Guiding patients to appropriate care: developing Japanese outpatient triage nurse competencies

Japanese patients often seek hospital services without a primary provider's referral. A triage nurse who is the initial point of contact for a patient is challenged with the task of expertly evaluating the urgency of the condition and selecting the appropriate specialty service for every patient's needs. A triage nurse must also recognize any conditions requiring emergency medical services instead of a specialty outpatient service. A modified Delphi method was used to establish expert consensus regarding triage nursing competencies for secondary and higher-level health care facilities in Japan. The initial Delphi round was completed using a questionnaire of 80 competencies that were evaluated by 85 Japanese nurse experts with in-depth knowledge of triage and/or the current Japanese hospital system. Four additional competency items were added based on the experts' suggestions for a total of 84 items. The experts rated these items on a 7-point Likert scale based on importance. Minimal attrition rate yielded consistent and rich results. The results were analyzed to identify items rated as very important by the majority. Twenty-two items were included in the final list of competencies. The authors then refined the language and reorganized the items into four proposed domains. The proposed domains and the refined list of competencies provide a foundation for the development of training programs for outpatient triage nurses in the current Japanese health care system.