Table Of ContentThe Lived Experience of Percutaneous
Injuries Among US Registered Nurses: A
Phenomenological Study
Author: Karen Ann Daley
Persistent link: http://hdl.handle.net/2345/1830
This work is posted on
Boston College
William F. Connell School of Nursing
THE LIVED EXPERIENCE OF PERCUTANEOUS INJURIES AMONG
US REGISTERED NURSES: A PHENOMENOLOGICAL STUDY
A dissertation
by
KAREN A. DALEY
submitted in partial fulfillment of the requirements
for the degree of
Doctor of Philosophy
May, 2010
copyright by KAREN A. DALEY
2010
The Lived Experience of Percutaneous Injuries Among US Registered Nurses:
A Phenomenological Study
Karen A. Daley
Rosanna DeMarco, PhD, PHCNS-BC, ACRN, FAAN – Dissertation Chairperson
ABSTRACT
The purpose of this study was to understand the lived experience and meanings of percutaneous
injury (PI) and its aftermath among US registered nurses. An interpretive phenomenological
approach was utilized to carry out the study which included nine percutaneous injury
experiences. Van Manen’s existential framework was used as a reflective guide.
Findings from this study emerged as three essential themes which were common to all
participants: being shocked: the potential of a serious or life-threatening infection; needing to
know it’s going to be okay; and sensing vulnerability. The first theme, being shocked, was
identified as the primary mode of living with the sudden occurrence of PI. In the moment of
injury, participants’ language reflected shock and an immediate consciousness of the potential
threat of a serious or life-threatening infection. Nurses’ responses were visceral and emotional.
All acted on their need to reduce foreign blood contamination and the urgency they felt for
immediate care. Needing to know it’s going to be okay represented the initial meaning of living
in the aftermath of PI as nurses assessed their risk and sought post exposure intervention and
caring responses from others. Sensing vulnerability was identified as the secondary mode of
living in the aftermath of PI as participants reflected on the fragile nature of health into the
future, distinguished between supportive vs. non-supportive relationships in their overall PI
experience, and identified the need to be vigilant in the future with respect to their health, life
and PI prevention. Together, these three essential themes and their dimensions represent the
essence and meanings of percutaneous injury and its aftermath for at least one group of US
registered nurses.
Findings in this study support the conclusion that the lived experience of PIs and its aftermath
imposed a significant psychological burden on nurses. These findings offer a better
understanding of the essence and meanings of PIs and their aftermath and contribute knowledge
to inform nursing education, nursing practice, health policy and future research.
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Acknowledgements
This journey of personal and professional growth and scholarship culminating in my completion
of doctoral education has been an undoubtedly extraordinary one for me – one I could not have
completed without the guidance, support, encouragement and tolerance of many people in my
life.
First and foremost, I must thank the community of faculty at Boston College and, in particular
my advisor and dissertation chair, Dr. Rosanna DeMarco. Rosanna has been a steady, learned,
and supportive teacher, mentor and colleague throughout this process of education and growth.
Through his expert, wise and patient counsel and encouragement, Dr. Danny Willis has helped
me persevere as I learned and grew in this phenomenological method. Dr. Pamela Grace brought
a depth and thoughtful moral perspective to this work, and always challenged and stretched my
thinking.
I credit and thank two particular individuals for putting me on this path of doctoral education.
The first, a member of the Boston College nursing community, is former dean Dr. Barbara
Hazard. I think of how often Barbara would pull me aside in professional meetings to ask me
when I was planning to come to Boston College for my PhD. The other is Mary Manning, one
of my longtime professional mentors and closest friends. Mary always saw things and qualities
in me that I did not or was not able to see in myself. I wish every nurse could have such a
generous, caring and insightful mentor. Mary has been as caring, supportive and honest a friend
as anyone could want or need. I will always be grateful for the way she has enriched and made
such a profound difference in my life.
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I have also been fortunate in my years at Boston College to work as a research fellow with two
extremely gifted and generous teachers. Dr. Ellen Mahoney laid much of the groundwork for my
early years of scholarly learning and growth. In my time with Dr. Barbara Wolfe, the director of
the Connell School of Nursing’s Center for Nursing Research, she has become a valued
colleague, mentor, and friend. Other faculty who have enhanced my experience at BC and to
whom I owe a sincere thanks are Dr. Angela Amar and, once again, Dr Pamela Grace. Angela
and Pam are wonderful teachers who shared their love of teaching with me as I worked with
them as their teaching assistant. Their friendships became a valued part of my experience at BC.
