Triage is the process whereby persons presenting to the emergency department are quickly assessed by a nurse and their need for care and service is prioritized. Research examining the care of persons presenting to emergency departments with psychiatric and mental health problems has shown that triage has often been cited as the most problematic aspect of the encounter. Three questions guided this investigation: Where do the decisions that triage nurses make fall on the intuitive versus analytic dimensions of decision making for mental health presentations in the emergency department, and does this differ according to comfort or familiarity with the type of mental health/illness presentation? How do “decision aids” (ie, structured triage scales) help in the decision-making process? To what extent do other factors, such as attitudes, influence triage nurses’ decision making?
Eleven triage nurses participating in this study were asked to talk out loud about the reasoning process they would engage in while triaging patients in 5 scenarios based on mental health presentations to the emergency department.
Themes emerging from the data were tweaking the results (including the use of intuition and early judgments) to arrive at the desired triage score; consideration of the current ED environment; managing uncertainty and risk (including the consideration of physical reasons for presentation); and confidence in communicating with patients in distress and managing their own emotive reactions to the scenario.
Findings support the preference for using the intuitive mode of decision making with only tacit reliance on the decision aid.
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Diana E. Clarke is Associate Professor and Associate Dean (Research), College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
Krystal Boyce-Gaudreau is Instructor, Red River College, Winnipeg, Manitoba, Canada.
Ana Sanderson is Senior Practitioner, Salford Mental Health Liaison Team, Greater Manchester West NHS Foundation Trust, Manchester, United Kingdom.
John A. Baker is Professor of Mental Health Nursing, School of Healthcare, University of Leeds, Leeds, United Kingdom.
Published online: May 29, 2015
Funding was provided by the University of Manitoba Research Grants Program and the Associated Commonwealth Universities Gordon and Jean Southam Titular Fellowship Program.
© 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.