LIST OF ABBREVIATIONS USED

S.L NO. ABBREVIATIONS EXPANSIONS

1. ED Emergency Department
2. STP Structured Teaching Programme
3. SD Standard Deviation
4. ESI Emergency Severity Index
5. A.V.AIDS Audio Visual Aids
6. DF Degree of Freedom
7. DV Dependent Variale
8. IV Independent Variales
9. r !eliaility
10. E"# Electro cardio graph
11. $!I $agnetic !esonance Image
12. IV Intra Venous
VIII
ABSTRACT
BACKGROUND STUD
The hospital emergency department%ED& is one of the
most important components of the health care delivery
system. ED has an important role in triaging patients 'ho
have a range of prolems of variale urgency( from life)
threatening to mild. Triage is usually performed in the ED y
nursing sta* 'ho allocate a triage designation and initiate
emergency care efore the patient is examined y a doctor.
The present study focuses +to assess the e*ectiveness of
structured teaching program on ,no'ledge regarding triage
system of patient in emergency department among nursing
personnel in a selected hospital at -huanes'ar.
T!"# #$%&' ($$)*+$# $, -%./.. $!) -,..,0"12 ,34)5$"6)#7
.. To assess the ,no'ledge regarding triage system of
patient in Emergency Department among nursing
personnel on the asis of pre test score.
/. To develop a structure teaching programme on triage
system of patients in Emergency Department.
0. To conduct a structure teaching programme on triage
system of patient in Emergency Department among
nursing personnel in selected hospital at -huanes'ar.
1. To evaluate the e*ectiveness of structured
teaching programme regarding triage system of patient
in Emergency Department y comparing pre test and
pos test ,no'ledge scores among nursing personnel.
2. To determine the association et'een the
,no'ledge of nursing personnel regarding triage
system of patients in Emergency Department 'ith
selected demographic variales.
IX
8ET9ODOLOG7
A Pre experimental 'ith one group pre and post test
design is selected for the study 'ith the evaluative research
approach. Von -ertalan*y #eneral system model 'as felt
appropriate for the present study.
In order to assess the e*ectiveness of the structure
teaching programme on triage system( a total of 23 nursing
personnel from ET"$ hospital at 4olar 'ere selected y
simple random sampling techni5ue using lottery method
'ho met inclusive criteria. The investigator otained
consent from the participants and data 'as collected using
structure 5uestionnaire 'hich consisted partl)demographic
variales and Part ) II6 02 items pertaining to Structured
,no'ledge 5uestionnaires on Triage System. The collected
data 'as analy7ed using descriptive and inferential
statistics.
RESULT
The present study reveals that in pre test the
overall mean ,no'ledge value is ...11 'ith standard
deviation 1.82 and in post test of overall mean ,no'ledge
value is 0..2/ 'ith standard deviation /.19.It is evident that
the otained :t; value /<.1= is greater than the tale value
at 3.3. level of signi>cance. Therefore :t: value is found to
e signi>cant. ?ence the null hypothesis framed for the
study is re@ected. It means there is gain in ,no'ledge level
of nursing personnel after structure teaching programme on
triage system.
INTERPRETATIONS AND CONCLUSION
The study sho'ed that nursing personnel 'ere having
inade5uate ,no'ledge regarding triage system in
Emergency Department. So the structure teaching
programme conducted 'as found e*ective in increasing the
,no'ledge level of nursing personnel.
X
TABLE OF CONTENTS
SL.
NO.
CONTENT PAGE
NO.
I IAT!BDC"TIBA 3.)38
II B-DE"TIVES 39).0
III !EVIEE BF FITE!ATC!E .1)/=
IV !ESEA!"? $ET?BDBFB#G 03)1/
V !ESCFTS 10)28
VI DIS"CSSIBA 29)<.
VII "BA"FCSIBA </)<2
VIII SC$$A!G <<)<=
IX -I-FIB#!AP?G 83)80
X AAAEHC!ES 81)..<
XI
LIST OF TABLES
SL. NO. TABLES PAGE
NO.
S)5$",1:
;
D)*,2<(+!"5 6(<"(3.) ,- 1%<#"12
+)<#,11).
1. Fre5uency and Percentage Distriution of
nursing personnel according to their age
12
2. Fre5uency and percentage distriution of
nursing personnel according to their gender
1<
3. Fre5uency and percentage distriution of
nursing personnel according to their
professional 5uali>cation
18
4. Fre5uency and percentage distriution of
nursing personnel according to their years of
'or, experience.
19
5. Fre5uency and percentage distriution of
nursing personnel according to area of
1=
6. Fre5uency and percentage distriution of
nursing personnel according to their previous
information.
23
S)5$",1:
II
P<)$)#$ =1,0.)&2) .)6). ,- 1%<#"12 +)<#,11).
,1 $<"(2) #'#$)*
7. $ean( mean percentage and standard
deviation of the pretest ,no'ledge of nursing
personnel on triage system.
2.
8. Fre5uency and percentage distriution of pre)
test level of ,no'ledge of nursing personnel
on triage system
2/
S)5$",1:
I..
P,#$ $)#$ =1,0.)&2) ,- 1%<#"12 +)<#,11).
,1 $<"(2) #'#$)*
9. $ean( mean percentage and standard
deviation of the posttest ,no'ledge of nursing
personnel on triage system.
20
10. Fre5uency and percentage distriution of
post)test level of ,no'ledge of nursing
personnel on triage system.
21
S)5$",1:
IV
E>)5$"6)1)## ,- S$<%5$%<) T)(5!"12
+<,2<(**) ,1 $<"(2) #'#$)* (*,12 1%<#"12
+)<#,11)..
11. "omparison of pre)test and post)test
,no'ledge scores of nursing personnel on
triage system.
22
S)5$",1:
V
A##,5"($",1 3)$0))1 $!) .)6).# ,- =1,0.)&2)
,- 1%<#"12 +)<#,11). 0"$! $!)"< &)*,2<(+!"5
6(<"(3.).
12 Association et'een the levels of ,no'ledge
of nursing personnel 'ith their demographic
variale.
28
XII
LIST OF FIGURES
SL. NO. FIGURES
PAGE
NO.
1.
$odi>ed "onceptual Frame'or, -ased on
4ing:s #oal Attainment Theory.
.0
2. Schematic !epresentation of research
design.
0/
S)5$",1
:1
D)*,2<(+!"5 6(<"(3.) ,- 1%<#"12 +)<#,11).
3. Percentage distriution of age of nursing
personnel .
12
4.
Percentage distriution of nursing personnel
according to their gender.
1<
5.
Percentage distriution of nursing personnel
according to their professional 5uali>cation.
18
6
Percentage distriution of nursing personnel
according to their total years of 'or,
experience
19
7.
Percentage distriution of nursing personnel
according to their area of experience
1=
8
Percentage distriution of source of
information( nursing personnel according to
their previous information
23
S)5$",1
:II
P<)$)#$ =1,0.)&2) .)6). ,- 1%<#"12 +)<#,11).
,1 $<"(2) #'#$)*
9
!epresenting distriution of pretest level of
,no'ledge of nursing personnel on triage
system
2/
S)5$",1
:*
P,#$ $)#$ =1,0.)&2) ,- 1%<#"12 +)<#,11). ,1
$<"(2) #'#$)*
10
Distriution of post)test level of
,no'ledge nursing personnel on triage
system
21
S)5$",1:
IV
E>)5$"6)1)## ,- S$<%5$%<) T)(5!"12
+<,2<(**) ,1 $<"(2) #'#$)* (*,12 1%<#"12
+)<#,11)..
11
!epresenting "omparison of pre test and
post test mean of nursing personnel
2<
HIII
ANNEXURES
ANNEXUR
E NO.
CONTENT
PAGE
NO.
I Fetter see,ing permission to conduct pilot
study
81
II Fetter see,ing permission to conduct main
study
82
III Fetter see,ing permission for content
validity
8<
IV "ontent validity certi>cate 89
V Fist of experts for content validation of the
tool
8=
VI !esearch participants consent form 9.
VII
Tool for data collection
Part ).6 Demographic Data .
Part ) II6 Structured ,no'ledge
Iuestionnaire
9/
VIII 4ey ans'er of ,no'ledge assessment
5uestionnaire
=.
IH -lue print of ,no'ledge 5uestionnaire in
triage system.
=/
H
Evaluation criteria chec,list for
content validity of structured
5uestionnaire
=0
HI Fesson plan on triage system in Emergency
Department
=2
HII A.V. Aids ..3
HIII
"riteria rating scale for validating the
lesson plan on triage system in Emergency
Department
..0
HIV Formulas used for statistical analysis ..2
HIV
INTRODUCTION
?A S$"$5! "1 T"*) S(6)# N"1)?
NEED FOR T9ESTUD
The hospital emergency department%ED& is one of the
most important components of the health care delivery
system. EDs 'orld'ide are reportedly serving increasing
numers of patients 'ho have a range of prolems of
variale urgency( from life)threatening to mild. Studies have
found that around 23J of ED visits are for non urgent
reasons( leading to unnecessary costs and multiple adverse
conse5uences. All patients arriving for emergency care
need to e assessed and classi>ed to prioriti7e those 'ho
have the most urgent medical prolems and are in need of
immediate care. This classi>cation process is termed triage
and it is usually performed y an ED nurse.
In India( as else'here( improving the utili7ation of EDs
is the su@ect of research and deate. This revie' evaluates
the ,no'ledge and understanding of nursing personnel on
triage in order to provide a ,no'ledgeale nurse to the
medical community in India to manage emergency
speci>cally and in general. The aim is to develop the
,no'ledge of nursing personnel to apply formal triage
systems in the EDs of general and specialist hospitals and
other relevant health settings.
Triage is the process of categori7ing patients
according to their need for medical care( irrespective of
their order of arrival or other factors including sex( age(
socioeconomic status( insurance status( residential status(
nationality( race( ethnicity or religion.
Triage involves an assessment to prioriti7e ED patients
in need of immediate care( in accordance 'ith clinical
severity and time urgency( compared 'ith patients 'ith
non urgent illness( 'ho can 'ait longer to e seen. Triage is
the process of categori7ing ED patients according to their
need for medical severity and time urgency( compared 'ith
patients 'ith non urgent illnesses 'ho can 'ait longer to e
seen or 'ho need referral to a more appropriate health care
setting.
In the past t'o decades( a standard triage scale 'as
developed in countries such as Australia( Ae' Kealand(
"anada( -ritain and the Cnited States as a asis
determined the patient deterioration scale. Accuracy(
authenticity and the time of triage decision ma,ing can e
e*ective on achievements and success of the emergency
department.
According to a research et'een triage ,no'ledge
and 'or, experience( it 'as sho'n that pure ,no'ledge
aout triage 'as a more important factor in comparison
'ith 'or, experience in triage decision( although a stronger
perception is needed from the relationship of these t'o
factors 'ith success rate of the triage.
?ence( triage training has een considered in parallel
'ith its implementation in emergency departments of the
hospitals. In Australia( nurses need to pass at least 9 hours
theoretical training and /1 hours practical training of
patient triage under the supervision of the experienced
nurses has een considered essential.
The history of the implementation of the triage in
emergency departments goes ac, to recent years.
Evaluation chec, list of the emergency department( as a
regulatory means for Deputy ?ealth Treatment and $edical
Education paid very little attention to the triage audit. So
that( only one 5uestion had een as,ed in this regard %Is
there one triage sta* per 03)13 thousand emergency
patients annuallyL& 'hich is certainly not ale to evaluate
various aspects of the triage and does not provide
appropriate information to health managers for revie'ing
this issue.
Therefore( revie'ing this issue is of high importance.
