An educational framework for triage nursing based on gatekeeping, timekeeping and decision-making processes.
BACKGROUND
The role of the triage nurse has emerged in response to growing community demand for a more accessible and efficient emergency department (ED) service. The focus of triage research has been on measuring outcomes and improving the delivery of emergency care. This has meant that the context of care, and triage processes and practices have remained concealed. Thus, little evidence about the role and ways to prepare nurses for this role is available. The aim of this study was to provide insight and understanding needed to educate and support the triage nursing role in Australian EDs.


METHODS
A 12-month ethnographic study of triage nursing practice was conducted in Sydney metropolitan EDs. Data were then collected from participant observation in four EDs and interviews with 10 triage nurses. Analysis used standard content and thematic analysis techniques.


RESULTS
Findings reveal that notions of timeliness, efficiency and equity are embedded in a culture of ED care. This sustains a particular cadence of care to which triage nurses are culturally oriented. Triage nurses maintain, negotiate and restore this cadence of emergency care by using gatekeeping, timekeeping and decision-making processes.


CONCLUSIONS
The comprehensive study of triage nursing has led to the development of an educational framework based on the processes of gatekeeping, timekeeping and decision-making.
Fry
Margaret
M
Emergency Department, St. George Hospital Kogarah, Sydney, NSW 2217, Australia. frym@sesiahs.nsw.gov.au
Stainton
Colleen
C
D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003657:Decision Making; D004509:Education, Nursing, Continuing / Q000458:organization & administration; D017598:Efficiency, Organizational; D016529:Emergency Nursing / Q000193:education / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D017145:Models, Educational; D009517:New South Wales; D024802:Nurse's Role / Q000523:psychology; D015402:Nursing Education Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D017748:Time Management; D017749:Total Quality Management; D014218:Triage / Q000458:organization & administration*