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Wilson S, Rixon A, Brown C. Non-clinical intuitions and adaptive heuristics in emergency care: A scoping review. Int Emerg Nurs 2023; 71:101371. [PMID: 37866122 DOI: 10.1016/j.ienj.2023.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Across a range of fields, including healthcare, heuristics are typically conceived as a source of bias and systematic error. However, research across the psychological and management sciences shows that intuition and heuristics are also vital sources of adaptive decision strategies, especially in complex, uncertain environments. The complexity of the emergency care environment marks this environment as one in which non-clinical intuitions and heuristics are likely to emerge and function as adaptive decision strategies. The aim of this study was to map and contextualize what is known about leadership and non-clinical intuitions and heuristics in emergency care. METHODS Based on a systematic search of the Pubmed, Scopus, Web of Science, MEDLINE and CINAHL electronic databases, we conducted a scoping review to map what is known about leadership and non-clinical intuitions and adaptive heuristics in emergency care. RESULTS Of the 1219 articles retrieved, 9 met the inclusion criteria. Our review revealed four key findings. First, intuitions are used to make judgments about patients, caring for patients, and coordinating with colleagues. Second, although non-clinical intuitions are documented, non-clinical heuristics are rarely studied. Third, the literature is focused on nurses and silent on the use of non-clinical intuition and heuristics among medical doctors. Finally, professional cultures influence clinicians' use of intuitive sense- and decision-making. CONCLUSION This review highlights the dearth of research into non-clinical intuitions and heuristics in emergency care. Understood in the context of insights from the psychological and management sciences about intuitions and 'smart' heuristics as adaptive decision strategies, our findings point to new frontiers of research into leadership in emergency care.
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Affiliation(s)
- Samuel Wilson
- Swinburne Business School, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Griffith Business School, Griffith University, Gold Coast, Queensland, Australia.
| | - Cornelia Brown
- Swinburne Business School, Swinburne University of Technology, Melbourne, Victoria, Australia
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Gorick H, McGee M, Wilson G, Williams E, Patel J, Zonato A, Ayodele W, Shams S, Di Battista L, Smith TO. Understanding triage assessment of acuity by emergency nurses at initial adult patient presentation: A qualitative systematic review. Int Emerg Nurs 2023; 71:101334. [PMID: 37716173 DOI: 10.1016/j.ienj.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how nurses make these decisions and why they deviate from triage algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness. AIMS This qualitative systematic review aimed to understand decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation. METHODOLOGY Medline, CINAHL and Academic Search Complete were systematically searched to 15th December 2022. Data were analysed using thematic synthesis. Established themes were reviewed with GRADE-CERQual to evaluate certainty of evidence. RESULTS 28 studies were included in the review. Data analysis uncovered three superordinate themes of holistic reasoning, situational awareness, and informed decision-making. The findings show nurses value holistic assessments over algorithms and rely on knowledge and experience. They also assess the wider situation in the emergency department. CONCLUSIONS This review presents new perspectives on nurses' decision-making processes about patient's acuity. Nurses holistically gather information about patients before translating that information into acuity scores. These actions are informed by their knowledge and experience; however, the wider situation also impacts their decisions. In turn, the nurses use interpretations of patients' acuity to control the wider situation.
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Affiliation(s)
- Hugh Gorick
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom.
| | - Marie McGee
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
| | - Gemma Wilson
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Emma Williams
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Jaimik Patel
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Anna Zonato
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Wilfred Ayodele
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Sabina Shams
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Luca Di Battista
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Toby O Smith
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom; University of Warwick, Coventry CV4 7AL, United Kingdom
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Soola AH, Mehri S, Azizpour I. 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. BMC Emerg Med 2022; 22:174. [PMID: 36303127 PMCID: PMC9613063 DOI: 10.1186/s12873-022-00729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Aghil Habibi Soola
- Department of nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saeid Mehri
- Department of Emergency nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Islam Azizpour
- Department of Emergency nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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Meysman J, Morreel S, Lefevere E, Verhoeven V, De Graeve D, Monsieurs KG, Philips H. Triaging and referring in adjacent general and emergency departments (the TRIAGE-trial): A process evaluation of medical staff experiences in a nurse-led triage system. Int Emerg Nurs 2022; 63:101191. [PMID: 35810679 DOI: 10.1016/j.ienj.2022.101191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS This process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). DESIGN & METHODS Semi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a Belgian general hospital and GPs (n = 5) affiliated with the adjacent GP cooperative (GPC). The process evaluation ran in parallel with the TRIAGE trial that started in March 2019 and ended 31st of December 2019. The first set of interviews was conducted in June 2019 and the second set in January 2020. Data were analysed based on grounded theory. RESULTS Through a deductive framework, facilitators and inhibitors could be identified on three levels: the organisational, group and individual level. Main inhibitors are the degree of risk aversion of individual nurses, possible language barriers during delivery of the triage advice and the non-adapted ED infrastructure. Training on both the use of the triage protocol and effective delivery of the triage advice, in combination with periodical feedback from the GPC were the most important facilitators. CONCLUSION Based on the process evaluation we can conclude that a consensus exists among stakeholders that the ED Nurses are considered ideally positioned to perform the triage of walk-in patients, although a certain degree of experience is necessary. Although the extended triage protocol and GPC referral increases the complexity and duration of triage and entails a higher workload for the triage nurses, ED nurses found it did lead to a lower (perceived) workload for the ED in general.
