부산대학교 도서관

This study explores the experiences of emergency nurses working in a new Major Trauma Centre in the UK National Health Service, and how reconfiguration of trauma services has affected perceptions and working practices. Methods: Drawing on the principles of focused ethnography, fieldwork was conducted over 5 months in the Emergency Department (ED) of a newly designated Major Trauma Centre in London. It comprised approximately 53 hours of participant observation, and conversations and semi-structured interviews with 31 nurses. Qualitative thematic analysis was conducted of fieldnotes and interview data. Results: The findings reveal a complex picture of the experiences of emergency nurses within the Major Trauma Centre, with interrelated themes emerging. The first gives an account of how major trauma work has led to a perceived increase in the status and profile of the ED. The second theme explores the draw of trauma and how it is viewed as an exciting component of the nurses‘ work. The third looks at the idea of the „decent‟ trauma patient, examining the hierarchy of interest within trauma work, and the final theme explores ED nurses‘ accounts of their task-orientated roles in looking after trauma patients. Conclusion: The study shows how the value placed on the high profile ‗specialist‘ major trauma work pervades the culture of the department and how the protocol-driven nature of this work fits the immediate patient needs but minimises the ability of nurses to negotiate their professional boundaries in a way they are able to in other areas of their practice. Thus major trauma work is an outwardly exciting but ultimately unsatisfying aspect of the ED nurses‘ work. More importantly, the collectively accepted notion of the major trauma patient as the one with technically demanding complex injuries that can only be catered for by a ―Centre of Excellence‖, risks undermining the value placed on the care of other patients in the ED.