In addition( it is necessary to pay attention to the nurses:
aility in the hospital triage to have an accurate landscape
from the emergency department status at the time of
disasters( evaluate nurses: reaction 'hen facing 'ith
excess numer of the patients and chec, the availale
capacity of the triage. Cnfortunately( there are serious
concerns aout nurses: ,no'ledge level aout triage.
A study in Australia it is indicated that 1/J of the
nurses have not een trained for the triage and .1J of
them also mentioned that although they have participated
in the triage training courses( still they do not feel it inside
to implement triage. Another study in S'eden sho'ed that
the emergency departments of that country do not use
standardi7ed and modi>ed triage methods and thus
implementation of the ,no'ledge)ased triage is not
provided for the nurses. In Iran( no national triage scale has
ever een noti>ed to the hospitals and hospitals are the
reference of the triage system y themselves.
It is a fact that there is not a comprehensive academic
course for triage training %the share of the triage in
emergency nursing course is one session& and the only
solution has een 'or,shops and referral to some articles
'hich have een pulished. These de>ciencies can cause
unavailaility of the ,no'ledge)ased ehavior of the
nurses.
?o'ever( there is very fe' information aout triage(
ut Taheri et al. %/33<& said that performance and
,no'ledge of the nurses of 4erman Cniversity of $edical
Sciences had received a lo' average .<= A survey on
4no'ledge Fevel of the Aurses aout ?ospital Triage score
in triage. $ale,shahi et al found that nurses: ,no'ledge
aout triage 'as average. Aasi et al. also in a study
found that ,no'ledge level of the physicians of -ushehr in
facing 'ith nuclear accidents( diagnosis and treatment of
the nuclear victims 'as very lo'.
The aove mentioned studies suggested that triage is
implemented in the hospitals 'hile there is not availale
,no'ledge for the nurses.
This study has tried to identify and introduce the gap
of ,no'ledge)ased triage in providing services to the
referring patients to the emergency departments 'ith
re5uired standards. The current study aimed to determine
,no'ledge level of the nurses of the hospitals of Kahedan
Cniversity of $edical Sciences aout hospital triage.
Throughout history( people have een su@ected to
unexpected events that cause massive destruction( death
and in@ury. Almost every day of 'ee,( the ne's media cover
some ,ind of disaster some'here in the 'orld. Preparation
for disaster occurs can help minimi7e the long)term e*ects
of the events to peoples. ED has an important role in
triaging such patients. The process of triage decision)
ma,ing is inMuenced y 0 interrelated factors6 the
characteristics of the patient( the triage decision)ma,er and
the health care setting. Triage is important for redistriuting
and reducing 'aiting times and admission rates( increasing
the eNciency and e*ectiveness of the ED( enhancing
patient and family satisfaction( improving the 5uality of
health care( managing funding and assessing the
e*ectiveness of ED activities. Ehile the importance of
triage in the ED has een recogni7ed for some time in
developed countries( less developed countries are not
utili7ing the full potential of this health developmental
trend. !esearch and training on triage is extremely limited
in India and this study hopes to stimulate more research on
triage systems:
There is an increasing re5uirement for health service
to demonstrate and improve the 5uality of healthcare
delivery. Triage is a complex health care activity and the
achievement of est practice ased upon ade5uate
education of triage practioners. A consistent approach to
triage throughout hospitals 'ill enale e5uity of access for
patients and ench mar,ing of hospitals to inform
opportunities for improving performance.
Triage is predominantly a nursing assessment that
egins 'hen the patient presents to the Emergency
Department. Triage is usually performed in the ED y
nursing sta* 'ho allocates a triage designation and initiate
emergency care efore the patient is examined y a doctor.
Triage nurses usually have advanced training in decision)
ma,ing( they have een sho'n to have the necessary s,ills
to ma,e appropriate triage decisions and provide a highly
e*ective service to ED patients in health care settings.
In a study of decisions aout appropriate care provider(
priority rating and preliminary investigations for amulatory
patients the level of agreement et'een the triage nurses
and physician oservers 'as 9.J and et'een the triage
nurses and treating physicians 'as =1J.Triage nurses
identi>ed a greater numer of patients %.=J& as having
emergency prolems %.8J&( and fe'er patients %12J& as
having prolems of a non)urgent nature compared 'ith
physician oservers %18J&.The study concluded that
experienced emergency nurses in the role of triage 'ere
safe( eNcient and cost)e*ective( 'ith statistically signi>cant
levels of safety and accuracy of priority rating 'hen
compared to triage physicians and treating physicians. The
increasing use of triage and the increasing numers of ED
visits y patients raises the important issue of a parallel
need to increase the numer of triage nurses in EDs.
2
Throughout history( people have een su@ected to
unexpected events that cause massive destruction( death
and in@ury. Almost every day of 'ee,( the media cover some
,ind of disaster some'here in the 'orld. Preparation for
disaster occurs can help minimi7e the long)term e*ects of
the events to peoples. ED has an important role in triaging
such patients. The process of triage decision)ma,ing is
inMuenced y 0 interrelated factors6 the characteristics of
the patient( the triage decision)ma,er and the health care
setting. Triage is important for redistriuting and reducing
'aiting times and admission rates( increasing the eNciency
and e*ectiveness of the ED( enhancing patient and family
satisfaction( improving the 5uality of health care( managing
funding and assessing the e*ectiveness of ED activities.
Ehile the importance of triage in the ED has een
recogni7ed for some time in developed countries( less
developed countries are not utili7ing the full potential of this
health developmental trend. !esearch and training on triage
is extremely limited in India and this study hopes to
stimulate more research on triage systems.
8
-ased on researchers experience it is felt that
education among nursing personnel is important to improve
triage system of patient in Emergency Department. As
teaching enhances the ,no'ledge the researcher designed
structure teaching programme for nursing personnel to >nd
out its e*ectiveness on triage system of patient in
Emergency Department.
8
2. OB@ECTIVE OF T9E STUD
A set defnite objective must be established if we are to accomplish
anything in a big way.
- John McDonald
STATE8ENT OF T9E PROBLE87
+A study to assess the e*ectiveness of structured teaching
program on ,no'ledge regarding triage system of patient in
emergency department among nursing personnel in a selected
hospital at -huanes'ar.
.. To assess the ,no'ledge regarding triage system of patient in
Emergency Department among nursing personnel on the asis of
pre test score.
/. To develop a structure teaching programme on triage system of
patients in Emergency Department.
0. To conduct a structure teaching programme on triage system of
patient in Emergency Department among nursing personnel in a
selected hospital at O -huanes'ar.
1. To evaluate the e*ectiveness of structured teaching programme
regarding triage system of patient in Emergency Department y
comparing pre test and pos test ,no'ledge scores among
nursing personnel.
2. To determine the association et'een the ,no'ledge of nursing
personnel regarding triage system of patients in Emergency
Department 'ith their selected demographic variales.
OPERATIONAL DEFINITION7
1. ASSESS7 In this study it refers to >nding the level of
,no'ledge among nursing personnel.
2. EFFECTIVENESS7 I1 this study it measures the
improvement score in post test 'hen compare 'ith the
pretest score after exposing to structured teaching
programme.
3. STRUCTURED TEAC9ING PROGRA88E7 I1 this
study it refers to a 'ell planned teaching instruction
'hich includes $eaning and evolution of triage( Types(
#oals PFunction of Triage in Emergency Department
%ED&( $ethods of Triage System( Triage components(
Triage process and Aursing process in Triage System(
Importance and ene>ts of Triage system.
4. KNOALEDGE7 In this study it refers to the 'ritten
responses received from the nursing personnel to the
,no'ledge items listed in structured 5uestionnaire.
5. TRIAGE SSTE87 In this study it refers to $ethods of
ran,ing sic, or in@ured people according to the severity
of their sic,ness or in@ury in order to receive medical
attention.
6. E8ERGENC DEPART8ENT7 I1 this study it refers to
the department of a hospital responsile for the
provision of immediate medical or surgical care to
patients.
7. NURSING PERSONNEL7 I1 this study it refers to the
nursing personnel( 'ho have completed #A$( -. Sc%A&
or $. Sc nursing course.
ASSU8PTIONS7
The nursing personnel 'ill have some ,no'ledge
regarding triage system of patient in Emergency
Department.
Structured teaching programme 'ill enhance the
,no'ledge of nursing personnel.
The 'ritten responses to the 5uestionnaires 'ould
accurately reMect the actual ,no'ledge of the nursing
personnel.
9POT9ESIS7
?
o.
There 'ill e no signi>cant di*erence et'een pre test
and post test ,no'ledge scores of nursing personnel
regarding triage system of patient in Emergency
Department.
?
3/
There 'ill e no signi>cant association et'een post
test ,no'ledge scores of nursing personnel 'ith their
selected demographic variale.
DELI8ITATIONS OF T9E STUD
The study is delimited to nursing personnel( 'ho are
1. 'or,ing in ET"$ ?ospital
2. availale during data collection
3. 5uali>ed 'ith $Sc AursingQ-Sc Aursing or #A$.
4. 'ithin the age group of /3 to 2=yrs
5. selected ased on the inclusive criteria 'ith the sample
si7e of 23
CONCEPTUAL FRA8EAORK
"onceptual frame'or, deals 'ith astractions
%concepts& that are assemled y virtue of their relevance to
a common theme. "onceptuali7ation is a process of forming
ideas 'hich is utili7ed and forms conceptual frame for
development of research design. It helps the researcher y
giving direction to go aout entire research process BP,."$
(1& 9%12.)< 1999C.
8
The present study aims at assessing the ,no'ledge of
nursing personnel on triage system 'ith a vie' to develop a
structure teaching programme.
The frame'or, for the study %>g& 'as developed y the
investigator( ased on general system theory 'hich consists
of 1 ma@or components li,e input( throughput( output and
feedac,.
#eneral system theory 'as >rst introduced y Von
-ertalan*y in .=<9.?e de>nes a system as an organi7ed
'hole unit that produces an e*ect or product 'hen
independent component parts interact 'ith the
environment. All living system are open systems( 'hich
promote the exchange of matter energy and information
'ith other systems li,e susystems and environment %supra
system&.The exchange 'ithin the open system and their
supra system is continuous. The dynamic alance 'ithin and
et'een the systems helps to create and maintain internal
changes in other parts.
The openness of human system made the investigator
to assess the relationship among the factors that a*ects the
person( 'hich includes the inMuence of susystem and
supra system.
I1+%$
Input refers to the information( energy or matter 'hich
enters the system.
In this study nursing personnel is a system and has
input 'ithin the system itself %su system& and ac5uired
from the environment %supra system&.These inputs includes
learners: ac,ground li,e age(gender(professional
5uali>cation( total years of experience( area of
experience(souce of information that may inMuence the
,no'ledge of nursing personnel regarding triage system in
emergency department.
T!<,%2!+%$
Throughput refers to the action needed to accomplish
the desired tas,. In this study it refers to the administration
of structured teaching programme on triage system of
patients in emergency department.
O%$+%$
Butput refers to the end result or product of the
system
In this study it refers to the result in terms of
,no'ledge level as ade5uate( moderately ade5uate or
inade5uate in relation to the structure 5uestionnaire on
triage system .If ,no'ledge level is found inade5uate and
moderately ade5uate( recti>cation can e done y
strengthening the existing ,no'ledge through structure
teaching programme.
F))& 3(5=
Feedac, is the process 'here y the output of the
system is redirected to input and throughput if ,no'ledge is
found to e immoderately ade5uate and inade5uate after
teaching programme. The system input and throughput has
to e reevaluated 'hich is not included in the present study.
=
3. REVIEA OF LITERATURE
!evie' of literature is the tas, of revie'ing literature 'hich
involves the identi>cation( selection critical analysis and reporting of
existing information on the topic of interest. It provides the ases to
locate the data( ne' ideas that need to e included in the present
study. It helps the researcher to >nd the accurate data that could e
used for supporting the present >nding and dra'ing conclusion.