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Affiliation(s)
- Jasmine Meysman
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium.
| | - Stefan Morreel
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Eva Lefevere
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Veronique Verhoeven
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Diana De Graeve
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of emergency medicine, Antwerp University Hospital, University of Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Abstract
BACKGROUND Thirty-five years ago, Benner defined an expert nurse as one who applies deep knowledge and experience across different contexts and clinical situations. Since that time, there has been little exploration of expertise in cancer nursing. OBJECTIVES To explore and describe characteristics of expert cancer nurses and to consider whether Benner's typology of an expert nurse remains relevant in today's complex oncology settings. METHODS An exploratory, descriptive study using audio-recorded focus group methodology was undertaken. Audio-recordings were transcribed, and an inductive thematic analysis approach applied to the data. Nurses also documented key characteristics of expert practice on Post-it notes to illustrate dominant characteristics. RESULTS Twenty-four registered nurses from a comprehensive cancer center in Australia took part in 1 of 3 focus groups. Seven key themes were identified: knowledge, leadership, adaptability, communication, motivation, patient-centered care, organization, and culture. Key word cloud characteristics included knowledge, compassion, motivation, experience, and communication. CONCLUSIONS Many of the expert characteristics identified in this study reflect traits common to other nursing specialty groups. Of particular relevance to cancer nurses was "adaptability," reflecting the complexity of contemporary cancer care and reaffirming Benner's definition of an expert nurse as one who can fluidly connect knowledge and experience to unfamiliar practice contexts. IMPLICATIONS FOR PRACTICE Understanding characteristics of expert cancer nurses may help inform and support professional practice advancement and guide future research about select characteristics of expert cancer nurses to patient- and system-level outcomes.
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Nino V, Claudio D, Schiel C, Bellows B. Coupling Wearable Devices and Decision Theory in the United States Emergency Department Triage Process: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9561. [PMID: 33371223 PMCID: PMC7766031 DOI: 10.3390/ijerph17249561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Abstract
This research was motivated by the nurses' decision-making process in the current emergency department (ED) triage process in the United States. It explores how continuous vital signs monitoring can be integrated into the ED. The article presents four shortcomings on current ED triage systems and proposes a new conceptual clinical decision support model that exploits the benefits of combining wireless wearable devices with Multi-Attribute Utility Theory to address those shortcomings. A literature review was conducted using various engineering and medical research databases, analyzing current practices and identifying potential improvement opportunities. The results from the literature review show that advancements in wireless wearable devices provide opportunities to enhance current ED processes by monitoring patients while they wait after triage and, therefore, reduce the risk of an adverse event. A dynamic mathematical decision support model to prioritize patients is presented, creating a feedback loop in the ED. The coupling of wearable devices (to collect data) with decision theory (to synthesize and organize the information) can assist in reducing sources of uncertainty inherent to ED systems. The authors also address the feasibility of the proposed conceptual model.
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Affiliation(s)
- Valentina Nino
- Mechanical & Industrial Engineering Department, Montana State University, Bozeman, MT 59715 USA; (C.S.); (B.B.)
| | - David Claudio
- Mechanical & Industrial Engineering Department, Montana State University, Bozeman, MT 59715 USA; (C.S.); (B.B.)
