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Emergency department triage decision-making by registered nurses: An instrument development study.

Gudrun Reay1, James A Rankin1,2, Karen L Then1

  • 1Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.

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|June 3, 2024
PubMed
Summary

A new Triage Decision-Making Instrument (TDMI) was developed and validated to measure Emergency Department Registered Nurses' decision-making. The 22-item tool demonstrates reliability and validity, offering a way to improve nursing education and patient care.

Keywords:
decision‐makingemergency nursinginstrument developmentnursingtriage

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Area of Science:

  • Nursing Science
  • Healthcare Management
  • Clinical Assessment

Background:

  • Emergency Department (ED) nursing involves complex decision-making.
  • Quantifying triage decision-making is crucial for improving patient flow and safety.
  • Existing tools may not fully capture the nuances of ED triage decisions.

Purpose of the Study:

  • To develop and psychometrically test the Triage Decision-Making Instrument (TDMI).
  • To create a reliable and valid tool for assessing ED Registered Nurses' decision-making processes.
  • To provide a foundation for targeted interventions in triage education and practice.

Main Methods:

  • A five-phase development and testing process.
  • Concept definition informed by grounded theory, followed by item generation and revision.
  • Face and content validity established through focus groups and expert review.
  • Psychometric properties assessed via exploratory factor analysis on data from 204 triage nurses.

Main Results:

  • The TDMI is a 22-item, four-factor instrument: clinical judgement, managing acuity, professional collaboration, and creating space.
  • Exploratory factor analysis supported the four-factor structure, explaining 48.64% of the variance.
  • The instrument demonstrated good internal consistency, with Cronbach's alphas ranging from .596 to .822.

Conclusions:

  • The TDMI meets criteria for face validity, content validity, and internal consistency.
  • The instrument is suitable for further testing and refinement in clinical settings.
  • The TDMI provides a valuable tool for quantifying triage decision-making, enabling targeted interventions and staff development.