Psychometric Testing of the Nurses' Cardiac Triage Instrument in a Nationwide Sample

Triage nurses are responsible for determining the urgency with which patients are evaluated and treated. How triage nurses make decisions is critical to providing effective care.

The aims were to (1) analyze the psychometric properties of the Nurses' Cardiac Triage Instrument in a large, national sample of emergency department nurses, and (2) make recommendations for refining the instrument.

Data were obtained from a descriptive, survey study. Participants were recruited from the Emergency Nurses Association website using stratified random sampling. Participants completed the Nurses' Cardiac Triage Instrument. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed.

Emergency nurses (n = 414) had a mean age of 41.7 years (SD, 12.0 years) and had a median of 8.0 years (interquartile range, 11.0 years) of emergency department experience. The CFA demonstrated a poor fit with the original factor structure (χ2[402] = 1872.59, P = .000, root mean square error of approximation = .094, comparative fit index = .585, Tucker-Lewis Index = .551, standardized root mean square residual = .086). Therefore, the dataset was divided into 2; EFA and CFA were conducted. Factor 3 (nurse action) showed ceiling effects and was excluded from analysis. EFA and subsequent CFA resulted in 7 factors explaining 63.49% of the variance.

Factors 1 and 2 (patient presentation and nurses' reasoning process) of the original Nurses' Cardiac Triage Instrument were validated by EFA and CFA. Factor 3 items could be used as outcome measures in the future. This study supports further testing to compare purported versus actual nurse actions.