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Ghazali SA, Abdullah KL, Moy FM, Ahmad R, Hussin EOD. The impact of adult trauma triage training on decision-making skills and accuracy of triage decision at emergency departments in Malaysia: A randomized control trial. Int Emerg Nurs 2020; 51:100889. [PMID: 32622225 DOI: 10.1016/j.ienj.2020.100889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients who visit emergency departments need to undergo a precise assessment to determine their priority and accurate triage category to ensure they receive the right treatment. AIM To identify the effect of triage training on the skills and accuracy of triage decisions for adult trauma patients. METHOD A randomized controlled trial design was conducted in ten emergency department of public hospitals. A total of 143 registered nurses and medical officer assistants who performed triage roles were recruited for the control group (n = 74) and the intervention group (n = 69). The skill and accuracy of triage decisions were measured two weeks and four weeks after the intervention group were exposed to the intervention. RESULTS There was a significant effect on the skill of triage decision-making between the control and the intervention group p < 0.001, η2partial = 0.31. Concerning the accuracy of triage decisions, the effect was significantly different between the control group and the intervention group p < 0.001, η2partial = 0.66 across time. CONCLUSION The triage training improved the skills of the participants and the accuracy of triage decision-making across time.
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Affiliation(s)
- Siti Aishah Ghazali
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia; Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Foong Ming Moy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Rashidi Ahmad
- Department of Emergency Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Emni Omar Daw Hussin
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Abstract
Decision making by nurses is complicated by the stress, chaos, and challenging demands of the work. One of the major stressors confronting nurses is perceived time pressure. Given the potential negative outcomes on nurses due to perceived time pressures, it seems logical that a nurse manager’s ability to lead nurses in moderating this time pressure and in turn to make better decisions could enhance nurse well-being and performance. Paralleling research in the nursing literature suggests that, in order to improve patients’ judgement of the care they received, nurse managers should embrace ways to lower nurses’ perceived time pressure. In this conceptual paper, we propose a model to help mitigate time pressure on nurse managers and their frontline nurses based on the research regarding time pressure, psychosocial care, time management, and self-leadership. Three metaconjectures and suggested future studies are given for further consideration by organizational and psychological researchers.
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Triage education in rural remote settings: A scoping review. Int Emerg Nurs 2018; 43:119-125. [PMID: 30424946 DOI: 10.1016/j.ienj.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Triage is a complex nursing task to prioritise patient care, based on acuity. Triage decisions can affect patient safety and must employ critical thinking. Graduate registered nurses are expected to triage in rural facilities, which is in contrast to current guidelines. The purpose of this review was; to discover how effective education support programs were in developing clinical decision-making skills for graduates at triage; and to determine what is known about triage education support programs for graduate or novice registered nurses undertaking triage in rural and remote settings. METHOD A scoping review was undertaken to identify and analyse primary research articles following PRISMA guidelines, sourced from four electronic databases. RESULTS 6158 retrieved articles were found, after duplicate removal and screening against inclusion/exclusion criteria; fourteen articles were included. Themes included 'variability of triage accuracy and assessment'; 'education qualifications and experience'; and 'training and supervision'. CONCLUSION This review demonstrates significant gaps in the literature reporting on this topic area, particularly in the rural context. Common recommendations include standardised triage education strategies, and strategies that account for differences in resourcing levels. Further research is required to attempt to link education strategies in rural contexts to acceptable triage outcomes like triage accuracy.
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Petruniak L, El-Masri M, Fox-Wasylyshyn S. Exploring the Predictors of Emergency Department Triage Acuity Assignment in Patients With Sepsis. Can J Nurs Res 2018; 50:81-88. [DOI: 10.1177/0844562118766178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purposeEvidence suggests that septic patients, who require prompt medical attention, may be undertriaged, resulting in delayed treatment. The purpose of this study was to examine patient and contextual variables that contribute to high- versus low-acuity triage classification of patients with sepsis.MethodsData were abstracted from the medical records of 154 adult patients with sepsis admitted to hospital through a Canadian Emergency Department. Logistic regression was used to explore the predictors of triage classification.ResultsLanguage barriers or chronic cognitive impairment (odds ratio 5.7; 95% confidence interval 2.15, 15.01), acute confusion (odds ratio 3.4; confidence interval 1.3, 8.2), unwell appearance (odds ratio 3.4; 95% confidence interval 1.7, 7.0), and hypotension (odds ratio 0.98; confidence interval 0.96, 1.0) were predictive of higher acuity classification. Temperature, heart rate, respiratory rate, and contextual factors were not related to triage classification.ConclusionsSeveral patient-related factors were related to triage classification. However, the finding that temperature and heart and respiratory rates were not related to triage classification was troubling. Our findings point to a need for enhanced education for triage nurses regarding the physiological indices of sepsis. The sensitivity of the Canadian Triage Assessment Scale, used in Canadian Emergency Rooms, also needs to be examined.
