Influence of Health Education on Nurses' Perceptions and Attitudes in Emergency Department Triage

Baitus Sholehah* -  Universitas Nurul Jadid, Indonesia
DOI : 10.33650/ahnj.v2i2.13848

Introduction: Compliance with standard operating procedures (SOPs) in intravenous (IV) infusion is essential for patient safety and quality of care. Nurses play a pivotal role in implementing SOPs, and their level of knowledge may significantly influence their adherence.. Objectives: This study aimed to examine the correlation between nurses’ knowledge levels and their compliance with intravenous infusion SOPs in the emergency department. Methods: A cross-sectional correlational study was conducted involving 116 nurses in the emergency department of RSU dr. H. Koesnadi Bondowoso. Data were collected using structured questionnaires to assess knowledge and direct observation checklists to evaluate SOP compliance. Spearman’s rho was used for statistical analysis with a significance level set at p < 0.05. Results: Of the 116 nurses, 88.8% had good knowledge, 6.0% had moderate knowledge, and 5.2% had poor knowledge. Full compliance was observed among nurses with good knowledge, while non-compliance was highest among those with poor knowledge. A strong positive correlation was found between knowledge and compliance (Spearman’s r = 0.730, p = 0.001). Conclusions: There is a significant positive association between nurses’ knowledge levels and their compliance with IV infusion SOPs. Enhancing nurses' knowledge through continuous education and monitoring is essential to promote safe and standardized nursing practices.

Keywords : nurse compliance; intravenous infusion; standard operating procedure; knowledge level; emergency department; patient safety

