Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study
Introduction: Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. The influence of nurses’ belief systems on triage decision making has not to the authors’ knowledge been addressed. This study attempted to gain an understanding of the...
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| Format: | Article |
| Language: | English |
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Mashhad University of Medical Sciences
2019-10-01
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| Series: | Patient Safety and Quality Improvement Journal |
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| Online Access: | http://psj.mums.ac.ir/article_14409_b8e15ed6264a88533f5220c6f73bd76d.pdf |
| _version_ | 1818453907945291776 |
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| author | Amir Mirhaghi Mohsen Ebrahimi Mohsen Noghani-Dokht-Bahmani Abbas Heydari |
| author_facet | Amir Mirhaghi Mohsen Ebrahimi Mohsen Noghani-Dokht-Bahmani Abbas Heydari |
| author_sort | Amir Mirhaghi |
| collection | DOAJ |
| description | Introduction: Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. The influence of nurses’ belief systems on triage decision making has not to the authors’ knowledge been addressed. This study attempted to gain an understanding of the ED nurses’ culture of practice with respect to contextual factors that affect triage decision making.<br /> Methods: A focused micro-ethnographic study based on Spradley’s developmental research sequence (DRS) has been conducted in the emergency department of the Mashhad University hospital, Iran, from February 2014 to February 2015. Data were collected during 300 hours of participant observations that were accompanied by formal and informal interviews, then analyzed based on Spradley’s DRS. <br /> Results: Nine study participants were formally interviewed. From these interviews, eight core beliefs emerged related to nurses’ culture of practice: namely, triage decision making is arbitrary; the facility/locale of the emergency medicine department is the pivotal contextual factor affecting decision making; not every nurse can be assigned to triage; each patient assumes the existence of an emergency condition; the on-duty physician must be known; triage decision making must be considered plausible by colleagues; “they” tell us something, we should do something else; and triage guidelines are not practical. <br /> Conclusion: Contextual factors have a strong tendency to guide triage decision making and violate the principle of patient acuity (that is, that patients with the most acute medical conditions should be prioritized). In response, triage guidelines need to integrate the priorities of patients, nurses, physicians, and administrators. |
| first_indexed | 2024-12-14T21:46:27Z |
| format | Article |
| id | doaj.art-2a7d87204909408295dc987b5177c243 |
| institution | Directory Open Access Journal |
| issn | 2345-4482 2345-4490 |
| language | English |
| last_indexed | 2024-12-14T21:46:27Z |
| publishDate | 2019-10-01 |
| publisher | Mashhad University of Medical Sciences |
| record_format | Article |
| series | Patient Safety and Quality Improvement Journal |
| spelling | doaj.art-2a7d87204909408295dc987b5177c2432022-12-21T22:46:21ZengMashhad University of Medical SciencesPatient Safety and Quality Improvement Journal2345-44822345-44902019-10-017414515410.22038/psj.2019.40868.123114409Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic studyAmir Mirhaghi0Mohsen Ebrahimi1Mohsen Noghani-Dokht-Bahmani2Abbas Heydari3Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Department of Social Sciences, Faculty of Letters and Humanities, Ferdowsi University of Mashhad, Mashhad, Iran.Department of Medical-Surgical Nursing, Mashhad University of Medical Sciences, Mashhad, Iran.Introduction: Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. The influence of nurses’ belief systems on triage decision making has not to the authors’ knowledge been addressed. This study attempted to gain an understanding of the ED nurses’ culture of practice with respect to contextual factors that affect triage decision making.<br /> Methods: A focused micro-ethnographic study based on Spradley’s developmental research sequence (DRS) has been conducted in the emergency department of the Mashhad University hospital, Iran, from February 2014 to February 2015. Data were collected during 300 hours of participant observations that were accompanied by formal and informal interviews, then analyzed based on Spradley’s DRS. <br /> Results: Nine study participants were formally interviewed. From these interviews, eight core beliefs emerged related to nurses’ culture of practice: namely, triage decision making is arbitrary; the facility/locale of the emergency medicine department is the pivotal contextual factor affecting decision making; not every nurse can be assigned to triage; each patient assumes the existence of an emergency condition; the on-duty physician must be known; triage decision making must be considered plausible by colleagues; “they” tell us something, we should do something else; and triage guidelines are not practical. <br /> Conclusion: Contextual factors have a strong tendency to guide triage decision making and violate the principle of patient acuity (that is, that patients with the most acute medical conditions should be prioritized). In response, triage guidelines need to integrate the priorities of patients, nurses, physicians, and administrators.http://psj.mums.ac.ir/article_14409_b8e15ed6264a88533f5220c6f73bd76d.pdfcontextual factorsemergencyethnographytriage |
| spellingShingle | Amir Mirhaghi Mohsen Ebrahimi Mohsen Noghani-Dokht-Bahmani Abbas Heydari Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study Patient Safety and Quality Improvement Journal contextual factors emergency ethnography triage |
| title | Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study |
| title_full | Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study |
| title_fullStr | Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study |
| title_full_unstemmed | Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study |
| title_short | Contextual factors interfacing with quality of care in the emergency department: A micro-ethnographic study |
| title_sort | contextual factors interfacing with quality of care in the emergency department a micro ethnographic study |
| topic | contextual factors emergency ethnography triage |
| url | http://psj.mums.ac.ir/article_14409_b8e15ed6264a88533f5220c6f73bd76d.pdf |
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