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Affiliation(s)
- Leon Petruniak
- London Health Sciences Centre, Victoria Adult Emergency Department, London, Ontario, Canada
| | - Maher El-Masri
- Toldo Heath Education, University of Windsor, Windsor, Ontario, Canada
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Williams JM, Jones D, Thornton C. Owners' perception of veterinary medical emergencies. Vet Rec 2017; 181:vetrec-2016-104050. [PMID: 28724641 DOI: 10.1136/vr.104050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/04/2022]
Affiliation(s)
- J M Williams
- Department of Animal and Land Sciences, Hartpury University Centre, Hartpury College, Gloucester GL19 3BE, UK
| | - D Jones
- Department of Veterinary Nursing, Hartpury University Centre, Hartpury College, Gloucester GL19 3BE, UK
| | - C Thornton
- Department of Veterinary Nursing, Hartpury University Centre, Hartpury College, Gloucester GL19 3BE, UK
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Chang W, Liu HE, Goopy S, Chen LC, Chen HJ, Han CY. Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses. Clin Nurs Res 2016; 26:651-666. [PMID: 26935346 DOI: 10.1177/1054773816636360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.
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Affiliation(s)
- Wen Chang
- 1 Chang Gung University of Science and Technology, Taiwan, ROC.,2 Chang Gung University, Taiwan, ROC
| | | | | | | | - Hsiao-Jung Chen
- 1 Chang Gung University of Science and Technology, Taiwan, ROC
| | - Chin-Yen Han
- 1 Chang Gung University of Science and Technology, Taiwan, ROC
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Wolf LA. How to Use Research Findings in Your Practice NOW. J Emerg Nurs 2015; 41:536-7. [PMID: 26409659 DOI: 10.1016/j.jen.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Clinical Decision Making in Triage: An Integrative Review. J Emerg Nurs 2015; 41:396-403. [DOI: 10.1016/j.jen.2015.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 01/02/2015] [Accepted: 02/05/2015] [Indexed: 11/21/2022]
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Jiao M, Ning N, Wu Q, Peters DH, Hao Y, Li Y, Wei X, Kang Z. Determinants of emergency response responsibility perceptions in the local public health workforce after China's health sector restructuring. BMC Health Serv Res 2015; 15:339. [PMID: 26293247 PMCID: PMC4546225 DOI: 10.1186/s12913-015-1003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background Local health departments are the backbone of public health emergency (PHE) response plans. The front line of emergency response preparedness is people. Role perceptions of individual staff members of a given organization strongly affect response probability and performance. Therefore, the aim of this study was to determine local public health employees’ perceptions of emergency response responsibilities, identify factors that influence their perception, and indicate the challenges and bottlenecks of PHE response in the Health Inspection Institution (HII) after its separation from China’s multiple Centers for Disease Control and Prevention (CDC). Methods We used a stratified randomized sample survey to examine HII workers’ knowledge of their own duties concerning PHE response in 17 facilities in Heilongjiang, a province in northeastern China. Data were collected from May to July 2010 using a 9-item combined question inquiring about the workers’ statutory duties. Results Of 348 administered surveys, 309 were returned for an overall response rate of 88.8 %. Overall, the correct recognition rate of PHE responsibilities was low. Some HII workers were confused about their responsibilities required by law, regulations, and emergency response plans. A quarter of all the respondents had the lowest knowledge for PHE responsibilities. Factors influencing their perceptions of responsibilities were department, work experience in a CDC, and PHE response experience. Conclusions To improve preparedness for a PHE, efforts are needed to train, support, and monitor the workers’ knowledge and competencies in PHEs as part of an organizational change; the worker’s knowledge of their responsibilities should be measured and used as an indicator of preparedness for a PHE, and training should be undertaken where there are deficiencies. Management should also encourage workers in the departments of food hygiene/school health surveillance to be more involved in PHE preparedness and response issues.
