How triage nurses generate initial hypotheses during the first patient encounter: A focused ethnographic study

The ability of triage nurses to quickly identify an urgent situation is crucial and requires good clinical reasoning, which is strongly influenced by the context and professional environment.

To explore how triage nurses generate initial hypotheses at the very start of the triage encounter and which immediately available cues contribute to this early sense-making.

This qualitative study was conducted in three regional hospitals and included 10 triage nurses. Nurses wore a forehead-mounted GoPro camera to record triage from their point of view. Semi-structured, video-cued recall interviews were conducted immediately after triage. Deductive and inductive coding was then carried out and analysed using thematic analysis methods.

The average age of triage nurses was 36 years, with an average of 6.5 years of professional experience in the emergency department. Triage nurses generated hypotheses as soon as they encountered the patient, largely through pattern recognition (a core mechanism associated with intuition). These hypotheses were sometimes made as soon as the patient was registered at the emergency desk reception and even before talking to them. These hypotheses were based on the patient's main presenting complaint, their facial expression, and the time reported for the onset of symptoms.

Triage nurses operate in a complex environment and use rapid clinical reasoning processes that draw on readily available cues and prior experience. These findings may inform triage education by highlighting the early, experience-based processes involved in hypothesis generation and the potential value of explicitly addressing intuitive reasoning in triage training.