title: Momentary fitting in a fluid environment: A grounded theory of triage nurse decision making.
abstract: BACKGROUND
  Triage nurses control access to the Emergency Department (ED) and make decisions about patient acuity, patient priority, and placement of the patient in the ED. Understanding the processes and strategies that triage nurses use to make decisions is therefore vital for patient safety and the operation of the ED. The aim of the current study was to generate a substantive grounded theory (GT) of decision making by emergency triage Registered Nurses (RNs).
  
  
  METHODS
  Data collection consisted of seven observations of the triage environment at three tertiary care hospitals where RNs conducted triage and twelve interviews with triage RNs. The data were analyzed by constant comparison in accordance with the classical GT method.
  
  
  RESULTS
  In the resultant theory, Momentary Fitting in a Fluid Environment, triage is conceptualized as a process consisting of four categories, determining acuity, anticipating needs, managing space, and creating space. The findings indicate that triage RNs continually strive to achieve fit, while simultaneously considering the individual patient and the ED as a whole entity.
  
  
  CONCLUSIONS
  Triage RNs require appropriately designed triage environments and computer technology that enable them to secure real time knowledge of the ED to maintain situation awareness.
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4. Electronic address: gudrun.reay2@ucalgary.ca.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Reay
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4.
authors.forename: James A
authors.initials: JA
authors.lastname: Rankin
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Then
mesh_terms: D002170:Canada; D003657:Decision Making; D016529:Emergency Nursing / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D066296:Grounded Theory; D006304:Health Status; D006801:Humans; D009726:Nurses / Q000523:psychology / Q000592:standards*; D036301:Qualitative Research; D014218:Triage / Q000379:methods*; D000078329:Workforce
keywords: Decision making; Distributed cognition; Emergency nursing; Fluid environment; Grounded theory; Situation awareness; Software design; Triage