Decision making of triage nurses in determination of patients' level of urgency in accident & emergency departments in Hong Kong

Abstract

This thesis documents a descriptive study using non-experimental design to explore the process of decision making of the triage nurses in determining patients' level of urgency in the Accident & Emergency Department (AED), and identifies factors influencing the triage nurses in this process. Fifty-three (N=53) Registered Nurses (RN) currently working in 14 AEDs participated in the study. The subjects were required to triage five simulated patients using a notebook computer containing the self-developed Computer-assisted Simulated Patient Scenarios (CSPS) programme, and to answer a questionnaire to identify factors influencing the triage decision making. The usability level of the CSPS was assessed in various aspects, namely software interface, screen layout, and documentation. The overall mean score for usability test was 3.3 (above GOOD). The content validity index of the questionnaire was high (0.81). The results indicated that: 1. triage was a difficult nursing duty in the AED; 2. formal triage education should be enhanced; 3. the triage decision process was generally led by objective data e.g. blood pressure readings; 4. the triage decision was conservative as evidenced by high rate of over-triage; 5. the attributes of the patient, the physical structure of the triage station, the triage nurse, and the management were considered as important influencing factors; and, 6. senior nurses could handle the decision making process confidently, independently, decisively and felt less stress compared to junior nurses. The findings are discussed within the local context of AED clinical practice focusing on the triage work. Future directions for study on decision making are recommended. The limitations of the present study are discussed.