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Affiliation(s)
- Mingli Jiao
- Department of Health Policy and Hospital Management, Health Management School of Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, China. .,Institute of Quantitative and Technical Economics, Chinese Academy of Social Science, 5 Jian guo men nei Road, Dongcheng District, Beijing, China.
| | - Ning Ning
- Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, China.
| | - David H Peters
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA.
| | - Yanhua Hao
- Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, China.
| | - Ye Li
- Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, China.
| | - Xingang Wei
- Health Bureau of Heilongjiang Province, Heilongjiang, Peoples Republic of China.
| | - Zheng Kang
- Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin City, Heilongjiang Province, China.
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Ashour OM, Okudan Kremer GE. Dynamic patient grouping and prioritization: a new approach to emergency department flow improvement. Health Care Manag Sci 2014; 19:192-205. [PMID: 25487711 DOI: 10.1007/s10729-014-9311-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/25/2014] [Indexed: 11/25/2022]
Abstract
The demand on emergency departments (ED) is variable and ever increasing, often leaving them overcrowded. Many hospitals are utilizing triage algorithms to rapidly sort and classify patients based on the severity of their injury or illness, however, most current triage methods are prone to over- or under-triage. In this paper, the group technology (GT) concept is applied to the triage process to develop a dynamic grouping and prioritization (DGP) algorithm. This algorithm identifies most appropriate patient groups and prioritizes them according to patient- and system-related information. Discrete event simulation (DES) has been implemented to investigate the impact of the DGP algorithm on the performance measures of the ED system. The impact was studied in comparison with the currently used triage algorithm, i.e., emergency severity index (ESI). The DGP algorithm outperforms the ESI algorithm by shortening patients' average length of stay (LOS), average time to bed (TTB), time in emergency room, and lowering the percentage of tardy patients and their associated risk in the system.
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Affiliation(s)
- Omar M Ashour
- Industrial Engineering Department, Pennsylvania State University, The Behrend College, Erie, PA, 16506, USA.
| | - Gül E Okudan Kremer
- Industrial and Manufacturing Engineering, and School of Engineering Design, Pennsylvania State University, University Park, PA, 16802, USA
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Claudio D, Kremer GEO, Bravo-Llerena W, Freivalds A. A dynamic multi-attribute utility theory–based decision support system for patient prioritization in the emergency department. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/19488300.2013.879356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martin A, Davidson CL, Panik A, Buckenmyer C, Delpais P, Ortiz M. An examination of ESI triage scoring accuracy in relationship to ED nursing attitudes and experience. J Emerg Nurs 2013; 40:461-8. [PMID: 24290530 DOI: 10.1016/j.jen.2013.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 08/30/2013] [Accepted: 09/16/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This research was designed to examine if there is a difference in nurse attitudes and experience for those who assign Emergency Severity Index (ESI) scores accurately and those who do not assign ESI scores accurately. Studies that have used ESI scoring discussed the role of experience, but have not specifically addressed how the amount of experience and attitude towards patients in triage affect the triage nurse's decision-making capabilities. METHODS A descriptive, exploratory study design was used. Data from 64 nurses and 1,644 triage events at 3 emergency departments was collected. Participants completed demographic data, attitude (Caring Nurse Patient Interaction, CNPI-23) survey, and triage data collection tools during the continuous 8-hour triage shift. Clinical nurse expert raters retrospectively reviewed the charts and assigned an ESI score to be compared with the nurse. Descriptive statistics were used to describe the nurse and Pearson's correlation was used to examine the relationship between experience and attitude. RESULTS In this study of 64 nurse participants, the ESI score assigned by nurse participants did not differ significantly based on years of experience or CNPI mean score. The Kappa statistic ranged from a high of 0.63 in the nurse participant with 1.00 to 1.99 years of experience to a low of 0.51 in the nurse participant with 15 to 19 years of experience. The nurse participants with an overall mean CNPI-23 score of 106 to 115 achieved the highest agreement compared with a single participant with a CNPI-23 overall mean score of less than 77 who had a Kappa agreement of 0.50. The nurse participants with a CNPI-23 overall mean score between 81 and 92 demonstrated agreement of 0.54 to 0.60. DISCUSSION Based on the high level of liability the triage area presents, special consideration needs to be made when deciding which nurse should be assigned to that area. The evidence produced from this study should provide some reassurance to ED managers and nurses alike that nurses with minimal ED experience and a working understanding of the ESI 5-level triage algorithm possess the knowledge and the capacity to safely and appropriately triage patients in the emergency department.
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Noon AJ. The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum? Int Emerg Nurs 2013; 22:40-6. [PMID: 23685041 DOI: 10.1016/j.ienj.2013.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/13/2013] [Accepted: 01/18/2013] [Indexed: 10/26/2022]
Abstract
High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice.
