Nurses' Knowledge and Practice About In-Hospital ‎Triage: A Cross-Sectional Study in Jahrom

Abstract

Background: Triage is one of the basic components in the emergency room and its correct ‎application improves health care outcomes. Nurses are commonly responsible for the first triage at ‎emergency department. Therefore, their knowledge and practice of triage would greatly affect ‎healthcare prioritizing process. The purpose of this study was to investigate the knowledge and ‎practice of nurses in educational and medical hospitals of Jahrom city regarding in-hospital triage in ‎‎2020.‎

Methods: This research was an analytical cross-sectional study. Sampling was done by census ‎method of all nurses working in the emergency department of hospitals affiliated with Jahrom ‎University of Medical Sciences, in September 2020. Data collection tools included three ‎questionnaires of demographic information, knowledge and practice of nurses about hospital ‎triage. The range of scores that could be obtained for the knowledge assessment ranged from 1 to ‎‎15, and from 1 ‎to 10 for the performance assessment and from 1 to 25 for the total score.‎

Results: A 53.47% of the responses in knowledge section were correct with mean score of 7.87±1.99. ‎In performance assessment, 73.17% of the responses were true with a mean score of 71.31±1.47. The ‎mean total score (total of knowledge and performance) of hospital triage participants was ‎‎15.06±3.12. Spearman correlation coefficient showed a positive correlation between nurses' ‎knowledge and practice in in-hospital triage (r = 0.44, P = 0.001).‎

Conclusion: The results of this study indicate that the level of knowledge and attitude of nurses ‎working in the emergency departments of the centers covered by Jahrom University of Medical ‎Sciences regarding triage is moderate. In this regard, holding triage training courses for staff in ‎order to provide high-quality services is recommended.‎

Ethics approval and consent to participate:

The study was approved by the Institutional Review Board of Jahrom University of Medical Sciences.

Consent For Publication:

Not Applicable.

Availability of Data and Materials:

All data are available in the article. Persian format of the questionary would be available for researchers upon a request to corresponding author.‎

Competing interests:

None.

Funding:

Jahrom University of Medical Sciences.

Authors' contributions: 

MC and SA designed the study. NZ, NE and FN surveyed participants. The manuscript was written by MC, FA and SA and revised by NE.

Acknowledgments ‎

None.

---------------------------------------------------------------------------------------------------------------------

Full Text

Introduction

The emergency department usually provides 24-hour emergency care, and an unpredictable number of ‎patients present to the emergency department with urgent conditions. Patients with life-threatening ‎conditions such as cardiac arrest, airway obstruction, and shock should be given priority for immediate ‎primary care. However, the overcrowding of patients affects the quality of care provided to them (1,2). ‎Triage is placing patients in the right place and time to receive the right care and allocate the right ‎resources to meet the medical needs of patients (2). In other words, triage is an essential method in the ‎emergency department as an effective system for reducing waiting time and ensuring proper treatment for ‎all patients (1). Triage is a classification of patients with priority groups based on the severity of their ‎medical conditions to receive the necessary assistance (3). Patients' triage is divided by nurses into five ‎categories from immediate to delayed priority based on the severity and severity of the disease (4). Triage ‎is one of the essential components of the emergency department, which, if done correctly and ‎scientifically, reduces patient mortality (5) and improves resource utilization (6). This is done to perform ‎the best treatment, which is one of the most important goals of the emergency department. The goal of ‎triage in accidents with limited medical resources is to provide the maximum necessary services to most of ‎the injured in the shortest possible time. Rapid identification of patients with serious illnesses and rapid ‎implementation of vital measures is possible with triage and prioritization of patients (3). Emergency ward ‎triage is a type of triage performed daily by emergency nurses. The goal is to identify high-risk patients ‎who need immediate care (1). Triage in critical situations has different goals and processes than triage in ‎normal conditions. In times of disaster, due to a large number of injured and limited facilities and ‎services, there is a need for accurate classification and allocation of services (3). Previous studies have ‎shown that the main factor related to triage skills are knowledge and awareness of emergency nurses (1). ‎Nurses who perform triage need sufficient knowledge, information, and experience in this field (5). ‎Unfortunately, there are serious concerns about the knowledge and practice of triage nurses. In various ‎studies, the knowledge and practice of triage nurses have been reported to be poor or below average. ‎Stiell et al. reported that nursing triage performance in Canada is moderate (7). In Meyer et al.'s study, the ‎knowledge and practice of nursing triage in South Africa were reported to be moderate (8). Another study ‎from Ethiopia showed that participants in the study had no knowledge about patient classification and ‎waiting time for treatment groups (2). A study in Sweden found that nurses did not receive adequate ‎training in triage (9). The study of Mirhaghi et al. also showed that nurses are not well acquainted with the ‎knowledge of hospital triage (4). Therefore, it is necessary to evaluate the knowledge and skills of triage of ‎emergency nurses (2). Therefore, the purpose of this study was to investigate the knowledge and practice ‎of nurses in educational and medical hospitals of Jahrom city about in-hospital triage in 2020.‎  ‎

