Nursing Research: Critique of Broadbent, Moxham & Dwyer's Article

This report critically appraises a qualitative research article by Broadbent, Moxham & Dwyer (2014), focusing on the challenges faced by nurses in triage environments when attending to clients with mental illness. The study, published in the Australasian Emergency Nursing Journal, utilizes an ethnographic research design to explore the impact of the triage environment on nurses' assessment processes. The report details the research background, methods, including participant observation and interviews, and results, which highlighted environmental barriers affecting triage assessment and patient privacy. The analysis emphasizes the relevance of the findings to nursing practice, particularly in addressing the dilemma of providing optimal care for patients with mental health issues in emergency departments. The report concludes with a discussion of the study's limitations and recommendations for future research, including modifications to the architectural environment of triage areas to improve patient care and experience. This student assignment, available on Desklib, offers valuable insights into evidence-based nursing and its application to real-world healthcare challenges.

Running head: EVIDENCE BASED NURSING RESEARCH
Evidence based nursing research
Name of the student:
Name of the University:
Author’s note

1EVIDENCE BASED NURSING RESEARCH
Introduction:
The report provides a critique of a qualitative research article by Broadbent,
Moxham & Dwyer, (2014) to find out the best practice available to address the
environmental challenges and challenges faced by staffs in attending to client with
mental illness. The research article is published in the Australasian Emergency Nursing
Journal which is an official journal of the College of Emergency Nursing Australia. The
main advantage that college members and others subscribers get from this journal is
that it provides high quality and thought provoking knowledge related emergency
nursing practice in Australia, New Zealand and overseas. The impact factor of the
journal is high as its accepts original research work and double-blind peer review
process is used to enhance the quality and trustworthiness of the evidence
(Australasian Emergency Nursing Journal, 2017). In addition, the credibility of the
article is also understood from the research interest and professional background of the
researchers. Dr. Marc Broadbent’s main research interest is emergency care,
management of vulnerable people in the emergency department (Dr Marc Broadbent,
2017). Secondly, Lorna Moxham is a professor of Mental Health nursing with research
interest in the same field and Trudy Dwyer has research interest in rapid response
system and clinical teaching (Dwyer, 2017). With years of experience in their
professional field and publication of past research work, it is confirmed that the research
would offer high quality of data for ED nursing.
Name: Student number: | 1

2EVIDENCE BASED NURSING RESEARCH
Background/aim
Broadbent, Moxham & Dwyer, (2014) used ethnographic research design to
investigate about the challenges associated with working in a triage environment and
identifying about the impact of triage practice environment on the role of triage nurse in
conducting triage assessment in clients coming to mental illness in emergency
department (ED). The reason for such research is understood from the case scenario
that maximum client with mental illness attend ED first to access care and lack of
appropriate triage environment affect patient safety and privacy. The motivation for the
research on this topic is also understood from the problem statement in the research
article that flow of clients with mental illness to the Australian ED has increased due to
mainstreaming of mental health service into general health service (Shafiei, Gaynor, &
Farrell, 2011). Although the Australian government has responded to this issue by
introducing specialist mental health triage scales and specialist mental health clinicians
within ED, the research emphasized that management of such patients remains the
core responsibility of triage nurse (Ebrahimi et al., 2016). Hence, as there is lack of
evidence regarding the impact of triage environment on triage assessment process
done by nurse, this research became important.
The review of literature related to the topics has also helped Broadbent, Moxham
& Dwyer, (2014) to engage in decision making and plan research design. For example,
literature review of recent research work mainly discussed about the ED design in
Australia and the provision needed in ED triage design according to the policy
documents in Australia (Ebrahimi et al., 2016). Research evidence regarding use of
space in ED and mental health setting was also found (Nugus & Forero, 2011).
Name: Student number: | 2

3EVIDENCE BASED NURSING RESEARCH
However, the author identified the gap in past research work by the statement that
studies has been done regarding the role of triage nurse in ED, however there is lack of
research on evaluation of the architectural environment of triage. Hence, this gap in
study informed the research design as well as the study objective.
Methods:
Broadbent, Moxham & Dwyer, (2014) has mainly used ethnographic research
design to extend knowledge regarding the impact of triage environment on the role and
performance of triage nurse in ED. Such research design is appropriate when the focus
of any study is to find or explore impact of any process on participants. Hence,
ethnographic research design facilitates observation and interaction with participants to
understand the problem facing them in real setting (Hammersley, 2016). Congruent with
the ethnographic research design, the decision regarding collecting data by means of
participant observation and interview with participants is a right approach by the
researcher. The reflexivity in the design was also seen by the collation of document and
field notes to gain understanding regarding triage environment and triage nurse
performance. However, one important point in research design is that enough time is
not spent with study participants as this research only evaluated one element from a
wider study on interdisciplinary relationship between ED triage nurse and specialist
mental health triage nurse.
Although Broadbent, Moxham & Dwyer, (2014) had analyzed one element of
broader study to investigate on the research topic, however sample population and
setting has been described in detail. The research setting included a large emergency
Name: Student number: | 3

