Development of a Triage Competency Scale for Emergency Nurses

Sun Hee Moon; Yeon Hwan Park

doi:10.4040/jkan.2018.48.3.362

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Moon and Park: Development of a Triage Competency Scale for Emergency Nurses

Original Article

J Korean Acad Nurs 2018;48(3):362-374.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.3.362

Development of a Triage Competency Scale for Emergency Nurses

Sun Hee Moon¹, Yeon Hwan Park^2,

¹Department of Nursing, College of Health and Welfare and Education, Gwangju University, Gwangju

²College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Address reprint requests to : Park, Yeon Hwan College of Nursing · The Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8846 Fax: +82-2-765-4103 E-mail: hanipyh@snu.ac.kr

Received 12 March 2018 Revised 9 June 2018 Accepted 10 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to develop a triage competency scale (TCS) for emergency nurses, and to evaluate its validity and reliability.

Methods

Preliminary items were derived based on the attributes and indicators elicited from a concept analysis study on triage competency. Ten experts assessed whether the preliminary items belonged to the construct factor and determined the appropriateness of each item. A revised questionnaire was administered to 250 nurses in 18 emergency departments to evaluate the reliability and validity of the scale. Data analysis comprised item analysis, confirmatory factor analysis, contrasted group validity, and criterion-related validity, including criterion-related validity of the problem solving method using video scenarios.

Results

The item analysis and confirmatory factor analysis yielded 5 factors with 30 items; the fit index of the derived model was good (χ ²/df =2.46, Root Mean squared Residual=.04, Root Mean Squared Error of Approximation=.08). Additionally, contrasted group validity was assessed. Participants were classified as novice, advanced beginner, competent, and proficient, and significant differences were observed in the mean score for each group (F=6.02, p=.001). With reference to criterion-related validity, there was a positive correlation between scores on the TCS and the Clinical Decision Making in Nursing Scale (r=.48, p<.001). Further, the total score on the problem solving method using video scenarios was positively correlated with the TCS score (r=.13, p=.04). The Cronbach's α of the final model was .91.

Conclusion

Our TCS is useful for the objective assessment of triage competency among emergency nurses and the evaluation of triage education programs.

Keywords: Emergency Nursing, Triage, Clinical Competence, Factor Analysis

References

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Figure 1.

Flow chart for this study.

Table 1.

Characteristics of the Participants (N=250)

Characteristics	Classification	n (%) or M±SD
Age (yr)		30.20±7.10
	20~29	138 (55.2)
	30~39	85 (34.0)
	40~49	22 (8.8)
	≥50	5 (2.0)
Sex	Male	21 (8.4)
	Female	229 (91.6)
Most recent degree	Diploma	79 (31.6)
	Bachelor’s degree	157 (62.8)
	≥ Master’s degree	14 (5.6)
Experience in Nursing (yr)		7.27±6.98
	<1	37 (14.8)
	1~ less than 3	44 (17.6)
	3~ less than 7	68 (27.2)
	≥ 7	101 (40.4)
Experience in the emergency department (yr)		3.83±3.72
	<1	60 (24.0)
	1~ less than 3	59 (23.6)
	3~ less than 7	95 (38.0)
	≥ 7	36 (14.4)
Experience of Triage (yr)	Yes	131 (52.4)
	Duration of triage	2.10±2.84
	No	119 (47.6)
Triage training	Yes	169 (67.6)
	No	81 (32.4)
Type of emergency department	Regional emergency	46 (18.4)
	department
	Local emergency	204 (81.6)
	department

M±SD=Mean±standard deviation.

Table 2.

Measured Variable Estimates of the Confirmatory Factor Model (N=250)