Methods‏

Study setting and participants:‎

‎ This descriptive cross-sectional study was performed in 2020 on nurses of educational and medical hospitals in ‎Jahrom (Motahhari and Peymanieh). Sampling was done by census of all ED nurses. Nurses working in the ‎emergency department who have at least one year of experience in this department and express a desire to ‎participate in the study were included in the study. Incomplete completion of questionnaires and lack of ‎cooperation in the implementation of the study were considered exclusion criteria. ‎

Data collection:

‎ The data collection tool was a researcher-made questionnaire. In the first part, this questionnaire included ‎questions in the field of demographic information, working conditions and triage experience status. The ‎second part consisted of 15 questions to assess the knowledge of nurses by performing hospital triage. ‎Finally, to evaluate the performance of emergency department nurses in the field of triage, a test ‎consisting of 10 questions, each of which presented a different scenario for patient prioritization, was ‎designed and provided to nurses. These scenarios were designed by two emergency medicine specialists ‎with expertise in the field of triage according to the prevalence of the type of ED referrals. The range of ‎scores that could be obtained for the knowledge assessment ranged from 1 to 15, and from 1 to 10 for the ‎performance assessment and from 1 to 25 for the total score (10).‎

Ethical issues:

 ‎ Before conducting the study, the researchers introduced themselves to the nurses and after explaining the ‎objectives and method of the research, informed written consent was obtained to participate in the study. ‎At the same time, the research samples were assured that the obtained information would be kept ‎confidential.‎

Analytical methods:

 ‎ Data analysis was performed using SPSS software version 21 and using descriptive (mean and standard ‎deviation) and inferential statistical tests (Shapiro-Wilk and Spearman correlation coefficient) at a ‎significant level of P <0.05 took place.‎

Results‎

Among 74 nurses registered in ED of Motahhari and Peymanieh hospitals, 61 (82.43%) responded to our ‎survey of which 54.1% of participants were working in Peymanieh emergency department and the rest ‎were working at Motahhari hospital emergency department. The ratio of male and female participants in ‎the study was almost equal. The majority of emergency department nurses (72.1%) were active in rotating ‎shifts. 37.7% of them were having working experience of fewer than 5 years old, 23% were between 5 and ‎‎10 years, 26.2% from 10 to 15 years, and the rest were over 15 years. Most nurses in the emergency ‎department (67.2%) have one year or less experience in ED (Table 1).‎

Table 1. Demographic variables in study participants

‎‎34.4% of them were familiar with triage through workshops, 18% through university courses and 37.7% ‎from colleagues and the rest from other sources.  A 53.47% of the responses in knowledge section were ‎correct with mean score of 7.87±1.99. In performance assessment, 73.17% of the responses were true ‎with a mean score of 7.31±1.47. It is worth mentioning that the range of nurses 'attitudes was zero to 10 ‎and the range of nurses' performance scores was zero to 15. The mean total score (total of knowledge and ‎performance) of hospital triage participants was 15.06±3.12.‎ A non-parametric test was used to investigate the relationship between nurses' demographic ‎characteristics and their knowledge and practice in the field of in-hospital triage. The results showed that ‎there was a significant difference between nurses' service history and their performance in inpatient triage ‎‎(P = 0.007). The highest performance was observed in nurses with a history of 5 to 10 years. Also, nurses ‎who performed in-hospital triage had significantly higher performance in in-hospital triage (P = 0.007) ‎‎(Table 2). Spearman correlation coefficient also showed that there was a positive and direct correlation ‎between nurses' knowledge and practice in inpatient triage (r = 0.44, P = 0.001). This result showed that ‎with the increase in nurses' knowledge about in-hospital triage, their performance improves.‎

