Knowledge and Practices of Postgraduate Student Nurses in UK Universities Regarding Triage System in Hospital Emergency Departments

KNOWLEDGE AND PRACTICES OF
POSTGRADUATE STUDENT NURSES IN UK
UNIVERSITIES REGARDING TRIAGING
SYSTEM IN HOSPITAL EMERGENCY
DEPARTMENTS
A research proposal submitted by
Student Name
Faculty of Health Sciences and Wellbeing

Table of Contents
Table of Contents........................................................................................................................................2
CHAPTER ONE: INTRODUCTION......................................................................................................3
1.1 Introduction.......................................................................................................................................3
1.2 Background of the Study...................................................................................................................3
1.2. Problem Statement............................................................................................................................6
1.4 Research Objectives...........................................................................................................................9
1.4.1 Aim.................................................................................................................................................9
1.4.2 Specific Objectives.........................................................................................................................9
1.5 Research Questions............................................................................................................................9
1.6 Significance of the Study...................................................................................................................9
1.7 Limitation of the study.....................................................................................................................10
CHAPTER TWO: LITERATURE REVIEW.......................................................................................10
CHAPTER THREE: MATERIAL AND METHODOLOGY..............................................................12
Research methodology:.........................................................................................................................12
Aims & objectives:................................................................................................................................12
Method:.................................................................................................................................................12
Rationale for the methodology:.............................................................................................................12
3.1 Research Study Design....................................................................................................................13
3.2 The Population and Sampling..........................................................................................................13
3.3 Sampling design and Sampling frame..............................................................................................14
3.5 Sampling technique.........................................................................................................................14
3.7 Research approach...........................................................................................................................14
3.8 Data collection methods: The questionnaire....................................................................................14
3.10 Validity and Reliability..................................................................................................................16
3.11 Ethical Considerations...................................................................................................................16
3.12 Pilot Study.....................................................................................................................................16
3.13 Data Analysis Methods..................................................................................................................16
3.14 Gantt Chart....................................................................................................................................17
REFERENCES........................................................................................................................................20

CHAPTER ONE: INTRODUCTION
1.1 Introduction
The triage system is characterized as a beneficial technique in the Emergency Department
(ED) that involves prioritizing patients based on the severity of their conditions (Wolf et al.,
2018), hence lowering the amount of time patients must wait before obtaining medical treatment
and enhancing the quality of patient care (Fathoni, et al., 2016), (Gilboy, et al., 2019) and
(Considine, et al., 2017) as well as healthcare in general. When a patient is triaged, they are
placed in the proper area at the appropriate time in order to get the appropriate degree of care and
the relevant resources are allocated in order to satisfy the patient's medical requirements. This
area of the hospital makes it possible for the caretaker to be assigned to an appropriate evaluation
and treatment location (Jenson et al., 2018) and (Weber, 2019). However, triage is a widespread
issue in ED worldwide.
1.2 Background of the Study
There are 25.0 million people that present themselves to emergency rooms in the United
Kingdom every time, and triage must be used to prioritize these patients based on the acuity, or
severity, of their conditions (The KingFunds, 2022). In the discourse of an ED, the term "triage"
known to the first step of the initial patient interaction, which is also the stage that is often
considered to be the most formal. Nevertheless, the rising amount of duties needed by triage
personnel as imposed by regulatory authorities (for example, prescription reconciliation and
suicide screening) makes it take longer to evaluate each patient, which in turn slows down the
flow of patients. Higher percentages of patients departing without being seen have been related
to bottlenecks that occur during the intake process and to lengthy wait periods in waiting rooms
(Wolf et al., 2018) and (Carter, Pouch & Larson, 2014). The approach that has been used in
many emergency rooms is to gather less information during the triage process or to use a "instant
bedding" or "pull till full" system. "Instant bedding" or "pull till full" system occurs when the
sick people is transferred immediately to a bed that is available; this procedure is repeated until
no more beds are left. ED.
In the ED, the step that is most critical is called triage. The purpose of triage is to
guarantee that each and every patient receives treatment that is prompt, precise, supportive, and
accurate according to their situation relying on ABCDE (Airway, Breathing, Circulation,

Disability, and Environment) preferences. Triage is useful because it helps ensure that every
patient receives treatment (Fadli and Sastria, 2017). The evaluation of emergency casualties by
urgent care nurses consists of a general examination, the taking of a patient history, and the
measurement of vital signs. In UK, the victims are then labelled per the emergency situation that
accompany them, with Priority 1 (P1) denoting emergent patients, Priority 2 (P2) denoting
urgent patients, Priority 3 (P3) denoting non-urgent patients, and Priority 4 (P4) denoting
patients who have passed away (Mersh, Vassallo and Royal College of Emergency Medicine,
2020), whilst with red denoting emergent patients, yellow denoting urgent patients, green
denoting non-urgent patients, and black denoting patients who have passed away are used
globally (Fadli and Sastria, 2017).
Emergency nurses are in the front of the hospital care delivery system; they are always
the introductory to engage critically sick or wounded patients and provide them with medical
attention. In addition to this, they focus on the primary anchors that are used for triage in health
facilities (Dulandas & Brysiewicz, 2018). Thus triage student nurses ought to be taught to always
have quick access to, or should have a clear view of, the areas designated for registration and
waiting.
In order to achieve the goal of the triage system and get assistance from the triage nurse
in determining the appropriate level, the student triage nurses should learn to follow a series of
stages. These steps including from danger environmental for all healthcare units and patients,
optical signs, major concerns, centered appraisal, presumption building, acuity dedication and
reassessment (Culley and Svendsen, 2014) and (AlMarzooq, 2020) and acuity determination and
reassessment involved triage. The expertise and cognitive content of triage nurses have been
mentioned as crucial variables in the decision-making process during triage. This is mirrored in
the allocation of triage categories, which indicate which victims need to be examined first (Kerie,
Tilahun & Mandesh 2018). Being a competent decision maker is essential for a triage nurse since
the decisions they make will determine the result of the triage.
The overestimation or underestimation of the triage level may have a negative impact on
the quality of treatment provided, can waste resources, can extend the duration of a patient's stay,
and may even alter the death rate. The right triage choice, on the other hand, demonstrates a high