T!) <)6")0 ,- ."$)<($%<) "# +<)#)1$)& %1&)< $!) -,..,0"12
!)(&"127 S)5$",1 :I6 Studies related to)the importance of triage
system
S)5$",1 :II6 Studies related to ,no'ledge of nursing personnel on
triage system
S)5$",1 :III 6 Studies related to e*ectiveness of structure teaching
program
S)5$",1 :I7 STUDIES RELATED TO I8PORTANCE OF TRIAGE
SSTE87
Triage is the process of categori7ing patients according to their
need for medical care. It is important for redistriuting and reducing
'aiting times and admission rates( increasing the eNciency and
e*ectiveness of the ED( enhancing patient and family satisfaction(
improving the 5uality of health care( managing funding and
assessing the e*ectiveness of ED activities
(3
A cohort study 'as conducted in medicine righam and
'omens hospital( oston( CSA to implement a ne' >ve)level
emergency department %ED& triage algorithm( the Emergency
Severity Index %ESI&( into nursing practice( and validate the
instrument 'ith a population)ased cohort using hospitali7ation and
ED length of stay as outcome measure. The >ve)level ESI algorithm
'as introduced to triage nurses at t'o university hospital EDs(
and implemented into practice 'ith reinforcement and change
management strategies. Interrater reliaility 'as assessed y a
posttest and y a series of independent paired patient triage
assignments( and a sta* survey 'as performed. All adult patients
registered during a one)month period immediately follo'ing
implementation 'as performed. Eight thousand t'o hundred >fty)
one ED patients 'ere studied. Eeighted ,appa for reproduciility of
triage assignments 'as 3.93 for the posttest %n R </ nurses&( and
3.80 for patient triages %n R /.=&. ?ospitali7ation 'as /9J overall
and 'as strongly associated 'ith triage level( decreasing from 29Q<0
%=/J& of patients in triage category .( to ./Q80= %/J& in triage
category 2. $edian lengths of stay 'ere t'o hours shorter at either
triage extreme %high and lo' acuity& than in intermediate
categories. Butcomes follo'ed a)priori predictions. Sta* nurses
rated the ne' program easier to use( and more useful as a triage
instrument than previous three)level triage. They provided
feedac,( 'hich resulted in signi>cant revisions to the algorithm
and educational materials. Triage nurses at these t'o hospitals
successfully implemented the ESI algorithm
An evaluative study has een conducted y the $inistry of
health of Saudi Araia on triage system 'hich 'as aimed to
encourage national health planners and decision)ma,ers to apply
formal triage systems in the emergency department of general and
specialist hospitals and other relevant health settings( including
primary care. Study 'as conducted in a military hospital( Saudi
Araia among the care providers of emergency department. The
study sho'ed that decisions aout appropriate care provider(
priority rating and preliminary investigations for amulatory
patients the level of agreement et'een the triage nurses and
physician oservers 'as 9.J and et'een the triage nurses and
treating physicians 'as =1J.Triage nurses identi>ed a greater
numer of patients %.=J& as having emergency prolems %.8J&(
and fe'er patients %12J& as having prolems of a non)urgent nature
compared 'ith physician oservers %18J&.The study concluded that
experienced emergency nurses in the role of triage 'ere safe( eNcient
and cost)e*ective( 'ith statistically signi>cant levels of safety and
accuracy of priority rating 'hen compared to triage physicians and
treating physicians.
A retrospective study 'as conducted in Cniversity of Aorth
"arolin to determine the sensitivity and speci>city of the Emergency
Severity Index %ESI& triage instrument for the identi>cation of elder
patients receiving an immediate life)saving intervention in the
emergency department %ED&.The authors revie'ed medical records for
consecutive patients 'ith the age group of <2 years or older 'ho
presented to ED during .)month period. ESI triage scores 'ere
compared to actual ED course 'ith attention to the occurrence of an
immediate life)saving intervention. The sensitivity and speci>city of an
ESI triage level of . for the identi>cation of patients receiving an
immediate intervention 'as calculated. 23 cases( 'ere selected out of
89/ consecutive patients 'ho presented to ED. These 23 cases 'ere
designated y using ESI 'as compared to the triage level
determined y an expert triage nurse ased on retrospective record
revie'. T'enty)six patients received an immediate life)saving
intervention. ESI triage scores for these /< individuals is <9J and The
sensitivity of ESI to identify patients receiving an immediate
intervention 'as 1/.0J and speci>city 'as ==.. J.For .8 of 23 cases
in 'hich actual triage nurse and expert nurse ESI levels disagreed( under
triage y the triage nurses 'as more common than over triage % .0vs1
patients&.The study sho'ed that the ESI triage instrument identi>ed
fe'er than half of elder patients receiving an immediate life)saving
intervention failure to follo' estalished ESI guidelines in the triage
of elder patients may contriute to apparent under triage
.0
A study 'as conducted in -ox ?ill hospital( Victoria( Australia
on revie' of triage system in emergency department 'ith the aim to
provide a critical revie' of the literature pertaining to emergency
department triage in order to inform the direction for future
research .An International Triage Scale %ITS& 'hich is supported y
an international collaorative approach to'ards a triage research
agenda has een developed. A detail analysis 'as conducted of the
use of the scale over ./ months. These studies sho'ed a relatively
high level of concordance in triage assessment et'een nurses and
a direct association 'ith outcomes such as mortality( time in
hospital and resource utili7ation.
.
:
.
A comparative study 'as conducted in t'o hospital ased
emergency department in 4ingston( Bntario( 'hich includes
9federal and provincial prisons for adult males. The aim of the study
'as to descrie in@uries experienced y the male prisoner
population in the 4ingston( Bntario area and to compare them 'ith
those oserved in the general population and to compare the
incidence and patterns of prisoner in@uries seen in emergency
departments efore and after the introduction of a prison in@ury
triage system. The study 'as conducted among male prisoners
%agesl9)82years& 'ho 'ere .treated in the emergency department
'ith in@uries 'ere compared 'ith the general male population of the
same age range. An onsite emergency care triage system 'as
introduced to area prisons in .==0.Prison in@uries seen in the
emergency department during .==<)=9 'ere compared 'ith those
seen during a similar period prior to the introduction of the triage
system. A chart revie' has een done. The introduction of the triage
system appeared to e associated 'ith a decrease the total numer
of emergency department visits y prisoners.:
2
A retrospective oservational study 'as conducted in Dulius
centre of Aetherlands. The aim of the study 'as to compare the
degree to 'hich the Emergency Severity Index %ESI& and the
$anchester Triage System %$TS& predict admission and mortality.
Patients 'ho presented to the ED et'een . Danuary to .9 Duly /33<
'ere triaged 'ith the ESI or $TS 'ere included in the study. =81
patients triaged 'ith the ESI and /29 patients triaged 'ith the $TS.
The li,elihood of admission decreased signi>cantly 'ith urgency
categories in oth populations( and 'as greater for patients triaged
'ith the ESI than 'ith the $TS. $ortality rates 'ere lo' in oth
populations. $ost patients 'ho died 'ere triaged in the most urgent
triage categories of oth systems. -om the ESI and $TS predicted
admission 'ell. The ESI 'as a etter predictor of admission than the
$TS.
A study 'as conducted in medical care research unit
.Cniversity of SheNeld C4 to examine the consistency of triage
outcomes y nurses using four types of computeri7ed decision
support soft'are in A?S Direet...= scenarios 'ere
constructed ased on calls to amulance services that had een
assigned the lo'est priority category y the emergency medical
dispatch systems in use. These scenarios 'ere presented to
nurses 'or,ing in four A?S Direct call centres using di*erent
computeri7ed decision support soft'are( including the A?S
"linical Assessment System. The overall level of agreement
et'een the nurses using the four systems 'as +fair+ rather than
+moderate+ or +good.S. For example( the proportion of calls
triaged
t3
accident and emergency departments varied from //J
%/< of ..=& to 11J %20 of ..=&. -et'een /.J %/2 of ..=& and 0.J
%08 of ..=& of these lo' priority amulance calls 'ere triaged ac,
to the === amulance service. Ao system had oth high sensitivity
and speci>city for referral to accident and emergency services.
There 'ere large di*erences in outcome et'een nurses using
di*erent soft'are systems to triage the same calls:
.8
A prospective oservational study 'as conducted using a
randomi7ed crossover design at Cniversity of "alifornia)Fos Angeles
Emergency $edicine "enter. Purpose of the study 'as to measure
the inter oserver reliaility of the triage process. /3. Patients 'ere
included in the study 'ho 'ere spo,e English. Aineteen nurses
participated in the triage of the /3. study patients. Agreement
et'een / in)person designations made 'ithout ,no'ledge of vital
signs 'as poor %percent agreement 20J&. 4no'ledge of vital signs
did not improve agreement %percent agreement 1=J&.The study
sho'n that there 'as poor inter oserver agreement et'een
certi>ed triage nurses using a 2)item triage scale designed for
triage.
.S
A /)phase experimental study 'as conducted in Cniversity
ritish "olumia to measure interrater and intrarater agreement for
an emergency department triage system. Standardi7ed patient
scenarios 'ere presented t'ice over < 'ee,s. Participants rated
severity for each patient using a 2)tier triage system %nurses only&
and estimated the proaility of hospital admission( the most
appropriate time frame to physician evaluation %2 choices( from
+Immediate
.
+ to +$ore than /1 hours+&( the need for a monitored ED
ed( and the need for diagnostic services. Inter rater agreement
'as measured y a coeNcient of agreement for multiple raters and
multiple categories of the 08 participants %fe'er than =3J of those
eligile&( .= %2.J& completed oth phases %./ nurses( 8
physicians&. Four %00J& of the nurses assigned the same severity
ratings for the 2 cases in phase / as they did in phase .. Intra rater
agreement among the ./ nurses rating triage severity 'as. 828.
Inter rater agreement of nurses and physicians 'as sustantial
regarding need for ED monitoring( and moderate to sustantial for
other triage assessments. There 'as general agreement in inter
rater assessment of triage classi>cation. "ontinued 'or, is
necessary to more fully delineate areas of variation:
.=
S)5$",1 :II7 STUDIES RELATED TO KNOALEDGE OF NURSING
PERSONNEL ON TRIAGE SSTE87
A 5ualitative( descriptive study 'as conducted in Cniversity of
$ichigem( CSA to explicating nurses cardiac triage decision. The aim
of the study 'as to explicate the decision ma,ing processes of
Emergency Department Aurses 'ho triage men and 'omen for $I.A
synthesi7ed conceptual model 'as used to guide focus group
discussions and to egin the process of developing a conceptually
ased( 5uanti>ale measure of ED nurses: cardiac triage decisions.
Participants: %A R ./& oral descriptions 'ere audiotape recorded(
transcried veratim( and analy7ed using the 4rueger content
analysis method. Study sho'n that Aurses are ,no'ledgeale of
age and sex di*erences in $I presentation. ?o'ever( some nurses
hold cultural iases and stereotypes that may interfere 'ith the
timely delivery of emergency cardiac healthcare. Findings from this
study 'ill e used to develop a 5uanti>ale measure of ED nurses:
cardiac triage decision)ma,ing processes.
