Assessment of knowledge and skills of triaging amongst nurses working in the emergency department in Dar es salaam hospitals

Abstract

Background: Triage is an essential function in the emergency department. An effective triage system aims to ensure that patients seeking emergency care receive appropriate attention, in a suitable location, with the requisite degree of urgency and that emergency care is initiated in response to clinical need rather than order of arrival. The triage nurse in the emergency department is the first person that a patient encounters when presenting for emergency medical care to the department. Triage nurses' knowledge has been cited as an influential factor in triage decision-making, however there has been 1,10 study in Dar es Salaam hospitals undertaken to assess the knowledge of nurses working in the emergency departments on triaging. This study therefore aimed at assessing knowledge and skills of triage among nurses working in the emergency departments in Dar es Salaam hospitals. Objectives: Two objectives guided this study: (1) To determine the knowledge of triage among nurses working in the emergency departments in Dar es Salaam hospitals. (2) To describe the skills of triage among nurses working in the emergency departments in Dar es Salaam hospitals. Materials and Methods: Both descriptive cross-sectional and observational study designs were used and data were collected using structured questionnaire, observation checklist and review guide. The study population was all nurses (enrolled and registered) working in the emergency departments in Muhimbili National Hospital, and the municipal hospitals that are Mwananyamala, Ilala, and Temeke hospitals. Descriptive statistical data analysis such as frequencies and percentages were used to make interpretation of the data easier, whereby a computer program running SPSS 13.0 for windows was utilized in the analysis. Results: Seventy eight percent (47/60) of the respondents had no postgraduate/post basic nursing training on emergency nursing care. Forty seven percent (28/60) of the respondents had never attended in-service training/education workshop on emergency nursing care. Among those who attended in-service training/education workshop on emergency nursing care, 13% reported that the workshop did not include information on how to triage patients. Approximately 67% (40/60) of the respondents had knowledge on what triage is all about. More than half (52%) of the respondents were not able to allocate proper patient's triage category. Fifty eight percent (35/60) of the respondents had no knowledge on waiting time limits for patients' triaged categories. Among the four hospitals observed, only one had triage nurses allocated for patients triage. Among the

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VI triage nurses observed while triaging patients, 84% of them did not assess for the respiratory rate. Pain assessment was not done by all triage nurses observed. Three of the four emergency departments participating in the study had no triage guidelines and triage assessment forms. Conclusions and Recommendations: Nurses who participated 111 this study demonstrated significant knowledge and skills deficits on patients triaging in the emergency departments of the four hospitals that participated in the study. To correct this deficit and improve the knowledge and skills of these nurses, an in-service training/education workshop should be carried out as soon as possible, to be followed by a continuous professional development (CPD) program that should include refresher training, supportive supervision and clinical skills sessions on a regular basis. Besides CPD program, providing up-to-date policy guidelines on Emergency Triage Assessment and equipments is also needed so as to improve the quality of emergency care.