quality of care, proper patient allocation, and enough time for treatment provided by the
emergency triage nurse (Mohammed, 2017) and (Dulandas & Brysiewicz, 2018,).
The quantity of patients who present themselves to emergency departments (EDs) has
grown over the last several years in industrialised high income nations as well as in low income
countries, in part due of self-referrals; this has led to EDs being congested (Afaya, Azongo and
Yakong, 2017). This gave rise to the issue that there should be a system that prioritises patients
in the order of urgency in the treatment that they need. In emergency departments of many
hospitals in low-income nations, there is no structured triage procedure. When compared to rich
nations, emergency treatment, including triage, is often one of the weakest links in the health
systems of low-income countries; yet, if it is well-organized, it has the potential to save lives and
save healthcare costs (Afaya, Azongo and Yakong, 2017).
When it comes to seeing patients, student nurses will often operate on a "first-come, first-
served" basis just like other clinician nurses. Frequently, there is no emergency department, and
patients who arrive at the hospital are examined either in the wards or in the outpatient clinic
(Lindskou et al., 2019). Because of this approach, there is no space for urgent and life-
threatening situations to be handled quickly. At this time, the majority of hospitals have EDs that
are consistently at capacity. This large volume of patients attending the ED may have an effect
on the quality of healthcare provided since the resources that are allocated for emergency
situations may be diverted to persons who have requirements that are possibly less urgent. As a
result, there is widespread agreement that triage is an essential component of the ED that cuts
down on patients' total wait times while ensuring that each and every patient receives the
appropriate care (Afaya, Azongo and Yakong, 2017).
The most important responsibilities of a nurse who is in charge of triage are to ensure that
patients are assessed by observing their overall appearance, collecting a focused history in order
to identify the issues that are now being presented, and evaluating the clinical risk (Lewis et al.,
2016). This same research reveals that nurses are responsible for ensuring the gathering and
analysis of physiological data using a primary survey technique, as well as the prompt
implementation of first aid procedures whenever they are required to do so.
In a similar vein, the use of speedy first aid measures may often avert an increase in the
fatality rate. In addition, the primary domain of a triage nurse is to do a speedy evaluation of

each patient within five to ten minutes. If there is sufficient space in the waiting area, the nurse
may perform further evaluations of patients at his or her own discretion (Rahmatullah et al.,
2017).
The student nurse doing triage has to have sufficient professional education and expertise
in emergency triage, as well as decision making and the provision of emergency nursing care.
Hence, engaging qualified and experienced nursing personnel for the triage process in the ED
and educating them how to correctly do triage may avert a significant number of fatalities,
impairments, and extra expenditures associated with treatment. Therefore, formal education
basically implementing the pedagogical strategies in triage enhances the efficacy of triage
student nurses, and with improved confidence, they will be better equipped to function more
effectively (Wu et al., 2018). Additionally, professional education in triage improves patient
safety (Torres, 2016).
1.2. Problem Statement
The UK universities follow Nursing and Midwifery Council (NMC) guideline that
enforced through the following standards: “The Standards framework for Nursing and Midwifery
Education, Standards for Student Supervision and Assessment, and Programmed Standards
Specific to each approved programmer” (NMC, 2018). Students studying nursing may attain
programme objectives and proficiency levels in recognition of these criteria. All nursing and
midwifery personnel must conduct their work in accordance with the Code’s criteria, as well as
the conduct that nurses, midwives, and certified nursing assistants are supposed to maintain
(NMC, 2018). The Code outlines the competency standards for nurses, midwives, and nursing
associates to be licensed to practice in the United Kingdom. All nursing students in their final
year are now eligible to participate in extended practicum for up to 100% of their programme
thanks to the emergency standards. If these criteria are implemented locally, learners may choose
to participate in a paid clinical placement while the emergency standard is in effect, depending
on necessity. As usual, the Approved Educational Institutions’ (AEIs) responsibility is to ensure
that students have satisfied all of their instructional objectives and programme criteria in order to
graduate from their programme and register with the NMC (NMC, 2021).
Since its inception, the Evidence-Based Practice (EBP) movement has been tasked with
the mission of bridging the gap that has existed between scientific research and clinical