/3
A study 'as conducted in Sirira@ hospital -ang,o,( Thailand
'ith an aim of the study to compare the performance of non)
pediatric nurses 'ho are responsile for pediatric patients in the
emergency department efore and after pediatric triage training at
Sirira@ ?ospital. Pediatric Triage Training 'as set up for emergency
department and outpatient department nurses et'een Dune and
Bctoer /33< The training consisted of 2 hours of didactic sessions
on the concepts of pediatric triage and 1)2 hour sessions 'here the
nurses 'ere allo'ed to triage actual pediatric patients under the
supervision of a triage)training nurse. For comparison of
performance( the nurses 'ere divided into t'o groups( those 'ith
'or, experience of less than or e5ual to 2 years %group .& and more
than 2 years %group /&. An independent sample t)test 'as used to
determine the di*erence in performance et'een the t'o groups. A
pretest and post)test examination 'as administered. The nurses in
#roup . had higher pre)test scores %#roup . mean R </.02J( #roup
/ mean R 2/.1.J( p)valueR3.33.&( 'ere less li,ely to over triage
%#roup . mean R 1...J( #roup / meanR<.1<J( p)valueR3.3/.& and
had higher speci>city o* triage than #roup / %#roup . mean R
=2.<.( #roup / R =/.0=( p)value R 3.3.=&. ?o'ever( the nurses in
#roup / had more improvement in their post)test scores %percent of
improvement from pre)test6 #roup I mean R 9.2<J( #roup / R
01.<=J( p)value R 3.332&.Study sho'n that Eor, experience is an
important consideration in the triage ,no'ledge and performance of
non)pediatric nurses during triage training.
Accuracy of triage decisions is a ma@or inMuence on patient
outcomes. Triage nurses: ,no'ledge and experience have een
cited as inMuential factors in triage decision)ma,ing. The aim of this
study is to examine the independent roles of factual ,no'ledge and
experience in triage decisions. All of the articles cited in this revie'
'ere research papers that examined the relationship et'een
triage decisions and ,no'ledge andQor experience of triage nurses.
Aumerous studies have sho'n that factual ,no'ledge is an
important factor in improving triage decisions. Although a numer
of studies have examined the role of experience as an independent
inMuence on triage decisions( none have found a signi>cant
relationship et'een experience and triage decision)ma,ing.
Factual ,no'ledge appears to e more important than years of
emergency nursing or triage experience in triage decision
accuracy. $any triage education programs are planned 'ith the
assumption that ,no'ledge ac5uisition 'ill result in improved
triage decisions. The study sho'n that a etter understanding of
the relationships et'een clinical decisions( ,no'ledge( and
experience is pivotal for the rigorous evaluation of education
programs.
//
A retrospective study 'as performed at the emergency department
of the -ar7ilai $edical "enter( Ash,elon( Israel The study o@ective
'as to evaluate the capaility and the consistency of the triage
nurse to categori7e correctly emergency patients and its impact on
the 'aiting time for physician examination over a period of 0 years.
A retrospective revie' of the medical records 'as performed. All
patients 'ho 'ere examined y a triage nurse during / randomly
chosen consecutive 'ee,s during the years .==2 and .==9
participated. All the medical records 'ere revie'ed y the authors
and the follo'ing information 'as extracted from the medical
records6 nurse triage category( time of initial evaluation y a triage
nurse( duration of employment of the nurse in the ED( and her
experience as a triage nurse( time of initial examination y a
physician( the total length of stay in the ED( the history ta,en y the
triage nurse and the physician( and the physician:s urgency category.
Patient in urgency category . is a patient 'hose condition may
deteriorate if not examined 'ithin . hourT patient in category / is a
patient 'hose condition may deteriorate if not examined 'ithin /
hoursT category 0 is all the rest. Any deterioration and or delay of
treatment of the patients 'ere also recorded. Data concerning
patients 'ith an initial complaint of chest pain 'ere extracted
separately. The data 'ere analy7ed using the SPSS soft'are and the
results 'ere tested y the student t test and chi s5uare test. Inter
oserver agreement 'as measured using the ,appa value. A total of
/(99< completely full medical records 'ere revie'ed y the authors6
.(0.3 records from period I %.==2& and .28< from period II %.==9&. Bf
the patients =/J and 99./J 'ere classi>ed y the triage nurse as
category 0 in periods I and II respectively( 8J and =.9J as category
2 and .J and /J as category . respectively. Full agreement of
triage category et'een nurse and physician 'as found in =3.2J of
the cases in period I and =0J in period II %,appa R 3.=3 and ,appa
R 3.=0 respectively&. In period I( 83J of the patients in category .
'ere examined y a physician in . hour versus .33Ji in period II.
Almost all the patients in category / 'ere examined 'ithin / hours
%=9J( =8J&( and =9J of those in category 0 'ere examined 'ithin 0
hours. The average 'aiting time for physician examination in
category . patients dropped from 10.. minutes in period I to .9./
minutes in period II. The average 'aiting time for the triage nurse
'as = minutes in period I( and 8.1/ minutes in period II. The average
length of stay in the ED in period I 'as I hour and /1 minutes and I
hour and 03 minutes in period II. Bf the anamneses ta,en y the
triage nurse =..9J 'ere fully identical 'ith the physicians:
anamneses( ut in period II this percentage @umped to =9J. Patients
'ith chest pain 'ere categori7ed correctly y the triage nurse in
8<.9J of the cases in period I and 8/.1J in period II( 'ith an
overtriage of .9.<J and /3.8J respectively %,appa R 3.82( ,appa R
3.83 respectively&.The study concluded that nurse triage 'as safe
and e*ective in classifying patients to urgency categories. The
results are consistent and even improved. $ost of the patients 'ere
examined y the physician 'ithin the expected time. Triage nurse
predicted correctly the urgency category of patients 'ith chest in
most of the cases and the rate of missing acute coronary events 'as
very lo'.
/0
A study 'as conducted in Fremantle ?ospital( Eestern Australia
examine the consistency of triage outcomes y nurses using four
types of computeri7ed decision support soft'are in A?S Direct...=
scenarios 'ere constructed ased on calls to amulance services
that had een assigned the lo'est priority category y the
emergency medical dispatch systems in use. These scenarios 'ere
presented to nurses 'or,ing in four A?S Direct call canters using
di*erent computeri7ed decision support soft'are( including the A?S
"linical Assessment System. The overall level of agreement
et'een the nurses using the four systems 'as +fair+ rather than
+moderate+ or +good+ %,appaR3.082( =2J "I6 3.01 to 3.1.&. For
example( the proportion of calls triaged to accident and emergency
departments varied from //J %/< of ..=& to 11J %20 of ..=&.
-et'een /.J %/2 of ..=& and 0.J %08 of ..=& of these lo' priority
amulance calls 'ere triaged ac, to the === amulance service.
Ao system had oth high sensitivity and speci>city for referral to
accident and emergency services. There 'ere large di*erences in
outcome et'een nurses using di*erent soft'are systems to triage
the same calls. If the variation is primarily attriutale to the
soft'are then standardi7ing on a single system 'ill oviously
eliminate this.
A study is conducted in Fos Angeles "ounty ?aror C"FA
$edical "enter Aursing Department. Triage nursing is evolving as
a suspecialty of emergency nursing. Bf the >ve ma@or types of
triage systems in use( for utili7e nursing personnel. The Advanced
Triage System is the most comprehensive system and is utili7ed in
the Emergency Department at ?aror)C"FA $edical "enter. This
article de>nes the process of triage( revie's various types of triage
systems and discusses the ,no'ledge and role of the triage nurse
in the Advanced Triage System utili7ed at ?aror)C"FA $edical
"enter.
/2
In Australia( triage is predominantly a nursing assessment that
egins 'hen the patient presents to the Emergency Department A
study 'as done to revie' the consistency of triage in Victoria:s
emergency department in Australia. The Australasian Triage Scale
%ATS& 'as developed to priorities patient care and provide a
consistent approach to triage practice at a national level. ?o'ever(
its use has een extended to include measurement of ED
performance( funding allocation and determination of 5uality of
care. Therefore( it is vital that the application of the ATS is
consistent y oth individual triage nurses and organi7ation.
"onsistency of application of the ATS has een sho'n to vary
depending on the speci>c clinical characteristics identi>ed y the
triage nurse. The study reveals the role of education in achieving
consistency of triage appears important( the re5uirement for triage
nurses to e speci>cally prepared for the triage role.
/<
S)5$",1 : III 7 STUDIES RELATED TO EFFECTIVENESS OF
STRUCTURED TEAC9ING PROGRA87
A study 'as conducted in Sir Ivan Stedeford hospital( "hennai
to investigate the e*ectiveness of structured teaching program in
prevention of nipple sore to the primi)postnatal mothers. The
sample si7e consists of <3 pri mi)postnatal mothers %03 in control
group P 03 in experimental group&. A structured teaching plan 'as
administered to the experimental group of primi)postnatal mothers.
Pretest and post)test on ,no'ledge 'as conducted for oth control
and experimental group. The analysis revealed the overall mean score
of the experimental group 'as 1/..1 in the pretest and 88.09 in the post)
test 'hereas for the control group( the overall mean score 'as 13.19 in
the pretest and only 2...= in the post)test. There 'as a signi>cant
improvement of ,no'ledge after the structure teaching program.
A study 'as conducted in $.S. !amaiah Aarayana ?rudayalaya
heart centre( -angalore to investigate the e*ectiveness of structured
teaching program in care of clients undergoing "A-#. The sample si7e
consists of 23 sta* nurses. Pretest and post)test on ,no'ledge 'as
conducted for the group follo'ed y a structured teaching program. The
analysis revealed the overall mean score of group 'as /1.< in the
pretest and 03.<9 in the post)test . There 'as a signi>cant
improvement of ,no'ledge after the structure teaching program.
The 5uasi experimental study 'as conducted in 4omarapalayam(
Tamil Aadu regarding iron de>ciency anemia( among high school
girls to evaluate the e*ectiveness of planned teaching programme.
!andom sampling techni5ue 'as used to have <3 sample. The tool used
'as self administer 5uestionnaire. The study results revealed the overall
mean value in the posttest 92.//J 'as higher than the pretest mean
value /<.3 regarding ,no'ledge on iron de>ciency anemia among high
school girls. The otained mean di*erence 'as 2=.//.The otained
paired t value =0.== 'as found to e highly signi>cant at 3.333. level. It
'as sho'n that planned teaching programme 'as signi>cantly
e*ective.
A Iuasi)experimental study 'as conducted to determine the
e*ectiveness of planned teaching programme given to patient
a'aiting for Extra "orporeal Shoc, Eave Fithotropsy %ESEF&
treatment. A sample of 13 patients 'as chosen and pre test 'as
done using simple 5uestionnaire and as per assessment( planned
teaching 'as given. After 0days efore treatment post test 'as
given y means of same pretest 5uestionnaire. Ehile comparing the
,no'ledge level and the anxiety level 'ith pre and post test( it
sho'ed that there 'as an association et'een the planned teaching
programme and increase in ,no'ledge regarding the treatment(
'hich decreases the level of anxiety in patient.
03
A Iuasi)experimental study 'as conducted to determine the
e*ectiveness of planned teaching programme on 4no'ledge
regarding AIDS among Auto ric,sha' Drivers of Pune( $aharastra. A
sample of 13 Auto drivers 'as chosen and pre test 'as done using
simple 5uestionnaire and planned teaching 'as given. After 8 days
post test 'as conducted 'ith the same pretest 5uestionnaire. Ehile
comparing the ,no'ledge the $a@ority %<.J& of Auto driver level of
,no'ledge scores are .2 to //J.Ehere the post test score sho'ed
that the auto ric,sha' drivers are having .33J ade5uate
,no'ledge. The study concluded that planned teaching programme
is an e*ective strategy for gaining ,no'ledge.
A study 'as conducted on e*ectiveness of a <)'ee, online
course in the "anadian Triage and Acuity Scale for emergency
nurses. The purpose of this study 'as to explore the e*ectiveness
of an online course in the 2)level "anadian Triage and Acuity Scale
%"TAS& on the clinical practice of the triage nurse. Intervie's 'ere
held 'ith /0 emergency nurses from across "anada. A chart audit
of triage codes from 0<8 charts from < hospita.s 'as conducted.