4EVIDENCE BASED NURSING RESEARCH
hospital in regional Australia with about 4.5% client presentation for mental illness and
the study participants included emergency nurse rostered in morning shift, afternoon
shift and day shift. In addition, emphasis on richness was also seen because purposive
sampling method was used to conduct interview with the triage nurse. In qualitative
research, purposive sampling is mainly done to ensure that a sample is selected that
represent the population of interest (Etikan, Musa & Alkassim, 2016). As Broadbent,
Moxham & Dwyer, (2014) focused mainly on evaluating the experience of triage nurse
in ED, the validity of the data was enhanced by taking 28 ED triage nurse who were
trained in triage practice and has been rostered to work at triage.
The method of collecting data is found to be effective in the article as the
researchers tried to achieve triangulation through two or more method of data collection.
Triangulation is a process of using multiple data in research to better understand the
topic and it ensures that rich, robust and well developed data is presented. Hussein
(2015) achieved triangulation by collecting data using documents and field notes,
participant observation and interview method. This reflects that sufficient amount of data
was there to explore the triage environment in depth and explore the challenges of
nurse in triage assessment.
The richness in collecting data has been already proved by use of different data
collection method to achieve triangulation. In addition, during the data collection process
for each method too, face to face interaction with study participant and observation
related to triage practice environment on ED triage nurse is considered to be effective.
The effort to minimize biasness in collection and interpretation of data is also seen
because the researcher themselves were involved in face to face interaction and
Name: Student number: | 4

5EVIDENCE BASED NURSING RESEARCH
observation and all of them had great professional experience in mental health and ED
nursing practice. The biasness in research data is also done by blinding the
investigators and this is evident from the research by Jordi et al., (2015) which used this
approach to collect survey data and keep nurse response anonymous.
The credibility and substantiality of any research become evident if the eminent
and renowned researchers are involved in conducting the research. With evidence
regarding publication of innovative research work on emergency and mental health
nursing by all three writers, any reviewer can develop confidence in the finding.
Moreover, trustworthiness and fairness of the data is also seen by the compliance with
ethical considerations in qualitative research such as taking informed consent, right to
withdraw from research and taking ethical approval (Silverman, 2016).
Results:
The use of thematic approach in data analysis justified the compatibility of the
process with the type of data collected. As the data was huge, using any other approach
would have made the analysis process very complex. However, thematic analysis
ensure that multiple data could be effectively presented under specific themes relevant
to the research objective (Broadbent, Moxham & Dwyer, 2014). In addition, use of
systematic inductive method through constant comparison and theoretical coding by
different authors independently and then comparing them reduced all possibility of
biases too.
As multiple methods were used to collect and analyse the data, interpretability of
the study result was enhanced by categorizing the data into different themes. Use of
Name: Student number: | 5

6EVIDENCE BASED NURSING RESEARCH
thematic approach in presentation of result is found to be beneficial because despite
getting huge data, individual theme made it easier to understand the triage environment
and its impact on triage nurse (Vaismoradi,Turunen, & Bondas, 2013). The meaning of
the data was captured well with the use of specific themes. For example, in the context
of triage environment, the results revealed that presence of high activity staff, free
movement of public, non sound attenuating ceiling and no barrier for interacting with
client seriously challenge work of triage nurse. For the themes of triage assessment, the
nurses excerpts revealed that their triage practice was seriously affected by
inappropriate practice environment and lack of privacy for client (Broadbent, Moxham &
Dwyer, 2014). Hence, the study was successful in giving insight regarding
environmental barrier in triage assessment and the need for serving the best interest of
patients by building a separate ED triage environment. The research by Opiro, Wallis &
Ogwang, (2017) presented variation in triage protocols, absence of administrative
support and shortage of staff on duty as barrier to development of triage system and
there is need to work in these areas in the future.
Summary assessment and conclusion
The research by Broadbent, Moxham & Dwyer, (2014) gave the idea that
architectural environment of an ED triage area is factor that challenges triage nurse in
triage assessment and their ability to provide optimal care. The analysis of data by
multiple methods shows that environmental characteristics of a triage area comes in the
way of building a therapeutic environment and this results is considered trustworthy and
reliable as different researchers have evaluated the data and then compared it to come
to this conclusion. The only limitation that may affect the transferability of the research
Name: Student number: | 6

