Wednesday, 9 December 2015

Culturally biased misconception of triage nurse role in the emergency department

Amir Mirhaghi

Commentary on: Innes K. (2015) Care of patients in emergency department waiting rooms – an integrative review. Journal of Advanced Nursing 71, 2702–2714.

With reference to the recent JAN article from Innes et al. (2015). Triage in the emergency department (ED) is defined as the priority allocation in the provision of care and cure for the patients in the ED (Mirhaghi et al. 2015), so most EDs have developed triage practice in response to overcrowding to ensure critically-ill patients receive required services in a timely manner. However the role appears to be challenging for emergency nurses in the ED, the triage nurse role needs to be extended as overcrowding grows too (Oredsson et al. 2011). Therefore, triage-related interventions have been developed to reduce the negative effects of overcrowding and advance triage practice. Consequently, I would like to bring your attention to the culturally biased misconception of triage nurse role in the ED. It is globally accepted that the triage nurse role is to mitigate the effect of ED overcrowding through prioritizing patient care and carrying out interventions to lessen waiting time (Oredsson et al. 2011, Rowe et al. 2011). In fact, the triage nurse is responsible for ensuring patient safety as well as early recognition of patient deterioration by means of reassessment and re-triage prior to being seen by a physician in the ED, so any study in this regard must address triage nurse role dimensions to examine healthcare roles in the waiting room.

Overall, it is not reasonable to limit health care roles to a specific label called 'clinical initiative nurse role' (CIN) and exclude triage from search strategy, resulting in a significant bias in the review. However, the authors declared that CIN has been viewed as an adjunct to the triage role as well as indicating the same definition as triage nurse role that has been well known to practitioners for CIN, They did not use the search strategy to uncover ultimate aspects of care of patients in emergency department waiting rooms (Whittemore & Knafl 2005).

We highly recommend further studies on the role of triage nurse address culturally sensitive investigation on diverse variations of triage nurse role worldwide to reveal transforming nature of triage practice in EDs.

Amir Mirhaghi
Evidence-Based Caring Research Center,
Department of Medical-Surgical Nursing, School of Nursing and Midwifery,
Mashhad University of Medical Sciences, Mashhad, Iran


Innes K., Jackson D., Plummer V. & Elliott D. (2015) Care of patients in emergency department waiting rooms - an integrative review. Journal of Advanced Nursing 71, 2702–2714.

Oredsson S., Jonsson H., Rognes J., Lind L., Göransson KE., Ehrenberg A., Asplund K., Castrén M. & Farrohknia N. (2011) A systematic review of triage-related interventions to improve patient flow in emergency departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 19, 43.

Rowe BH., Villa-Roel C., Guo X., Bullard MJ., Ospina M., Vandermeer B., Innes G., Schull MJ. & Holroyd BR. (2011) The role of triage nurse ordering on mitigating overcrowding in emergency departments: a systematic review. Academic Emergency Medicine 18, 1349-57.

Mirhaghi A., Kooshiar H., Esmaeili H. & Ebrahimi M. (2015) Outcomes for emergency severity index triage implementation in the emergency department. Journal of Clinical and Diagnostic Research 9, OC04-7.

Whittemore R. & Knafl K. (2005) The integrative review: updated methodology. Journal of Advanced Nursing 52, 546-53.

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