The study reveals that most consistent >nding 'as that the ma@ority
of !A sta* en@oyed the online course and elieved it had improved
their triage practice. Triage accuracy 'as highT the overall
agreement et'een "TAS graduates and the chart auditorQexpert
'ithin one "TAS level 'as ==.8J. Aurses aiso identi>ed a numer
of organi7ational arriers to "TAS implementation after the course.
0/
A prospective study 'as conducted in university of Aleca
Edmonton an uran tertiary care ED. In phase .( eT!IA#E 'as
deployed after a 0)hour training course for /1 triage nurses 'ho
'ere as,ed to share this ,no'ledge during regular $age shifts 'ith
colleagues 'ho had not received training %n R 88&. In phase /( a
targeted group of 9 triage nurses under'ent further training 'ith
eT!IA#E. In each phase( patients 'ere assessed >rst y the duty
triage nurse and then y a linded independent study nurse( oth
using eT!IA#E. Inter)rater agreement 'as calculated using ,appa
%'eighted ,appa& statistics.In phase .( 2<= patients 'ere enrolled
'ith 2.0 %=3./J& complete recordsT 288 patients 'ere enrolled in
phase / 'ith 222 %=<./J& complete records. Inter)rater agreement
during phase . 'as moderate % =2J con>dence interval U"IV 3.1=)
3.</&T agreement improved in phase / % =2J "I 3.<3)3.83&. $anual
overrides of eT!IA#E scores 'ere infre5uent %approximately .3J&
during oth
P
eriods.Agreement et'een study nurses and duty
triage nurses( oth using eT!IA#E( 'as moderate to good( 'ith a
trend to'ard improvement 'ith additional training. Triage overrides
'ere infre5uent. "ontinued attempts to re>ne the triage process and
training appear 'arranted.
00
A study 'as conducted in $elourne on Bptimi7ing triage
consistency in Australian emergency departments y training the
nurses y using Emergency Triage Education 4it. The Emergency
Triage Education 4it 'as designed to optimi7e consistency of triage
using the Australasian Triage Scale. The study 'as also conducted
to determine the inter rater reliaility of a set of scenarios for
inclusion in the programme. A postal survey of /08 paper)ased
triage scenarios 'as utili7ed. 1/ nurses participated. The scenarios
'ere analysed for concordance and agreement. Data 'ere collected
during / April to .1 $ay /338. All scenarios that sho'ed good levels
of agreement have een included in the Emergency Triage
Education 4it and those that sho'ed moderate agreement have
een incorporated for teaching purposes.
4. 8ET9ODOLOG7
!esearch methodology is a systematic 'ay to solve
the research prolem. It involves the systematic procedure
y 'hich the researcher starts from the initial identi>cation
of the prolem to its >nal conclusion.
This chapter deals 'ith the methodology adopted y
the researcher for the study 'hich includes research
approach( research design( the variales of the study(
setting( population( sample( sampling techni5ue( selection
and development of study tool( development of structure
teaching programme( preparation of lue print( validity of
the study tool( reliaility of the tool( pilot study( data
collection procedure and plan for data analysis on the
'hole it gives the general process for gathering and
processing of research data.
The present study is conducted to assess the
e*ectiveness of structure teaching programme on
,no'ledge regardmg triage system of patient in emergency
department among nursing personnel.
RESEARC9 APPROAC97
!esearch approach is a systematic( controlled(
empirical and critical investigation of natural phenomena
guided y theory and hypothesis aout the presumed
relations among the phenomena.
The appropriate choice of the research approach
depends on the purpose of the study 'hich underta,en. A
research approach tells the researcher 'hat data to collect
and ho' to analy7e it. It also suggests possile conclusions
to e dra'n from the data.
!esearch approach selected for this study is evaluative
approach 'hich is considered as appropriate to assess the
,no'ledge of nursing personnel on triage system P evaluate
the e*ectiveness of structure teaching programme on triage
system.
R)#)(<5! &)#"217
!esearch design is the researcher:s overall plan for
otaining ans'ers to research 5uestions and it spells out the
strategies that the researcher adopts to develop information
that is accurate( o@ective and interpretive.
The Pre experimental research design is used in vie' of
the nature of the prolem and to accomplish the o@ectives
of the study. ?ence a Pre experimental research 'ith one
group pre test and post test design 'as used to assess the
,no'ledge and e*ectiveness of planned teaching
programme on triage system of patient in emergency
department among nursing personnel.
VARIABLE UNDER T9E STUD
Variales are the central uilding loc,s of 5uantitative
studies. It refers to as a concept 'hich can ta,e on di*erent
5uantitative values.
INDEPENDENT VARIABLES7
Structured teaching programme on triage system of
patient in Emergency Department.
DEPENDENT VARIABLE7
4no'ledge of nursing personnel regarding triage
system of patients in Emergency Department.
EXTRANEOUS VARIABLES
Selected demographic variales such as age( gender(
total years of 'or, experience( area of 'or,( and source of
information.
SETTING OF T9E STUD
The physical location and condition in 'hich data
collection ta,es place in a study is the research setting and
the criteria for selecting the study setting are the availaility
of clients( feasiility of conducting the study and the
investigators familiarity 'ith the setting.
The study re5uires nursing personnel 'or,ing in
hospital ( so the study 'as conducted in ET"$ ?ospital at
,olar.
POPULATION
Population is an aggregate or totality of all su@ects
'ho poses some common characteristics.
In this study( population consists of all nurses 'or,ing
in hospital.
T(<2)$ +,+%.($",1
It is the aggregate of cases aout 'hich the researcher
'ould li,e to ma,e
generali7ations.
In the present study target population 'ere nurses
'or,ing in hospital 'ith 5uali>cation of #A$( -.Sc %A&( $Sc
Aursing.
A55)##"3.) +,+%.($",1
It is the aggregate of cases that conform to the
designated criteria and that are accessile as a pool of
su@ects for the study.
In the present study( accessile population are
nursing personnel 'ho ful>ll the inclusion criteria( 'or,ing in
Aditya "are ?ospital( -huanes'ar.
SA8PLE AND SA8PLE SIDE7
Sample consists of a suset of the units that comprises the
population.
In this study sample si7e consisted of 23 nurses 'ho are
'or,ing in Aditya "are ?ospital and also 'ho ful>lls the
inclusive criteria for present study.
SA8PLING TEC9NIEUE
Sampling is the process of selecting a suset of a
population in order to otain information regarding a
phenomenon in a 'ay that represents the entire population.
Simple random sampling techni5ue 'as used in this study to
select the samples y using lottery method.
SA8PLING CRITERIA
The sample selection 'as ased on the follo'ing
inclusion and exclusion criteria
I15.%#"6) C<"$)<"(7 S$%&' "15.%&)&7
-oth male and female nursing personnel.
Aursing personnel 'ho have completed #A$Q-.ScQ$Sc
35
Aursing course.
Aursing personnel 'ho are 'illing to participate in the
study.
EF5.%#"6) 5<"$)<"(7 S$%&' )F5.%&)&7
Aursing personnel 'ho are asent during data
collection.
Aursing Personnel 'ho have completed AA$ course
SELECTION AND DEVELOP8ENT OF T9E STUD TOOL
A tool is a 'ritten device that a researcher uses to
collect data and it is a vehicle 'hich 'ould e the est in
otaining data pertinent to the study and at the same time
adds to the ody of general ,no'ledge in the discipline.
-ased on research prolem and o@ectives of the study
the follo'ing steps 'ere underta,en to select and develop
the data collection tool. Tool 'as developed y using the
follo'ing6
-oo,s( @ournals( research studies 'ere revie'ed
Internet #oogle search( Pu med( $edline
Expert:s opinions and suggestions 'ere ta,en from the
>eld of $edical and surgical nursing %8&( Statistician %.&(
and Doctors %/&
Personal experience and discussion 'ith ac5uaintances.
Tool 'as prepared consisting of 13 5uestionnaires and
is given to experts from $edical and surgical nursing(
Statistician and Doctors for validation. According to experts
suggestions modi>cations 'ere made. Total 02
5uestionnaires 'ere >nali7ed.
DESCRIPTION OF T9E TOOL
Structured 5uestionnaire consist of t'o parts i.e.( part I
and part II
P(<$ I7 D)*,2<(+!"5 D($(7
This part consist of items on demographic variales
Age( #ender( Gears of experience( Area of 'or, experience(
Source of information regarding Triage system in
Emergency Department( personal experience met 'ith
accident and mode of travel to college.
P(<$ II7 A##)##*)1$ ,- =1,0.)&2)7
Structure ,no'ledge 5uestionnaire consist of 02
,no'ledge items related to Triage system in Emergency
Department 'hich includes
$eaning and Evolution of Triage %1items&
Types( #oals WFunction of Triage in Emergency
Department %2items&
$ethods of Triage System in Emergency Department
%ISitems&
Triage components( Triage process and Aursing process
in Triage System In Emergency Department %<items& .
Importance and ene>ts of Triage system in Emergency
Department %/items&
Each correct ans'er 'as assigned a score of one and
a 'rong response a 7ero.
The ,no'ledge of the respondents 'as aritrarily
categori7ed as follo's6
Inade5uate ! 23J
$oderately ade5uate 23)82J
Ade5uate X82J
PREPARATION OF BLUE PRINT
A lue print 'as prepared on the level of understanding
of the nursing personnel.02 Iuestions 'ere framed under
topics of triage system.
-ased on the concept of the study the lue print 'as
prepared under three main areas i.e.( 4no'ledge %.<&(
"omprehension %<&( Prolem Solving %.0&.
DEVELOP8ENT OF CRITERIA RATING SCALE LIST FOR
VALIDATION OF T9E TOOL
"riteria rating scale for validation of the tool 'as developed(
'hich consist of follo'ing parts
P(<$ I7 D)*,2<(+!"5 &($(
P(<$ II7 S$<%5$%<)& G%)#$",11("<) ,1 $<"(2) #'#$)* "1
E*)<2)15' D)+(<$*)1$.
SCORING KE
Scoring ,ey 'as prepared for part II( Score :.: and :3:
'ere a'arded to correct and 'rong responses respectively.
Thus the maximum score 'as 02.
To interpret the level of ,no'ledge the scores su@ected
as follo's6 Inade5uate Y 23( $oderate 23 ) 82 Ade5uate X
82 and aove.
DEVELOP8ENT OF STRUCTURED TEAC9ING
PROGRA88E7
The structured teaching programme 'as prepared y
the researcher using charts and Mash cards comprising
general information regarding $eaning and Evolution of
Triage Types( #oals PFunction of Triage in Emergency
Department %ED&($ethods of Triage System in Emergency
Department %ED&( Triage components( Triage process and
Aursing process in Triage System In Emergency Department(
Triage components( Triage process and Aursing process in
Triage System In Emergency Department( Importance and
ene>ts of Triage system in Emergency Department%ED&.
The content 'as prepared in English for 12 minutes for the
'hole teaching programme 'ith veral interactions. The
content of planned teaching programme 'as validated y
otaining the suggestion of .3 experts from medical surgical
department 8( Doctors /( including statistician as
one expert. The modi>cations( suggestions and
recommendations %i.e.( expansions of areviations used
and correction of certain items& the >nal draft of structure
teaching programme 'as prepared.
DEVELOP8ENT OF CRITERIA RATING S"AFE FOR STP
A criterion rating scale 'as prepared to assess the
validity of the structure teaching plan i.e.( to >nd out the
relevancy of the content according to the o@ectives of the
teaching( appropriateness( se5uence( presentation of the
language of content and appropriateness of visual images
used.
CONTENT VALIDIT
It refers to 'hether an instrument accurately measures
'hat it is supposed to measure.
