Critical Analysis of a Nursing Research Article: ED Triage

This report offers a critical analysis of a qualitative research article by Broadbent et al. (2014) exploring the impact of the emergency department (ED) triage environment on triage practice for patients with mental illness. The analysis covers the research design, which employed an ethnographic approach, sample and setting, data collection methods including interviews and observations, and the thematic data analysis process. The findings highlighted the influence of the triage environment on nurses' ability to provide optimal care, including factors like noise levels and privacy. The report assesses the study's strengths, such as its in-depth data collection and thematic analysis, as well as its limitations, like the small sample size. The report concludes with a discussion of the research's relevance to nursing practice, emphasizing the importance of a suitable triage environment to address patient privacy and safety concerns in EDs and suggesting the need for future research in this area.

1Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

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Table of Contents
Introduction................................................................................................................................3
Background................................................................................................................................3
Methods......................................................................................................................................4
Research design......................................................................................................................4
Sample and setting.................................................................................................................5
Data collection.......................................................................................................................6
Procedures..............................................................................................................................6
Enhancement of trustworthiness............................................................................................6
Results........................................................................................................................................6
Data analysis..........................................................................................................................6
Findings..................................................................................................................................7
Summary assessment and conclusion........................................................................................8
Relevance to nursing practice and case scenario.......................................................................8
References................................................................................................................................10

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Introduction
Critique of journal articles is important for nurses for bringing improvement in their
practice. Insights from research articles are to be applied in practice as best available
evidence. The present report is critical analysis of a qualitative research article relevant to
nursing practice. The article presented by Broadbent et al., (2014) investigates the
implications of emergency department triage environment on triage practice for patients
presented with mental illness. The article had been published in Australasian Emergency
Nursing Journal, which is the official journal of the College of Emergency Nursing
Australasia (CENA) (journals.elsevier.com, 2017). The journal has recognized credibility
since it is internationally peer-reviewed. Further, the authors are doctoral degree holders
from reputed schools of nursing, rendering integrity to the article.
Background
According to Jelinek et al., (2013) Australian emergency departments (ED) are the
first line of care services that patients with mental illness have access to. Considering this
fact, initiatives have been taken for bringing improvements in the provision of mental health
service in EDs in Australia. Nevertheless, there is no certainty regarding a number of mental
health presentations to Australian EDs. It is known that ED triage nurses need to care for
patients with mental illness presenting at the ED until a clinician arrives. This is a serious
concern for nurses at these departments at they are faced with challenges while making
decisions that are in alignment with principles of optimal quality care delivery. A better triage
environment would possibly provide better positions to triage nurses at ED to care for
patients.
The researchers of the present paper had the prime focus on understanding the relation
between emergency triage environment and the experience of nurses who are compelled to

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care for patients suffering from mental conditions. For ensuring that the research paper is
comprehensive and provides the readers with sufficient background information, the
researchers have attempted to present the background information and past literary work on
the same topic. The literature review of an article aims at identifying the gaps in existing
literature. The sole purpose of the literature review is to highlight the areas that have not been
addressed in previous research and need immediate attention (Parahoo, 2014). The present
article, however, does not have a section on identified gaps in existing literature. The
researchers in here have failed to present the particular areas that have remained unexplored
in previous literature, presenting a limitation to the literature review. Nevertheless, the
researchers were successful in setting up the stage for the present study, and the research aim
was accurately outlined. The objective of the research to be undertaken was to undertake an
in-depth exploration of the issues pertaining to triage assessment and suitable milieu required
for managing it.
Methods
Research design
According to Nieswiadomy and Bailey (2017), the research design of a study
determines whether the findings of the research would be able to address the research
questions or not. It is important to decide on the appropriate research design aligned with the
research objectives. The study by Broadbent et al., (2014) considered an ethnographic
research design to understand the relationship between different aspects of triage
environment and concerns and performance of triage nurse in ED. Lewis (2015) highlight
that ethnographic research design is advantageous for exploring or finding the influence of a
certain phenomena on the concerned participants. The authors further highlight that
ethnographic research is valuable for facilitating interaction between different groups of
people and observing the association between them. In real settings, such research design

