Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study

Triage knowledge, perceived skills, and associated factors among nurses working in adult emergency departments of selected public hospitals in Addis-Ababa, Ethiopia, 2023: multicenter cross-sectional study

Background

Triage is an essential function in the emergency department. Knowledge of nurses working in triage has been cited as an influential factor in triage decision-making. As there are increased numbers of clients with life-threatening traumatic injuries and medical patients in the emergency department in Addis-Ababa, triage knowledge and skill are essential competencies required for the nurses working in the emergency department.

Objective

To assess nurses' knowledge and perceived skills towards triage and associated factors among nurses working in the adult emergency department of selected public hospitals in Addis-Ababa, Ethiopia, 2023.

Methods

A multicentre cross-sectional study design was used. Three hospitals were purposefully selected. A census sampling technique was used to obtain the required sample size. Data was collected by an open data kit (ODK) version 2022.1.2. Then, it was exported to SPSS version 27 for final analysis. Bivariate analysis at a P-value of 0.25 and multivariable analysis at a P-value of 0.05 were applied. Results were presented using tables, figures, and texts.

Results

A total of 384 participants were included in this study. The proportions of poor triage knowledge and perceived poor triage skills among nurses were 58.1 and 50.3%, respectively. Educational level, triage experience, training experience, and the availability of triage equipment were significant predictors of triage knowledge and perceived triage skill, respectively.

Conclusion and recommendation

The triage knowledge and skill levels were found to be low. As nurses' knowledge about triage is a key tool in triage decision-making, there is a need to improve nurses' knowledge and skills in triaging at the ED.

Effect of triage training on nurses with Emergency severity index and Australian triage scale: Α quasi-experimental study

Introduction

Triage training has positive effects on health professionals, the quality of indicators in emergency departments, and the patients. However, data on the effectiveness of triage training on nurses with two different triage scales is limited.

Objective

This study sought to evaluate the effectiveness of a triage training program in Emergency Departments (EDs), as well as the effect on the accuracy, knowledge, and skills of nurses working in the National Health System of Greece.

Methods

Α quasi-experimental study was carried out, with measurements taken pre-, post-, and three months after implementing the education program. Data were collected between March 2021 and July 2022. Eligible participants for this study included nurses employed in the hospital units of the 4th Health Region of the National Health System. A total of 117 nurses participated in the study. Skills, knowledge, and accuracy were assessed using the Emergency Severity Index and the Australian Triage Scale.

Results

After completing the training program, there was a noticeable improvement in the nurses' performance. Their triage skills displayed an overall statistically significant increase (p < 0.001) and, more crucially, in the subscales of rapid patient assessment skills, patient categorization skills, and patient allocation skills. Additionally, statistically significant increases were observed for triage knowledge and for both screening scales that measured triage accuracy, namely the Emergency Severity Index (p < 0.001) and the Australian Triage Scale (p < 0.001). In addition, the number of over-triage and under-triage cases decreased.

Conclusions

The education program had a positive impact on the nurses, resulting in a statistically significant increase in their triage skills and knowledge. Moreover, the use of both triage scales resulted in an increase in the triage accuracy. The increase in triage skills, knowledge, and accuracy decreased after three months.

Mapping the evidence of emergency nursing research in who Afro-region states: A Scoping Review

Introduction

The introduction of emergency nursing in Africa has resulted in the establishment of several training schools across the continent. This has translated into a growing body of emergency care research being carried out by nurses; however, the breadth and extent of evidence remains unclear. The aim of the review was to map and collate the available literature on emergency nursing research in WHO Afro-region states.

Methods

The review adopted the methodology of the Joanna Briggs Institute (JBI) scoping reviews. The review protocol was registered on 27 June 2022 (osf.io/5wz3x). The Population (nurse), Concept (emergency nursing research), Context (WHO Afro-region) (PCC) elements guided the development of the inclusion and exclusion criteria. Papers were searched across seven electronic data bases and two search engines using a three-search strategy. The screening was performed initially on the abstract and title and lastly on full text. The reporting for the review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Results

One hundred and thirteen papers were included in the review. Publication of emergency nursing research occurred from 2000 to 2022. The year 2017 and 2019 recorded the highest number of publications (n = 14). The country with the most publications was South Africa (n=50). Emergency nursing research used predominantly quantitative methodologies (n=58). The professional groups involved in research were nurses (n=69) as well as nurses and doctors (n=26). The identified papers focused primarily on emergency nursing education (n=23) and epidemiology (n=24).

