Content
Emergency departments are often areas of high activity, excitement and emotion, and this commences at triage. 131 Imagine a busy department: patients lining up at the desk; ambulances bringing in more patients on trolleys; relatives, crying children and other staff seeking advice and information. The Triage Nurse is often the common link in all this activity, and must be able to communicate effectively with relatives, ambulance officers, medical and other nursing staff, and clerical staff and visitors, as well as establish a functional communication process to allow effective patient assessment.
As the triage clinician, you must make a needs-based assessment based on the information you obtain during the triage encounter. Effective communication is essential to obtaining accurate information, and therefore making an accurate assessment, at this time. When problems occur within the communication process, the ability of the Triage Nurse to gather the required information may be compromised. It is vital for the Triage Nurse to be aware of the potential barriers to effective communication in the triage environment 131 and to minimise their impact upon the triage encounter.
14
So, what do we do if verbal communication is impossible, as in the case of a patient who is unconscious? In such instances, having a sound skill base in physical assessment is paramount, as the collection of data by which to identify physiological predictors and thus determine urgency becomes our primary triage method. Remember, too, that in some instances communication through a third person, such as a relative, caregiver or interpreter, may contribute to the assessment process. In such cases communication may also be challenging, as the message sent from the third person is their own interpretation of events, which provides another potential barrier.
Communication is a process of sending and receiving messages between individuals within a dynamic context. Each individual carries responsibilities as both sender and receiver of messages. The entire communication encounter is influenced by a range of factors and stimuli. 132
There are important issues related to the patient, the nurse and the environment that may impact upon the complexity of the communication process. Communication literature commonly refers to such influencing factors as‘ noise’: external or physical noise, internal or psychological noise, and semantic or interpretational noise. 133-5 One of the most important considerations here is that the patient may experience difficulty fulfilling their responsibilities as a sender and receiver of communication, due to the‘ noise’ that is inherent within triage. This means that the Triage Nurse will often carry the responsibility of recognising and managing the influencing factors for both themself and the patient.
Department of Health and Ageing – Emergency Triage Education Kit