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permits optimal information collection on the issues and challenges faced by the participants
in relation to a certain aspect. The decision to collect data for the research through the
interview and open observations was in harmony with the ethnographic research design. It
can be considered as a right approach to understand the natural process prevailing in the
setting. The research design also had reflexivity imbibed in it as documents were maintained
along with field notes for later references. The negative aspect of the research was that the
time frame for conducting the study was not sufficient. The research considered the
evaluation of one particular aspect from a wider perceptive; interdisciplinary relationship
existing between mental health triage nurse and those who are ED triage nurse.
Sample and setting
The research conducted by Broadbent et al., (2014) contributed to an examination of
one particular aspect from the inferences drawn from wider observation ethnographic study.
The study setting was a regional hospital situated in Australia having an emergency
department with sufficient resources. At this setting, about 4.5% of the patients coming for
care services had mental health issues. The patients taking part in the study were 45 qualified
professionals apart from one ED nurse working in night and morning shifts and two nurses
working in afternoon shifts. The sample and setting were adequately described by the
researcher. The sampling technique used was purposive sampling with the aim of conducting
an interview of the nurses. As opined by Houser (2016) purposive sampling is beneficial for
selecting a sample that is a representation of the broader population of interest. There are,
however, certain points of limitation presented in the sampling method. The hospital setting
had limited number of patients coming in with a mental illness. It would have been desirable
if the flow of patients suffering from mental health disorder was more, thereby augmenting
the research validity (Merriam & Tisdell, 2015).

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Data collection
Houser (2016) advised that validity of qualitative research is to be established through
analysis of the study from multidimensional perspectives. This enables identification of any
underlying inconsistencies in the research. Triangulation is the best method for maintaining
validity (Caretr et al., 2014). In the present research, these techniques were adhered to.
Informal and formal semi-structured interviews, participant observation and examination of
field notes and documents were the aspects of triangulation.
Procedures
The key strength of the research under scrutiny lies in the fact that the focus of the
researchers was on extracting in-depth data. The richness of data was also beneficial. The
participant observation led to the collection of data related to the extent to which triage
practice environment influences triage nurse practice. The interview method was a promising
opportunity to contextualize the data. It formed the basis for understanding the issues faced
by the triage nurses at the time of patient assessment.
Enhancement of trustworthiness
The trustworthiness and credibility of research are reflected from the proficiency of
the researchers carrying out the study (Nieswiadomy & Bailey, 2017). In the present case, the
researchers had a similar interest in mental health care services and had sufficient knowledge
on the concerned subject. Further, the decision to use both interview method and participant
observation renders credibility. The trustworthiness of the data collection is reflected from
the emphasis given on responses of triage nurses and operational efficiency.
Results
Data analysis
A thematic approach was utilized for the data analysis step. Since the data collected
was wide, other approaches could have made the process of analyzing it much more difficult

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and complex. Since the study was an exploratory one, highlighting the perceptions of the
triage nurses, thematic analysis allowed the researchers to bring into limelight the themes
underpinning the data extracted. According to Maltby et al., (2014) thematic analysis is
useful for providing a comprehensive research result addressing the research questions.
Moreover, systematic inductive method reduced the chances of bias. Theoretical coding and
continual comparison by the three authors in a separate and independent manner was justified
(Parahoo, 2014).
Findings
The study under examination gave rise to themes such as client management, triage
assessment, and triage environment. It is easier for a reader to understand the study findings
if the same are presented in an organized manner (Day et al., 2017). The categorization into
the themes was therefore effective. While reflecting on the ability to capture the meaning of
the collected data, it can be commented that a summary of the elaborated feelings and
experiences of the nurses were presented addressing the research aims. For instance, the
study revealed that non-sound attenuating ceiling in the triage area is responsible for
decreasing the ability to engage in a private conversation. Such attribute also hampers the
control over movement and has a negative influence on the decision making procedure. The
reliability and consistency of the result of the study are apparent from the research conducted
by Craig et al., (2016) highlighting the fact that environmental context and resource makes an
influence on documenting, screening, and restructuring behavioral changes. Further, the
practice environment was found to affect ED triage assessment process in nurses. Lastly, the
study indicated that the practice environment has a deep impact on ED triage assessment
process of nurses.
In summary, it can be stated that the research was helpful in identifying the
architectural aspects related to the triage area that has a profound impact in clinical settings.

