Individu Aza
Individu Aza
Individu Aza
a r t i c l e i n f o a b s t r a c t
Article history: Introduction: Triage is implemented to facilitate timely and appropriate treatment of patients, and is typ-
Received 19 December 2016 ically conducted by senior nurses. Triage accuracy and consistency across emergency departments
Received in revised form 26 May 2017 remain a problem in mainland China. This study aimed to investigate the current status of triage practice
Accepted 31 May 2017
and knowledge among emergency nurses in Changsha, Hunan Province, China.
Method: A sample of 300 emergency nurses was selected from 13 tertiary hospitals in Changsha and a
total of 193 completed surveys were returned (response rate = 64.3%). Surveys were circulated to head
Keywords:
nurses, who then distributed them to nurses who met the selection criteria. Nurses were asked to com-
China
Emergency department
plete the surveys and return them via dedicated survey return boxes that were placed in discreet loca-
Emergency nursing tions to ensure anonymity.
Triage Results: Just over half (50.8%) of participants reported receiving dedicated triage training, which was pro-
Nursing education research vided by their employer (38.6%), an education organisation (30.7%) or at a conference (26.1%).
Hospitals Approximately half (53.2%) reported using formal triage scales, which were predominantly 4-tier (43%)
or 5-tier (34%).
Conclusions: The findings highlight variability in triage practices and training of emergency nurses in
Changsha. This has implications for the comparability of triage data and transferability of triage skills
across hospitals.
Ó 2017 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ienj.2017.05.007
1755-599X/Ó 2017 Elsevier Ltd. All rights reserved.
26 K. Hammad et al. / International Emergency Nursing 35 (2017) 25–29
easy to use and apply in various health care settings [4]. The scale 2.2. Participants
is based on a presumptive disease diagnosis made from a detailed
history or description of the patient’s presenting problem [3]. Participants included registered nurses with experience in ED
While this scale is primarily focused on the provision of timely care triage who were aged 18 years and over. Participants’ roles
to those who most urgently require it, it also takes into account the included Junior Nurses (with Diploma or Masters Degree and less
concept of customer service. Therefore, the scale also prioritises than five years of nursing experience), Senior Nurses (Diploma
providing care to patients with less urgent problems within a rea- holders with over five years of nursing experience or Masters
sonable time frame that would meet patients’ expectations [4]. The Degree holders with over one year of nursing experience), Nurses
Australasian Triage Scale was first developed and implemented in in Charge (experienced nurses responsible for managing nurses
Australia in 1993 and was substantially revised in 2000. It is also a in their department), Associate Professors (Associate Chiefs of
5-point triage scale, with patients allocated to different categories Nursing with extensive knowledge and experience, similar to a
based on their need for time-critical intervention, the potential Nurse Practitioner) and Professors (senior professionals with
threat to their life from their presenting problem and the need to extensive knowledge and experience in the field).
relieve suffering [2,3,6]. Surveys were circulated to head nurses of the ED from each par-
In mainland China, most EDs do not have a dedicated emer- ticipating hospital who then distributed them to nurses who met
gency triage system in place and there is a shortage of appropri- the selection criteria. The inclusion criterion was a nurse currently
ately trained triage nurses [1]; however, large urban hospitals are working as a triage nurse within the ED, while the exclusion crite-
increasingly adopting triage scales [7]. It has been noted that triage rion was a nurse who had previously worked as a triage nurse
accuracy is an ongoing problem in China, yet unsolved by any one within the ED, but currently holds a different position in the
‘‘gold standard” triage method [8,9]. A review of the literature department.
examining the current state of ED triage in mainland China showed
wide variation across the country in terms of how patients are 2.3. Data collection
triaged [10]. The review also noted limitations in triage training
for nurses and confusion regarding the minimum experiential The researchers used a survey they had adapted from Gorans-
and knowledge requirements for those undertaking triage as part son [12]. Nurses were asked to complete the surveys and return
of their role [10]. them via a dedicated survey return box located in each of the par-
In 2012 a national guideline for triage practice was released by ticipating hospitals. The boxes were placed in discreet locations
the central Chinese government, which refers to the design of nor- away from foot traffic to ensure that completed surveys could be
mative flow in the emergency department [11]. This document returned anonymously. The completion of a survey was taken to
provides guidance on patient treatment options, the arrangements indicate voluntary participation and informed consent to be
for ED patients and the management of the quality of medical care involved in the research project. The surveys were in Chinese
in the ED. The guideline specifies that nurses should undertake the (Mandarin) and took approximately 20 min to complete. Com-
role of triage and that triage needs to be provided on a 24 h per day pleted surveys were collected over a period of 1 month from 12
basis. Furthermore, nurses assigned to triage duty should have at March 2015 to 12 April 2015.
least five years of nursing experience. The guideline instructs
nurses to record patient demographic details, presenting problem,
2.4. Data analysis
any treatment provided at triage, and the disposition of the patient,
along with an assigned triage category in the patient record. The
The translation of the surveys into English was undertaken by
guideline promotes a 4-tier scale whereby Tier A includes life-
members of the research team fluent in Chinese and English. From
threatening cases, requiring immediate and aggressive interven-
a sample of 300 participants, a total of 193 completed surveys were
tions, Tier B includes serious cases with a potential threat to life,
returned at the conclusion of the study (response rate = 64.3%).
limb or function requiring rapid intervention, Tier C includes
Quantitative survey data were analysed using SPSS software ver-
urgent, acute symptoms without a potential threat to life, limb or
sion 22, while text responses were thematically analysed without
function, and Tier D includes patients with mild or non-urgent con-
the use of specialised software due to the limited range and length
ditions without evidence of deterioration [11].
of responses.