Factor	Item	Unstandardized λ	Standard Error	Critical Ratio	l Standardized λ
Clinical judgment	Q1: On a patient’s arrival, I can decide if the patient needs immediate care based on a first look.	1.00	-	-	0.57
	Q2: I can intuitively identify a patient experiencing a cardiac arrest.	1.11	0.16	6.84	0.52
	Q3: I can connect a patient’s symptoms with the vital signs.	0.83	0.12	6.73	0.51
	Q4: I can connect a patient’s symptoms caused by an accident with injury mechanisms.	1.05	0.15	7.25	0.56
	Q5: I can interpret a patient’s symptoms by considering his/her underlying diseases.	0.97	0.14	7.09	0.54
	Q7: I can identify clues of an emergent disease from a patient’s trivial actions or words.	1.20	0.16	7.48	0.58
	Q8: I can identify several diseases based on a patient’s complaints.	1.20	0.16	7.62	0.60
	Q9: I know which severe symptoms should be addressed with priority.	1.14	0.14	8.21	0.67
	Q10: Based on a patient’s complaints, I can identify if the patient needs to be isolated for a suspected infectious disease.	1.17	0.16	7.16	0.55
	Q12: I am able to clearly identify the health problems of a patient who reports symptoms discursively.	1.36	0.16	8.32	0.68
	Q13: I can make evidence-based decisions on triage.	1.27	0.15	8.36	0.69
	Q15: I can predict the treatments and interventions that may be provided to a patient.	0.89	0.12	7.42	0.58
	Q17: I try to review the accuracy of or mistakes in my triage.	0.96	0.15	6.21	0.46
Expert assessment	Q30: While interviewing a patient, I can take a rough look at patients waiting behind.	1.00	-	-	0.46
	Q21: I can understand what a patient and caregivers expect from the treatment at the emergency room.	1.24	0.22	5.70	0.58
	Q19: I can perform a simple physical assessment to confirm the disease I suspect.	1.43	0.25	5.80	0.60
	Q18: During an interview with a patient for triage, I can investigate about the patient by scanning from his/her head to toe.	1.60	0.26	6.21	0.72
Management of medical resources	Q26: I am aware of the types of medical resources available at the emergency room.	1.00	-	-	0.69
	Q27: I can determine the best placement for a patient.	0.93	0.11	8.70	0.70
	Q25: I know the internal regulations of the emergency room about the placement of patients after triage.	1.08	0.12	8.82	0.71
	Q23: When several patients arrive at the hospital simultaneously, I can handle the situation by asking for help from team members (doctors, nurses, emergency medical technicians, security guards, etc.).	0.35	0.12	2.92	0.21
Timely decision	Q38: My team members (doctors, nurses, emergency medical technicians, security guards, etc.) think that I work efficiently and rapidly.	1.00	-	-	0.53
	Q37: I can rapidly intervene when a patient’s condition exacerbates suddenly.	0.94	0.14	6.88	0.58
	Q11: I am confident that I can perform triage reasonably.	1.19	0.15	8.02	0.77
	Q34: I am confident that my clinical experiences in the emergency room may be helpful for patients.	0.91	0.15	6.26	0.51
Communication	Q44: I can easily understand what a patient means.	1.00	-	-	0.72
	Q42: I can ask appropriate questions to clarify the meaning when a patient speaks discursively.	0.84	0.11	7.58	0.59
	Q41: Patients understand my questions or explanations well.	0.75	0.10	7.78	0.61
	Q48: I provide a clear explanation to a patient who needs Nothing Per Os (NPO).	0.67	0.12	5.57	0.42
	Q49: I can reduce a patient’s anxiety in the emergency room by giving a brief explanation about the treatment process.	0.72	0.12	5.83	0.44
Model fitness: χ²=971.2 (p<.001), χ²/df=2.46, RMR=.04, RMSEA=.08

RMR=Root mean squared residual; RMSEA=Root mean squared error of approximation.

Table 3.

Mean Score between each Stages for Contrasted Groups Validity (N=250)

Stages	Experience in the ED (yr)	Number of participants	M±SD	F	p-value	Post hoc (Dunnett T3)
Novice (a)	<1	60	85.50±12.30	6.02	.001	a, b <c,d
Advanced beginner (b)	1~ less than 3	59	84.63±13.18
Competent (c)	3~ less than 7	95	89.89±9.66
Proficient (d)	≥ 7	36	92.69±7.48
Total		250	88.00±11.32

ED=emergency department; M±SD=Mean±standard deviation.

Table 4.

Correlation between the Clinical Decision Making in Nursing Scale and the Triage Competency Scale, and Reliability Coefficients (N=250)

	Clinical judgment	Expert assessment	Management of medical resources	Timely decision	Communication	Triage competency scale
Correlation
CDMNS	.41	.46	.27	.17	.51	.48
p-value	<.001	<.001	<.001	<.001	<.001	<.001
Cronbach’s α	.86	.67	.62	.69	.69	.91
Score range	0~52	0~16	0~16	0~16	0~20	0~120
M±SD	38.47±5.67	10.22±2.26	12.82±1.96	11.45±2.12	15.04±2.12	88.00±11.32

CDMNS=clinical decision making in nursing scale; M±SD=Mean±standard deviation.

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