How Triage Nurses Use Discretion: a Literature Review

Abstract

Discretion is quintessential for professional work. This review aims to understand how nurses use discretion when they perform urgency assessments in emergency departments with formalised triage systems-systems that are intended to reduce nurses' use of discretion. Because little research has dealt explicitly with this topic, this review addresses the discretionary aspects of triage by reinterpreting qualitative studies of how triage nurses perform urgency assessments. The review shows (a) how inexhaustive guidelines and a hectic work environment are factors that necessitate nurses' use of discretion and (b) how nurses reason within this discretionary space by relying on their experience and intuition, judging patients according to criteria such as appropriateness and believability, and creating urgency ratings together with their patients. The review also offers a synthesis of the findings' discretionary aspects and suggests a new interactionist dimension of discretion.

Beyond guidelines: discretionary practice in face‐to‐face triage nursing

“…, Ruston ). Nurses have also been shown to rely on intuition (Johannessen , O'Cathain et al . , Randell et al .…”

“…; Russell ). A second explanation is that nurses deviate because of organisational factors, such as having to assign patients’ triage codes in light of resource situation in the ED as a whole (Bjørn and Balka , Johannessen ). A third explanation is that guidelines’ ‘encoded’ knowledge only partially reflects and/or is at odds with the knowledge required for performing urgency assessments (Bjørn and Balka , Greatbatch et al .…”

“…Studies adopting this third explanation report that nurses view guidelines as inflexible, reductionist and ill‐adapted to nurses’ particular settings (Dowding et al . , Johannessen , Murdoch et al . , O'Cathain et al .…”

“… Exceptions pertaining to face‐to‐face triage include Dowding et al . () and the studies reviewed by Johannessen (). The former includes face‐to‐face triage as only one of four case studies; the latter reviews descriptive studies that focus more on decision‐making in general than on nurses’ use of guidelines.…”

Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls: A qualitative interview study

“…Typically, information about symptoms, medications, and previous illnesses are entered into a CDSS and a priority and measures are recommended. The standardization of the CDSS' is presumed to increase the accuracy and reliability of decisions (Johannessen, 2016; Noon, 2014). However, Pope et al.…”