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But what remains a point of criticism is that confrontational arguments have not been
presented for supporting or refuting the outcomes of the study.
Summary assessment and conclusion
The research paper put forward by Broadbent et al., (2014) was a valuable one as it
presented accurately the concept that architectural environment of the ED triage area is to be
considered as a key factor acting as a challenge for triage nurses while caring out assessment
and delivering optimal quality care. Data collected during the research highlighted that a
nurse working in the triage area needs to consider the environmental characteristics as they
act as a barrier in developing a therapeutic relationship with patients. The findings of this
study are reliable and credible since other researchers have undertaken an evaluation of the
data and rigorous comparison before coming to the conclusion (Tappen, 2015). The limitation
of the study that impairs the transferability of the research findings in different settings is the
sample size. In the present case, the sample size was too small. Further, cultural, historic and
social links were pointed out as factors behind triage assessment. Nevertheless, the study has
been a useful one to gain knowledge of the process by which nursing practice can witness
development in the triage area. The meaningful insights received can be used as the
foundation for future research on the same context with special reference to triage area
nursing.
Relevance to nursing practice and case scenario
The research article put forward by Broadbent et al., (2014) was considered for
reviewing for solving the issues faced in the case scenario. The scenario relates to the concern
that individuals suffering from mental illness seek help and care from the professionals of the
ED in the first place. The challenge lies in the fact that the EDs do not have the sufficient
resource, both human and non-human, for managing the increased number of patients

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presenting to the ED with each passing year. In such a scenario, the issue relates to the
privacy of the patients having diverse mental health issues and safety of the individuals as
well. The research undertaken by Broadbent et al., (2014) is an appropriate ray of light that
would guide authorities to solve the arising issues since it deals with the concept that triage
nurses are to be appointed at the ED for addressing needs of patients coming in with mental
health conditions. The primary implication of the inferences drawn from the study is that a
suitable triage environment would serve as the resolution to privacy issues of the patients as
well as the safety concerns. Respect for patient values can be demonstrated by eliminating all
sources of distraction from the triage area. A noise-free area that also has no barriers for
movement would be suitable since the nurses would be in a position to communicate closely
with the patient. The competency and skills of the triage nurses can also witness advancement
if communication is strong and a suitable environment supports their need for concentration.
Enhanced decision making power would be the key advantage for the nurses as they would
be better able to make significant clinical decisions.
At this juncture, it is to be noted that the results contributed by the study is not
suitable for utilization in informed, evidence-based practice since it did not consider
researching about the feelings and experiences of the patients. The prime focus of the study
was on the triage nurses, and their viewpoints were only discussed. There is an urgency to
carry out further research on the experiences of the patients in the triage area. This would act
as the foundational base for coming up with strategies for providing comprehensive care to
these patients. More novice recommendations would come up in due course of research on
the same field that is precious.

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References
Australasian Journal (2017). Australasian Emergency Nursing Journal. [online]
Journals.elsevier.com. Available at: https://www.journals.elsevier.com/australasian-
emergency-nursing-journal [Accessed 13 Oct. 2017].
Broadbent, M., Moxham, L., & Dwyer, T. (2014). Implications of the emergency department
triage environment on triage practice for clients with a mental illness at triage in an
Australian context. Australasian Emergency Nursing Journal, 17(1), 23-29. DOI:
0.1016/j.aenj.2013.11.002
Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014, September).
The use of triangulation in qualitative research. In Oncology nursing forum (Vol. 41,
No. 5).
Craig, L. E., McInnes, E., Taylor, N., Grimley, R., Cadilhac, D. A., Considine, J., &
Middleton, S. (2016). Identifying the barriers and enablers for a triage, treatment, and
transfer clinical intervention to manage acute stroke patients in the emergency
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(TDF). Implementation Science, 11(1), 157. DOI: 10.1186/s13012-016-0524-1
Day, J., Lindauer, C., Parks, J., & Scala, E. (2017). Exploring the Best Practices of Nursing
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Houser, J. (2016). Nursing research: Reading, using and creating evidence. Jones & Bartlett
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Jelinek, G. A., Weiland, T. J., Mackinlay, C., Gerdtz, M., & Hill, N. (2013). Knowledge and
confidence of Australian emergency department clinicians in managing patients with
mental health-related presentations: findings from a national qualitative
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1380-6-2
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five
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Maltby, J., Williams, G., McGarry, J., & Day, L. (2014). Research methods for nursing and
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Merriam, S. B., & Tisdell, E. J. (2015). Qualitative research: A guide to design and
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Tappen, R. M. (2015). Advanced nursing research. Jones & Bartlett Publishers.