There are many family and other friends who’ve supported me throughout this journey. My sister
Ruth, Bill and the boys were always willing to listen whether or not they understood what I was
talking about. Their interest, tolerance and support for my ongoing educational pursuit knew no
bounds. It always helped me to know that if I needed a respite or a change of pace – and I did at
times – that I was always welcome in Charleston. Fred, Lynn, Jay and Joanie have been tireless
supporters and cheerleaders for me throughout the time I’ve been engaged in this work and this
process of learning.
The same has been true of my friends. Mary has listened for countless hours to me talk about the
demands of course and dissertation work, and at the same time shared in the pride and
excitement I felt along the journey as my scholarly knowledge and critical thinking ability
expanded. Mike and Mary, Doris and John, and Ellen and Jim have fed me countless times on
my weekends at the Cape and provided welcome distractions when I needed time away from the
intensity of this work. I never once heard complaints from any of them about my schedule or my
lack of availability at times when school needed to be a priority for me. Instead, I always felt
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their pride and support. I cannot express the gratitude I feel for having such wonderful and
generous friends in my life.
I also need to express my gratitude to my classmates at BC. I was fortunate to have had two
different years of classmates as I engaged in my dual degree course work. I can’t imagine
having better or more supportive classmates – in my first year: Annie, Kate, Mary, Angeleen,
Margaret, Jenny, Wi, Kathy, and Sue. To Annie Lewis O’Connor – you have been a longtime
and faithful friend. I remember how excited I was when I first realized we would be starting BC
together. I have appreciated your support over the years and I so admire the nurse and person
you are and have become over the years through this educational growth process. I am proud to
have you as my friend. Margaret – thank-you for your willingness to take time to listen to me as
I reflected on my dissertation data and for reading through all the interviews and sharing your
own reflections with me. To my second year classmates: Nola, Ann, Clara, Ruthann, Deb,
Jackie, Kathy – your encouragement and support have meant so much. Ann Cousins – you,
more than anyone else have been there to share this dissertation journey with me and it made
such a difference. Thank-you.
To the nurse participants who so generously shared their experience and insights concerning very
personal percutaneous injury experiences through participation in this study – you have helped
me reach a deeper understanding of my own experience. Most importantly, your honesty and
willingness to relive your own experiences have made a contribution to the state of the science. I
will do my best to assure that your voices are heard and that others benefit from your willingness
to contribute knowledge to inform and improve post-injury care for nurses across the country.
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TABLE OF CONTENTS
Chapter
1 AIM OF THE STUDY 1
Phenomenon of Interest 4
Existing Knowledge Gap 9
Study Justification and Relevance to Nursing 10
Study Aim and Questions 13
Brief Overview of Design 14
Researcher Interest, Biases and Assumptions 15
Definition of Terms 18
2 REVIEW OF THE LITERATURE 21
Nursing’s Duty to Care for the Profession 21
Percutaneous Injuries 22
Injury Antecedents and Consequences 29
Summary 37
3 METHODOLOGY 38
Study Design 38
Recruitment and Sample 43
Study Setting 48
Study Instruments 49
Data Collection Procedures 50
Data Analysis 51
Study Rigor 56
v
Study Limitations 59
4 RESULTS 60
Sample and Injury Demographic Characteristics 60
Phenomenological Reflection 61
Essential Themes, Dimensions, and Thematic Statements 62
Figure 1: Themes and Dimensions 62
Theme 1: Being Shocked 63
Dimension A: Responding viscerally and emotionally 64
Dimension B: Acting on the body to reduce contamination 70
Dimension C: Feeling the urgency for immediate care 72
Theme 2: Needing to Know It’s Going to Be Okay 79
Dimension A: Assessing risk 79
Dimension B: Seeking post-exposure intervention and caring responses 86
Theme 3: Sensing Vulnerability 104
Dimension A: Facing the fragility of health 105
Dimension B: Distinguishing supportive vs. non-supportive relationships 115
Dimension C: Being vigilant as necessity 121
Summary 132
5 DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 135
Van Manen’s Existential Lifeworld 135
Discussion Related to the Essence and Meanings of PI and Its Aftermath 136
Being Shocked and Constituting Dimensions 137
Dimension A: Responding viscerally and emotionally 137
