Research Proposal on "Applicability of Having One Universal Triage System in Emergency Nursing"

Research Proposal 8 pages (2212 words) Sources: 8

[EXCERPT] . . . .

Universal Triage System in Emergency Nursing

The word "triage" has its origin traced from "trier" a French word meaning sort, classify or choose (Williams,1992). The triage system of prioritizing the way care is dispensed to a large number of patients has been adapted from its earlier origin which was military to fit into civilian context as the very first step in the process of handling medical/clinical emergencies. The context of triage in the emergency department (ED) is considered a rather formal process that has to be performed in order to immediately assess all the patients who are in need of emergency clinical care (Mallett & Woolwich, 1990).The finding an obtained from the triage assessment are then utilized in prioritizing or rather classifying the various patients based on their level of sickness or severity of their injury. This is then used in planning accordingly for the appropriate medical/nursing need (ACEM,1993a).

The aim of an effective triage system is to ensure that the patients in the ED "receive appropriate attention, in a suitable location, with the requisite degree of urgency"( George, Read, Westlake, Williams, Pritty & Fraser Moodie,1993). Therefore the main essence in having the universal triage system is to promote a clinical environment that promotes the safety of all the patients who are in any emergency department of a medical facility. This therefore ensures that there is proper timing in terms of the rate at which care is dispensed and that there is appropriate allocation of the resources that are available. The allocation of the resources is done is accordance to the degree/severity of illness or injury (ACEM,1993b).It is worth pointing out that the decisions involved in any triage system is made up complex clinical/medical decisions that are mainly made under conditions that can best be described as uncertain with lack of concise information and minimal time frame but with the utmost requirement of minimal rates of error.

It is therefore very important for the triage nurses to have the knowledge that would allow them to effectively evaluate/assess every emergency situation and to come up with the appropriate information necessary for the successful execution of the various triage operations.This therefore means that it is the responsibility of the nurse who carries out the triage to come up with a rapid identification and response to a certain threat to a patient's life.

Aims and Objectives

Aim

Our aim is to determine the applicability of having one universal triage system in emergency nursing

Core objectives

Our core objective is to come up with the appropriate framework and conditions which can favor the rolling out of a universal triage system. Our need for to meet these objectives are fuelled by globalization and unification of the global system with the possibility of reducing time, money and improving efficiency. This in the health care sectors means the saving of more lives.

Statement of the problem

The requirement for the triage system in the emergency department(ED) of most hospitals means that it is a necessary component of every health facility. We are at a time when everyone is longing for a universal health system that is aimed at harmonizing the standards used in various regions of the world. The result will be an increase in efficiency in service delivery as well as a reduction in the cost of running hospitals and also a reduction of the rate of cost of health care. The main application of the universal triage system is however pegged on its ability to deliver rapid success rate in tackling of problems entailing mass casualty and of universal gravity such as floods, hurricanes, earthquakes as well as terrorism. These kinds of calamities usually demand the help of various nations and therefore it would be appropriate to have all the workers and volunteers having a common knowledge on how to handle the clinical emergencies. This would therefore assist in the easy integration of the various volunteers and workers when tackling a particular incident.

Triage is process of evaluating and determining which patients need priority treatment on the basis of their severity of the medical condition. The word triage is coined from the French word "trier" meaning to sort and has its roots in the battlefields during world war 1. The triage system is divided into three categories. Pre-Hospital Triage that identifies where to send hospital resources based on priority. Triage at the scene of a medical condition or emergency by the arriving clinician or paramedic. The third triage systems involve triage on arrival at a health facility or emergency department. Various countries have different triage models. The more common ones are the Manchester triage system. The Australian Triage Score. The French SAMU triage system. The Cape Triage System and the Canadian Triage Assessment Score. One of the major shortcomings of triage systems is that the early triage systems were trauma based. They were designed to handle battlefield situations, mass accidents or natural disasters. There is need to have a triage system that handles the full spectrum of disease from the very minor clinical condition to more advanced medical cases. The pre-hospital triage systems have a very wide application in different countries. However they have been shown to lack sensitivity. They have been shown to be lacking in applicability inside the hospital during emergencies. This is because different clinical parameters have to be measured. For those patients who are identified as requiring only routine care the challenge is in putting them into the right care channel.

Literature review

Several pieces of literature has been dedicate to the context of triage. In this proposal we present a variety of aspects of the triage systems.

The need for triage

Several pieces of literature have been dedicated to the roles that triage plays in various health facilities. The common aspect of the literature is the fact that the triage system expects nurses to make a decision within a short period of time on the urgency that is needed for each and every patient in the ED so as to allocate them the appropriate care/interventions as well as space (Purnell,1991). The triage system has to be very simple as a complication of the process is a recipe for a lot of problems. It is therefore necessary to ensure that there is an extensive knowledge base to be used in the process of modeling the various triage systems. This is coupled by the need to come up with unique presentations and the large volume of care practices that need to be taken in order to ensure that there is a timely style of investigation as well as referrals as necessary for every patient (VanBoxel, 1995).

As to the origin of the triage practice, a lot of literature has been dedicated to the issue of triage system. The 70s saw the nurses in the U.S. start practicing triage in their hospitals facilities (Estrada, 1979). A move that was adopted as a result of the adoption of the emergency triage technique. This therefore meant that the process be undertaken by a professional (George, 1995). It is worth noting that at that period, the triage system was regarded as a sub-specialty of the then emergency nursing as postulated by Shields (1976).

Literature reveals that the triage system was implemented in the Britain in the 1980s.A dedicated triage nursing system as well as the appropriate emergency departments in which it is practiced were then established in 1989 (George et al., 1993). The race towards a universal triage system began years ago when several countries started to systematically acknowledge the role played by the triage system in solving of problems related to patient emergencies. Their basis was however on the NTS guidelines (Jelinek and Little, 1996).

There are various problems that dog the various types of triages. For example the pure NTS-based systems were very popular in many regions. Their application was however limited to certain areas only. They were also just applicable for certain subgroups of patients .The subgroups in this case were pediatrics and mental health patients. This therefore propelled many health care practitioners to adopt modified versions of the triage. A perfect example is the Canadian system that has a solution for the various limitations through the inclusion of a large number of subgroups (the missing ones) (Canadian Association of Emergency Physicians, 1999). Another system that was modified to take care of the deficiencies is the Manchester triage system that was developed on the basis of the NTS but with completely different guidelines. The Manchester system was developed by means of clinical algorithm as opposed to the use of diagnostic algorithm in an effort to help in making of decisions within a short period of time (Manchester Triage Group, 1997). It is worth noting that the Manchester guidelines' validity and reliability are yet to be ascertained (Robertson, 1997).It is worth noting that the only countries with robust and robust triage systems are New Zealand and Canada (Standen et al., 1997).

A lot of literature has been dedicated testing the reliability and… READ MORE

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