Journal List > J Korean Acad Nurs > v.49(2) > 1121937

Kim and Kang: Effects of a Web-Based Korean Triage and Acuity Scale Learning Program on Triage Self-Efficacy and Triage Performance Ability for Nurses in Emergency Department



The Korean Triage and Acuity Scale (KTAS) is a tool used to classify the severity and urgency of emergency department (ED) patients, focusing on their symptoms. In consideration of the importance of the KTAS, a web-based learning program has emerged as a new mode of education; it enables ED triage nurses to access it anytime and anywhere, and according to their own learning abilities. This study aimed to develop a web-based KTAS learning program and evaluate its effects on self-efficacy and triage performance ability in ED nurses.


A quasi-experimental design with a non-equivalent control group pretest-posttest was used. The conceptual framework was Bandura's self-efficacy theory. There were 30 participants in the experimental group and 29 in the control group. The experimental group attended an orientation and 4 sessions of a web-based KTAS learning program. The learning program lasted 280 minutes over five weeks, consisting of 40 minutes of orientation and four 60-minute sessions.


The scores of self-efficacy, triage performance ability in KTAS level, and chief complaints significantly increased in the experimental group compared to the control group. In addition, the numbers of under-triage in KTAS significantly decreased in the experimental group in comparison to the control group.


The results suggest that the learning program was effective in improving ED nurses' level of self-efficacy and triage performance ability (KTAS level and KTAS chief complaint). Accordingly, the web-based KTAS learning program can be applied as an education intervention to improve ED nurses' triage skill.

Figures and Tables

Figure 1

Research progress flow diagram.

Figure 2

Web-based Korean triage and acuity scale learning program.

Table 1

Homogeneity of General Characteristics and Dependent Variables between Experimental and Control Groups (N=59)


Exp.=Experimental group; Cont.=Control group; KTAS=Korean Triage and Acuity Scale; M=mean; SD=standard deviation.

Table 2

Comparison of Triage Self-Efficacy and Triage Performance Ability between Experimental and Control Groups (N=59)


Exp.=Experimental group (n=30); Cont.=Control group (n=29); KTAS=Korean Triage and Acuity Scale; M=mean; SD=standard deviation.


The authors thank the KTAS committee in the Korean Society of Emergency Medicine.


This manuscript is a condensed form of the first author's doctoral dissertation from Chosun University.

CONFLICTS OF INTEREST The authors declared no conflict of interest.


