Understanding triage assessment of acuity by emergency nurses at initial adult patient presentation: A qualitative systematic review.
Decision making
Emergency service
Hospital
Nurses
Triage
Journal
International emergency nursing
ISSN: 1878-013X
Titre abrégé: Int Emerg Nurs
Pays: England
ID NLM: 101472191
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
06
03
2023
revised:
28
04
2023
accepted:
12
07
2023
medline:
27
11
2023
pubmed:
17
9
2023
entrez:
16
9
2023
Statut:
ppublish
Résumé
Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how nurses make these decisions and why they deviate from triage algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness. This qualitative systematic review aimed to understand decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation. Medline, CINAHL and Academic Search Complete were systematically searched to 15th December 2022. Data were analysed using thematic synthesis. Established themes were reviewed with GRADE-CERQual to evaluate certainty of evidence. 28 studies were included in the review. Data analysis uncovered three superordinate themes of holistic reasoning, situational awareness, and informed decision-making. The findings show nurses value holistic assessments over algorithms and rely on knowledge and experience. They also assess the wider situation in the emergency department. This review presents new perspectives on nurses' decision-making processes about patient's acuity. Nurses holistically gather information about patients before translating that information into acuity scores. These actions are informed by their knowledge and experience; however, the wider situation also impacts their decisions. In turn, the nurses use interpretations of patients' acuity to control the wider situation.
Sections du résumé
BACKGROUND
BACKGROUND
Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how nurses make these decisions and why they deviate from triage algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness.
AIMS
OBJECTIVE
This qualitative systematic review aimed to understand decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation.
METHODOLOGY
METHODS
Medline, CINAHL and Academic Search Complete were systematically searched to 15th December 2022. Data were analysed using thematic synthesis. Established themes were reviewed with GRADE-CERQual to evaluate certainty of evidence.
RESULTS
RESULTS
28 studies were included in the review. Data analysis uncovered three superordinate themes of holistic reasoning, situational awareness, and informed decision-making. The findings show nurses value holistic assessments over algorithms and rely on knowledge and experience. They also assess the wider situation in the emergency department.
CONCLUSIONS
CONCLUSIONS
This review presents new perspectives on nurses' decision-making processes about patient's acuity. Nurses holistically gather information about patients before translating that information into acuity scores. These actions are informed by their knowledge and experience; however, the wider situation also impacts their decisions. In turn, the nurses use interpretations of patients' acuity to control the wider situation.
Identifiants
pubmed: 37716173
pii: S1755-599X(23)00073-3
doi: 10.1016/j.ienj.2023.101334
pii:
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Pagination
101334Informations de copyright
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.