Emergency triage marred by lack of staff and heavy workloads
Study finds hectic working conditions in emergency departments, including overcrowded waiting areas, can ‘result in nurses making rushed decisions’
Staffing shortages, heavy workloads and lack of space can affect emergency care nurses’ ability to triage patients safely and accurately, according to new research.
A study by the University of East Anglia (UEA) also found that nurses prefer to use a mix of ‘intuition’ and clinical judgement to assess patients rather than relying on standardised assessment tools.
However, effective decision-making could be hampered by environmental pressures including lack of staff, high numbers of patients and overcrowded waiting areas, according to the study published in the journal International Emergency Nursing.
Knowledge and experience inform decisions
The research team analysed data from 28 studies focusing on nurse triage in emergency departments around the world including in the UK, USA and Australia.
They found nurses took a holistic, hands-on approach to triaging patients and made decisions on acuity based on knowledge and experience.
Nurses favour individualised patient assessment
‘We found that nurses value hands-on assessments that focus on the individual over standardised assessment tools,’ said UEA School of Health Sciences postgraduate researcher Hugh Gorick.
‘For example, nurses are more likely to look at the patient as a whole, rather than just concentrating on assessing one particular symptom.
‘This might include taking into account how much the symptoms are affecting them, what their previous medical history is and even how sick they look.’
However, factors such as hectic working conditions could get in the way, he told Nursing Standard.
Many factors ‘reduce the capabilities of nurses to make accurate decisions’
‘Triage often takes place in a busy environment, with nurses having to modify their decision-making processes to be able to deal with the high workload caused by overcrowding and lack of space,’ Mr Gorick said.
‘These decisions are also impacted by staff shortages which further reduce the capabilities of the nurses to make accurate decisions. These environmental factors result in nurses making rushed decisions, potentially resulting in missed acuity cues.’
Call for improved triage training
Some nurses included in the analysis said training in triage was important to help accurately assess patients, but many felt current training was lacking in quality and quantity.
The researchers have since carried out a survey of UK triage nurses to find out more about their decision-making processes, training and the impact of various pressures. They are currently analysing the results.
Read the University of East Anglia study
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