Triage-clinical Reasoning on Emergency Nursing Competency: a Multiple Linear Mediation Effect

Overview

Journal BMC Nurs

Publisher Biomed Central

Specialty Medical Education

Date 2024 Apr 24

PMID 38658947

Authors

Won-Oak Oh

Myung-Jin Jung

Affiliations

Soon will be listed here.

Abstract

Background: Triage is the first step in providing prompt and appropriate emergency nursing and addressing diagnostic issues. Rapid clinical reasoning skills of emergency nurses are essential for prompt decision-making and emergency care. Nurses experience limitations in emergency nursing that begin with triage. This cross-sectional study explored the mediating effect of perceived triage competency and clinical reasoning skills on the association between Korean Triage and Acuity Scale (KTAS) proficiency and emergency nursing competency.

Methods: A web-based survey was conducted with 157 emergency nurses working in 20 hospitals in South Korea between mid-May and mid-July 2022. Data were collected utilizing self-administered questionnaires to measure KTAS proficiency (48 tasks), perceived triage competency (30 items), clinical reasoning skills (26 items), and emergency nursing competency (78 items). Data were analyzed using the PROCESS macro (Model 6).

Results: Perceived triage competency indirectly mediate the relationship between KTAS proficiency and emergency nursing competency. Perceived triage competency and clinical reasoning skills were significant predictors of emergency nursing competency with a multiple linear mediating effect. The model was found have a good fit (F = 8.990, P <.001) with, a statistical power of 15.0% (R² = 0.150).

Conclusions: This study indicates that improving emergency nursing competency requires enhancing triage proficiency as well as perceived triage competency, which should be followed by developing clinical reasoning skills, starting with triage of emergency nurses.

Citing Articles

Effects of Critical Thinking Disposition, Clinical Judgement, and Nurse-Physician Collaboration on Triage Competency Among Triage Nurses.

Song J, Park H Healthcare (Basel). 2025; 13(4).

PMID: 39997280 PMC: 11855330. DOI: 10.3390/healthcare13040405.

References

Millsaps E, Swihart A . Utilization of a Stroke Escape Room to Enforce Best Practice Standards for Acute Ischemic Stroke. J Nurses Prof Dev. 2021; 37(6):347-350. DOI: 10.1097/NND.0000000000000793. View

Sharma S, Rafferty A, Boiko O . The role and contribution of nurses to patient flow management in acute hospitals: A systematic review of mixed methods studies. Int J Nurs Stud. 2020; 110:103709. DOI: 10.1016/j.ijnurstu.2020.103709. View

Kim S, Shin G . Effects of nursing process-based simulation for maternal child emergency nursing care on knowledge, attitude, and skills in clinical nurses. Nurse Educ Today. 2015; 37:59-65. DOI: 10.1016/j.nedt.2015.11.016. View

Zaboli A, Sibilio S, Magnarelli G, Rella E, Fanni Canelles M, Pfeifer N . Daily triage audit can improve nurses' triage stratification: A pre-post study. J Adv Nurs. 2022; 79(2):605-615. DOI: 10.1111/jan.15521. View

Hinson J, Martinez D, Schmitz P, Toerper M, Radu D, Scheulen J . Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Int J Emerg Med. 2018; 11(1):3. PMC: 5768578. DOI: 10.1186/s12245-017-0161-8. View

Hu F, Yang J, Yang B, Zhang F, Yu S, Liu Q . The impact of simulation-based triage education on nursing students' self-reported clinical reasoning ability: A quasi-experimental study. Nurse Educ Pract. 2020; 50:102949. DOI: 10.1016/j.nepr.2020.102949. View

Park J, Lee J, Kim Y, Lee J, Lim T . Reliability of Korean Triage and Acuity Scale: Interrater Agreement between Two Experienced Nurses by Real-Time Triage and Analysis of Influencing Factors to Disagreement of Triage Levels. J Korean Med Sci. 2019; 34(28):e189. PMC: 6639506. DOI: 10.3346/jkms.2019.34.e189. View