Conclusion

There is a notable increase in the number of publications on emergency nursing research in WHO Afro-region states, however from only 11 countries. Since most of the research is still at descriptive level, there is need to encourage emergency nursing research on interventions and measuring outcomes and impact in the emergency care system.

Knowledge, Awareness, and Understanding of Pediatric Triage Among Nursing Officers in India: A Multicenter Study

INTRODUCTION

 Triage is crucial in patient screening within emergency departments (EDs) worldwide. It is one of the essential and standard medical practices in many developed countries. However, in India, there is a need for improvement in triage utilization, as it is predominantly performed by resident doctors or medical officers, leading to an uneven distribution of clinical skills among healthcare providers (HCPs). A comprehensive analysis incorporating literature review and data collection revealed that while mandatory screening is conducted in most Indian EDs, the formal implementation of standardized triage protocols remains limited. Like in developed countries, registered nurses or nursing officers (NOs) can be effectively trained and directed to play the role of dedicated triage personnel in EDs of most of the healthcare facilities in India.

METHOD AND MATERIALS

 This study aimed to examine the current state of triage utilization and its impact on the distribution of responsibilities among HCPs in Indian EDs. Through this online survey, the investigators assessed the knowledge and practical understanding of clinical triaging among NOs, working at various hospitals nationwide.

RESULTS

 The participants included 5,029 NOs working in various parts of India, predominantly nursing graduates (82.52%), the majority being employed in government healthcare settings (84.01%) and most having over five years of cumulative working experience in the ED (70.77%). Nurses showed inadequate knowledge and awareness about the Pediatric Assessment Triangle (PAT) used for quick initial evaluation (62.18% among all participants). Concerning the complete triage process applicable, especially in pediatric ED settings, they had even less satisfactory knowledge and understanding, e.g., identifying primary (28.27%) and secondary (22.69%) survey components via focused history and examination, properly using temperature assessment (23.32%) and instant blood glucose level assessment (22.95%) in triage, and knowing various types of internationally accepted triage systems for ED-based health facilities such as the Emergency Severity Index (ESI), Canadian Triage and Acuity Scale (CTAS), and Australasian Triage Scale (ATS) (15.87%). ANOVA and post hoc analysis revealed that the intergroup performance of the study participants with maximum correct responses to the knowledge-determining specified subset of the questionnaire depicts the significantly higher role of graduate nursing degree over diploma such as General Nursing and Midwifery (GNM)/Auxiliary Nursing and Midwifery (ANM) qualification, working in government hospital versus private setup, and ED working experience of >5 years over that of <5 years.

CONCLUSIONS

 Of the participants in the study, 50% were not evaluated for cognitive or psychomotor domains during their assessment examinations. The research illuminated a significant disparity in knowledge and proficiency levels among Indian nurses concerning pediatric triage, especially with the ability to effectively apply the PAT for initial patient evaluations, discern components of primary and secondary surveys, and comprehend various triage systems. This study underscores the importance of comprehensive reform in the Indian healthcare system and teaching curriculum by emphasizing clinical triage training and interprofessional collaboration, and establishing guidelines and regulations to ensure consistent and standardized triage practices across all EDs.

Investigating the professional capability of triage nurses in the emergency department and its determinants: a multicenter cross-sectional study in Iran

BACKGROUND

Planning to improve the professional capabilities of triage nurses requires determining the level of professional capabilities and its determinants. In this regard, the present study was conducted to determine the professional capability of triage nurses and its determinants for the first time in Iran.

METHODS

A descriptive cross-sectional multicenter study was conducted in 2022. The research population included all nurses working in triage units of emergency departments of seven selected hospitals in Fars Province, south of Iran. The samples were selected using convenience sampling. The data collection tools were the "Triage nurses' professional capability questionnaire in the emergency department" and a questionnaire to investigate determinants of triage nurses' professional capability. Descriptive and analytical (Pearson's correlation test and multiple linear regression analysis) were used for data analysis in the SPSS software version 27. P values ≤ 0.05 were considered significant.

