Emergency Nurses' Perceptions of Nursing Care in an Emergency Department: A Phenomenographic Study

Missed nursing care in hospital wards is associated with patient safety risks and reduced quality of care. Emergency departments are high-risk settings; therefore, missed nursing care in these settings must be explored. Studies on missed nursing care in emergency departments show, for instance, that patient education, nutrition, and the maintenance of patient privacy are often missed. These findings are similar to those of previous studies conducted in hospital wards. However, crowding, boarding, and patients with acuity issues in emergency departments are examples of contextual differences with hospital wards. How emergency nurses perceive their nursing practices in relation to missed nursing care and their ability to maintain patient safety and quality of care is not well-known. This study aimed to explore emergency nurses' perceptions of nursing care in the emergency departments.

This study used a qualitative descriptive design and a purposive sampling strategy. Semi-structured interviews were conducted with 15 emergency nurses. A phenomenographic approach was used for the analyses.

The findings showed variations in the perceptions of emergency nurses regarding the quality of nursing care and missed nursing care. Subordinate to acute medical needs, fundamental care needs were addressed if there was sufficient time, which negatively affected older adult patients, particularly frail patients. Emergency nurses strived to maintain adequate patient flow throughout the emergency department and were attentive to all patients in their care; however, they were aware that missed nursing care was a recurring phenomenon.

Emergency nurses had various perceptions of nursing care. Demanding conditions, prioritization of medical needs, and maintenance of adequate patient flow challenged them in their efforts to meet patients' fundamental needs and fulfill their responsibilities.