Essay on Triage Nursing in the Emergency Department

Introduction

During a disaster, many healthcare facilities receive patients with critical health conditions. In some cases, the number of patients out-do the resources available in hospitals. As such, triage nursing is needed to ensure that all patients receive proper treatment, reducing the death cases in the emergency rooms. Historically, the need for triage nurses was a result of the First World War(2). Due to the increased number of wounded soldiers, medical staff had to classify the soldiers based on; those with minimal injuries and could survive without medical care, those whose survival depended on medical care, and those whose probability of dying was high even after receiving medication. According to Christ et al., triage refers to the criteria used to assess and examine patients in the emergency room based on their severity of illness or injury immediately they arrive in the hospital and sort them according to their treatment priority. (1) a triage nurse, therefore, is a registered person in the emergency department responsible for handling patients with critical health conditions.

Objectives

This topic aims to;

To examine the roles and responsibilities of a triage nurse.

To assess the necessary skills and knowledge in triage nursing.

To investigate the significance of triage in the emergency department

Roles and responsibilities of a triage nurse

According to Moon et al., the process of triage involves evaluating and determining the priority of patients’ treatment, ensuring that patients are safe and, reduce crowding in the emergency department. (3) Since triage nurses play life-saving roles in the emergency department, it is worthwhile to examine their specific roles and responsibilities. First, a triage nurse assesses patients when they are admitted to the emergency room. They perform physical examinations and interviews. They sort patients according to urgency and priority. For instance, patients with emergency signs such as unusual bleeding require urgent attention and treatment. Besides, those with priority signs such as pain are given priority in the queues for further assessment and ensure that patients whose cases are not urgent can queue as they wait for treatment.

Secondly, they provide immediate care if the patient has severe signs while waiting for treatment. For instance, if a patient in the emergency room portrays abnormal symptoms, the triage nurse takes an immediate action course. Therefore the nurse can call a specialist doctor for further examination. The patient can also be secluded from other patients for special care.

Thirdly, triage nurses provide the necessary education to patients and families when necessary. They can, for instance, demonstrate to patients some self-help management strategies to prevent and manage some medical conditions. For example, the triage nurse can educate the patient and the family on dealing with such cases in-case the patient faints while on the queue, before the responsible doctor or nurse provides special care.

Skills and knowledge in triage nursing

Since triage nursing involves quick responses to patients in the emergency department, they should possess unique skills essential for preventing death among patients with critical conditions. (4) Firstly, they should have time-sensitive decision-making skills. They should make quick and reasonable decisions such as determining the right specialist doctor to deal with a patient’s case, where to take a patient after examination, and decide on the best management strategy in case of an overflow of patients in the emergency rooms. Secondly, triage nurses should have the ability to identify the patient’s problem accurately. Some patients in the emergency rooms cannot speak due to the severity of pain and language barrier; hence the nurse should perform a physical examination and determine the patient’s problem. Finally, triage nursing requires good communication and interpersonal relationship. For instance, the triage nurse should effectively communicate with the patients and the family members in the emergency department. The nurse should also be quick in building a good relationship with the patients for smooth communication and determination of patient’s needs.

Significance of triage nursing in the emergency department

Any healthcare aims to sustain the life of every patient. Therefore, triage nursing in the emergency department plays a significant role in reducing deaths among patients with critical health conditions. Triage nursing ensures that the hospital’s resources and facilities are appropriately used to equally support the survival of patients, especially during an outbreak or a pandemic. Since triage nursing becomes vital during a disaster, their roles of prioritizing care service based on the severity and urgency of care cannot be ignored whatsoever.

Problems facing triage nursing

According to Bijani and Khaleghi, hospitals across the globe face triage problems, which, when left unaddressed, may lead to an increased death rate in the emergency department. (5) First, triage nurses are exposed to risks of disease transmission. Since triage nurses interact with patients physically in the emergency department, they are more likely to contract diseases if they are not well protected. For instance, during the outbreak 0f COVID 19 disease, very little was known about the most appropriate preventive measures, and therefore patients with critical conditions were handled without protective gear. As a result, many nurses were infected with the virus. Next, many health care facilities are faced with a shortage of space in case of a disaster. Lack of enough space may expose patients and nurses to airborne diseases or other infections due to patients’ bleeding. Thirdly the roles of triage nursing are limited by inadequate personnel in the emergency department. Many hospitals lack skilled personnel in the emergency department. Many hospitals lack professional persons who can work in emergency rooms. Also, lack of proper technical skills limits triage nursing’s effectiveness and efficiency in the emergency departments.

Recommendations

Based on triage nurses’ critical roles, hospitals should be on the front line to protect the nurses. For instance, all nurses should be well protected throughout their operations in the emergency rooms. Besides, triage nurses should be compensated in case of risk of risk during their delivery of services. On the other hand, the education sector should advocate for triage skills and knowledge to increase the emergency rooms’ labor force. The government should also equip hospitals with up-to-date equipment for effective care during an emergency or disaster. Hospitals should also initiate quick and reliable communication tools in the emergency department to manage all patients effectively.

References

1. Christ M, Grossmann F, Winter D, Bingisser R, Platz E. Modern triage in the emergency department. Deutsches Ärzteblatt International. 2010 Dec;107(50):892. Available at: https://www.ncbi.nlnih.gov/pmc/articles/PMC3021905/
2. Yancey CC, O’Rourke MC. Emergency Department Triage. StatPearls [Internet]. 2020 May 15. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557583/
3. Moon SH, Shim JL, Park KS, Park CS. Triage accuracy and causes of mistriage using the Korean Triage and Acuity Scale. PLoS One. 2019 Sep 6;14(9):e0216972. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216972
4. Duko B, Geja E, Oltaye Z, Belayneh F, Kedir A, Gebire M. Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study. BMC research notes. 2019 Dec;12(1):1-4. Available at; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332676/
5. Bijani M, Khaleghi AA. Challenges and barriers affecting the quality of triage in emergency departments: a qualitative study. Galen Medical Journal. 2019 Oct 12;8:1619. Available at: https://www.gmj.ir/index.php/gmj/article/view/1619