The developed structured ,no'ledge 5uestionnaire and
STP on triage system 'ere given to .3 experts( 8 from the
>eld of medical and surgical nursing( / medical and .
statisticians along 'ith the criteria rating scale for
estalishing the validity. -ased on their suggestion and
recommendations the tool and structure teaching
programme 'as modi>ed.
RELIABILIT OF T9E STUD TOOL
!eliaility of a research instrument is de>ned as the
extent to 'hich the instrument yields the same result on
repeated measures.
In order to estalish the reliaility( the tool 'as
administered to ./ college students of FD$ "ollege of
nursing. The split half method 'as used to estimate
homogeneity. The tool 'as >rst divided into t'o e5ual halves
'ith odd and even numer of 5uestions. "orrelation of the
test 'as found out y using 4arl)Pearson:s correlation co)
eNcient formula.
The reliaility co)eNcient of the 'hole test 'as then
estimated y using Spearman)-ro'n Prophecy formula. The
,no'ledge 5uestionnaire 'as found reliale %r R3.2<&.
?ence the tool 'as reliale for the study
PILOT STUD REPORT
A pilot study is a small)scale version or trail run( done
in preparation for a ma@or study.
Pilot study 'as conducted at $edicare ?ospital(
-angalore on 31.32./3.0 to assess the existing ,no'ledge
of nursing personnel on triage system in emergency
department. The investigator used simple random sampling
techni5ue using lottery method to select the sample from
the total samples from the total population. Ten samples
'ere selected for the study. The study su@ects 'ere
selected ased on the inclusion criteria and the. purpose of
the study 'as explained. The pretest 'as conducted on
31.32./3.0 y administering structured 5uestionnaire to
nursing personnel( then follo'ed y structured teaching on
triage system in Emergency Department on the 9
lh
day post
test 'as conducted y using the same tool for the same
group. The pilot study >ndings revealed that the overall post
test ,no'ledge scores %8=..8& 'as otained 'as higher than
the overall pre)test ,no'ledge scores %13.28& 'ith :t: value
.9.38 'hich sho'ed signi>cant at pY 3.33.( so there is a
signi>cant gain in ,no'ledge among nursing personnel after
attending structure teaching programme on triage system in
emergency department. ?ence the null hypothesis 'hich
'as framed in the study 'as accepted.
DATA COLLECTION PROCEDURE
Data collection is the gathering of information needed to
address a research prolem. The data collection 'as done
for a period of one 'ee, from 30.3=./3.0 to ./.3=./3.0. The
ethical clearance 'as otained from the research committee
of the FD$)"ollege of Aursing( -huanes'ar and the formal
permission to conduct the study 'as otained from the
$edical Superintendent of Aditya "are)?ospital(
-huanes'ar.
!andom sampling method y using lottery system
samples 'ere selected for the study. Informed consent 'as
otained from the participants enrolled for the study and
their con>dentiality and anonymity 'as maintained.
Investigator introduced herself to the group and the data
collection procedure 'as carried out y conducting pretest P
post test.
P<) $)#$
Pre test 'as conducted 'ith the help of structured
5uestionnaire among 23 nursing personnel 'ho 'ere
selected y using simple random sampling techni5ue.
I*+.)*)1$($",1 ,- #$<%5$%<)& $)(5!"12 +<,2<(**)
Structured teaching module 'as administered on the same
day after the pre test.
P,#$:$)#$
Post)test 'as conducted on 9
th
day 'ith same structured
5uestionnaire for the same group of nursing personnel.
PLAN FOR DATA ANALSIS
Data analysis is a systemic is a systematic organi7ation
and synthesis of research data. The data otained 'as
analy7ed y using descriptive statistics %$ean( median(
standard deviation( fre5uency and fre5uency and
percentage& and inferential statistics %"hi)s5uare test&.
T!) #$)+# +.(11)& -,< &($( (1(.'#"# (<)7
Brgani7ing the data on a master data sheet
S)5$",1 )1
Analy7ing the demographic data of nursing personnel
in terms of fre5uencies and percentages 'hich is presented
in the form of tales and diagrams.
S)5$",1 : 2
Analy7ing ,no'ledge of nursing personnel on their
selected demographic variale in terms of fre5uency(
percentage( mean( mean percentage and standard deviation
'hich is presented in the form of tales and diagrams.
S)5$",1 ) 3
Determining the association et'een selected demographic
variales of nursing personnel 'ith their ,no'ledge
regarding triage system in emergency department.
.
5. RESULTS
This chapter deals 'ith the analysis and interpretation of
data in order to evaluate the e*ectiveness of structured teaching
programme on triage system in emergency department among
nursing personnel 'or,ing in Aditya "are ?ospital at
-huanes'ar.
The purpose of the analysis is to reduce the data to a
manageale and interpretale form( so that the research
prolem can e studied and tested.
The data collected 'ere analy7ed according to the plan for
data analysis 'hich includes oth descriptive and inferential
statistics. The analysis of data for the present study 'as
processed on the asis of the o@ectives and hypothesis
formulated for the purpose of study.
.& To assess the ,no'ledge regarding triage system of patient in
Emergency Department among nursing personnel on the
asis of pre test score.
/& To develop a structure teaching programme on triage system
of patients in Emergency Department.
0& To conduct a structure teaching programme on triage system
of patient in Emergency Department among nursing
personnel in selected hospital at -huanes'ar.
1& To evaluate the e*ectiveness of structured teaching
programme regarding triage system of patient in Emergency
Department y comparing pre test and pos test ,no'ledge
scores among nursing personnel.
2& To determine the association et'een the ,no'ledge of
nursing personnel regarding triage system of patients in
Emergency Department 'ith selected demographic
variales.
9POT9ESIS7
?o i There 'ill e no signi>cant di*erence et'een pre test and
post test ,no'ledge scores of nursing personnel regarding
triage system of patient in Emergency Department.
?3/ There 'ill e no signi>cant association et'een post test
,no'ledge scores of nursing personnel 'ith their selected
demographic variale.
PRESENTATION OF DATA
The data otained 'ere entered in a master data sheet
for taulation and statistical processing. The analysis of data is
organi7ed and presented under the follo'ing sections.
S)5$",1 I7 Demographic variale of nursing personnel
S)5$",1 II7 Pretest ,no'ledge level of nursing personnel on
triage system
S)5$",1 III7 Posttest ,no'ledge level of nursing personnel on
triage system
S)5$",1 IV7 E*ectiveness of Structured teaching programme
on triage system
S)5$",1 V7 Association et'een the levels of ,no'ledge of
nursing personnel 'ith their demographic variales.
SECTION :1
DE8OGRAP9IC VARIABLES OF NURSING PERSONNEL
T(3.):17 F<)G%)15' (1& P)<5)1$(2) D"#$<"3%$",1 ,-
1%<#"12 +)<#,11). (55,<&"12 $, $!)"< (2)
N H 50
AGE IN
EARS
FREEUENC PERCENTAGE
20:29 02 83
30:39 .1 /9
40:49 . /
50:59 3 3
T,$(. 50 100
The aove tale sho's that maximum numer of nursing
personnel %83 J& elongs to the age group of /3)/= years
and only 03 J 'ere in the age group of 03)0= years.
FIGURE : 3
T(3.):2
D"#$<"3%$",1 ,- 1%<#"12 +)<#,11). (55,<&"12 $,
$!)"< 2)1&)<
N H
50
GENDER FREEUENC PERCENTAGE
$ale .< 0/
Female 01 <9
T,$(. 50 100
The aove Tale sho's that 'ith regard to the gender
of nursing personnel( ma@ority of them %<9J& 'ere females
and only 0/J 'ere males.
FIGURE :4
T(3.):3 7
F<)G%)15' (1& P)<5)1$(2) D"#$<"3%$",1 O- N%<#"12
P)<#,11).
(55,<&"12 $, $!)"< P<,-)##",1(. E%(."/5($",1
N H 50
PROFESSION
AL
EUALIFICATIO
FREEUENC PERCENTAGE
GN8 36 8/
B.S5.
N%<#"12
14 /9
8.S5.
N%<#"12
0 3
T,$(. 50 100
The aove tale sho's that regarding professional
5uali>cation of nursing personnel( 8/J of them 'ere having
general nursing and mid'ifery and only /9J 'ere 'ith -.Sc
%A& degree.
!e)presentation of percentage of distriution of nursing
personnel according to their professional 5uali>cation
FIGURE : 5
TABLE:S7 FREEUENC AND PERCENTAGE
DISTRIBUTION OF NURSING
PERSONNELACCORDING TO AREA OF
EXPERIENCE
A R se) "ji..
AREA OF
EXPERIENCE
FREEUENC

PERCENTAGE
8)&"5(. ICU 0 0
S%<2"5(. ICU 6 12
E*)<2)15' 10 20
C(<&"(5 ICU 4 8
OT 2 4
OPD 0 0
8)&"5(. A(<& 11 22
S%<2"5(. A(<& 9 18
T,$(. 42 84
The aove tale sho's that in relation to the area of 'or,
experience maximum %// J& of nursing personnel had
experience in $edical 'ard and only 1J 'ere from BT.

TABLE:6 7 FREEUENC AND PERCENTAGE
DISTRIBUTION OF NURSING PERSONNEL
ACCORDING TO T9EIR PREVIOUS
INFOR8ATION
N H 50
PREVIOUS
INFOR8ATE8TIO
N ON TRIAGE
SSTE8
FREEUENC

PERCENTAGE
P)<#,11). 7 .1
P<"1$)& 8)&"( 35 83
E.)5$<,1"5
8)&"(
8 .<
T,$(. 50 100
The aove tale sho's that .1 J of the nursing
personnel had previous Information on triage
system from personnel media( 83 J had from
printed $edia and .<J from electronic media.
R)+<)#)1$"12 +)<5)1$(2) &"#$<"3%$",1 ,-
1%<#"12 +)<#,11). (55,<&"12 +<)6",%#
"1-,<*($",1
FIGURES:8
SECTION:II
PRE TEST LEVEL OF KNOALEDGE OF NURSING PERSONNEL ON
TRIAGE SSTE8
TABLE:7
8EANI 8EAN PERCENTAGE AND STANDARD DEVIATION OF T9E
PRETEST KNOALEDGE SCORE OF NURSING PERSONNEL ON
TRIAGE
SSTE8.
A R 23
SL.
NO
ASPECTS OF KNOALEDGE ON
TRIAGE SSTE8
8EAN 8EANJ S.D
I $eaning and Evolution of Triage 1.62 13.2 3.9320
2 Types( #oal P Function In ED /(.1 1/.9 3.8
3 $ethod of Triage System In ED 1.<9 /< ..=81
4
Triage components( Triage Process
and Aursing Process In Triage System
..8/ /9.<8 3.28/=
5 Importance and ene>ts of Triage
system in Emergency Department
1.28 <1 3.8
Bverall 11.44 13.0= 1.820.
The aove tale sho's that the maximum mean
percentage otained y the nursing personnel is <1 'ith
standard deviation of 3.8 in the aspects of Triage components(
Triage Process and Aursing Process in Triage System. The
minimum mean percentage is /< 'ith standard deviation ..=8 in
the aspect of $ethod of Triage System. The overall ,no'ledge
otained y the nursing personnel on triage system is 13.0=
'ith standard deviation 1.820.
TABLE:87 FREEUENC AND PERCENTAGE
DISTRIBUTION OF PRETEST LEVEL OF KNOALEDGE
OF NURSING PERSONNEL ON
TRIAGE SSTE8
NH50
SI.
N,.
L)6).
,-
=1,0.)&
2)
I1(&)G%($)
=1,0.)&2)
K50J
8,&)<($).'
