Explicating Nurses' Cardiac Triage Decisions

Background and Research Objective: Although nurses frequently determine patient priority and urgency status for emergency evaluation and treatment of symptoms suggestive of myocardial infarction (MI), surprisingly few studies have specifically examined the cardiac triage decisions of emergency department (ED) nurses. Therefore, the purpose of this study was to explicate the decision-making processes of ED nurses who triage men and women for MI. Subjects and Methods: A qualitative, descriptive study was conducted using focus group methodology. A synthesized conceptual model was used to guide focus group discussions and to begin the process of developing a conceptually based, quantifiable measure of ED nurses' cardiac triage decisions. Participants' (N = 12) oral descriptions were audiotape recorded, transcribed verbatim, and analyzed using the Krueger content analysis method. Results: When making MI triage decisions and determining triage urgency status, ED nurses determine the underlying cause of patients' chief complaints based on clinical presentation, patient demographics, past medical history, as well as their own attitudes, perceptions and beliefs, nursing knowledge, and ED experience. Important patient cues include general appearance, vital signs, cardiac history, chest pain, and mode of transportation. Nurse's ultimate goal when making cardiac triage decisions is to have the patient receive a prompt electrocardiogram and prompt medical evaluation and to advocate for the patient. Conclusions: Nurses are knowledgeable of age and sex differences in MI presentation. However, some nurses hold cultural biases and stereotypes that may interfere with the timely delivery of emergency cardiac healthcare. Findings from this study will be used to develop a quantifiable measure of ED nurses' cardiac triage decision-making processes.