2.50
Hdl Handle:
http://hdl.handle.net/10755/198340
Title:
Emergency Nurse Clinical Decisions with Pediatric Pain and Triage
Abstract:
[ENA Annual Conference 2011 - Research Presentation]Emergency Nurse Clinical Decisions with Pediatric Pain and Triage

Purpose: Children visit the ED more than any age except those over 65. The purpose of this study was to describe triage decision-making and pediatric pain assessment, and factors influencing decision-making. Research questions: Phase I: 1. What are the cognitive processes/ knowledge sources ED nurses use in pediatric pain assessment triage decision-making? 2. What factors influence ED nurses’ clinical decisions? Phase II: 1. What nurse variables are associated with differences in triage level assigned for a given vignette? 2. What patient variables are associated with differences in triage level assigned for a given vignette?

Design: A mixed methods approach included a qualitative component, (semi-structured interviews) and a quantitative component (triage vignette exercise). Methodology triangulation allowed for describing and then assessing the distribution, strength, and direction of commonalities and differences found.

Setting: Phase I included Emergency Departments from a four-hospital system, and a metropolitan Level One Pediatric ED located in the Southeast United States. Phase II consisted of an Internet-based triage vignette exercise completed by ED nurses.

Participants: Inclusion criteria consisted of ED Nurses who worked more than 16 hours per week, with more than 6 months experience as triage nurse, completion of triage orientation, or a triage course, and speaking English. Following IRB approval, participants were recruited by posting announcements in the ED nurses’ lounge. A convenience sample of 13 nurses was interviewed and tape recorded. Ages ranged from 26 to 48 years and all were of non-Hispanic white ethnicity.
Participants for Phase II were recruited from ED nurses who responded to an e-mailed announcement. A convenience sampling procedure based on a four phase process resulted in 118 completed questionnaires.. Participants were predominantly White females with an age range of 26 to 72 years, and an ED experience mean of 20 years.

Methods: Interview questions were piloted with a sample of ED nurses to assess credibility and dependability Interviews were tape recorded, transcribed and analyzed using qualitative descriptive methods including constant comparison, reflective analysis and coding, and field notes. The factors and meanings derived were incorporated into a series of triage vignettes. Demographic data included age, gender, ethnicity, education, and years of ED experience.
For Phase II, ED nurses assigned a triage level to patient vignettes. Validity for the vignettes was estimated by a panel of experts rating the relevance and sufficiency of information in vignettes on a 4-point scale. A content validity index (CVI) was calculated. Reliability was estimated by assessing stability with a test – retest procedure. Ordinal logistic regression with a cumulative logit model identified patient and nurse variables which influenced triage decisions.

Results/Outcomes: Five common themes emerged from the qualitative data. Ordinal logistic regression (Wald ?2 , p< .005) identified variables associated with higher triage levels. Significant variables included infant age range, Hispanic ethnicity, ED experience (11 – 20 years), and education.

Implications: Enhancement of triage and care of the pediatric patient experiencing pain, expanding the knowledge base of emergency nursing, identify areas for change, and provide direction for future education, training, and research.
Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleEmergency Nurse Clinical Decisions with Pediatric Pain and Triageen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198340-
dc.description.abstract[ENA Annual Conference 2011 - Research Presentation]Emergency Nurse Clinical Decisions with Pediatric Pain and Triage <br/><br/>Purpose: Children visit the ED more than any age except those over 65. The purpose of this study was to describe triage decision-making and pediatric pain assessment, and factors influencing decision-making. Research questions: Phase I: 1. What are the cognitive processes/ knowledge sources ED nurses use in pediatric pain assessment triage decision-making? 2. What factors influence ED nurses’ clinical decisions? Phase II: 1. What nurse variables are associated with differences in triage level assigned for a given vignette? 2. What patient variables are associated with differences in triage level assigned for a given vignette? <br/><br/>Design: A mixed methods approach included a qualitative component, (semi-structured interviews) and a quantitative component (triage vignette exercise). Methodology triangulation allowed for describing and then assessing the distribution, strength, and direction of commonalities and differences found.<br/><br/>Setting: Phase I included Emergency Departments from a four-hospital system, and a metropolitan Level One Pediatric ED located in the Southeast United States. Phase II consisted of an Internet-based triage vignette exercise completed by ED nurses.<br/><br/>Participants: Inclusion criteria consisted of ED Nurses who worked more than 16 hours per week, with more than 6 months experience as triage nurse, completion of triage orientation, or a triage course, and speaking English. Following IRB approval, participants were recruited by posting announcements in the ED nurses’ lounge. A convenience sample of 13 nurses was interviewed and tape recorded. Ages ranged from 26 to 48 years and all were of non-Hispanic white ethnicity. <br/>Participants for Phase II were recruited from ED nurses who responded to an e-mailed announcement. A convenience sampling procedure based on a four phase process resulted in 118 completed questionnaires.. Participants were predominantly White females with an age range of 26 to 72 years, and an ED experience mean of 20 years. <br/><br/>Methods: Interview questions were piloted with a sample of ED nurses to assess credibility and dependability Interviews were tape recorded, transcribed and analyzed using qualitative descriptive methods including constant comparison, reflective analysis and coding, and field notes. The factors and meanings derived were incorporated into a series of triage vignettes. Demographic data included age, gender, ethnicity, education, and years of ED experience. <br/> For Phase II, ED nurses assigned a triage level to patient vignettes. Validity for the vignettes was estimated by a panel of experts rating the relevance and sufficiency of information in vignettes on a 4-point scale. A content validity index (CVI) was calculated. Reliability was estimated by assessing stability with a test – retest procedure. Ordinal logistic regression with a cumulative logit model identified patient and nurse variables which influenced triage decisions. <br/><br/>Results/Outcomes: Five common themes emerged from the qualitative data. Ordinal logistic regression (Wald ?2 , p< .005) identified variables associated with higher triage levels. Significant variables included infant age range, Hispanic ethnicity, ED experience (11 – 20 years), and education. <br/><br/>Implications: Enhancement of triage and care of the pediatric patient experiencing pain, expanding the knowledge base of emergency nursing, identify areas for change, and provide direction for future education, training, and research.<br/>en_GB
dc.date.available2011-12-21T12:46:23Z-
dc.date.issued2011-12-21T12:46:23Z-
dc.date.accessioned2011-12-21T12:46:23Z-
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