenza pandemics occurring every 10 to 50 years and responsible for millions of deaths and substantial economic impact. Increasing globalisation through travel and trade means New Zealand is vulnerable to the risks of pandemic influenza, placing a strain on the healthcare system, putting lives at risk and posing a significant cost to the country. Emergency Departments are at the frontline of New Zealand’s healthcare system and are a crucial component in the response to an influenza pandemic, however little research has been done on the impact such an event would have on the nursing staff who work in this area and the care they provide to influenza patients.

This study aims to explore what New Zealand Emergency Department nurses perceive as the biggest challenges to nursing care and staff safety during an influenza pandemic, in order to provide information on how to ensure the engagement of these nurses at the frontline of the pandemic response. With a lack of evidence-based research available, a qualitative descriptive design was used to allow an exploration of the first-hand perspectives of Emergency Department nurses, gaining meaningful insights into a phenomena which has been little explored.

Sixteen nurses from two Emergency Departments participated in face-to-face interviews conducted using semi-structured questions. Raw data was transcribed, and an inductive approach was taken to data analysis, guided by the principles of both content and thematic analysis.

The findings demonstrate that Emergency Department nurses work in an environment that poses risk to patient and staff safety every day, and an understanding of these safety problems is provided in the theme ‘the everyday reality for Emergency Department nurses’. Working within this context shapes the fears that Emergency Department nurses hold about what could happen if an influenza pandemic were to affect New Zealand in the future, and are summarised within the theme ‘fears for a pandemic’. The final theme, ‘strategy and planning for pandemics’ provides insight into how Emergency Department nurses feel these issues could be managed within future pandemic planning at Emergency Department, District Health Board and government level.

This thesis identifies both existing and potential future safety concerns in relation to the management of influenza in New Zealand Emergency Departments, affecting the safety of patients and staff. It also provides specific multi-level and multi-agency recommendations for future pandemic plans that could help to mitigate the significant risks highlighted by those who work within the system every day.