Introduction
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?
Methods
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.
Results
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.
Discussion
Findings support the preference for using the intuitive mode of decision making with
only tacit reliance on the decision aid.
Key words
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Biography
Diana E. Clarke is Associate Professor and Associate Dean (Research), College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
Biography
Krystal Boyce-Gaudreau is Instructor, Red River College, Winnipeg, Manitoba, Canada.
Biography
Ana Sanderson is Senior Practitioner, Salford Mental Health Liaison Team, Greater Manchester West NHS Foundation Trust, Manchester, United Kingdom.
Biography
John A. Baker is Professor of Mental Health Nursing, School of Healthcare, University of Leeds, Leeds, United Kingdom.
Article info
Publication history
Published online: May 29, 2015
Footnotes
Funding was provided by the University of Manitoba Research Grants Program and the Associated Commonwealth Universities Gordon and Jean Southam Titular Fellowship Program.
Identification
Copyright
© 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
