Emergency departments (EDs) in Australia have been seeing an increase in recent years in the number of patients presenting with mental illness. This study aims to determine if the triage environment of the ED influences the triage practice of ED nurses. Using an ethnographic approach, the research found that ED nurses felt that triaging mentally ill patients in an area that is very public, noisy, and lacks privacy can impact their ability to effectively conduct assessments and manage patients.
The objective of this research was to study the impact of the ED triage environment on the practice of ED nurses who triage mental health patients in a regional ED in Australia.
An ethnographic methodology was used to conduct this research. It involved the observation of nurse practice while triaging mental health patients presenting to the ED, semi-structured (individual and group) interviews with 28 triage nurses, and examination of documents. Data analysis involved comparison and theoretical coding.
The triage environment, the authors found:
- Was located near the general public waiting area near the entrance. Patients triaged with low acuity waited here, and this area was accessible by ED staff, police, and ambulance personnel.
- Had workspaces with a desk-to-ceiling sheet of glass – as a barrier between the patient and the triage nurse/ clerk. This was installed for security purposes. There was a 30-cm gap in the glass for interaction.
- Was noisy; voices need to be raised to be heard.
- Was a very brightly lit area.
- Was a very public space – the triage nurse had no control over movement of staff
- Provided no privacy for the client.
- Provided no walls around the client.
The environment described above was found to affect triage assessment in the following ways:
- It was difficult to extract information essential for an informed assessment in the context of mental illness.
- The triage area was also a place where ED staff gathered. This affected privacy and confidentiality of patients.
- Nurses expressed concern about the impact of the assessment on the patient.
The environment also affected the management of clients
- Nurses could not perceive how patients could be managed because of their inability to provide privacy.
- There are potential security issues when mentally-ill patients and the general public are waiting in the same space.
ED triage nurses felt that the following were essential for mental health patients:
- a private space
- a quiet space
- a separate space
The authors express the following to be limitations of their study:
- The small sample of the research participants
- The social, cultural, and historical contexts of the participants’ responses during the interviews