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

Area of Science:

• Emergency Medicine
• Nursing Research
• Clinical Reasoning

Background:

• Effective triage nursing relies on rapid clinical reasoning to identify urgent situations.
• The professional environment significantly influences nurses' clinical judgment.

Purpose of the Study:

• To investigate how triage nurses formulate initial hypotheses at the beginning of patient encounters.
• To identify cues that contribute to nurses' early sense-making during triage.

Main Methods:

• Qualitative study involving 10 triage nurses across three regional hospitals.
• Forehead-mounted GoPro cameras captured triage encounters from the nurses' perspective.
• Semi-structured, video-cued recall interviews and thematic analysis were employed.

Main Results:

• Nurses generated hypotheses immediately upon patient encounter, often before speaking with them.
• Hypothesis generation was primarily driven by pattern recognition, a key aspect of intuition.
• Key cues included the presenting complaint, facial expression, and symptom onset time.

Conclusions:

• Triage nurses utilize rapid, experience-based clinical reasoning in complex environments.
• Findings suggest incorporating intuitive reasoning into triage training to enhance education.