Use of Multiple Pedagogies to Promote Confidence in Triage Decision Making: A Pilot Study

How simulation training for nursing students in emergency internships affects triage decision-making and anxiety: A quasi-experimental study

Purpose

This study aimed to determine the effects of simulation-based training on triage decision-making skills and anxiety in fourth-year nursing students.

Methods

This study employed an experimental pretest-posttest design and randomly assigned 90 nursing students from adult and pediatric emergency internships to control (n = 48) and intervention groups (n = 42). Although both groups underwent triage decision-making training, only the intervention group received simulation-based triage training.

Results

A significant difference in posttest triage decision-making knowledge and anxiety scores was observed between the control and intervention groups (p < 0.05). The posttest triage decision-making knowledge score of the intervention group was significantly higher than the pretest score, whereas the posttest anxiety score was significantly lower.

Conclusion

Theoretical triage decision-making training was effective, whereas simulation-based triage training improved the nursing students' knowledge and performance. Therefore, simulation-based training should be integrated into traditional learning methods to improve the triage decision-making skills of nursing students.

Training nurses to triage: a scoping review

Triage accuracy is important to ensure effective treatment and management of patients in the emergency department, however this requires nurses to receive high-quality triage training. This article reports the results of a scoping review that aimed to establish what research on triage training exists and what research is required to improve such training. Sixty-eight studies which used a range of training interventions and outcome measurements were reviewed. The authors conclude that the heterogeneity of these studies makes comparison challenging and that this, combined with low methodological quality, requires caution when applying the results in practice. The authors recommend establishing a gold standard for measuring triage training outcomes.

Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey

INTRODUCTION

The quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making.

METHOD

A total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form.

RESULT

Prior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability.

CONCLUSION

Emergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.

Evaluation of the factors affecting triage decision-making among emergency department nurses and emergency medical technicians in Iran: a study based on Benner's theory

Introduction

Emergency department (ED) nurses and emergency medical technicians (EMTs) find themselves performing triage under time pressure and with limited information. Identifying an effective triage decision-making process can play a significant role in promoting patient safety. Experts are able to make faster and more effective decisions in emergencies than novices.

Objective

The current study aimed to identify the level of triage decision-making (TDM) and its’ predictors in ED nurses and EMTs based on self-reported levels of nursing proficiency in Benner’s theory from novice to expert.

Materials and methods

Out of 821 ED nurses and EMTs who met the inclusion criteria, 320 ED nurses and 152 EMTs were included in this descriptive-analytical research. Data were collected by a demographic information form and triage decision-making inventory (TDMI) and analyzed by SPSSv.22 software using descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression.

Results

The total score of TDMI in the ED nurses and EMTs was higher in the expert nurses than in the proficient, competent, advanced beginner and novices. Multiple linear regression analysis showed that self-reported levels of nursing proficiency, age, work experience, marital status and triage training course were predictors of TDM in ED nurses (P < .05), and self-reported levels of nursing proficiency, service location, work experience, and triage training course were predictors of TDM in EMTs (P < .05).

Conclusion

Understanding the predictors influencing TDM health professionals may facilitate the understanding of their training needs. The training needs of a novice and inexperienced person may be different from those of an expert person, it is recommended that the training methods be based on the experiences and professional levels of nurses so that the training provided is effective and quality. Moreover, to increase the TDM power and reduce TDM errors due to lack of experience, a system is suggested to be established to allow novice nurses in the first year to work with experienced nurses. Also it is suggested that the determining educational and training focus with regards to triage before entering the bedside be done based on predictors.

Factors affecting nursing students' intention to use a 3D game to learn field triage skills: a structural equation modelling analysis

BACKGROUND

As mass casualty incidents are low-probability events, students often do not have the chance to practise field triage skills during their clinical placement. This study used a 3D game to engage participants in experiential learning in a realistic virtual environment. The purpose of the study was to explore factors affecting nursing students' intention to use a 3D game to learn field triage skills.

METHODS

This was a cross-sectional survey study. The technology acceptance model augmented by computer self-efficacy was used as a research model and a questionnaire was used to evaluate students' intention to use the 3D game to learn field triage. Data was collected from nursing students of a degree-awarding higher education institution in Hong Kong.

RESULTS

A total of 177 valid questionnaires were returned, and structural equation modeling was used to test the research model and hypotheses. Consistent with the technology acceptance model, perceived usefulness (0.21, p < 0.05) and perceived ease of use (0.91, p < 0.001) had a positive effect on the behavioral intention to use the 3D game. Computer self-efficacy positively influenced both perceived usefulness (0.66, p < 0.001) and perceived ease of use (0.73, p < 0.001). The research model explained 42 percent of the variance in the behavioral intention to use the 3D game.

