Arslanian-Engoren C
University of Michigan, Ann Arbor, USA.
J Emerg Nurs. 2000 Apr;26(2):117-24. doi: 10.1016/s0099-1767(00)90053-9.
Recently it has been recognized that women are less likely than men to be diagnosed with a myocardial infarction (MI) or to receive early or aggressive treatment and are more likely than men to die of an MI. The purpose of this qualitative study was to examine the triage decisions made by ED nurses for persons with symptoms suggestive of MI. The theoretical framework for this investigation was Hammond's lens model for clinical inference and Evan's two-stage reasoning model.
Four focus group sessions were conducted. The participant's oral descriptions were tape-recorded, transcribed verbatim, and analyzed using the Krueger method.
Content analysis revealed several important issues influencing triage decisions: patient presentation, nursing knowledge and experience, practice environment, intuition, the fear of liability, and gender-specific behaviors. ED nurses held different perceptions regarding the significance and likelihood of MI for male and female patients seeking evaluation and treatment. In addition, ED nurses admitted that MI is not the first diagnosis considered for middle-aged women.
The inability of ED nurses to associate middle-aged women's presenting symptoms with MI may contribute to the increased morbidity and mortality experienced by this population. The findings of this study have implications for nursing research, education, and practice.
最近人们认识到，女性被诊断出心肌梗死（MI）的可能性低于男性，接受早期或积极治疗的可能性也低于男性，且死于心肌梗死的可能性高于男性。这项定性研究的目的是检查急诊科护士对有心肌梗死症状患者的分诊决策。本调查的理论框架是哈蒙德的临床推理透镜模型和埃文斯的两阶段推理模型。
进行了四次焦点小组会议。参与者的口头描述被录音、逐字转录，并使用克鲁格方法进行分析。
内容分析揭示了影响分诊决策的几个重要问题：患者表现、护理知识和经验、实践环境、直觉、对责任的恐惧以及特定性别的行为。急诊科护士对寻求评估和治疗的男性和女性患者心肌梗死的重要性和可能性持有不同看法。此外，急诊科护士承认心肌梗死并非中年女性的首要诊断考虑。
急诊科护士无法将中年女性的症状与心肌梗死联系起来，这可能导致该人群发病率和死亡率增加。本研究结果对护理研究、教育和实践具有启示意义。