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Affiliation(s)
- Amy J Noon
- King's College Hospital Foundation Trust, Accident and Emergency Department, Denmark Hill, SE5 9RS, United Kingdom.
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Reducing uncertainty in triaging mental health presentations: examining triage decision-making. Int Emerg Nurs 2013; 22:47-51. [PMID: 23669028 DOI: 10.1016/j.ienj.2013.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 01/18/2013] [Accepted: 01/22/2013] [Indexed: 11/22/2022]
Abstract
Little is known about how emergency department (ED) nurses make decisions and even less is known about triage nurses' decision-making. There is compelling motivation to better understand the processes by which triage nurses make decisions, particularly with complex patient populations such as those with frequently emotive mental health and illness issues. While accuracy and reliability of triage decisions generally have been improved through the introduction of standardised triage scales and instruments, other factors such as lack of knowledge or confidence related to mental health issues, past experiences that may elicit transference and countertransference, judgments about individuals based on their behavioural presentations may impact on decisions made at triage. In this paper, we review the current research regarding the effectiveness of triage tools particularly with mental health presentations, present a theoretical framework that may guide research in understanding how triage nurses approach decision-making, and apply that framework to thinking about research in mental health-related triage. Developing a better understanding of how triage nurses make decisions, particularly in situations where issues related to mental health and illness may raise the levels of uncertainty, is crucial to ensure that they have the skills and tools they need to provide the most effective, sensitive, and compassionate care possible.
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Can Emergency Nurses' Triage Skills Be Improved by Online Learning? Results of an Experiment. J Emerg Nurs 2013; 39:20-6. [DOI: 10.1016/j.jen.2011.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 06/30/2011] [Accepted: 07/07/2011] [Indexed: 11/23/2022]
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Reay G, Rankin JA. The application of theory to triage decision-making. Int Emerg Nurs 2012; 21:97-102. [PMID: 23615516 DOI: 10.1016/j.ienj.2012.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/22/2012] [Accepted: 03/28/2012] [Indexed: 11/15/2022]
Abstract
Theory in nursing is frequently thought of as being a mainly academic exercise with little relevance to the everyday practice of nursing. In nursing there is disagreement about what theory is and what it is not. Scientific theory is an abstract systematic explanation of how concepts are related to each other. Many nursing theories do not fit this description and should therefore, in the opinion of the authors, be thought of as models. Nursing knowledge has been described as the knowledge that is useful to nurses, whether it is derived from the discipline of nursing or other disciplines. Decision-making (DM) and triage nursing have been investigated by several nurse researchers, however, most have not clearly articulated a theoretical or conceptual framework. The recognition primed decision (RPD) model is based on research about DM under uncertain conditions such as time pressure, limited time available, high stakes, and changing cues. The context of emergency triage nursing DM is congruent with the RPD model. The authors propose that the RPD model can serve as a foundation for research that seeks to understand DM by triage nurses with the aim of yielding new knowledge that is useful for their practice.
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Affiliation(s)
- Gudrun Reay
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
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Forsman B, Forsgren S, Carlström ED. Nurses working with Manchester triage – The impact of experience on patient security. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.aenj.2012.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Smith AJ. Assessing confidence in triage decision making: evaluation of an inventory in a sample of navy and civilian nurses. JOURNAL FOR NURSES IN STAFF DEVELOPMENT : JNSD : OFFICIAL JOURNAL OF THE NATIONAL NURSING STAFF DEVELOPMENT ORGANIZATION 2012; 28:132-6. [PMID: 22617784 DOI: 10.1097/nnd.0b013e3182551531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Triage decision making and prioritizing nursing care are essential nursing skills in all clinical settings. The purpose of this study was to evaluate the psychometric properties of the Triage Decision Making Inventory in a sample of Navy and civilian nurses with diverse clinical specialties and years of clinical experience. Establishing reliability and validity allows staff development educators to evaluate training strategies that promote confidence in decision making among nurses of all specialty practices.
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Affiliation(s)
- Anita J Smith
- College of Nursing, University of South Alabama, S721 USA Drive N. Mobile, AL 36688, USA.