CONCLUSION

Students believed that using the 3D game would enhance their field triage skills and found the game easy to use. Using 3D games to facilitate learning is a worthwhile educational approach for preparing healthcare professionals to handle low-probability clinical tasks, such as field triage in mass casualty incidents. Insights provided by findings of this study included the best way to design and promote interactive education programmes in a virtual environment.

Lessons Learned in a Large-Scale Mass Casualty Simulation

BACKGROUND

Traditional Nursing Programs are required to provide student instruction regarding disaster care. The Brigham Young University College of Nursing, in conjunction with campus emergency medical services (EMS), holds two large-scale mass casualty simulations each year. Nursing students work alongside EMS to provide initial care to the victims.

METHOD

After the mass casualty simulation, nursing students completed an anonymous survey evaluating their preparation and experience during the simulation. Students were also prompted to reflect on future implications of the exercise and give suggestions for simulation improvement.

RESULTS

Nursing students felt the triage and communication skills they learned during this simulation will help them as future registered nurses. Interdisciplinary communication between nursing and EMS students presented a barrier to effective disaster response.

CONCLUSION

Data gathered from this postsimulation survey will be used to improve future nursing student preparation and simulation participation. [J Nurs Educ. 2022;61(1):50-52.].

A Clinical Nurse Specialist-Driven Project to Improve Emergency Department Triage Accuracy

PURPOSE/AIMS

The purpose of this quality improvement project was to examine the use of video-simulated scenarios and mobile technology to improve accuracy of emergency department (ED) nurses' triage using the Emergency Severity Index (ESI).

DESIGN

A quality improvement project with a pre/post educational intervention design consisting of a convenience sample (n = 33) of ED registered nurses (RNs) at a large tertiary hospital in the Midwest was used.

METHODS

A retrospective chart review (n = 495) was completed to obtain ESI accuracy for each triage RN. For 12 consecutive weeks, the ED RNs received different video simulations via mobile technology to determine the ESI level. After receiving their scores, the project team provided the RNs the correct ESI score with rationale via mobile technology. Post intervention, a retrospective chart review was conducted to evaluate RNs' ESI accuracy.

RESULTS

Results of this ED triage educational intervention to improve the accuracy of ED nurses' ESI scores were not significant; however, this novel approach may be considered in addition to other teaching strategies to improve outcomes.

CONCLUSIONS

Triage nurses' ESI scoring accuracy can be inconsistent. Therefore, to ensure patients are receiving prompt and appropriate care for their acuity level, it is important to continuously provide education on ESI scoring.

Innovative approaches to teaching vascular access to nursing students in the COVID-19 era

PURPOSE

For the student nurse, peripheral venous cannulation is one of the most stressful skills to be learned. Although some healthcare employers/establishments offer courses on vascular access and infusion nursing as part of their onboarding programs, ultimately educational institutions should share the responsibility to ensure that graduating nurses can provide safe infusion therapies.

METHODS

An innovative vascular access and infusion nursing (VAIN) curriculum was created and mapped onto the entry to practice undergraduate nursing program at McGill University in Montréal, Québec, Canada. This presented an opportunity to implement new teaching approaches.

RESULTS

Students experienced multiple new teaching approaches including multimedia and experiential learning and live simulation to ensure acquisition of knowledge and psychomotor skills. The teaching approaches had to be rapidly modified with the advent of the COVID-19 pandemic.

CONCLUSIONS

The VAIN curriculum emphasizes simulation and directed practice, seeking to increase competence, confidence, and knowledge. The pandemic underscored the need for flexibility and creativity in content delivery.

The impact of combining concept-based learning and concept-mapping pedagogies on nursing students' clinical reasoning abilities

BACKGROUND

Integrating contemporary teaching strategies into the nursing curriculum is an effective approach to enhance undergraduate clinical-judgment and reasoning abilities.

OBJECTIVE

This study aims to document the impact of blending the teaching strategies of concept-based learning and concept-mapping to enhance nursing students' clinical-reasoning abilities.

DESIGN

A quasi experimental design is used to guide data collection from second year students.

SETTING AND PARTICIPANTS

A consecutive sample of all students undertaking adult health nursing courses at a private university in Jordan and meeting the eligibility criteria resulted in (N = 40).

METHOD

Data was collected via a questionnaire and observation to reveal students' independence in both clinical-reasoning and clinical-judgment. General Clinical-Reasoning Behavior Scale, Independence in Clinical-Reasoning and Clinical-Judgment scales were completed by the students at the beginning and end of the courses.