7EVIDENCE BASED NURSING RESEARCH
in real setting is that the sample size was small and there was social, cultural and
historical links to the study site understood from student’s comment. Despite this
limitation, the study gives useful knowledge to improve nursing practice in the triage
area and find the factors needed to build an ideal triage area.
Relevance to nursing practice and case study
The critical appraisal of Broadbent, Moxham & Dwyer, (2014) article was done in
this report mainly to solve the dilemma in the case study. The case study presented the
issue that ED is a busy area and people with mental illness first approach ED as first
point of access to care. However, the dilemma in the case scenario was that mental
health clinicians are not rostered to ED normally and such practice affected the patient
safety and privacy significantly. In relevance with issues, it is found that the article by
Broadbent, Moxham & Dwyer, (2014) is most suitable to address the dilemma. The
study presented that specialist triage nurse should be present in ED to assess and
screen clients attending ED with mental illness. The study gave the idea about how
triage nurse engage in rapid decision making and obtaining the best possible data for
the optimal care of clients. In this context, it can be said that the article is informing
nursing practice regarding the preparedness for triage assessment. Ebrahimi et al.,
(2016) also affirmed that triage nursing is a relatively new role of nurses and they need
comprehensive educational program as well as organizational support to increase
efficiency in the triage process. The article is an effort towards extending knowledge
and skills regarding the new role of triage practice for nurse.
Name: Student number: | 7

8EVIDENCE BASED NURSING RESEARCH
The findings of results pointed out that patient’s privacy and right to therapeutic
environment is seriously violated by the free movement and noise near the triage desk.
In this context, it reflects about the need to preserve patient value in care and the
recommendation from the study was to modify the architectural environment of triage so
that clients do not face issues during assessment. However, there is a need for future
research in studying about the experience of client in ED triage area as client’s
perspective were not evaluated in the study. The research is also significant because it
also points out to ways clinical expertise in triage can be enhanced and this included
both organizational support as well as environmental modification of triage area. The
study supported their results with many arguments. The clinical practice in the triage
area for nurses is also informed by other available evidence. For example, Ebrahimi et
al., (2016) which gives detail results regarding the role description of triage nurse in the
ED.
Name: Student number: | 8

9EVIDENCE BASED NURSING RESEARCH
Reference
Australasian Emergency Nursing Journal. (2017). Aenj.com.au. [online] Available at:
http://www.aenj.com.au/ [Accessed 9 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.
Dr Marc Broadbent. (2017). Usc.edu.au. [online] Available at:
http://www.usc.edu.au/explore/structure/faculty-of-science-health-education-and-
engineering/staff/dr-marc-broadbent [Accessed 9 Oct. 2017].
Dwyer, T. (2017). Staff Profile. [online] My.cqu.edu.au. Available at:
https://my.cqu.edu.au/documents/10165/5667933/Trudy+Dwyer+Staff+profile+20
13.pdf/35f2f9e1-2d53-4eb8-8c56-224e394bd9aa [Accessed 9 Oct. 2017].
Ebrahimi, M., Mirhaghi, A., Mazlom, R., Heydari, A., Nassehi, A., & Jafari, M. (2016).
The role descriptions of triage nurse in emergency department: a Delphi
study. Scientifica, 2016.
Ebrahimi, M., Mirhaghi, A., Mazlom, R., Heydari, A., Nassehi, A., & Jafari, M. (2016).
The role descriptions of triage nurse in emergency department: a Delphi
study. Scientifica, 2016.
Name: Student number: | 9

10EVIDENCE BASED NURSING RESEARCH
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling
and purposive sampling. American Journal of Theoretical and Applied
Statistics, 5(1), 1-4.
Hammersley, M. (2016). Reading ethnographic research. Routledge.
Hussein, A. (2015). The use of triangulation in social sciences research: Can qualitative
and quantitative methods be combined?. Journal of Comparative Social
Work, 4(1).
Jordi, K., Grossmann, F., Gaddis, G. M., Cignacco, E., Denhaerynck, K.,
Schwendimann, R., & Nickel, C. H. (2015). Nurses’ accuracy and self-perceived
ability using the Emergency Severity Index triage tool: a cross-sectional study in
four Swiss hospitals. Scandinavian journal of trauma, resuscitation and
emergency medicine, 23(1), 62.
Nugus, P., & Forero, R. (2011). Understanding interdepartmental and organizational
work in the emergency department: an ethnographic approach. International
Emergency Nursing, 19(2), 69-74.
Shafiei, T., Gaynor, N., & Farrell, G. (2011). The characteristics, management and
outcomes of people identified with mental health issues in an emergency
department, Melbourne, Australia. Journal of psychiatric and mental health
nursing, 18(1), 9-16. Opiro, K., Wallis, L., & Ogwang, M. (2017). Assessment of
hospital-based adult triage at emergency receiving areas in hospitals in Northern
Uganda. African Health Sciences, 17(2), 481-490.
Name: Student number: | 10

11EVIDENCE BASED NURSING RESEARCH
Silverman, D. (Ed.). (2016). Qualitative research. Sage.
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic
analysis: Implications for conducting a qualitative descriptive study. Nursing &
health sciences, 15(3), 398-405.
Name: Student number: | 11