RESULTS

Out of 580 participants, 342 (59%) were female. The professional capability of triage nurses was at a moderate level with a mean score of 124.11 ± 14.72. The mean score of clinical competence, psychological empowerment, and professional commitment was 71.56 ± 9.67, 19.86 ± 3.95, and 32.69 ± 3.54, respectively. The results of multiple linear regression analysis showed that 5 factors, including participation in educational courses (p < 0.001), having clinical experience and specialized knowledge in emergency department (p < 0.001), error registry and assessment system (p < 0.001), managers' support (p < 0.001), and recruiting experienced staff (p = 0.018) affected the nurses' professional capability.

CONCLUSION

In the present study, the triage nurses had moderate levels of professional capability. It is necessary that nursing managers develop effective plans to improve the professional capability of triage nurses in emergency departments to enhance the quality and effectiveness of emergency services.

Challenges for Optimum Cardiopulmonary Resuscitation in the Emergency Departments of Limpopo Province: A Qualitative Study

AIM

To describe the challenges for optimum resuscitation processes in Emergency Departments in Limpopo Province, South Africa.

DESIGN

A qualitative explorative research approach was adopted to explore the resuscitation team's experiences in Emergency Departments.

METHOD

Five medical doctors and twelve professional nurses were purposively sampled to participate in the study. The depth of the information obtained from the participants determined the sample size. Data collected from semi-structured individual interviews were analyzed using thematic analysis. Data quality was ensured by applying four elements: credibility, transferability, dependability, and confirmability.

RESULTS

The study findings indicated diverse challenges for optimum resuscitation processes that include: A general shortage of emergency personnel, the lack of material resources and the unavailability of funds for payment of national and international trauma symposiums, the poor maintenance of emergency equipment, the lack of a continuous training program and the resuscitation team receiving different instructions from various team leaders about the standardized procedures and policies of the resuscitation process. The team leaders and managers often blamed, depreciated and disregarded the resuscitation team for failed resuscitation efforts. Public contribution: The study findings are a point of reference for the emergency resuscitation team and the department of health policymakers. Trained and well-equipped emergency resuscitation teams can improve the quality of life for patients with cardiac arrest.

Association between triage nurses' job satisfaction and professional capability: Results of a mixed-method study

AIM

This study aims to examine factors related to the job satisfaction of triaging nurses and their professional capability in the clinical setting.

BACKGROUND

Triage is a complex process that relies on making decisions in favour of the patient and his treatment. The professional capability of a triaging nurse is an important psychological construct of job satisfaction.

METHODS

The study used a mixed-method methodology, with data collection based on an explanatory research design. The research instrument in the quantitative part was a survey questionnaire, and in the qualitative part, a semi-structured interview. The results were integrated using the 'Pillar Integration Process'.

RESULTS

There are significant relationships between professional capability and job satisfaction. Six main topics were exposed: characteristics and traits, work organization, safety is the key, burdening circumstances, capability and self-evaluation.

CONCLUSION

Professional capability is associated with job satisfaction. The necessary managerial changes should be made to achieve job satisfaction and develop professional competence while focusing on already trained and competent triage nurses, as satisfied triage nurses will stay longer in the institution.

IMPLICATIONS FOR NURSING MANAGEMENT

The manager's job is to be aware of the level of job satisfaction, take care to develop their employee's professional capability and take action in case of disrupted balance.

Triage Knowledge and Practice and Associated Factors Among Emergency Department Nurses

Objective

The study aims at assessing the triage knowledge and practices and their associated factors among emergency department nurses employed in King Fahad Medical City (KFMC), Saudi Arabia.

Method

The study employed a cross-sectional, descriptive, and correlational design. Data collection was carried out from February 11, 2021, until April 27, 2021. The study included all emergency department nurses who were working in the KFMC during the data collection period and excluded those who were on leave at the time of data collection. A self-reported questionnaire with adequate validity and reliability was used. Statistical analysis was performed using the IBM SPSS Version 25 employing descriptive statistics, independent t-test, one-way ANOVA, and Pearson correlation test.

Results

A total of 147 emergency department nurses completed the study. Participants demonstrated generally high levels of triage knowledge and triage practice. However, knowledge deficit and incorrect practice related to some aspects were noted. There were no significant differences in triage knowledge and practice according to participants’ demographics including gender, job title, qualification, emergency nursing training, and previous training in triage (P > 0.05). Most participants (n = 141, 95.9%) had access to their triage systems and the majority (n = 79, 53.7%) utilize triage systems on a daily basis. Half said that only professional nurses performed the triage role (n = 69, 46.9%). There was a significant positive relationship between triage knowledge and practice (r = 0.486, P < 0.01).

