Disciplined silence: A focused ethnography of exemplary emergency nursing practice

Date of Completion

January 2009


Health Sciences, Nursing




Nurse presence exists within certain nurse-patient relationships and has been shown to have positive outcomes for patients and nurses. For emergency nurses, nurse presence often falls victim to the avalanche of overcrowded, understaffed, and task-laden times as emergency departments nationwide struggle to survive. With initiatives to promote patient flow and pressures to multitask, cultivating nurse-patient relationships is almost impossible. Despite hard times, there were emergency nurses who continuously embodied nurse presence despite arduous, chaotic, and demanding conditions. The purpose of this study was to discover and describe the knowledge, shared beliefs, values, practice patterns and sustainability of emergency nurses who presence. The three research questions were: what were the shared beliefs, values, practice patterns, and common knowledge of emergency nurses who consistently exemplify nurse presence; what facilitated, constrained, and sustained emergency nurses' engagement in nurse presence; and how did emergency patients engage with nurses who exemplified nurse presence. The theoretical foundation was interpretivism (symbolic interactionism), the epistemology was constructionism, and the methodology was focused ethnography. Specific research methods were participant observation, interviews, and focus groups. Findings revealed five themes: Unfolding the Gift, Building the Mosaic, Have or Have Not, The Audible Wheeze, and From Strangers to Intimates with a Simple "Good Morning." Strong characteristics for presencing nurses included steadfast-in-being, being committed, having courage, instilling hope, and being grateful. Nurses valued their interactions with patients and enjoyed caring for them, giving a sense of we're in this together. An important finding revealed the invisibility of nurse presence. The only trace found was etched in the memory of the patients and nurses.^ This study made four major contributions to professional nursing: (1) it confirmed the belief that nurse presence is part of a nurse's being, that the nurse's gift to a patient is the gift of him/herself; (2) results showed that even in a busy and chaotic area like the emergency department, with limited time to care for patients, nurse presence can flourish; (3) the findings unearthed deeper and richer characteristics of a presenting nurse; and (4) it provided witness to the elusive visibility of nurse presence. ^