Holanda F, Marra C, Cunha I . Evidence of validity of the Competence Scale of Actions of Nurses in Emergencies. Rev Lat Am Enfermagem. 2019; 27:e3128. PMC: 6432994. DOI: 10.1590/1518-8345.2814.3128. View

ONeill E, Dluhy N, Chin E . Modelling novice clinical reasoning for a computerized decision support system. J Adv Nurs. 2004; 49(1):68-77. DOI: 10.1111/j.1365-2648.2004.03265.x. View

10.

Hitchcock M, Gillespie B, Crilly J, Chaboyer W . Triage: an investigation of the process and potential vulnerabilities. J Adv Nurs. 2013; 70(7):1532-41. DOI: 10.1111/jan.12304. View

11.

Dubovsky S, Antonius D, Ellis D, Ceusters W, Sugarman R, Roberts R . A preliminary study of a novel emergency department nursing triage simulation for research applications. BMC Res Notes. 2017; 10(1):15. PMC: 5217538. DOI: 10.1186/s13104-016-2337-3. View

12.

Sanchez-Salmeron R, Gomez-Urquiza J, Albendin-Garcia L, Correa-Rodriguez M, Martos-Cabrera M, Velando-Soriano A . Machine learning methods applied to triage in emergency services: A systematic review. Int Emerg Nurs. 2021; 60:101109. DOI: 10.1016/j.ienj.2021.101109. View

13.

Campbell D, Fetters L, Getzinger J, Perko A, Slater S . A Clinical Nurse Specialist-Driven Project to Improve Emergency Department Triage Accuracy. Clin Nurse Spec. 2021; 36(1):45-51. DOI: 10.1097/NUR.0000000000000641. View

14.

Garrafa E, Levaggi R, Miniaci R, Paolillo C . When fear backfires: Emergency department accesses during the Covid-19 pandemic. Health Policy. 2020; 124(12):1333-1339. PMC: 7584647. DOI: 10.1016/j.healthpol.2020.10.006. View

15.

Royan R, Wu C, Theyyunni N, Montas S, Cranford J, House J . Anything but Shadowing! Early Clinical Reasoning in Emergency Department Improves Clinical Skills. West J Emerg Med. 2018; 19(1):177-184. PMC: 5785190. DOI: 10.5811/westjem.2017.10.36691. View

16.

Zaboli A, Brigo F, Sibilio S, Fanni Canelles M, Rella E, Magnarelli G . The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department. Int Emerg Nurs. 2022; 65:101229. PMC: 9550667. DOI: 10.1016/j.ienj.2022.101229. View

17.

Wolf L, Delao A, Perhats C, Moon M, Zavotsky K . Triaging the Emergency Department, Not the Patient: United States Emergency Nurses' Experience of the Triage Process. J Emerg Nurs. 2017; 44(3):258-266. DOI: 10.1016/j.jen.2017.06.010. View

18.

Curtis K, Munroe B, Van C, Elphick T . The implementation and usability of HIRAID, a structured approach to emergency nursing assessment. Australas Emerg Care. 2019; 23(1):62-70. DOI: 10.1016/j.auec.2019.10.001. View

19.

Bentley S, Iavicoli L, Boehm L, Agriantonis G, Dilos B, LaMonica J . A Simulated Mass Casualty Incident Triage Exercise: SimWars. MedEdPORTAL. 2019; 15:10823. PMC: 6521923. DOI: 10.15766/mep_2374-8265.10823. View

20.

Saban M, Dagan E, Drach-Zahavy A . The Relationship Between Mindfulness, Triage Accuracy, and Patient Satisfaction in the Emergency Department: A Moderation-Mediation Model. J Emerg Nurs. 2019; 45(6):644-660. DOI: 10.1016/j.jen.2019.08.003. View