  1. Abdelwahab, N., Mohamed, H., & Elkholy, G. (2020). The effect of educational program on nurses' knowledge and practice regarding emergency triage. Egyptian Journal of Health Care, 11(2), 45–59.
  2. Alsulami, H., Alharbi, M., & Ahmad, S. (2022). Evaluating nurses’ adherence to infection control procedures: A comparison of self-report and direct observation. International Journal of Nursing Practice, 28(5), e13040. https://doi.org/10.1111/ijn.13040
  3. Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. I., Lurie, N., & Camargo, C. A. (2003). A conceptual model of emergency department crowding. Annals of Emergency Medicine, 42(2), 173–180. https://doi.org/10.1067/mem.2003.302
  4. Bahreini, M., Shahamat, S., Hayatdavoudi, P., & Mirzaei, M. (2017). The impact of triage training on the knowledge and practice of emergency nurses. Journal of Clinical and Diagnostic Research, 11(4), JC05–JC08.
  5. Bairagi, A., Deshmukh, P. R., & Garg, N. (2019). Assessment of the effectiveness of a triage training programme on nurses’ knowledge and skills in emergency care. International Journal of Nursing Education, 11(1), 43–46.
  6. Carter, A. J., Chochinov, A. H., & Harlos, M. (2014). Triage and triage scales. In B. Cameron & G. Lee (Eds.), Emergency Nursing Core Curriculum (6th ed., pp. 237–252). Elsevier.
  7. CDC. (2023). Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol
  8. Christ, M., Grossmann, F., Winter, D., Bingisser, R., & Platz, E. (2010). Modern triage in the emergency department. Deutsches Ärzteblatt International, 107(50), 892–898. https://doi.org/10.3238/arztebl.2010.0892
  9. Considine, J., Botti, M., & Thomas, S. (2008). Do knowledge and experience have specific roles in triage decision-making? Academic Emergency Medicine, 15(8), 722–726. https://doi.org/10.1111/j.1553-2712.2008.00174.x
  10. Considine, J., LeVasseur, S. A., & Villanueva, E. (2011). The role of nurses in triage decision-making in the emergency department. Australasian Emergency Nursing Journal, 14(2), 87–94. https://doi.org/10.1016/j.aenj.2011.04.003
  11. Ebrahimi, M., Haghani, F., & Sheikhi, R. A. (2021). The impact of clinical knowledge on nurses’ decision-making: A systematic review. Nurse Education Today, 97, 104701. https://doi.org/10.1016/j.nedt.2020.104701
  12. Farrohknia, N., Castrén, M., Ehrenberg, A., Lind, L., Oredsson, S., & Jonsson, H. (2011). Emergency department triage scales and their components: A systematic review of the scientific evidence. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19, 42. https://doi.org/10.1186/1757-7241-19-42
  13. Fernandes, C. M. B., Wuerz, R., Clark, S., & Djurdjev, O. (2005). How reliable is emergency department triage? Annals of Emergency Medicine, 46(5), 503–510. https://doi.org/10.1016/j.annemergmed.2004.12.008
  14. Gholami, M., Asadi, N., & Salarvand, S. (2020). Barriers to clinical guideline adherence among nurses: A qualitative study. BMC Nursing, 19, 68. https://doi.org/10.1186/s12912-020-00450-9
  15. Gilboy, N., Tanabe, P., Travers, D., & Rosenau, A. M. (2012). Emergency Severity Index (ESI): A triage tool for emergency department care, Version 4. AHRQ Publication No. 12-0014.
  16. Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice (5th ed.). Jossey-Bass.
  17. Hardcastle, T. C., Thomas, B., & Lutge, E. (2019). Triage scoring systems in trauma and emergency care: A review of the South African context. South African Medical Journal, 109(7), 460–464.
  18. Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126–136. https://doi.org/10.1016/j.annemergmed.2008.03.014
  19. ICN. (2021). Code of Ethics for Nurses. International Council of Nurses. https://www.icn.ch
  20. Iserson, K. V., & Moskop, J. C. (2007). Triage in medicine, Part I: Concept, history, and types. Annals of Emergency Medicine, 49(3), 275–281. https://doi.org/10.1016/j.annemergmed.2006.05.019
  21. Jang, Y. R., & Kim, M. J. (2023). Educational level and compliance to nursing protocols in Korean hospitals. Asian Nursing Research, 17(1), 45–52. https://doi.org/10.1016/j.anr.2022.10.003
  22. Jeong, S. Y., & Lee, J. H. (2017). The effects of education on nurses’ triage decision making and patient outcomes in emergency departments. Journal of Clinical Nursing, 26(15–16), 2324–2332. https://doi.org/10.1111/jocn.13352
  23. Kendall, K., Reeves, S., & Macfarlane, A. (2015). Nurses’ role in triage decision-making in emergency departments. Emergency Nurse, 23(5), 22–27. https://doi.org/10.7748/en.23.5.22.e1347
  24. Krathwohl, D. R. (2002). A revision of Bloom’s taxonomy: An overview. Theory Into Practice, 41(4), 212–218. https://doi.org/10.1207/s15430421tip4104_2
  25. Lee, S. Y., Kim, Y. J., & Park, H. J. (2024). Simulation-based training improves clinical skill adherence among nurses: A randomized trial. Nurse Education Today, 124, 105734. https://doi.org/10.1016/j.nedt.2024.105734
  26. Mackway-Jones, K., Marsden, J., & Windle, J. (2014). Emergency triage: Manchester Triage Group (3rd ed.). Wiley-Blackwell.
  27. Ministry of Health Indonesia. (2019). Profil Kesehatan Indonesia Tahun 2018. Jakarta: Kementerian Kesehatan RI. https://pusdatin.kemkes.go.id
  28. Moll, H. A. (2012). Challenges in the triage of children. British Journal of Anaesthesia, 109(S1), i61–i69. https://doi.org/10.1093/bja/aes421
  29. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259
  30. Pines, J. M., Pilgrim, R. L., Schneider, S. M., & Siegel, B. (2011). Practical implications of implementing emergency department crowding interventions: Summary of a moderated panel. Academic Emergency Medicine, 18(12), 1278–1282. https://doi.org/10.1111/j.1553-2712.2011.01224.x
  31. Qommaruddin, A., Rahmat, M., & Nurdin, A. (2022). Effectiveness of standard operating procedure training on infusion complications. Journal of Nursing Practice, 6(1), 101–108. https://doi.org/10.30994/jnp.v6i1.260
  32. Shrestha, S., Devkota, S., & Sharma, D. (2022). Age and experience as predictors of clinical competence among nurses. Journal of Multidisciplinary Healthcare, 15, 1595–1604. https://doi.org/10.2147/JMDH.S360172
  33. Sun, B. C., Hsia, R. Y., Weiss, R. E., Zingmond, D., Liang, L. J., Han, W., ... & Asch, S. M. (2013). Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine, 61(6), 605–611. https://doi.org/10.1016/j.annemergmed.2012.10.026
  34. World Health Organization. (2020). Emergency care systems for universal health coverage: Ensuring timely care for the acutely ill and injured. Geneva: WHO. https://www.who.int/publications/i/item/9789240005040

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