Momentary Fitting in a Fluid Environment: A Grounded Theory of Triage Nurse Decision Making
Date
2014-09-12
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Abstract
Emergency departments (EDs) are fluid environments where conditions are constantly changing. Triage nurses control access to the ED and make decisions about patient acuity, placement, and priority to be examined by a physician. Understanding the processes and strategies that triage Registered Nurses (RNs) use in decision making is therefore vital for patient safety and operation of the ED.
The aim of this classical grounded theory study was to understand the processes and strategies that experienced emergency RNs use when making triage decisions and to generate a substantive grounded theory of triage RN decision making. Data collection consisted of twelve interviews with triage RNs and seven observations of the triage environment at three hospital sites in a major urban centre. Initial sampling was purposive; as categories began to emerge theoretical sampling was used in accordance with grounded theory. The data were analyzed using the constant comparative method.
Findings reveal that the main concern of triage RNs was to achieve best possible fit between patients and the ED as a whole, given the circumstances for each moment in time. The main concern was conceptualized as the core category Momentary Fitting in a Fluid Environment. Best possible fit was not synonymous with optimal fit. Decision making occurred in a context where each decision changed the conditions for subsequent decisions. Momentary fitting consists of the interrelated categories determining acuity, anticipating needs, managing space, and creating space. At certain critical junctures, RNs decided to create space by pushing boundaries and, at times, temporarily crossing boundaries.
Momentary Fitting theory makes explicit the importance for triage RNs to maintain up to date awareness of what is transpiring in the ED. This includes knowledge of incoming critical patients, the condition of patients waiting to be examined, and real time information about available treatment spaces, patients, and staff resources. Moreover, the findings point to the need for structuring triage environments to facilitate mechanisms that allow quick communication between co-workers. The results have implications for design of triage areas, computer programs, graphical user interfaces and education. Future research needs to account for the contextual and ethical nature of triage decisions.
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Medicine and Surgery, Nursing, Psychology--Cognitive
Citation
Reay, G. (2014). Momentary Fitting in a Fluid Environment: A Grounded Theory of Triage Nurse Decision Making (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26996