2.50
Hdl Handle:
http://hdl.handle.net/10755/162354
Type:
Presentation
Title:
"I Didn't Like How he Looked: Decisionmaking at Initial Presentation"
Abstract:
"I Didn't Like How he Looked: Decisionmaking at Initial Presentation"
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Wolf, Lisa, RN, MS, CEN
P.I. Institution Name:University of Massachusetts, Amherst
Title:Clinical Assistant Professor
Contact Address:Skinner Hall, Univ. of MA, Amherst, MA, 01035, USA
Contact Telephone:413-582-2468
Leadership Conference - Research Abstract: "I Didn't Like How he Looked: Decisionmaking at Initial Presentation"

Purpose: The purpose of the study is to explore the beliefs, behaviors, assumptions and expressions of meaning in a group of emergency department nurses in two community hospitals in the Northeastern United States as they relate to the generated meaning and understanding of patient acuity levels.
The triage nurse is generally the first person to interact with an ED patient, and the person who determines the acuity of condition and where the patient will go next; given that accurately placing patients in the correct area of the ED, and anticipating both their acuity and their need for resources is important to the safe care and efficient treatment of ED patients, the ability of the triage nurse to do this work well is crucial.
The literature describing the processes by which triage nurses make decisions in their day-to-day practice describes heuristics (Cioffi, 1998; Brannon & Carson, 2003), thinking strategies (Goransson et al, 2008), factors that might influence decision making in triage (Andersson et al, 2006; Fry & Burr, 2001), and the relevance of physiologic data (Chung, 2005; Gerdtz & Bucknall, 2001). Importantly, though, there is still a lot of uncertainty about the processes and critical thinking strategies used by triage nurses to assign acuity, and therefore, surrounding the possible strategies for improving nursing practice in this area.

Design: Ethnography concentrates on the qualitative, prospective, in-depth exploration of small groups of people to understand how they organize their daily lives and how they view their world (Helman, 2007). Ethnography offers a richly descriptive report of an individualÆs perceptions, attitudes, meanings and interpretations of different events (Hakim, 2000). This study examined individual assumptions in the context of the subculture of emergency room nurses; the investigation was of a group and a culture, not of individual nurses.

Setting: A 429 bed level II trauma center and a 25 bed critical access hospital

Participants/Subjects: 10 emergency nurses; 9 white, 9 female, with a range of experience from 3-30 years in emergency nursing and an average length of experience in triage of 5 years.

Methods: Participants in the study were provided with a summary of the study and gave informed consent to be observed in their role as clinical ED nurses. Field notes were collected during observation, and organized and analyzed.
Demographic information about the nurse participants was also collected, specifically age, gender, educational level in nursing, number of years as an emergency nurse, and number of years in triage.

Results/Outcomes: Data suggests that ED nurses generate meaning about patient acuity from physical presentation, body habitus, and length of presenting symptoms. Decision making was also affected by crowding, providers, and staffing levels. Physiologic data was not rigorously collected nor considered primarily in patient acuity decisions.

Implications: Education and training for nurses in the triage role must consider the lack of emphasis on physiologic data. Unit and administrative leadership should consider staffing and crowding as contributors to the decision making process and address these issues accordingly.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.title"I Didn't Like How he Looked: Decisionmaking at Initial Presentation"en_GB
dc.identifier.urihttp://hdl.handle.net/10755/162354-
dc.description.abstract<table><tr><td colspan="2" class="item-title">&quot;I Didn't Like How he Looked: Decisionmaking at Initial Presentation&quot;</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Wolf, Lisa, RN, MS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Massachusetts, Amherst</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Skinner Hall, Univ. of MA, Amherst, MA, 01035, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">413-582-2468</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">noblewolf3@aol.com</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Research Abstract: &quot;I Didn't Like How he Looked: Decisionmaking at Initial Presentation&quot;<br/><br/>Purpose: The purpose of the study is to explore the beliefs, behaviors, assumptions and expressions of meaning in a group of emergency department nurses in two community hospitals in the Northeastern United States as they relate to the generated meaning and understanding of patient acuity levels.<br/> The triage nurse is generally the first person to interact with an ED patient, and the person who determines the acuity of condition and where the patient will go next; given that accurately placing patients in the correct area of the ED, and anticipating both their acuity and their need for resources is important to the safe care and efficient treatment of ED patients, the ability of the triage nurse to do this work well is crucial.<br/> The literature describing the processes by which triage nurses make decisions in their day-to-day practice describes heuristics (Cioffi, 1998; Brannon &amp; Carson, 2003), thinking strategies (Goransson et al, 2008), factors that might influence decision making in triage (Andersson et al, 2006; Fry &amp; Burr, 2001), and the relevance of physiologic data (Chung, 2005; Gerdtz &amp; Bucknall, 2001). Importantly, though, there is still a lot of uncertainty about the processes and critical thinking strategies used by triage nurses to assign acuity, and therefore, surrounding the possible strategies for improving nursing practice in this area.<br/><br/>Design: Ethnography concentrates on the qualitative, prospective, in-depth exploration of small groups of people to understand how they organize their daily lives and how they view their world (Helman, 2007). Ethnography offers a richly descriptive report of an individual&AElig;s perceptions, attitudes, meanings and interpretations of different events (Hakim, 2000). This study examined individual assumptions in the context of the subculture of emergency room nurses; the investigation was of a group and a culture, not of individual nurses. <br/><br/>Setting: A 429 bed level II trauma center and a 25 bed critical access hospital <br/><br/>Participants/Subjects: 10 emergency nurses; 9 white, 9 female, with a range of experience from 3-30 years in emergency nursing and an average length of experience in triage of 5 years.<br/><br/>Methods: Participants in the study were provided with a summary of the study and gave informed consent to be observed in their role as clinical ED nurses. Field notes were collected during observation, and organized and analyzed.<br/>Demographic information about the nurse participants was also collected, specifically age, gender, educational level in nursing, number of years as an emergency nurse, and number of years in triage.<br/><br/>Results/Outcomes: Data suggests that ED nurses generate meaning about patient acuity from physical presentation, body habitus, and length of presenting symptoms. Decision making was also affected by crowding, providers, and staffing levels. Physiologic data was not rigorously collected nor considered primarily in patient acuity decisions.<br/><br/>Implications: Education and training for nurses in the triage role must consider the lack of emphasis on physiologic data. Unit and administrative leadership should consider staffing and crowding as contributors to the decision making process and address these issues accordingly.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:26:42Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:26:42Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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