The aim of this study was to explore the experience and roles of
emergency nurses in Changsha, Hunan Province, China.
2.5. Ethics approval
have any formal triage training prior to undertaking the triage role,
Table 1 most reported that they learnt how to triage through work experi-
Demographic characteristics of survey participants. ence in the ED (80.9%), followed by experience in nursing practice
Age n % (66.7%) and the completion of an in-service triage program pro-
vided by the hospital after commencing their role (61.2%).
20–24 years 27 14.1
25–29 years 76 39.4
Approximately half of the participants reported using formal
30–34 years 51 26.4 triage scales when triaging patients (53.2%). Triage scales used by
35–39 years 25 13.0 nurses were either 4-tier (43%) or 5-tier (34%) scales. Participants
40–44 years 12 6.2 identified four key types of aids that influenced their triage deci-
45 years and over 2 1.0
sions, which included: triage guidelines, work and clinical experi-
Gender ence, decision making trees, and visit flowcharts. Participants
Male 5 2.6
were asked what kind of triage training they believed would be
Female 188 97.4
useful and the majority stated they would prefer to further develop
Educational qualification
their skills through a mentor or more experienced nurse (75.4%),
Diploma 35 18.1
Bachelor Degree 156 80.8 books and other printed material (64.9%) and conferences
Master Degree 2 1.0 (53.8%). There was a degree of variation in the time since partici-
Occupational position title pants last attended triage training. Table 4 details the triage
Junior nurse 48 24.9 requirements at the participating hospitals and the training pro-
Senior nurse 91 47.2 vided to nurses.
Nurse in charge 49 25.4
Associate Professor or Professor 5 2.6
Nursing experience (years) prior to triage role 4. Discussion
No experience 5 2.6
<1 0 0
1–4 76 39.8 The findings of this study highlight a degree of variability in the
5–9 67 35.1 triage practices and associated training of emergency nurses in ter-
10–14 24 12.6 tiary hospitals in Changsha, Hunan Province, China. While the
15–19 12 6.3
majority of participants indicated that their emergency depart-
20–24 7 3.7
ment had at least one staff member allocated to performing triage
Emergency nursing experience (years) prior to triage role
during day and evening shifts, nearly 20% of participants reported
No experience 8 4.2
<1 6 3.2 that no staff were allocated to triage in their emergency depart-
1–4 89 47.6 ment during the night shift. This finding suggests that all nurses
5–9 59 31.6 working during the night shift share the triage workload, meaning
10–14 17 9.1 that inexperienced or under-qualified nurses may be required to
15–19 8 4.3
20–24 3 1.6
triage patients if more experienced staff are busy or unavailable.
While previous studies have suggested that it is common for a
Triage role experience (years)
No experience 26 13.5
number of nurses to work as a team to perform triage, particularly
<1 16 8.3 in situations of uncertainty [13,14], it is generally accepted that at
1–4 97 50.3 least one nurse during any shift is the designated ‘triage nurse’ in
5–9 41 21.2 an emergency department who is responsible for making triage
10–14 9 4.7
decisions [15,16]. Further research is needed to establish whether
>15 4 2.1
the nurses performing triage in this study worked in environments
28 K. Hammad et al. / International Emergency Nursing 35 (2017) 25–29
Table 3
Number of staff typically allocated to triage role, by shift and hospital size.
Number of staff Day shift, 500–1000 Day shift, >1000 Evening shift, 500– Evening shift, >1000 Night shift, 500–1000 Night shift, >1000
allocated to triage bed hospital bed hospital 1000 bed hospital bed hospital bed hospital bed hospital
0 1 0 2 13 7 25
(2.7%) (0%) (5.4%) (9.0%) (18.9%) (17.2%)
1 26 126 29 132 29 120
(70.3%) (85.7%) (78.4%) (91.0%) (78.4%) (82.8%)
2 5 21 5 0 1 0
(13.5%) (14.3%) (13.5%) (0%) (2.7%) (0%)
3 1 0 1 0 0 0
(2.7%) (0%) (2.7%) (0%) (0%) (0%)
4 2 0 0 0 0 0
(5.4%) (0%) (0%) (0%) (0%) (0%)
5 2 0 0 0 0 0
(5.4%) (0%) (0%) (0%) (0%) (0%)