International Emergency Nursing (2008) 16, 140–142

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Research Review

Lyneham, J., Parkinson, C., Denholm, C.,2008. Intuition in emergency nursing: a phenom-enological study. International Journal of Nurs-ing Practice 14, 101–108.

While intuition is a complex, rather intangibleconcept, many experienced nurses identify anduse a ‘sense of knowing’ in their practice. Intui-tion is often proposed as one of the definingcharacteristics of expertise. Certainly, severalwriters in the literature have highlighted the roleof intuition in expert nursing practice, followingon from Benner’s (1984) seminal work. Thereare some differences in the way intuition is de-fined in the literature, but there is also a fair de-gree of agreement in that most definitionsinclude these five features: rapid perception, lackof awareness of the processes engaged, presenceof emotions, holistic understanding of the situa-tion, and overall good quality of the proposedsolutions. However, verification of the actualuse of intuition in emergency nursing practicehas, to date, been empirically unproven. Thishermeneutic, phenomenological study sought toaddress this deficit by exploring the experiencesand stories of 14 experienced Tasmanian emer-gency nurses. Six themes emerged from the data:Knowledge, experience, connection, feeling, syn-cretism (outside the rational self/inexplicable)and trust.

Comment: This is a well-structured, clear andrelevant paper which should interest most emer-gency nurses, dealing as it does with a challengingand fascinating issue. Any new research study onexpert intuition in nursing, which provides mecha-nisms for explaining how intuitive, perceptual deci-sion-making is linked to more analytical problemsolving, is to be very much welcomed.

Walker, W., 2008. Accident and emergencystaff opinion on the effects of family presenceduring adult resuscitation: a critical literature

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review. Journal of Advanced Nursing, 61(4),348–362.

Witnessed resuscitation is commonly acceptedin paediatric practice and is becoming morecommon in adult emergency departments. Thispractice has inspired much discussion and argu-ment over the past two decades, giving rise toa considerable body of the literature and the rec-ognition of the need for the development ofguidelines for clinical practice. This article is areport on a literature review which sought toidentify the positive and negative effects offamily attendance during adult resuscitation, asperceived by ED healthcare staff based in primary(out-of-hospital) and secondary (in-hospital) envi-ronments of care.

Methods: A comprehensive search was carriedout for the years 1987–2007, using multiple databases. Eighteen studies were eventually includedin the critical review, mainly comprising retrospec-tive survey research. The majority of the studieswere descriptive in design. A standardisedapproach to the appraisal process was achievedthrough the utilisation of guidelines for critiquingself-reports. The limitations of these designsinclude small convenience samples, low responserates, use of retrospective surveys and the associ-ated potential selection bias, and lack of consis-tency in survey instruments. These factors makecomparison of findings between studies somewhatdifficult. The findings revealed that emergencydepartment healthcare staff believe that thereare both positive and negative consequences as aresult of family presence during adult resuscitationand, interestingly, their views suggest that thereare more risks than benefits.

Comment: The findings of this review, andother published studies, indicate the need forthe development of written polices and guidelineson the practice in order to meet the needs of pa-tients, families and staff, by providing consistent,

Research Review 141

safe, and caring practices for all those involved inthe resuscitation process. Further research isessential if family presence during the resuscita-tion of adults is to be better characterised andunderstood. Experimental and qualitative methodsare especially needed to investigate the effect offamily presence during resuscitation on patients,families, and the multidisciplinary team. Overall,this is a worthwhile and interesting piece ofwriting.

O’Brien, A., Benger, J., 2007. Patient depen-dency in emergency care: do we have the nurseswe need? Journal of Clinical Nursing 16, 2081–2087.

The number and grade of nursing staff are oftendetermined by historical or random evaluations.However, staffing calculations based solely on thenumber of patients fail to take account of depen-dency and, therefore, the actual nursing workload.The aim of this study was to establish current pat-terns in the dependency of patients attending theadult ED of the Bristol Royal Infirmary (BRI) – an in-ner city teaching hospital – using the previouslyvalidated Jones Dependency Tool (JDT). The pur-pose was to inform decisions regarding nursingnumbers and grade mix better and to act as abenchmark for future developments and changesin emergency care.

