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

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.