TRIAGE NURSE REASONING

An Investigation into Triage Nurse reasoning's During Initial Assessment Affect on Patients' Outcome in the Emergency Department

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Abstract

Modern day emergency departments (EDs) are commonly required to provide service to more patients than their resources can handle, leading to significant pressures on emergency personnel and department overcrowding. Triage has been called the gateway to emergency care and as a result, triage decisions are believed to be fundamental in determining the course of a patient's care in the department. This research aims at exploring whether the triage nurse reasoning during initial assessment affect patient's outcome in the emergency department or not. Furthermore, the research finds out the weaknesses in triage nurse reasoning that affects the overall process of triage. Furthermore, the research also aims at understanding the triage decision making experiences of emergency nurses and of the contextual influences on triage decision making in emergency departments.

Table of Contents

Abstractii

Introduction1

Focus Questions, Aims and Objectives, and Rationale1

Focus Questions1

Aims and Objectives2

Rationale2

Methodology6

Research Design6

Research Method7

Material Analysis Method for Drawing Conclusions7

Search Technique8

Literature Search and Potential Sources8

Inclusion and Exclusion Criteria for Maintaining Relevancy9

Qualitative Research9

Secondary Data10

Limitations of Secondary Data10

Ethical Considerations11

Literature Review and Findings12

Emergency Department Triage13

Emergency Department's Standard Protocols14

Standard Protocol and Patient Management15

Accuracy and Reliability of Triage17

Triage Scales19

Decision Making in Triage20

Role of Education in Triage23

Overcrowding in the Emergency Department24

Role of the Triage Nurse25

Summary26

Implications and Recommendations for Practice27

Practice28

Education28

Research29

Conclusions30

References33

Appendices38

Introduction

Modern day emergency departments (EDs) are commonly required to provide service to more patients than their resources can handle (Considine, Ung & Thomas, 2000), leading to significant pressures on emergency personnel and department overcrowding (Ding et al., 2006; Dong et al., 2006). It seems to have become the norm that emergency departments are over-represented in depictions of hallway medicine and in other news stories of failures in the healthcare system. High demands on over-stretched resources typically require some type of process of prioritization; in emergency departments that process is called, triage.

As EDs worldwide face the persistent challenge of over-crowding, rising patient acuity and longer lengths of stay, there is increasing pressure to devise and implement triage systems that are both fast and accurate (Ruger, Lewis, & Richter, 2007). Triage has been called the gateway to emergency care and as a result, triage decisions are believed to be fundamental in determining the course of a patient's care in the department (Considine, Botti, & Thomas, 2007).

Focus Questions, Aims and Objectives, and Rationale

Focus Questions

RQ1: Does the triage nurse reasoning during initial assessment affect patient's outcome in the emergency department?

RQ2: What is the performance of registered nurses for triage in emergency department?

RQ3: What are the weaknesses in triage nurse reasoning that affects the overall process of triage?

Aims and Objectives

To explore whether the triage nurse reasoning during initial assessment affect patient's outcome in the emergency department or not

To find out the weaknesses in triage nurse reasoning that affects the overall process of triage

To illuminate triage nurses' work in an ED

To understand the triage decision making experiences of emergency nurses and of the contextual influences on triage decision making in emergency departments.

Rationale

Emergency personnel, namely physicians and nurses, rely on triage ...