Methods: The JDT was used prospectively to col-lect data on all patients attending an adult ED overa 2-week period. The primary outcome measurewas patient dependency, assessed on arrival anddeparture and at 4 and 8 h if the patient was stillin the ED. Data were collected on 48% of all patientattendances – a representative sample; 10% ofthese patients were in the high- or total-depen-dency groups on arrival. Data were analysed usingdescriptive statistics and chi-squared testing.

Results: The proportion of high and total-depen-dency patients did not vary by day of the week, butwas significantly increased overnight. Patientstended to become less dependent during their EDstay and analysis of those individuals in whomdependency increased was carried out. The find-ings were that by adding dependency data to abso-lute patient numbers, it was possible to tailor thenumber and grade of staff much more closely to pa-tients needs, which in turn would allow nursingstaff to take a more proactive role in defining careaccording to the patient’s condition. The findingsemphasise the weakness of basing staffing levelson patient numbers alone, rather than also includ-ing patient acuity levels.

Comment: In a busy ED, the clinical stability andthroughput of patients changes hourly, as does

nursing workload and the staff required to meetthese ever-changing demands. This study makesavailable strong clinical evidence that can contrib-ute to local nurse staffing benchmarking processes,with more credibility than simply using overall pa-tient numbers measurements. This is an interestingand relevant paper and has resonance for emer-gency nurses everywhere.

Luck, L., 2008. Staring, tone of voice, anxiety,mumbling, and pacing in the ED were cues forviolence toward nurses. Evidence-Based Nursing11, 29.

Violence in healthcare settings in general, anddirected at nurses in emergency departments inparticular, is a significant problem both nationallyand internationally. Although differences in defini-tions and methodologies make comparisons diffi-cult, several studies indicate that a sizeableproportion of emergency department nurses expe-rience some form of assault at some point in theirprofessional practice. There is also evidence thatincidents of violence are increasing.

Methods: An instrumental case study, using aconcurrent mixed-method approach, was used.The question asked was ‘which components of ob-servable behaviour in patients, their families, andfriends indicate a potential for violence towardnurses in the emergency department (ED)?’ Thestudy took place in a 33-bedded ED in a publichospital in Australia and the participants were20 ED nurses, 90% of whom were female. Violentbehaviour was defined as physical or non-physical(e.g., abusive or threatening language). Phase 1comprised thematic analysis of 50 h of unstruc-tured participant observation, an unstructuredinterview with three nurses, and researcherjournaling. In Phase 2, these findings provideditems for a structured observation tool to collectquantitative data and informed the content forthe qualitative interview guide. Qualitative datacollection comprised 290 h of participant observa-tion on 51 separate occasions over 5 months (16violent events were observed); 16 recorded,semi-structured, 45–60 min interviews withnurses; 13 recorded, informal, and unstructured30–40 min field interviews, some of which oc-curred after a violent event was witnessed; reviewof organisational documents; and research jour-naling. The main findings identified were that fiveinterconnected elements of observable behavioursindicated a potential for violence in patientsand accompanying persons. The five elements—were (i) staring and eye contact, (ii) tone andvolume of voice, (iii) anxiety, (iv) mumbling and(v) pacing.

142 F. Johnson

Comment: This is a single case study in an Austra-lian ED, so its applicability to other settings islimited. However, the authors offer a process(represented by the acronym STAMP) that is usefulnot only for assessing for violence but also forde-escalating violence in individual patients. Impor-tantly, the study showed how nurses were able torespond to patients displaying certain cues in waysthat averted violence. The study also highlights theimportance of the issue of violence in healthcare

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workplaces, with implications for managers andpolicy makers. The findings match with what isknown about the ED environment. These results high-light the importance of dealing with the contextualfeatures of emergency department settings thatcontribute to accelerating patient violence.

Felicity JohnsonDublin, Ireland

E-mail address: felicity.johnson@ucd.ie

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