The impact of job demands and job support in the Emergency Department in Malta

Abstract

BACKGROUND: The scope of this dissertation is to explore the impact of job demands and job support on meaningful work and work engagement in the Emergency Department (ED) in Malta. The ED poses demands from staff working in an unpredictable, high-demanding, high-stress environment. Job demands are exceptionally high on the physical, task and organisational levels, in addition to staff being exposed to trauma and human suffering daily. Nevertheless, the ED has been described as a unique working environment that is inspiring and challenging due to the exposure of staff to technical and non-technical skills and the teamwork and social connections at work. However, the current literature on how different dimensions at work interact to constitute meaningfulness, especially in highly demanding environments like the ED, is scant. What makes work meaningful and engaging in this high-demanding environment has yet to be fully understood.

METHODS: A qualitative grounded theory methodology with an interpretive-constructivist paradigm was used to explore how job demands and job support shape meaningful work and work engagement in the ED in Malta. Thirty-five semi-structured interviews were carried out with ED doctors and nurses of varying grades and years of experience, whereby flexibility was adopted to adjust the sampling through constant comparison and theoretical sampling. This enabled the simultaneous data collection and analysis to develop concepts about the data and consequently collect further data until theoretical saturation was attained. This circling, iterative process during data collection and analysis helped to construct the meaningful work engagement theoretical model.

ANALYSIS: The Gioia method, a three-stage approach to conducting qualitative, interpretive research to guide the analysis and presentation of research, was used to analyse the data in this study. Throughout the analysis of data, the use of memo-writing, comparing and coding the data helped to move from descriptions to the conceptualisation of the data. In the first-order analysis, participants’ terms were used, whereas, in the second-order analysis, similarities and differences among the numbers of categories were sought in addition to emerging themes that were suggestive of concepts to explain the topic under study. These second-order themes were distilled into second-order aggregate dimensions and set into a data structure that captured participants’ experience and the causal relationships between the concepts and the resulting theoretical model.

FINDINGS: The sense of identity, pride and purpose, learning technical and non-technical skills, teaching others as well as the significance of ED doctors and nurses’ role on patients during their most critical moments contribute towards meaningful and engaging work. This also increases ED doctors and nurses’ mental resilience. The supportive structure is attributed to the sense of belonging and support from colleagues, contributing to meaningful and engaging work and mental resilience. However, the change in teamwork culture and staff conflicts and attitudes contribute to the meaningless and disengaging days and decreased mental resilience. The job demands in the ED are identified as system bureaucracies, work pressure expectations, work overload, unnecessary tasks as well as the physical, psychological, and emotional demands of ED work. These demands lead to a lack of time with patients, lack of job control, feeling like numbers, lack of appreciation and recognition for the ED specialty and feeling a failure towards patients. Ultimately, this leads to job strain, compassion fatigue, moral distress, and decreased patient quality care and contributes mainly to the inability to detach after work and decreased mental resilience. The consequences include exhaustion, burnout, and turnover, also contributing to meaningless and disengaging days.

CONCLUSION: Ultimately, meaningful and engaging work can only ensue in combination with the appropriate support network from all individuals, the team itself, and from leaders to encourage a positive teamwork culture. Moreover, mental resilience is highlighted as an essential personal resource. However, it may only be built over time and exposure, together with the appropriate support from all stakeholders, to encourage staff well-being and performance.

Date of Award	4 Dec 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	Zeynep Yalabik (Supervisor)