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Dateo J. What factors increase the accuracy and inter-rater reliability of the Emergency Severity Index among emergency nurses in triaging adult patients? J Emerg Nurs 2011; 39:203-7. [PMID: 22079643 DOI: 10.1016/j.jen.2011.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 07/14/2011] [Accepted: 09/07/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Julie Dateo
- Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Abstract
Triage decision making is an essential skill for nurses. Through initial assessment, a nurse must be able to prioritize patient care on the basis of appropriate decision making. The purpose of this article is to present pilot study data on the Triage Decision-Making Inventory, which measures the identification of critical thinking, cognitive characteristics, intuition, and experience when making triage decisions. Establishing reliability and validity of the instrument in a sample of nurses with diverse specialties allows staff development experts to use the inventory to tailor training for new graduates and practicing nurses.
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Garbez R, Carrieri-Kohlman V, Stotts N, Chan G, Neighbor M. Factors influencing patient assignment to level 2 and level 3 within the 5-level ESI triage system. J Emerg Nurs 2010; 37:526-32. [PMID: 22074652 DOI: 10.1016/j.jen.2010.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/20/2010] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prospectively assessing factors that influence triage nurse assignment of patients to the higher risk level 2 compared to the lower risk level 3 has not previously been explored within the 5-level Emergency Severity Index (ESI) triage system. Considering the large amount of information available about the patient, less experienced triage nurses often struggle in deciding what patient information is truly relevant when assessing if a high-risk situation exists. The primary aim of this study was to identify specific factors used by triage nurses to differentiate level 2 patients from level 3 patients. METHODS A convenience sample of triage nurses was recruited from 2 ED sites. If at the completion of the nurse-patient triage interaction the nurse assigned the patient to either level 2 or level 3, the triage nurse then completed a questionnaire related to factors that influenced patient assignment. RESULTS Overall, 18 triage nurses participated in the study with a total of 334 nurse-patient triage interactions collected. Patient age, vital signs, and need for a timely intervention were found to be significant factors that influenced patient assignment to level 2 while expected number of resources influenced patient assignment to level 3. DISCUSSION Utilizing experienced triage nurses on average, this study identified specific, objective factors that, combined with factors already delineated in the ESI Version 4 Implementation Manual, have useful implications for less experienced triage nurses by providing a more comprehensive and relevant foundation for data gathering and decision making.
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Affiliation(s)
- Roxanne Garbez
- University of California, San Francisco, San Francisco, CA, USA
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King RV, North CS, Larkin GL, Downs DL, Klein KR, Fowler RL, Swienton RE, Pepe PE. Attributes of effective disaster responders: focus group discussions with key emergency response leaders. Disaster Med Public Health Prep 2010; 4:332-8. [PMID: 21149236 DOI: 10.1001/dmphp.d-09-00059r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
METHODS An effective disaster response requires competent responders and leaders. The purpose of this study was to ask experts to identify attributes that distinguish effective from ineffective responders and leaders in a disaster. In this qualitative study, focus groups were held with jurisdictional medical directors for the 9-1-1 emergency medical services systems of the majority of the nation's largest cities. These sessions were recorded with audio equipment and later transcribed. RESULTS The researchers identified themes within the transcriptions, created categories, and coded passages into these categories. Overall interrater reliability was excellent (κ = .8). The focus group transcripts yielded 138 codable passages. Ten categories were developed from analysis of the content: Incident Command System/Disaster Training/Experience, General Training/Experience, Teamwork/Interpersonal, Communication, Cognition, Problem Solving/Decision Making, Adaptable/Flexible, Calm/Cool, Character, and Performs Role. The contents of these categories included knowledge, skills, attitudes, behaviors, and personal characteristics. CONCLUSIONS Experts in focus groups identified a variety of competencies for disaster responders and leaders. These competencies will require validation through further research that involves input from the disaster response community at large.
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Affiliation(s)
- Richard V King
- University of Texas Southwestern Medical Center, Dallas, 75390, USA.
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Forsgren S, Forsman B, Carlström ED. Working with Manchester triage – Job satisfaction in nursing. Int Emerg Nurs 2009; 17:226-32. [DOI: 10.1016/j.ienj.2009.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 03/22/2009] [Accepted: 03/23/2009] [Indexed: 11/26/2022]
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Patel VL, Gutnik LA, Karlin DR, Pusic M. Calibrating urgency: triage decision-making in a pediatric emergency department. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2008; 13:503-20. [PMID: 17364221 DOI: 10.1007/s10459-007-9062-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 02/19/2007] [Indexed: 05/14/2023]
Abstract
Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.