Conclusion

The respondents had a high level of triage knowledge and practice. However, they have some areas of knowledge deficit and some deficiencies in the conversion of their knowledge into practice. The study recommends the development of further training and education in emergency nursing to address knowledge deficits and incorrect triage practices.

Strategies to Enhance Knowledge and Practical Skills of Triage amongst Nurses Working in the Emergency Departments of Rural Hospitals in South Africa

Purpose: Lack of knowledge and practical skills on triage remains a global problem, especially within rural hospitals, and very little is known about enhancing the knowledge and skills of emergency nursing staff in rural hospitals of South Africa. The objective was to describe the perceived strategies for enhancing knowledge and practices of triage among nurses working in the emergency departments (EDs) of rural hospitals in South Africa. Research methods: A descriptive qualitative research design was applied to achieve the research objective. A non-probability sampling method was applied to select 17 professional nurses from rural hospitals. An unstructured face-to-face interview method was used to collect data. Data collected were analyzed using Tesch’s method of data analysis. Results: The study findings highlighted the academic needs of nurses working in the ED of rural hospitals. Two themes emerged from this study; (1) The consistent description of the importance of triage training for emergency unit staff, and (2) The description of measures to enhance triage practices amongst emergency unit staff. Findings indicated that triage knowledge and practice remains a challenge, but with formulated strategies like continuous training by workshops, refresher courses, and offering a training module on triage, evaluation of developed guidelines and benchmarks is often enhanced. Conclusions: The study describes the strategies to enhance the conversion of knowledge and practice of triage amongst nurses working in the ED of rural hospitals. The paper argues that the knowledge and practical skills of nurses working in ED are enhanced through the provision of continuous training as workshops, triage module, evaluating the developed guidelines to implement triage, and benchmarking with other hospitals.

Advanced Trauma Life Support/Advanced Trauma Care for Nurses: A systematic review concerning the knowledge and skills of emergency nurse related to trauma triage in a community

BACKGROUND

In the trauma triage procedure, nurses with good knowledge and skills can start initial treatment immediately pending doctors availability, and before a final diagnosis is made. The Advanced Trauma Life Support/ Advanced Trauma Care for Nurses is one of the most important trauma education programmes to enhance the knowledge and skills of emergency nurses. This systematic review of the literature attempts to investigate the implications of introducing an Advanced Trauma Life Support/Advanced Trauma Care for Nurses' knowledge and skills related to trauma triage.

METHODS

A systematic review was carried out using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The included sites and databases are Web of Science, Scopus, PubMed, ScienceDirect, Cochrane Library, and Bielefeld Academic Search Engine (BASE) from 1994 to 2019. The quality of the selected studies was evaluated using a standard quality rating tool (SQRT). The quality of the criteria for inclusion and exclusion was independently reviewed by three researchers.

RESULTS

This study evaluated 5266 records in the identification stage. In the included stage, only four studies were included in this review. In the standard quality assessment, none of the included studies were evaluated as being a strong study, none used an experimental design at three points in time (pre, post and follow-up), and all showed a moderate to high risk of bias. There is a lack of knowledge and skills related to trauma triage among emergency nurses in the included studies.

CONCLUSION

A lack of knowledge and skills concerning trauma triage among emergency nurses could potentially have an adverse effect on the outcomes of the patients in trauma cases.

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

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.

Challenges and Barriers Affecting the Quality of Triage in Emergency Departments: A Qualitative Study

BACKGROUND

Correct and fast triage is the key to successful performance in emergency departments. Various factors can affect the quality of triage; therefore, the present study was conducted to identify and explore the existing challenges in triage units in emergency departments.

MATERIALS AND METHODS

The present study was a qualitative exploratory work conducted via the content analysis approach. Data were collected using in-depth, semi-structured interviews, and focus group interviews. Accordingly, 22 in-depth, semi-structured interviews were conducted in with 18 triage nurses and four emergency medicine specialists on a face-to-face basis.

RESULTS

The challenges related to triage nurses fall into two subcategories; lack of clinical competency and psychological capabilities. The challenges related to emergency management consist of challenges in human resources management, structural, and performance.

CONCLUSION

The challenges existing in triage units are influenced by factors related to triage nurses and emergency management. Emergency administrators can improve the effectiveness and quality of triaging patients by empowering triage nurses and removing structural problems in triage units.