Exploring the Factors Influencing Nurses’ Decisions in Applying a Mental Health Triage Scale: A Systematic Review

Abstract

The aim of this systematic review was to synthesise evidence regarding ED nurses’ decision-making when applying a mental health triage scale. The review sought to answer the question: What factors influence ED nurses’ decisions and decision-making process in applying a mental health triage scale? The views, attitudes and experiences of mental health triage nurses performing triages for patients with mental health presentations in emergency department settings were examined in a systematic review of published and peer-reviewed qualitative research articles. CINAHL, PsycINFO, PubMed, and EMBASE were used to find published works from 2013 to 2022. After reading the title and abstract, the whole text of relevant research was obtained. The results of the included papers were analysed using the thematic content and narrative analysis approach, and critical appraisal of the quality of included articles was carried out using CASP. Sub-themes and themes were created by collapsing emerging patterns and codes. A total of eight full-text studies were included in the review. All the eight articles were qualitative studies conducted in six different countries and published in peer-reviewed journals. The total sample in the included articles consisted of 135 emergency department triage nurses with semi-structured and focus groups used in data collection. The methodological quality of the articles varied, with scores ranging from 16 to 18 out of 20. Three main themes emerged from the systematic review. From the ED triage nurses’ points of view, factors affecting triage decision making for patients with mental health presentations were “nurse-related”, “workplace-related”, and “patient-related”. This is the first systematic review summarising the evidence of the factors affecting ED triage nurses’ decision-making involving patients with mental health presentations. The findings suggest that the nurse as an individual (personally and professional), the workplace (social, structural and architectural environment), and the patient as an individual (safety, risk, acuity and behaviour) affect the quality of nursing decision-making in applying mental health triage scales. Ongoing review of the literature in this area is important to provide further evidence to inform nursing policy, practice, education and further research.