Exploring stress management and coping in Emergency Department staff: A mixed-methods study

Abstract

Background: Emergency departments (EDs) are notoriously busy and challenging working environments. Internationally and locally, demands on healthcare services, including the number of presentations to EDs, have increased substantially. Recognising the challenges faced by healthcare workers and, in particular, clinicians working in EDs has prompted growth in interest around healthcare-related occupational stress. Despite the interest in occupational stress there is a paucity of clinician-informed interventions to improve perceptions of working environment and/or coping among clinicians. Aim: The aim of this programme of research was to elicit the core components of a work-based strategy to improve the perceptions of working environment and/or the coping of clinicians. Methods: Underpinned by the transactional stress and coping theoretical framework, a three-phase mixed methods study utilising a sequential explanatory design was conducted at a single health service with two EDs (Site A and Site B) in south-east Queensland. In Phase One, a cross-sectional retrospective descriptive study was conducted to describe the perceived stressors and coping strategies of nursing and medical staff at Sites A and B. In Phase Two, twelve qualitative semi-structured interviews were undertaken to explore clinician perceptions of their working environment, perceived stressors, coping strategies, and clinician-informed solutions to occupational stressors. Phase Three consisted of two components: (i) a scoping review of the literature and (ii) a modified-nominal group technique study. The aim of this phase was to elicit core components of a work-based strategy designed to improve the working environment and/or coping of ED clinicians. The findings of early phases in the programme of research were used to inform and scaffold subsequent phases, with Phase One also being situated within a larger international study. Results: Workload was consistently identified as a leading stressor across all three phases of this PhD. In Phases Two and Three, staff also described perceptions of demoralisation, feelings of not being valued, and lack of leadership within the workplace. Wellness, staffing, and teamwork were the foci of the nominal group discussions, with three core inter-related themes emerging from these discussions: (i) increased individual and team support, (ii) development of professional resilience, and (iii) maximising opportunities for social connection. Increased psychological safety and team connection and synergy were central to the face-to-face discussions, along with increased sense of value, shared visions, and deeper connectivity. Many of the stressors experienced and described by the clinicians stemmed from system and organisational level issues. Both adaptive and maladaptive coping strategies were described in response to exposure to occupational stress. Conclusion: The findings of this programme of research have highlighted that occupational stress continues to be an issue for clinicians working in EDs. Continued exposure to occupational stressors in the absence of strategies or solutions to reduce exposure to occupational stressor(s) and/or improve coping among clinicians is likely to lead to staffing concerns, increased attrition rates, and poor staff retention. The unique working environment of the ED calls for ED-specific, tailored and focussed interventions designed to meet the unique demands and needs of clinicians working in the ED. The results of this study identified three key areas that, if embedded into a work-based strategy, will help to develop a psychologically safe working environment and improve team synergy. These elements are: (i) increasing individual and team support, (ii) developing professional resilience, and (iii) maximising opportunities for social connection. These findings can be used to inform both the processes and actualities of intervention development within EDs, locally and internationally. However, further research is recommended to ensure the stressors, coping strategies, and solutions identified in this study mirror that of other working environments to avoid a 'one-size-fits-all' approach.