Conclusiones

management as an important aspect of their role differed from the palliative care nurses. As these emergency nurses explained, controlling clients to enable the smooth function of the emergency department, and to reduce the likelihood of harm to co-workers and others, was of prime importance. Therefore, emotional engagement was for instrumental purposes. In this instance, a senior nurse showed the importance of controlling the emotions of clients and the responsibility she took for this in this particular situation in which a client‟s son had been involved in a serious accident;

“…the guys in ED were saying just get rid of her, … and in the end I had hold of [name omitted] and I was giving her a big cuddle but

mainly…because I had the feeling that she was just going to run off. And in the end I got… her calm enough to be able to say to her… look, let me

sure that your son is ... alive. [I] went and said to the consultant…[name omitted] outside she‟s just really distressed, do you think she could just see her son? he said…you can bring her in… as long as you… just stand back, and I said oh we won‟t get in the way”. [EN1].

Abusive or violent clients were described as a common feature of the emergency department. As this nurse explained, she took responsibility for ensuring that a client left the department after he had assaulted his partner in front of their small child, and of protecting others in the vicinity. This was achieved by engaging emotionally with the client through the expression of an appropriate level of anger to reject the client‟s abusive behavior and was typical in the nurses‟ testimonies.

“I screamed, YOU, OUT, NOW, and he just … he just left. I mean, it was unfortunate that the kid was there but my concern was A, stop hitting her, B that you don‟t hit me or anyone else because I was … I was about four foot away and there were two guys right in front of him and I

thought, is he going to lunge forward and punch their heads together?…” [EN3].

The emergency nurses also engaged with clients who were distressed or in need of support but these descriptions were less prominent amongst the emergency nurses compared to the palliative care nurses;

“…it‟s when the relatives come in, oh my god, that‟s awful and you know I cry sometimes with them or hug them.”… “I like to touch them, stroke their forehead or hold their hand or whatever…I think it‟s fairly widely done.” [EN5].

The emergency nurses displayed evidence of a great deal of emotional

engagement as a normal aspect of their role. From their descriptions, the main purpose for their emotional engagement with clients was to quell disruptive and abusive

behaviour of clients in order to facilitate the efficient and safe running of the emergency department. There was also some evidence that the emergency nurses provided

emotional support to clients. There was a substantial point of difference between the manner in which emergency nurses and the patient registration clerks dealt with similar situations. The emergency nurses show that they engage actively with clients

emotionally when confronted with abuse and see this was perceived as being within their role parameters. Conversely, the clerks often withdrew from similar situations and took less responsibility for addressing the emotionality of clients in the workplace.

5.1.4 Renal nurses. There was a strong conviction among the renal nurse interviewees that the correct approach to dealing with clients was very important. The renal nurses acknowledged a responsibility for engaging with clients on an emotional level. In response to a question as to whether or not emotional management was an important aspect of the job, a nurse responded in the following way;

“Yes, it is a great part, yeah…Probably some days just to let them talk…Listening to them and again, we can't always solve all their problems and we won't but it‟s just to help direct them…” [RN2].

The following comment also showed how nurses on renal wards took

“Other times that you really need to control your emotions is when you‟ve had the death of a long-term patient and you actually need to go around and tell all the people that have been with that patient, like

sharing the same shifts so they‟ve known this patient a long time and you actually need to go around and inform each one of them that their friend or mate has died and often that‟s quite hard because they want to know all the details.” [RN3].

However, perhaps due to the close ties that develop in renal wards, the same nurse explained the difficulty some nurses had in dealing with such issues, creating problematic consequences when this level of emotional engagement was required;

“…they need to leave the work area. So they need to ... they actually go to the tearoom or somewhere else to compose themselves. They actually find it very difficult to tell the patient…” [RN3].

The lengthy and regular contact and relationship development lead to a great deal of familiarity between renal nurses and clients. This means that relationships between nurses and clients formed much more naturally than that described from any of the other groups and lent itself to a greater level of disclosure of personal information. This resulted in emotional engagement with clients that is manifest differently than for employees in the other three groups;

“…it‟s not like a ward where you have the limited time with them because I‟ve known these people for 10 years. I know all about their break ups, their relationships and their house moves and you know, stuff that you probably wouldn‟t even know from your family.” [RN5].

Also contributing to the more relaxed environment could be the chronic nature of renal illness in these wards. A senior nurse commented on how she felt the need to occasionally remind other nurses of the status of the patients;

“And you‟ve just got to remind people that they‟re chronically ill.” [RN2].

Renal nurses described a need for emotional engagement with clients. However, due to the long-term and intensive contact with clients, and the chronic nature of the illness, this engagement progressed differently than in the other groups. It could be said that the form of this engagement appeared more like a natural friendship than a

professional relationship in at least some cases.

5.1.5 Overview of emotional engagement. The level of emotional engagement