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Affiliation(s)
- Vimla L Patel
- Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University Medical Center, New York, NY 10032, USA.
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Ethical Decision Making in Disaster Triage. J Emerg Nurs 2008; 34:112-5. [DOI: 10.1016/j.jen.2007.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/26/2007] [Accepted: 04/10/2007] [Indexed: 11/20/2022]
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Kremser AK, Lyneham J. Can Australian Nurses Safely Assess for Thrombolysis on EKG Criteria? J Emerg Nurs 2007; 33:102-9. [PMID: 17379026 DOI: 10.1016/j.jen.2006.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Revised: 10/14/2006] [Accepted: 10/22/2006] [Indexed: 11/16/2022]
Abstract
INTRODUCTION According to the Australian Institute of Health & Welfare, 48,700 ischemic heart disease events occurred in Australia in 2001-2002; around half of these were fatal. The National Heart Foundation of Australia recommends that eligible patients presenting with acute myocardial infarction should receive thrombolysis within 30 minutes of presentation if primary angioplasty is not available. In Australia, fewer than 80% of eligible patients were treated within 1 hour in the first half of the year 2000. Literature reveals that a number of hospitals in the United Kingdom use a model of acute myocardial infarction management whereby suitably qualified cardiac nurses initiate thrombolysis where appropriate, prior to the patient being evaluated by medical staff. This practice is safe and effective in reducing the door-to-needle time to below 20 minutes. The questions are threefold: Are Victorian cardiac nurses similarly capable? What are the existing abilities of emergency nurses? What do they think about initiating thrombolysis? METHOD Mixed methodology (descriptive comparative and thematic analysis) was used. The survey instrument included EKG vignettes and a questionnaire. Participants were Victorian nurses practicing in a coronary care unit or an emergency department. RESULTS Seniority was the only apparent predictor of increased accuracy. DISCUSSION Nurses are very accurate and safe in their ability to recognize patients warranting immediate thrombolysis. Nurses' decision making is underpinned by 3 of 4 fundamental patterns of knowing identified by Carper-aesthetic, empirical, and ethical. In view of these findings, a number of recommendations are made for research, education, and benchmarking of quality patient management.
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Affiliation(s)
- Anne K Kremser
- Southern Health Monash Medical Center, Clayton, and School of Nursing and Midwifery, Monash University, Victoria, Australia.
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Abstract
The purpose of this article is to critically review and synthesize the literature related to the general concepts and the process of diagnosing the client's condition, and the possible variables which influence diagnostic practise in nursing. It is suggested that statistical theories are capable of capturing the diagnostic process and offer an effective means to predict diagnostic decisions. Studies underpinned by information-processing theory argue that diagnosing a patient's condition follows a hypothetico-deductive model that consists of specific stages. Those who hold a phenomenological perspective remark that there is yet another form of diagnostic practise: intuitive reasoning, which plays an important role in diagnosing the patient's clinical condition. Other related studies suggest that diagnostic practise is contingent on some personal, psychosocial, and structural variables. Regrettably, these studies offer no conclusive explanation to delineate diagnostic practise in nursing. Based on the literature reviewed, a conceptual framework is suggested to help articulate the underlying structures and processes of diagnostic practise in nursing.
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Affiliation(s)
- Joseph Lee
- School of Science and Technology, The Open University of Hong Kong, Homantin, Kowloon, Hong Kong.
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Chung JYM. An exploration of accident and emergency nurse experiences of triage decision making in Hong Kong. ACTA ACUST UNITED AC 2005; 13:206-13. [PMID: 16199164 DOI: 10.1016/j.aaen.2005.08.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 07/01/2005] [Accepted: 08/02/2005] [Indexed: 01/14/2023]
Abstract
This study used a descriptive qualitative design to explore emergency nurse experiences of decision making about triage in Hong Kong. Seven experienced nurses who were working in three different accident and emergency departments participated in the study. Unstructured interviews were used to provide the nurses with opportunities to describe their experiences. The findings fall into three main categories, including the experience of triage decision making, the use of information in the triage decision-making process, and the factors that influence triage decision making. Although the experience of triage was generally positive, the nurses felt frustrated and uncertain in some circumstances. In addition, triage decision making was influenced by a series of factors that occur in daily practice. The findings of this study have implications for the development of formal triage training and triage decision-making protocols in accident and emergency nursing. They also provide positive reinforcement and support to triage nurses that will enhance their ability to make decisions about triage. Avenues for further research in the area are recommended.
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