Pain assessment by emergency nurses at triage in the emergency department: A qualitative study

Abstract

This article presents triage nurses' reality in a time-pressured environment, and understanding this conflict may outline new educational targets to further improve pain management in ED.

Over-triage occurs when considering the patient's pain in Korean Triage and Acuity Scale (KTAS)

“…However, it is difficult to educate patients adequately in a situation where triage need to be performed within a short time. [23] On the other hand, patients may intentionally exaggerate their symptoms at triage in order to obtain medical treatment more quickly. Sometimes patients with mild pain may exaggerate their symptoms to justify their use of the emergency room.…”

“…[24] According to previous studies, triage nurses and doctors rated the pain intensity lower than the patient's experience. [23, 25] Even in a study on the MTS, pain assessment at triage was not performed in about 68% of patients, with concern that pain assessment could lead to over-triage. [26] Especially in Korea, where the non-emergency patients with KTAS 4 and 5 have lower national health insurance coverage rates, and patient's medical expenses increase by about twice as much, patients might therefore want to be seen as more urgent patients with a more acute KTAS score.…”

A multicenter randomized control trial evaluating professional practice assessment of patient pain management after simulation training course: Study protocol

“…Acute pain affects most patients admitted to emergency departments, but pain relief in this setting remains insufficient [ 23 ]. In spite of laws, recommendations, and ethical and moral obligations, only a third of patients receive analgesia during initial triage and rates of optimal analgesia are very low [ 24 ].…”

“…Evaluation of pain followed by its treatment at the time of patient triage accelerates the administration of analgesia. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management [ 23 ]. Pain management protocols have benefits but need to be regularly monitored to optimize pain management in the ED [ 25 ] and in the EMS [ 26 ].…”

Desempenho da triagem rápida realizada por enfermeiros na porta de emergência e sinais e sintomas associados à classificação de pacientes graves

“…Essa associação também foi identificada na presente pesquisa em relação à triagem rápida, uma vez que o grupo classificado como alta prioridade pelos enfermeiros apresentou mediana do número de recursos/procedimentos significativamente maior do que aqueles classificados como baixa prioridade (p>0,001).Por fim, os fatores associados à classificação de pacientes de alta prioridade pela triagem rápida foram alterações na ventilação, disfunção neurológica e presença de dor.Esses achados corroboram sinais e sintomas considerados importantes na avaliação de pacientes na porta de emergência na percepção dos enfermeiros triadores.Estudo sueco75 encontrou relação entre alteração do nível de consciência do paciente e aumento na chance de mortalidade no primeiro dia de permanência hospitalar. aguda afeta a maioria dos pacientes que procuram os serviços de emergência e, quando a enfermeira da triagem avalia os níveis de dor, ela também tenta decifrar o significado da dor de um paciente83 . Assim, estudo78 que analisou os determinantes da prioridade de atendimento pelo SMCR para pacientes com infarto agudo do miocárdio 1%) o mais frequente, assim como o discriminador alteração súbita da consciência (14,9%); o escore da ECG (74,2%) foi o sinal vital mais aferido.…”