University of British Columbia. Nursing

How do new emergency nurses describe their experiences as they make the transition from being a new to becoming a more experienced emergency nurse? What are the needs of new emergency nurses as they make this transition? In this qualitative study, new emergency nurses were interviewed for the purpose of identifying what is was like to be a new nurse in the emergency department; what were their needs; what health care personnel, educators and administers could do to help them; and their intent to leave. Interpretive description was the research approach utilized in this study. Ethical approval was obtained from the University of British Columbia Behavioural Research Ethics Board and the Fraser Health Clinical Investigation Committee. Using theoretical sampling, eight new emergency nurses, from the lower mainland and Vancouver Island of British Columbia, participated in semistructured, audiotaped interviews. They had three years or less of emergency nursing practice and had completed the core courses of an emergency specialty program. The new emergency nurses felt overwhelmed and unprepared as they started their emergency practice. They encountered inconsistencies and deficiencies in their orientation programs. They encountered factors in the workplace environment that created challenges for them to practice safely and ethically. Workplace challenges included: the nursing shortage; the lack of resources; frustrations with management; the high patient acuity and volume; the challenges of attempting to meet organizational and technical changes; and the expectations of patients and patient's families. Hospital overcrowding created an environment where the nurses experienced occupational stress; mental and physical fatigue plus abuse from patients, patient families and emergency personnel. The participants did not utilized professional services to debrief stressful incidents. They described favourable relationships with emergency physicians and experienced horizontal violence from nursing colleagues. Six of the eight participants anticipated leaving the emergency department or changing their status in a year. They expressed feelings of being frustrated, stressed, overwhelmed and exhausted. The study's findings suggest implications for policy makers, nursing practice and nursing education. Further research is needed to explore the experiences of emergency nurses, the work place environment, the abuse they encounter and strategies to retain them.

This descriptive study investigated mothers' perceptions of and responses to neonatal crying behavior for the purpose of providing more relevant and effective nursing care to mothers with young infants. With the guidance of an interactive framework, quantitative and qualitative data were collected at three different time periods in the first postpartum month from 19 primiparous women who delivered healthy full term infants. Findings indicated that on the third postpartum day neonatal crying behavior was not an anticipated caregiving concern for any of the mothers. By the fourth postpartum week, however, 9 of the 19 mothers rated crying as a concern and had recorded significantly more crying behavior than the 10 mothers for whom crying was of little or no concern. Data revealed that the infants whose crying was of less concern were more content, consistently consolable, gave clearer cues regarding distress and comfort and had more easily definable and more compatible behavioral patterns than the infants whose crying was a concern. Mothers with little or no concern about their infant's crying differed from those with concerns in that they expected more crying behavior, perceived crying more positively, and were more prompt in their response to signs of distress. There were also statistically significant differences in that mothers with little or no concerns about crying were less concerned about spoiling their infant and experienced neonatal crying as a less negative influence on their feelings of maternal confidence. As a total group, the mothers' interpretations and responses to neonatal crying behavior were empiric and reflective of little academic or experiential preparation for understanding and managing neonatal crying. Mothers' expectations and health professionals' responses support a societal belief that mothering is intuitive, instinctive and to be learned "on the job." Findings indicate that the perinatal nurse needs to anticipate neonatal crying as a caregiving concern of mothers with young infants and must know and utilize current theory associated with infant crying and maternal-infant interaction. The nurse must participate in the generation and subsequent promotion of innovative nursing interventions to decrease mothers' concerns about and increase their management of neonatal crying behavior.