Arslanian-Engoren Cynthia
University of Michigan, Ann Arbor, MI 48109, USA.
J Cardiovasc Nurs. 2009 Jan-Feb;24(1):50-7. doi: 10.1097/01.JCN.0000317474.50424.4f.
Although nurses frequently determine patient priority and urgency status for emergency evaluation and treatment of symptoms suggestive of myocardial infarction (MI), surprisingly few studies have specifically examined the cardiac triage decisions of emergency department (ED) nurses. Therefore, the purpose of this study was to explicate the decision-making processes of ED nurses who triage men and women for MI.
A qualitative, descriptive study was conducted using focus group methodology. A synthesized conceptual model was used to guide focus group discussions and to begin the process of developing a conceptually based, quantifiable measure of ED nurses' cardiac triage decisions. Participants' (N = 12) oral descriptions were audiotape recorded, transcribed verbatim, and analyzed using the Krueger content analysis method.
When making MI triage decisions and determining triage urgency status, ED nurses determine the underlying cause of patients' chief complaints based on clinical presentation, patient demographics, past medical history, as well as their own attitudes, perceptions and beliefs, nursing knowledge, and ED experience. Important patient cues include general appearance, vital signs, cardiac history, chest pain, and mode of transportation. Nurse's ultimate goal when making cardiac triage decisions is to have the patient receive a prompt electrocardiogram and prompt medical evaluation and to advocate for the patient.
Nurses are knowledgeable of age and sex differences in MI presentation. However, some nurses hold cultural biases and stereotypes that may interfere with the timely delivery of emergency cardiac healthcare. Findings from this study will be used to develop a quantifiable measure of ED nurses' cardiac triage decision-making processes.
尽管护士在对提示心肌梗死（MI）症状的患者进行紧急评估和治疗时经常确定患者的优先级和紧急状态，但令人惊讶的是，很少有研究专门考察急诊科（ED）护士的心脏分诊决策。因此，本研究的目的是阐明对疑似心肌梗死的男性和女性进行分诊的急诊科护士的决策过程。
采用焦点小组方法进行定性描述性研究。使用一个综合概念模型来指导焦点小组讨论，并开始开发一种基于概念的、可量化的急诊科护士心脏分诊决策测量方法。对参与者（N = 12）的口头描述进行录音、逐字转录，并使用克鲁格内容分析法进行分析。
在做出心肌梗死分诊决策并确定分诊紧急状态时，急诊科护士根据临床表现、患者人口统计学特征、既往病史以及他们自己的态度、认知和信念、护理知识和急诊科经验来确定患者主要诉求的潜在原因。重要的患者线索包括一般外观、生命体征、心脏病史、胸痛和交通方式。护士在做出心脏分诊决策时的最终目标是让患者迅速接受心电图检查和及时的医疗评估，并为患者争取权益。
护士了解心肌梗死表现中的年龄和性别差异。然而，一些护士存在文化偏见和刻板印象，这可能会干扰紧急心脏医疗服务的及时提供。本研究结果将用于开发一种可量化的急诊科护士心脏分诊决策过程的测量方法。