Table 2. Knowledge and practice scores based on characteristics of participants

Discussion:‎

Nurses in the triage department can examine patients' complaints in a centralized and comprehensive ‎manner (11).  The accuracy of triage decisions can affect the achievements of the emergency department (12-13). Data ‎showed that 53.47% of the responses to the data were 7.87 ± 1.99. Therefore, the level of knowledge of ‎nurses is at average level. Malekshahi and Mohammadzadeh stated that nurses' knowledge about ‎general knowledge about triage was moderate (14).‎ In the study by Sedaghat et al. (2017) which was conducted with the aim of determining the level of ‎knowledge and practice of emergency medical staff in the north of Khuzestan province about pre-hospital ‎triage, the results showed that the level of knowledge of triage was moderate (15). In their study, ‎Guranson et al. reported that nurses' knowledge of triage was moderate (9). The results of the present ‎study are consistent with the studies of Malekshahi, Aghababayan and Guranson. In their study, Tabatabai ‎et al. examined the knowledge of nursing students about hospital triage in the emergency department. The ‎results of this study showed that nurses' knowledge about hospital triage is poor (16). In their study, Mir ‎Haghi et al. examined the level of knowledge of emergency department nurses about hospital triage. The ‎results of this study showed that nurses were not well acquainted with the knowledge of hospital triage ‎‎(4). In their study, Javadi et al. examined the knowledge and practice of emergency department nurses ‎about in-hospital triage. The results of this study showed that the level of knowledge of nurses working in ‎the emergency departments of the centers covered by Shahid Sadoughi University of Medical Sciences ‎about triage is below average (10). In their study, Haghighi et al. examined the level of knowledge of ‎nurses working in the emergency department of hospitals affiliated with Ahvaz University of Medical ‎Sciences in 1394. The results of this study showed that the level of knowledge of emergency department ‎nurses who are very involved in patient triage is unsatisfactory (17). In their study, Sedaghat et al. ‎Examined the knowledge and practice of EMS emergency medical personnel in the north of Khuzestan ‎province regarding pre-hospital triage. The results of this study showed that the level of knowledge of EMS ‎emergency medical personnel in the north of Khuzestan province is poor (15). Hedayati et al. in their study ‎examined the knowledge of final year students of Birjand University of Medical Sciences about hospital ‎triage. The results of this study showed that the knowledge of Birjandi students is poor (18). The results of ‎the above studies are not consistent with the present study. It seems that this study differs from the ‎present studies in the study population as well as the tools used, which can cause inconsistencies in the ‎findings.‎ In their study, Javadi et al. examined the knowledge and practice of emergency department nurses regarding ‎in-hospital triage. The results of this study showed that the performance of nurses working in the ‎emergency departments of the centers under the auspices of Shahid Sadoughi University of Medical ‎Sciences in terms of triage is below average (10). In their study, Sedaghat et al. Examined the knowledge ‎and practice of EMS emergency medical personnel in the north of Khuzestan province regarding pre-hospital ‎triage. The results of this study showed that the performance of EMS emergency medical staff in the north ‎of Khuzestan province is poor (15). The results of the present study are not consistent with Javadi and ‎honesty studies. In their study, Sharafat et al. Evaluated the knowledge and performance of hospital ‎triage. The results of this study showed that the performance of nurses working in the emergency ‎department of the above centers is above average (19). The results of the present study are consistent ‎with the study of honor. It seems that this study differs from the present studies in the study population as ‎well as the tools used, which can cause inconsistencies in the findings.‎ ‎34.4% of them were familiar with triage through workshops, 18% through university courses, 37.7% from ‎colleagues and the rest from other sources. The highest level of knowledge in the field of triage was ‎related to educational workshops (10). In their study, Haghdoost et al. Examined the effect of triage ‎training on the knowledge, attitude and practice of nurses working in the emergency department of ‎Poursina Medical Center in Rasht. The results of this study showed that the most sources of information ‎are work experience (20).‎

Conclusion:‎

The results of this study indicate that the level of knowledge and attitude of nurses working in ‎the emergency departments of the centers covered by Jahrom University of Medical Sciences regarding ‎triage is moderate. In this regard, holding triage training courses for staff in order to provide high quality ‎services is recommended.‎