key: cord-0814586-s7p0dafo authors: Hou, Yongchao; Zhou, Qian; Li, Dongzhi; Guo, Yanhua; Fan, Jingjing; Wang, Juzi title: Preparedness of Our Emergency Department During Novel Coronavirus Pneumonia from the Nurses’ Perspectives: A Qualitative Research Study date: 2020-07-14 journal: J Emerg Nurs DOI: 10.1016/j.jen.2020.07.008 sha: b49ee57d5492f1cd9475a704381344d5d4f0e57b doc_id: 814586 cord_uid: s7p0dafo INTRODUCTION: This in-depth study explores the preparedness of our emergency department (ED) during the novel coronavirus pneumonia (NCP) outbreak from nurses’ perspectives, providing reference and a basis for our ED’s response to public health emergencies. METHODS: Using qualitative research methods, semi-structured interviews were conducted with 12 ED nurses who met the inclusion criteria, and Colaizzi analysis was used for data analysis, summary, and induction. RESULTS: Four themes that involved preparedness of the ED during the NCP outbreak were extracted: organizational preparedness, personal preparedness, patient and family preparedness, and deficiencies and challenges. DISCUSSION: The organizations, individuals, patients, and family members were actively prepared to respond to NCP in the ED. The ED nurses said that the trusted organization guaranteed personal preparedness, and the active cooperation from patients and families was a motivator for personal preparedness. In addition, our study showed that there were deficiencies in both multidisciplinary collaboration efforts and efforts to rapidly diagnose and treat patients with fever in critical condition. multidisciplinary collaboration efforts and efforts to rapidly diagnose and treat 23 patients with fever in critical condition. Concern (PHEIC) on 30 January 2020, 4 and on 11 March 2020, it was declared a 58 pandemic. 5 NCP is characterized as an acute respiratory infection with symptoms 59 of fever, dry cough, and fatigue, although some patients have atypical symptoms. 6,7 In 60 addition, minority of patients with NCP have nasal congestion, runny nose, sore throat, 61 myalgia, and diarrhea. 6, 7 In severe cases, patients can develop dyspnea and/or 62 hypoxemia after a week, which progress rapidly to acute respiratory distress 63 syndrome, septic shock, metabolic acidosis that is difficult to correct, coagulopathy, 64 multiple organ failure, and more. 7 It is worth noting that NCP is transmitted quickly 65 and widely and in hidden form. Currently, the accepted transmission routes of NCP 66 are droplet and contact transmission. 2,8,9 67 At present, therapies for the NCP are limited as the evidence to support a specific 68 drug treatment or vaccine against SARS-CoV-2 is lacking. 10, 11 According to statistics, 69 as of 17 May 2020, the NCP has been spreading worldwide, causing over 4.5 70 million cases and over three hundred thousand of death (an approximate fatality rate 71 of 6.79%) in all countries. 12 Furthermore, in China, more than 82 thousand 72 cases and more than four thousand deaths (an approximate fatality rate of 5.59%) 73 had been confirmed as of 17 May 2020. 12 In Shanxi, 134 confirmed cases and 0 74 deaths were reported, and 21 of the confirmed cases were in Taiyuan, a city in Shanxi 75 Province. 13 As a response to the NCP outbreak, the National Health Commission of 76 China immediately initiated a first-level public health emergency response. 77 Whilst the NCP spreads rapidly worldwide, ensuring the preparedness of public health The interviews were conducted in a comfortable and quiet conference room near the 136 hospital, where the outside door had a sign that read "Be quiet, meeting in process." Only the interviewer and interviewee were present. The first two interviews pre-tested the question for language clarity and cultural 156 acceptability; 21 no changes were made and the data gathered during the pre-interviews 157 were included in the analysis. Two audio-recorders were prepared and used during the 158 interviews. Each interview took about 40-60 minutes, and was conducted in Chinese. And no repeat interview was carried out. The feedback showed that all of the participants felt that their transcript accurately 176 represented what was said during the interview and was true to their experience. Quotes used below were translated by the researchers (DZ, YH, JJ). Colaizzi's seven-step data analysis method was performed in this study (Table 1) . 17,18 The process was carried out independently by two researchers (YC, ZQ) using Word 181 Processing System. Step Performed in our study 1. Acquiring a sense of each transcript a. Listened to each audiotape and read each transcript repeatedly to gain a sense of each participant's description of their experience. b. Personal thoughts, feelings and ideas that emerged during this stage were written in the reflective diary. c. Copies of the transcript with a comments sheet were returned to 12 participants for validation. 