(&)G%($)
=1,0.)&2)
50:75J
A&)G%($)
=1,0.)&2)
L75J
F<)G%)15'
P)<5)1$(2)
F<)G%)15'
P)<5)1$(2)
F<)G%)15'
P)<5)1$(2)
1. Pretest 48 96J 02 04J M M
The aove tale sho's that the maximum =<J nursing
personnel had inade5uate ,no'ledge 'hereas 31J of
nursing personnel had moderate ,no'ledge and none had
ade5uate ,no'ledge on triage system in emergency
department.
FIGURE ) 9
I Pretest 4no'ledge
SECTION III
POST TEST LEVEL OF KNOALEDGE OF NURSING
PERSONNEL ON
TRIAGE SSTE8
TABLE - 097 8EANI 8EAN PERCENTAGE AND STANDARD
DEVIATION OF T9E POSTTEST KNOALEDGE SCORE OF
NURSING PERSONNEL.
A R 23
SF.
AB
ASPE"TS BF 4ABEFED#E $EAA $EAA
J
S.D
. $eaning and Evolution of Triage 0.91 =< 3.08
/ Types( #oal P Function In ED 1.2/ =3.1 3.23
0 $ethod of Triage System In ED .<.01 =3.89 3.<<
1 Triage components( Triage Process
and Aursing Process In Triage System
1.=1 9/.00 3.</
2 Importance and ene>ts of Triage
system in Emergency Department
..99 =1 3.00
< Bverall 0..2/ =3.83/ /.19
The aove tale sho's that the maximum mean
percentage otained y the nursing personnel is =< 'ith
standard deviation 3.08in the aspects meaning and
evolution of Triage system. The minimum mean percentage
is 9/.00'ith standard deviation 3.</ of Triage "omponents
of Triage System. The overall ,no'ledge otained y the
nursing personnel in post test is =3... 'ith standard
deviation /.19.
TABLE:IO7 FREEUENC AND PERCENTAGE
DISTRIBUTION OF POST TEST LEVEL OF
KNOALEDGE OF NURSING PERSONNEL
N H 50
SI.
N,
.
L)6).
,-
=1,0.)
&2)
I1(&)G%($)
=1,0.)&2)
K50J
8,&)<($).'
(&)G%($)
=1,0.)&2)
50:75J
A&)G%($)
=1,0.)&2)
L75J
F<)G%)15'
P)<5)1$(2)
F<)G%)15'
P)<5)1$(2)
F<)G%)15'
P)<5)1$(2)
1. Posttest M M 03 06 18 =1
The aove tale sho's that the maximum% =1 J &
numer of nursing personnel had ade5uate ,no'ledge and
<J of nursing personnel had moderate ,no'ledge on triage
system in post test.
FIGURE :10
SECTION:IV
EFFECTIVENESS OF STRUCTURED TEAC9ING PROGRA88E
REGARDING ON TRIAGE SSTE8
TABLE:117 CO8PARISON OF PRE TEST AND POST TEST OF
KNOALEDGE SCORES A8ONG NURSING PERSONNELON
TRIAGE
SSTE8
N H 23
ASPECTS OF
KNOALEDGE
PRE TEST POST TEST BT;
VAFCE
8EAN SD 8EAN SD
$eaning and
Evolution of Triage
..</ 3.9320 0.91 3.08 ;.8.93
Types( #oal P Function
In ED
/..1 3.8 1.2/ 3.23 Z .=.2
$ethod of Triage
System In ED
1.<9 ..=81 .<.01 3.<< ;0=.8
Triage components(
Triage Process and
Aursing Process In
Triage System In ED
..8/ 3.28/= 1.=1 3.</ ;/8.32
Importance and
ene>ts of Triage
system in Emergency
../9 3.8 ..99 3.00 ;2.19
Bverall 4no'ledge ...11 1.820. 0..2/ /.19 ;/<.1=
;is signi>cantT AS6 is not signi>cant PY3.3. level
From the aove tale it is evident that in pre test the
overall mean ,no'ledge value is ...11 'ith standard
deviation 1.82 and in post test of overall mean ,no'ledge
value is 0..2/ 'ith standard deviation /.19.
It is evident that the otained :t: value /<.1= is greater than
the tale value at 3.3. level of signi>cance. Therefore T
value is found to e signi>cant. It means there is gain in
,no'ledge level of nursing personnel. This study supports
the structure teaching programme on triage system( is
e*ective in increasing the ,no'ledge level of nursing
personnel. ?ence the null hypothesis framed for the study is
re@ected.
REPRESENTINGCO8PARISON OF PRE AND
POSTTEST 8EAN KNOALEDGE OF NURSING
PERSONNEL IN VARIOUS ASPECTS ON
TRIAGE SSTE8
R)+<)#)1"12 5,*+(<"#",1 ,- +<) (1& +,#$
$)#$ *)(1 =1,0.)&2) ,- 1%<#"12 +)<#,11). "1
6(<"%# (#+)5$# ,1 $<"(2) #'#$)*
P
VARIUS ASPECTS ON TRIAGE SSTE8 IN
E8ERGENC DEPART8ENT
FI#C!E )..
./3
.33
F
)
93
<3
)))))))))
m
i
L
/3
FIGURE :9
SECTION:V
TABLE :12 7 ASSOCIATION BETAEEN T9E LEVELS OF
KNOALEDGE
AIT9 T9EIR DE8OGRAP9IC VARIABLES
AR
.3
Bverall ,no'ledge
Demographi
cal variales
Inade5ua
te
,no'ledg
e
$oderatel
y
ade5uate
,no'ledg
Ade5ua
te
,no'led
ge
"hi
s5uare
H
/
value
Ao. Ao. Ao.
Age in
Gears
/3)/= M / 00
H
/
R1./
2
DfR/
03)0= M . .0
13)1= M M .
23)2= M M M
#ender $ale M M .<
HWR3.
80 Female M 0 0.
Profession
al
Iuali>cati
on
#A$ M / 02
H
/
R3.<
2
DfRl
-.Sc. Aursing M . ./
$.Sc. Aursing M M M
Total year
of
experienc
e
Y.3 M 0 13
H
/
R3.3
=
DfRl
.3)/3 M M 38
/.)03 M M M
X03 M M M
Area of
Experien
ce
$edical I"C M M M
H
/
R8..3
2
DfR8
Surgical I"C M M 3<
Emergenc
y
M M .3
"ardiac I"C M M 31
BT M M 3/
BPD M M M
Pediatrics M M 39
$edical Eard N . .3
Surgical Eard M / 38
Previous
informati
on
on Triage
system
Personnel M M 38
H
/
)..11
DfR/
Printed $edia M / 00
Electronic
$edia
M . 38
; 6 is signi>cant S 6 is signi>cant
The aove tale sho's that the otained Dt
/
value is more than the tale
value oth at 3.3. and 3.32 levels of signi>cance. Therefore the research
hypothesis is accepted and sho's that there is signi>cant association
et'een selected demographic variales 'ith the ,no'ledge scores of
participants.
6. DISCUSSION
This chapter deals 'ith the discussion in accordance
'ith the o@ectives and hypothesis of the study.
The statement of the prolem +A study to assess the
e*ectiveness of structured teaching program on ,no'ledge
regarding triage system of patient in emergency
department among nursing personnel in a selected hospital
at -huanes'ar.
OB@ECTIVES
.. To assess the ,no'ledge regarding triage system of
patient in Emergency Department among nursing
personnel on the asis of pre test score.
/. To develop a structure teaching programme on triage
system of patients in Emergency Department.
0. To conduct a structure teaching programme on triage
system of patient in Emergency Department among
nursing personnel in selected hospital at -huanes'ar
1. To evaluate the e*ectiveness of structured teaching
programme regarding triage system of patient in
Emergency Department y comparing pre test and pos
test ,no'ledge scores among nursing personnel.
2. To determine the association et'een the ,no'ledge
of nursing personnel regarding triage system of
patients in Emergency Department 'ith selected
demographic variales.
S)5$",1 I7 F"1&"12# <)2(<&"12 D)*,2<(+!"5
V(<"(3.) ,- 1%<#"12 +)<#,11). AGE7
The distriution of the su@ect y age revealed that
ma@ority of nursing personnel %83 J& elongs to the age
group of /3)/= years.
This >nding is supported y Susan %/332& 'ho
assessed ,no'ledge of nurses on selected aspects of
antepartal assessment of fetal 'elleing and found that
ma@ority of nurses 00 %11J& 'ere in the age group et'een
/. ) /2 years.
09
GENDER
Eith regard to gender of nursing personnel( ma@ority
of them %<9J& 'ere females and only 0/J 'ere males.
This >nding is supported y study done y Poornima
%/3.3& 'ho assessed ,no'ledge of sta* nurses on
prevention of Dengue fever has found that ma@ority of
nurses 10 %9<J& 'ere female nursing personnel and 8 %.1J&
'ere male.
0=
PROFESSIONAL EUALIFICATION
Eith regard to professional 5uali>cation of nursing
personnel( 8/J of them 'ere having general nursing and
mid'ifery and only /9J 'ere 'ith -.Sc %A& degree.
This study is supported y Sidduvasanthi %/3.3& 'ho
assessed the ,no'ledge of sta* nurses on pre operative
care of "A-# patients( has found that 2<J of nursing
personnel had #A$ and 11J had -Sc %A& as their
professional 5uali>cation.
13
TOTAL EARS OF EXPERIENCE
Eith regard to the total years of experience of nursing
personnel( ma@ority %91JX& of nursing personnel 'ere
having Y .3yrs years of 'or, experience.
This result 'as supported y a study 'hich 'as
conducted y Srinivas %/330& 'ho assessed the ,no'ledge
of sta* nurses regarding care of patient 'ith diaetic
mellitus and found that ma@ority of su@ects had Y.3years
of experience. :
AREA OF EXPERIENCE
Eith regard to the area of 'or, experience maximum
%// J& of nursing personnel had experience in $edical 'ard
and only 1J 'ere had experience in BT.As more numer of
nurses are 'or,ing in medical 'ard the participants 'ere
found more in $edical 'ard.
SOURCE OF PREVIOUS INFOR8ATION
Eith regard to the source of previous information .1
J of the nursing personnel had previous Information on
triage system from personnel media( 83 J had from printed
$edia and .<J from electronic media. $a@ority of nurses
follo' oo,s and @ournals to get information.
S)5$",1 II7 A##)##*)1$ ,- K1,0.)&2) .)6). ,- 1%<#"12
+)<#,11).
The maximum %=<J& nursing personnel had
inade5uate ,no'ledge 'hereas 31J of nursing personnel
had moderate ,no'ledge and none had ade5uate
,no'ledge on triage system in emergency department in
pre test. The overall mean ,no'ledge value is ...11 'ith
standard deviation 1.82.
This study supported y Adosi( $'idimi E %/33=&
'ho assessed the e*ectiveness of planned teaching
programme on nurses ,no'ledge of pharmacology ehind
drugs they commonly administer( are found that the pretest
,no'ledge score 'as ./.12 'ith standard deviation 2.#
$ 2
S)5$",1 III7 E>)5$"6)1)## ,- +.(11)& $)(5!"12
+<,2<(**) ,1 =1,0.)&2) <)2(<&"12 $<"(2) #'#$)*
"1 E*)<2)15' D)+(<$*)1$.
The present study sho'ed that in pre test the overall
mean ,no'ledge value is ...11 'ith standard deviation
1.82 and in post test of overall mean ,no'ledge value is
0..2/ 'ith standard deviation /.19. It is evident that the
otained :t[ value /<.1= is greater than the tale value at
3.3. level of signi>cance. Therefore :t: value is found to e
signi>cant. It means there is gain in ,no'ledge level of
nursing personnel. This study supports the structure
teaching programme on triage system( is e*ective in
increasing the ,no'ledge level of nursing personnel. ?ence
the null hypothesis framed for the study is re@ected.