RESULTS

Despite requesting extensive preparation time, concept-based learning and concept-mapping as student-centered approaches enabled the move away from a content laden approach towards constructing criteria against which various patients' encounters were reflected. This study documented enhancement in students' independence in clinical-reasoning and clinical-judgment as they learned to take command of the elements of their clinical-reasoning. Significant improvement in students' general clinical-reasoning behavior was also documented.

CONCLUSION

The data collection tools utilized in this study can be used as clinical teaching aides, hence maximizing the impact of blended teaching strategies by providing the faculty with specific feedback regarding students' clinical reasoning and judgment abilities. Institutionalizing these processes by initiating relevant policies and guidelines is essential to help students take command of their clinical-reasoning, maturity, and responsibility in a practice area that is constantly changing and evolving.

A review of triage accuracy and future direction

BACKGROUND

In the emergency department, it is important to identify and prioritize who requires an urgent intervention in a short time. Triage helps recognize the urgency among patients. An accurate triage decision helps patients receive the emergency service in the most appropriate time. Various triage systems have been developed and verified to assist healthcare providers to make accurate triage decisions. The triage accuracy can represent the quality of emergency service, but there is a lack of review studies addressing this topic.

METHODS

A literature search was conducted in four electronic databases where 'emergency nursing' and 'triage accuracy' were used as keywords. Studies published from 2008 January to 2018 August were included as potential subjects. Nine studies were included in this review after the inclusion and exclusion criteria were applied.

RESULTS

Written case scenarios and retrospective review were commonly used to examine the triage accuracy. The triage accuracy from studies was in moderate level. The single-center studies which held better results than those from multi-center studies revealed the need of triage training and consistent training between emergency departments.

CONCLUSIONS

Regular refresher triage training, collaboration between emergency departments and continuous monitoring were necessary to strengthen the use of triage systems and improve nurse's triage performance.

Nurses' accuracy and self-perceived ability using the Emergency Severity Index triage tool: a cross-sectional study in four Swiss hospitals

Background

The Emergency Severity Index (ESI) is an English language emergency department patient triage tool. After translation, it has been adapted for use to triage patients in growing numbers of emergency departments in non-English-speaking countries. Few reports of the proficiency of triage nurses to score an ESI exist. We sought to determine accuracy, inter-rater reliability, and subjective confidence of triage nurses at four hospitals to determine an ESI from standardized ESI scenarios.

Methods

Triage nurses assigned an ESI score to each of 30 standard ESI (ESI Implementation Handbook Version 4) translated teaching case scenarios. Accuracy and Inter-rater reliability (Krippendorff’s alpha) of the ESI scoring was measured. Nurses’ subjective confidence applying the ESI algorithm was obtained by a Likert scale.

Results

Sixty-nine nurses from four EDs participated in the study. They scored 59.6 % of the case scenarios correctly. Inter-rater reliability was 0.78 (Krippendorff’s alpha). Most (54/69, 78 %) felt confident in their ability to apply the ESI.

Conclusions

Low accuracy of ESI score assignment was observed when nurses scored an ESI for 30 standard written case scenarios, translated into nurses’ native language, despite a good inter-rater reliability and high nurse confidence in their ability to apply the ESI. Although feasible, using standard written case scenarios to determine ESI triage scoring effectiveness may not be the optimum means to rate nurses’ triage skills.

Experiences of newly graduated nurses on strategies of gaining self-confidence during their initial work: a qualitative study

BACKGROUND

The presence of newly graduated nurses (NGNs) in clinical settings increases the rates of clinical errors and patient injury. In addition, the turnover rate for NGN staffs is significantly higher than the average turnover rate. Therefore, familiarizing NGNs with their workplace and increasing their professional self-confidence increase their empowerment and efficiency.

PURPOSE

This article elicits the strategies used by NGNs to gain self-confidence during their early career.

METHODS

This qualitative study was conducted using the purposive sampling method and was based on the data saturation principle. Data were collected using in-depth, semistructured interviews from 30 NGNs working at teaching hospitals in four northwest provinces of Iran during 2012 and 2013. Data were collected by means of in-depth semistructured interviews. Qualitative content analysis was used to analyze the data.

RESULTS

The interviews elicited eight coping strategies that participants used to form self-confidence during the first 6 months of their career. These strategies included familiarity, knowledge enhancement, clinical skills learning, self-exploration, validation, responsibility, mutual interaction, and personal creativity. In addition,participants used these strategies to reinforce their self-confidence during their first 2 years at work.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this research increase the understanding of NGNs, managers, and healthcare professionals regarding the strategies used by NGNs to gain self-confidence. This knowledge may be applied in programs designed to increase the empowerment and efficacy of nurses to improve the quality of patient care and reduce nurse turnover.