2. Extracting significant statements a. Read and re-read the transcripts to identify and analyze the participants' experiences that pertain to the phenomenon of preparedness. b. Significant phrases and statements were extracted and highlighted on each page of the transcripts in a word document. c. Personal thoughts and feelings that arose during this stage were incorporated into the reflective diary. d. Returned to the research team in the first debriefing session, and reached a consensus. 3.Formulating meanings from significant statements a. Studied each significant statement carefully and determined a sense of its meaning. b. Formulated meanings were developed, accounting for the reflective diary and interview field notes, and following each contextual significance statement. c. Returned to the research team in the second debriefing session, and reached a consensus. 4. Organising formulated meanings into clusters of themes a. Significant statements with similar terms and the formulated meanings were grouped together to form theme clusters. Related theme clusters were then aggregated together to establish themes. b. Returned to the research team in the third debriefing session, to examine the relationship between formulated meanings, theme clusters, and emergent themes, and reached a consensus. c. Finally, 411 formulated meanings were arranged into 13 theme clusters which were then focused into a cluster of 4 emergent themes for the description of ED preparedness. 5. Exhaustively describing the investigated phenomenon a. Achieved by re-examining and incorporating the emergent themes, theme clusters and formulated meanings into the description to create its overall structure, containing all of the elements of the experience. b. Exhaustive descriptions were returned to the research team in the fourth debriefing session, and reached a consensus. 6. Describing the fundamental structure of the phenomenon a. The fundamental structure of the phenomenon was revealed by re-examination, discussion and analysis by the research team. b. Depicted as the preparedness of our ED during NCP from the nurses' perspectives including a cluster of four themes. Organizational preparedness guaranteed the personal preparedness, and the preparedness of the patient and family represented the motivation for personal preparedness. 7. Returning to the participants for validating a. Exhaustive description and fundamental structure of the phenomenon in the paper were returned to the 12 participants for validation. b. All of the participants considered the findings to be an accurate depiction of their experiences of the phenomenon. To address credibility, the following were performed: (1) the data analysis method 187 well established was adopted in our study; (2) a detailed description of the research A cluster of four themes were extracted through the process of data analysis: 213 organizational preparedness, personal preparedness, patient and family preparedness, 214 and deficiencies and challenges. Eventually, 12 emergency nurses (3 men, 9 women) 215 with an average age of 30.42 ± 3.64 years were included. The demographic 216 characteristics in the study are shown in Table 2 Trust in the organization was the fifth subtheme in the study. This is a kind of The first subtheme is with concerned self-adjusting psychology, which is a 318 well-known necessity for nurses in responding to public health emergencies and 319 carrying out good work. Self-adjusting psychology means that nurses can actively 320 make psychological adjustments when they are faced with constantly updated 321 workflows and potential threats of NCP. Three participants described self-adjusting 322 psychology in the ED during the NCP outbreak. The second subtheme involved experiencing moral distress and making choices. Moral distress refers to a psychological disequilibrium and a state of negative feeling 339 that is experienced when a person makes a moral decision but does not follow through 340 by performing the moral behavior. 25 To rescue the patients in critical condition is In fact, there is a relationship between organizational, individual, and patient and The participants in the study also noted that there were some deficiencies in In the ED, during the NCP outbreak, the organization, individuals, patients, and 584 their families were actively prepared. 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