This study 'as supported y $eena "hac,o%/338&
'hich revealed that the structured teaching programme 'as
e*ective in increasing the ,no'ledge of nurses on
thromolytic therapy as the computed +t+ value 'as
signi>cant at B.BSlevel.:
.
S)5$",1 IV7 A##,5"($",1 3)$0))1 $!) +,#$:$)#$
K1,0.)&2) #5,<)# 0"$! #).)5$)& &)*,2<(+!"5(.
6(<"(3.)#
The analysis 'as done for association et'een post
test level of ,no'ledge 'ith selected demographic
variales. It 'as evident that there 'as no statistically
signi>cant association et'een the ,no'ledge score 'ith
selected demographic variales.
This study is supported y $enon "D %/338& 'ho
conducted a study to assess the e*ectiveness of STP on
,no'ledge regarding care of patient 'ith head in@ury among
sta* nurses 'or,ing in selected hospital( -angalore and
found that there 'as no signi>cant association et'een
,no'ledge score 'ith selected demographic variale.
7. CONCLUSION
This chapter deals 'ith the ma@or >ndings of the study(
nursing implications( limitations and recommendations.
8A@OR FINDINGS OF T9E STUD
I. F"1&"12# <).($)& $, &)*,2<(+!"5 6(<"(3.)#
$a@ority of the nursing personnel %83 J&(elonged to
age of /. /=yrs
$ost of them %<9J & 'ere Females.
$a@ority of them %8/J& had #A$ as their professional
5uali>cation.
Aout 91J of nursing personnel 'ere having
experience Y .3yrs.
$a@ority of nursing personnel %//J& 'ere experienced
m medical 'ard.
$a@ority of them %83J& had previous information from
printed media.
II. F"1&"12# <).($)& to =1,0.)&2) ,- 1%<#"12
+)<#,11). ,1 $<"(2) #'#$)* "1 E*)<2)15'
D)+(<$*)1$
The maximum %=<J& nursing personnel had
inade5uate ,no'ledge 'hereas 31J of nursing personnel
had moderate ,no'ledge and none had ade5uate
,no'ledge on triage system in emergency department in
pre test. The overall mean ,no'ledge value is ...11 'ith
standard deviation 1.82.
III. E>)5$"6)1)## ,- +.(11)& $)(5!"12 +<,2<(**)
,1 =1,0.)&2) <)2(<&"12 $<"(2) #'#$)* "1 E*)<2)15'
D)+(<$*)1$.
After the planned teaching programme to nursing
personnel .33J 'ere in the group of ade5uate ,no'ledge
and none of the patients 'ere in the group of moderate
,no'ledge and inade5uate ,no'ledge in post test.
The present study sho'ed that in pre test the overall
mean ,no'ledge value is ...11 'ith standard deviation 1.82
and in post test of overall mean ,no'ledge value is 0..2/
'ith standard deviation /.19. It is evident that the otained
:t: value /<.1= is greater than the tale value at 3.3. level
of signi>cance. Therefore :t: value is found to e signi>cant.
It means there is gain in ,no'ledge level of nursing
personnel. This study supports the structure teaching
programme on triage system( is e*ective in increasing the
,no'ledge level of nursing personnel. ?ence the null
hypothesis framed for the study is re@ected.
S)5$",1 IV7 A##,5"($",1 3)$0))1 $!) +,#$:$)#$
K1,0.)&2) #5,<)# 0"$! #).)5$)& &)*,2<(+!"5(.
6(<"(3.)#
Association et'een post test scores of the nursing
personnel and demographic variale 'as calculated y
using chi)s5uare test.
The result sho'ed that the otained H
/
value is more
than the tale value oth at 3.3. and 3.32 levels of
signi>cance. Therefore the null hypothesis is accepted and
sho's that there is no signi>cant association et'een
selected demographic variales 'ith the ,no'ledge scores
of participants.
I8PLICATIONS OF T9E STUD
The >ndings of this study have implications in various
areas of nursing namely nursing practice( nursing
education( nursing administration and nursing research.
N%<#"12 )&%5($",17
Aursing education help the sta* and student 'ith
ade5uate ,no'ledge to ful>ll their duties and
responsiilities in the nursing >eld. The study emphasi7e
the need for developing good teaching programme for
nurses on triage system in order to etter categori7ation
of patient in emergency department. Aurses should e
e5uipped 'ith updated ,no'ledge to care patients in
Emergency Department. A regular evaluation module
should e practiced to update their ,no'ledge.
N%<#"12 +<(5$"5)7
The >ndings of the study reveal that there is a need to
understand the reasons ehind the poor ,no'ledge among
nursing personnel on triage system. So nurse educators
need to ta,e responsiility to ma,e nurse:s ,no'ledgeale.
Aurses should e e5uipped 'ith updated ,no'ledge to care
patients in Emergency Department. The nurse educator
should have regular in)service teaching programme for
nursing personnel to update their ,no'ledge.
N%<#"12 (&*"1"#$<($",17
Aursing administration should ensure that periodical
conduction of training programme to nursing personnel to
improve their ,no'ledge. Aurse administrator must ma,e
sure that educational and informational material should have
consistent information 'hich can e displayed in Emergency
Department and also should organi7e seminars and
'or,shops on Triage system in Emergency Department to
improve ,no'ledge of nurses.
N%<#"12 <)#)(<5!7
This study 'ill e motivated for udding researcher to
conduct similar studies on large scale. The study 'ill e a
reference for research scholars.
LI8ITATION
Simple random sampling and only 23 nursing
personnel have ta,en participation 'hich limits the
generali7ation of the study.
Bnly one domain that is ,no'ledge 'as considered in
the present.
The ,no'ledge of the nursing personnel 'as assessed
only through structured ,no'ledge 5uestionnaire.
RECO88ENDATIONS7
Bn the asis of the study >ndings the follo'ing
recommendations 'ere made for further research.
The study can e replicated in di*erent setting.
The study can e done 'ith a large numer of sample.
A comparative study can e conducted et'een
,no'ledge and s,ills.
A true experimental study can e conducted 'ith
experimental and control group to assess the
e*ectiveness of structured teaching programme.
The chapter deals 'ith the o@ectives of the study( hypothesis(
methodology and ma@or >ndings of the study.
OB@ECTIVES OF T9E STUD
.. To assess+ the ,no'ledge regarding triage system of patient
in Emergency Department among nursing personnel on the
asis of pre test score.
/. To develop a structure teaching programme on triage system
of patients in Emergency Department.
0. To conduct a structure teaching programme on triage system
of patient in Emergency Department among nursing personnel
in selected hospital at -huanes'ar.
1. To evaluate the e*ectiveness of structured teaching
programme regarding triage system of patient in Emergency
Department y comparing pre test and pos test ,no'ledge
scores among nursing personnel.
2. To determine the association et'een the ,no'ledge of
nursing personnel regarding triage system of patients in
Emergency Department 'ith selected demographic
variales.
9POT9ESIS
?o. There 'ill e no signi>cant di*erence et'een pre test and
post test ,no'ledge scores of nursing personnel regarding triage
system of patient in Emergency Department.
?3/ There 'ill e no signi>cant association et'een post test
,no'ledge scores of nursing personnel 'ith their selected
demographic variale.
8.
8ET9ODOLOG
For this study conceptual frame 'or, is ased on
lud'ig von ertalan*y:s general system model. The
approach used for this study 'as evaluative research
approach. Pre experimental design 'as used. A total of 23
nursing personnel 'ho met the inclusive criteria 'ere
selected y using simple random sampling techni5ue. The
investigator introduced herself and aout the study(
otained consent from the participants and data 'as
collected.
The researcher used a structured 5uestionnaire for the
data collection. The tool consists of / parts.
P(<$:I: D)*,2<(+!"5 D($(
This part consisted of < items pertaining to the
demographic variales of the su@ects such as age( gender(
professional 5uali>cation( total year of 'or, experience(
area of experience( sources of previous information
regarding triage system in emergency department.
P(<$ ) II ) Assessment ,- K1,0.)&2)
Structured ,no'ledge 5uestionnaire 'as used to
assess the ,no'ledge of nursing personnel on triage system
of patient in Emergency Department. The 5uestionnaire
consists of 02 o@ective type 5uestions. Each 5uestion has 1
choices and participants need to select the correct one. The
5uestions 'ere developed as to cover the follo'ing topics 6
$eaning and Evolution of Triage
Types( #oals PFunction of Triage in Emergency
Department %ED&\
$ethods of Triage System in Emergency Department
%ED&
Triage components( Triage process and Aursing
process in Triage System In Emergency Department.
Importance and ene>ts of Triage system in
Emergency Department%ED&
The pilot study 'as conducted to >nd the
feasiility of the study on.8.././3.0 among .3 nursing
personnel 'ho ful>lled inclusion criteria at $edicare
?ospital( -angalore. The main study 'as conducted
from:/9Q.Q.1 to 2Q/Q.1 among 23 nursing personnel 'ho
'ere selected y random sampling techni5ue using lottery
method and the data analy7ed using descriptive and
inferential statistics.
8A@OR FINDINGS OF STUD
I. F"1&"12# <).($)& $, &)*,2<(+!"5 6(<"(3.)#
$a@ority of the nursing personnel %83 J&(elonged to
age of /.)/=yrs
$ost of them %<9J& 'ere Females.
$a@ority of them %8/J& had professional 5uali>cation
of #A$ .
Aout 91J of nursing personnel 'ere having
experience Y .3yrs.
$a@ority of nursing personnel %//J& 'ere experienced
in medical 'ard.
$ost of them %83J& had previous information from
printed media.
II. F"1&"12# <).($)& $, =1,0.)&2) #5,<) <)2(<&"12
$<"(2) #'#$)* "1 )*)<2)15' &)+(<$*)1$
The maximum =<J nursing personnel had inade5uate
,no'ledge 'hereas 31J of nursing personnel had
moderate ,no'ledge and none had ade5uate ,no'ledge on
triage system in emergency department in pre test. The
overall mean ,no'ledge value is ...11 'ith standard
deviation 1.82.Since the ,no'ledge 'as found to e
inade5uateT a structured teaching programme 'as
conducted.
III. C,*+(<"12 +<) (1& +,#$ $)#$ =1,0.)&2) #5,<)
<)2(<&"12 $<"(2) #'#$)* "1 )*)<2)15' &)+(<$*)1$.
After the planned teaching programme to nursing
personnel .33J 'ere in the group of ade5uate ,no'ledge
and none of the patients 'ere in the group of moderate
,no'ledge and inade5uate ,no'ledge in post test.
The present study sho'ed that in pre test the overall
mean ,no'ledge value is ...11 'ith standard deviation
1.82 and in post test of overall mean ,no'ledge value is
0..2/ 'ith standard deviation /.19. It is evident that the
otained :t: value /<.1= is greater than the tale value at
3.3. level of signi>cance. Therefore :t: value is found to e
signi>cant. It means there is gain in ,no'ledge level of
nursing personnel. This study supports the structure
teaching programme on triage system( is e*ective in
increasing the ,no'ledge level of nursing personnel. ?ence
the null hypothesis framed for the study is re@ected.
IV. F"1&"12# <).($)& $, (##,5"($",1 3)$0))1 +,#$
$)#$ =1,0.)&2) #5,<) 0"$! #).)5$)&
&)*,2<(+!"5 6(<"(3.)#
Association et'een post test scores of the nursing
personnel and demographic variale 'as calculated y
using chi)s5uare test.
The result sho'ed that the otained H value is more
than the tale value oth at 3.3. and 3.32 levels of
signi>cance. Therefore the null hypothesis is accepted and
sho's that there is no signi>cant association et'een
selected demographic variales 'ith the ,no'ledge scores
of participants.
SU88AR
This chapter riefs the o@ectives of the study(
research hypothesis( methodology and ma@or >ndings of
this study.
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