1. Ministry of Health and Welfare (MOHW). Enforcement regulations of emergency medical care law: Korean emergency patient triage criteria [Internet]. Sejong: MOHW;c2015. cited 2017 Jan 1. Available from:
2. Montejano AC, Visser LS. What is a triage nurse? Journal of Emergency Nursing. 2010; 36(1):85–86. DOI: 10.1016/j.jen.2009.07.010.
crossref pmid
3. Ganley L, Gloster AS. An overview of triage in the emergency department. Nursing Standard. 2011; 26(12):49–56. DOI: 10.7748/ns2011.
4. Baek MK. Relationship between level of autonomy and clinical decision-making in nursing scale of E.T nurse [master's thesis]. Seoul: Yonsei University;2005. 1–100.
5. Robertson-Steel I. Evolution of triage systems. Emergency Medicine Journal. 2006; 23(2):154–155. DOI: 10.1136/emj.2005.030270.
crossref pmid
6. Bandura A. Self-efficacy: The exercise of control. New York (NY): W.H. Freeman and Company;1997. p. 1–592.
7. Chung JY. An exploration of accident and emergency nurse experiences of triage decision making in Hong Kong. Accident and Emergency Nursing. 2005; 13(4):206–213. DOI: 10.1016/j.aaen.2005.08.003.
crossref pmid
8. KTAS Committee in the Korean Society of Emergency Medicine. Korean Triage Acuity Scale instructor training manual. Seoul: Korean Society of Emergency Medicine;2016. p. 1–150.
9. The Korean Society of Emergency Medicine. Validity and reliability verification report of Korean Triage Acuity Scale. Sejong: Ministry of Health and Welfare;2014. p. 1–80.
10. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Academic Emergency Medicine. 2000; 7(3):236–242. DOI: 10.1111/j.1553-2712.2000.tb01066.x.
crossref pmid
11. Lee HJ, Cho KJ. Comparison of knowledge level of triage in 119 EMTs. Korean Journal of Emergency Medical Services. 2014; 18(1):43–54.
12. Lee EK, Kim JS. Factors influencing triage nurses' the Korean Triage and Acuity Scale performance ability. Journal of Korean Clinical Nursing Research. 2018; 24(1):94–102. DOI: 10.22650/JKCNR.2018.24.1.94.
13. Fernandes CM, McLeod S, Krause J, Shah A, Jewell J, Smith B, et al. Reliability of the Canadian triage and acuity scale: Interrater and intrarater agreement from a community and an academic emergency department. Canadian Journal of Emergency Medicine. 2013; 15(4):227–232. DOI: 10.2310/8000.2013.130943.
crossref pmid
14. Lee MH, Choi SH, Park MJ. Effect of CPR training for lay trainees on their knowledge and attitudes. Journal of Korean Academy of Fundamentals of Nursing. 2007; 14(2):198–203.
15. Kook MJ. A study on the effect and application of motion picture materials in geography subject. Journal of the Korean Association of Geographic and Environmental Education. 2003; 11(3):119–132.
16. Kim YM, Chun IS, Park YM. Development of a hemodialysis nurse educational program and its effects. Journal of the Korea Academia-Industrial Cooperation Society. 2012; 13(12):5839–5848. DOI: 10.5762/KAIS.2012.13.12.5839.
17. Choi JS, Kim KS. Application and evaluation of a web-based education program on blood-borne infection control for nurses. Journal of Korean Academy of Nursing. 2009; 39(2):298–309. DOI: 10.4040/jkan.2009.39.2.298.
crossref pmid
18. Bandura A. Guide for creating self-efficacy scales. In : Pajares F, Urdan T, editors. Self-efficacy beliefs of adolescents. Greenwich (CT): Information Age Publishing;2006. p. 307–337.
19. Branch RM. Instructional design: The ADDIE approach. New York (NY): Springer Science & Business Media;2009. p. 23–173.
20. Lee SH. Effectiveness of web based learning program on self efficacy, knowledge, and competence in measurement of blood pressure. Journal of Korean Academy of Fundamentals of Nursing. 2012; 19(1):66–73.
21. Du S, Liu Z, Liu S, Yin H, Xu G, Zhang H, et al. Web-based distance learning for nurse education: A systematic review. International Nursing Review. 2013; 60(2):167–177. DOI: 10.1111/inr.12015.
crossref pmid
22. Boo EH. The effect of self-efficacy promoting program on the new staff nurse's self-efficacy and organizational socialization outcome [dissertation]. Seoul: Yonsei University;2006. 1–134.
23. Rankin JA, Then KL, Atack L. Can emergency nurses' triage skills be improved by online learning? Results of an experiment. Journal of Emergency Nursing. 2013; 39(1):20–26. DOI: 10.1016/j.jen.2011.07.004.
crossref pmid
24. Barsi C, Harris P, Menaik R, Reis NC, Munnangi S, Elfond M. Risk factors and mortality associated with undertriage at a level I safety-net trauma center: A retrospective study. Open Access Emergency Medicine. 2016; 8:103–110. DOI: 10.2147/OAEM.S117397.
crossref pmid
25. Jeong SK, Lim JY, Hong SY, Choi SM, Choi SP. Chief complaints and related features of elderly patients presenting to one region wide emergency medical center with medical problems. Journal of the Korean Geriatrics Society. 2013; 17(3):118–125. DOI: 10.4235/jkgs.2013.17.3.118.
26. Ha SO, Lim KS, Kim W, Oh BJ. Clinical characteristics and worsening prognosis for undertriage patients in the emergency department: A university affiliated hospital observational study. Journal of the Korean Society of Emergency Medicine. 2011; 22(6):701–708.
27. Cha MI. A comparison study of triage results between prehospital and hospital settings [dissertation]. Incheon: Gachon University;2017. 1–54.
28. National Association of Emergency Medical Technicians (US) Pre-Hospital Trauma Life Support Committee, American College of Surgeons Committee on Trauma. PHTLS: Basic and advanced prehospital trauma life support. 5th ed. St Louis (MO): Mosby;2005. p. 1–448.
29. Kim JH, Kim JW, Kim SY, Hong DY, Park SO, Baek KJ, et al. Validation of the Korean triage and acuity scale compare to triage by emergency severity index for emergency adult patient: Preliminary study in a tertiary hospital emergency medical center. Journal of the Korean Society of Emergency Medicine. 2016; 27(5):436–441.

Hyo-Jin Kim

Hee-Young Kang

Similar articles