Triage emergency nurse decision-making: Incidental findings from a focus group study

Reay, Gudrun; Smith-MacDonald, Lorraine; Then, K.; Hall, Marc; Rankin, James A.

doi:10.1016/j.ienj.2019.100791

Cited by 48 publications

(71 citation statements)

References 32 publications

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“…Así pues, la experiencia y habilidades de los profesionales de enfermería (24)(25)(26)(27) , la combinación de una búsqueda selectiva de las presentaciones cardinales con un grupo seleccionado de síntomas, junto con las escalas NIHSS y MRS, conforman herramientas útiles para el cribado y el diagnóstico correcto del ictus agudo. El papel clave de los profesionales de enfermería se vuelve fundamental en el presente y en el futuro inmediato del triaje hospitalario, y debe ser considerado en todos los servicios de emergencia.…”

Section: Discussionunclassified

Nursing triage in acute stroke

Vico¹,

Sánchez²

2021

Enf Global

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En las ultimas décadas, el papel de la enfermería en el triaje y cribado de pacientes en los servicios de urgencias y emergencias, tanto en el entorno prehospitalario como sobre todo en los hospitales, es esencial e indiscutible. Con el objetivo de analizar el triaje realizado por enfermería para detectar los pacientes con ictus agudo, y llegado el caso mejorarlo, se ha realizado un estudio retrospectivo de las presentaciones cardinales del ictus, la escala del Instituto Nacional de la Salud de Estados Unidos, y la escala modificada de Rankin, aplicadas en el set del triaje por enfermería en el Hospital Universitario de Salamanca, durante el período comprendido entre los años 2016 y 2019, ambos inclusive. El total de historias clínicas analizadas ha sido de 1572. El análisis está centrado en la fiabilidad, evaluado por enfermería, de la presentación cardinal del ictus agudo, y de las dos escalas, frente a los algoritmos tradicionales rápidos de detección del ictus, en particular el método FAST, y la escala de Cincinnati. Nuestro estudio demuestra que son varias las presentaciones clínicas que escapan a las escalas rápidas, por lo que es esencial ampliar los métodos de triaje del ictus agudo realizados por enfermería, con el fin de evitar retardos en la detección y el tratamiento definitivo (enfermedad tiempo-dependiente). Así pues, la identificación ampliada de las presentaciónes cardinales, junto con el uso de escalas más detalladas aplicadas por enfermería entrenada, se muestran como herramientas muy útiles de detección del ictus agudo. In recent decades, the role of nursing in triage and screening of patients in emergency services, both in prehospital environment and especially in hospitals, is essential and indisputable. In order to analyze the triage carried out by nursing to detect patients with acute stroke, and if necessary improve it, a retrospective study was carried out of the cardinal presentations of stroke, the scale of the National Institute of Health of the United States, and the modified Rankin scale, applied in the nursing triage set at the Salamanca University Hospital, during the period between 2016 and 2019, both inclusive. The total number of clinical records analyzed was 1572. The analysis is focused on the reliability, evaluated by nursing, of the cardinal presentations of acute stroke, and of the two scales, compared to the traditional rapid algorithms for stroke detection, in particular the FAST method, and the Cincinnati scale. Our study shows that there are several clinical presentations that escape the rapid scales, so it is essential to expand the triage methods of acute stroke carried out by nursing, in order to avoid delays in detection and definitive treatment (time-dependent disease). Thus, the expanded identification of cardinal presentations, together with the use of more detailed scales applied by trained nurses, appear to be very useful tools for the detection of acute stroke.

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Section: Discussionunclassified

Nursing triage in acute stroke

Vico¹,

Sánchez²

2021

Enf Global

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“…As an essential part of the professional duties of the medical personnel, clinical decisionmaking consists of analysis of information, making decisions, and taking action based on those decisions to accomplish the desired objective [6]. According to Emergency Nurses Association, clinical decision-making is one of the most important professional capabilities in emergency care personnel which can significantly improve the efficacy and quality of care provided [7].…”

Section: Introductionmentioning

confidence: 99%

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis

et al. 2021

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Background Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel. Methods The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis. Results The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues. Conclusion The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel’s professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel’s clinical decision-making skill.

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“…The process of triage in the hospitals is unpredictable and complicated [3]. Triage nurses are likely to encounter the patients whose conditions are critical and quickly changing-obviously thus, they should possess the necessary professional capability to assess the patients' conditions rapidly, determine the clinical priorities accurately, and make the right clinical decision in order to react properly to such quick changes [4]. Lack of the expected professional capability results in the triage nurses' errors in prioritization of the patients' needs, which, in turn, results in overcrowding in the triage unit, patients' dissatisfaction, and in some cases, deterioration of the patients' conditions [5].…”

Section: Introductionmentioning

confidence: 99%

Development and psychometric assessment of the triage nurses’ professional capability questionnaire in the emergency department

et al. 2020

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Background: Evaluation of triage nurses' professional capability is integral to identifying potentials for professional development and nurses' educational needs, thus, there is a need for valid instruments to assess their professional capability. The present study was conducted to develop and measure the reliability and validity of a triage nurses' professional capability questionnaire. Methods: This exploratory research was conducted in two stages: in the first stage (the qualitative phase), the concept of professional capability in triage nurses was defined and the items of the questionnaire were developed through conventional content analysis. In the second stage (the quantitative phase), the psychometric properties of the questionnaire were assessed based on analyses of its face validity, content validity, construct validity, internal homogeneity, and consistency. Results: The initial item pool consisted of 90 items, while the final scale was comprised of 35 items. The S-CVI/Ave of the questionnaire was found to be 0.96.The exploratory factor analysis showed that the factor loading of the items was between 0.46-0.89, all of which were significant, and the three dimensions introduced in the main instrument were verified with acceptable values. The overall intraclass correlation coefficient of the instrument was calculated to be 0.90. The reliability of the instrument was assessed in terms of its internal homogeneity where the Cronbach's alpha of the whole instrument was found to be 0.89. Conclusions: The results showed that the questionnaire developed for assessment of triage nurses' professional capability is sufficiently reliable and valid and can be employed by nurse administrators to evaluate triage nurses' professional capability.

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Triage emergency nurse decision-making: Incidental findings from a focus group study

Cited by 48 publications

References 32 publications

Nursing triage in acute stroke

Nursing triage in acute stroke

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis

Development and psychometric assessment of the triage nurses’ professional capability questionnaire in the emergency department

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