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Published on: January 15, 2017
Strategic simulation-based management of triage clinical reasoning in novice emergency nurses: A randomized block
1Department of Nursing, Jungwon University, 85 Munmu-ro, Goesan-gun, Chungcheongbuk-do 28024, South Korea.
Aim:
To develop and evaluate the effectiveness of the Triage Clinical Reasoning Simulation Program (Triage-CRSP).
Background:
Globally, emergency department (ED) triage is largely performed by general nurses, with increasing emphasis on clinical reasoning (CR) to assess care urgency; however, novice emergency nurses have limited triage-related competencies.
Design:
This study consisted of two phases: program development and effectiveness evaluation. The first phase involved developing Triage-CRSP. The second phase evaluated its effectiveness using a randomized block design, with the completion of KTAS (Korea Triage Acuracy Scale) training as the blocking factor.
Methods:
The theoretical framework of this program was based on O'Neill et al.'s clinical decision-making and novice clinical reasoning models. The simulation program was developed using a six-step approach to curriculum development. A total of 60 emergency nurses with less than three years of experience were stratified by completion of KTAS training and randomly allocated to either the intervention or control group; under a single-blind design, the intervention group received the developed Triage-CRSP, while the control group received the existing KTAS simulation.
Results:
The 'Triage-CR pattern' was identified as a structured multi-step clinical reasoning process. The intervention group demonstrated significantly greater improvements in triage clinical reasoning knowledge, recognition of critical clinical cues, emergency nursing performance and overall triage competence compared with the control group.
Conclusions:
The simulation-based triage clinical reasoning program was effective in enhancing multiple dimensions of triage practice among novice emergency nurses.
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