How triage nurses generate initial hypotheses during the first patient encounter: A focused ethnographic study
DOKPE
- Noiré, Yoann ORCID University of Fribourg
- Guechi, Youcef University of Fribourg
- Pelaccia, Thierry ORCID University of Strasbourg, France
- Mazar, Eliott Fribourg Cantonal Hospital, Switzerland
- Ribordy , Vincent ORCID University of Fribourg
- 2026
Published in:
- International Emergency Nursing. - Elsevier BV. - 2026, vol. 86, p. 101824
Emergency department
Triage
Triage nurses
Qualitative study
Clinical reasoning
Pattern recognition
Intuition
Video-cued recall
English
Background
The ability of triage nurses to quickly identify an urgent situation is crucial and requires good clinical reasoning, which is strongly influenced by the context and professional environment.
Aim
To explore how triage nurses generate initial hypotheses at the very start of the triage encounter and which immediately available cues contribute to this early sense-making.
Methods
This qualitative study was conducted in three regional hospitals and included 10 triage nurses. Nurses wore a forehead-mounted GoPro camera to record triage from their point of view. Semi-structured, video-cued recall interviews were conducted immediately after triage. Deductive and inductive coding was then carried out and analysed using thematic analysis methods.
Results
The average age of triage nurses was 36 years, with an average of 6.5 years of professional experience in the emergency department. Triage nurses generated hypotheses as soon as they encountered the patient, largely through pattern recognition (a core mechanism associated with intuition). These hypotheses were sometimes made as soon as the patient was registered at the emergency desk reception and even before talking to them. These hypotheses were based on the patient’s main presenting complaint, their facial expression, and the time reported for the onset of symptoms.
Conclusion
Triage nurses operate in a complex environment and use rapid clinical reasoning processes that draw on readily available cues and prior experience. These findings may inform triage education by highlighting the early, experience-based processes involved in hypothesis generation and the potential value of explicitly addressing intuitive reasoning in triage training.
The ability of triage nurses to quickly identify an urgent situation is crucial and requires good clinical reasoning, which is strongly influenced by the context and professional environment.
Aim
To explore how triage nurses generate initial hypotheses at the very start of the triage encounter and which immediately available cues contribute to this early sense-making.
Methods
This qualitative study was conducted in three regional hospitals and included 10 triage nurses. Nurses wore a forehead-mounted GoPro camera to record triage from their point of view. Semi-structured, video-cued recall interviews were conducted immediately after triage. Deductive and inductive coding was then carried out and analysed using thematic analysis methods.
Results
The average age of triage nurses was 36 years, with an average of 6.5 years of professional experience in the emergency department. Triage nurses generated hypotheses as soon as they encountered the patient, largely through pattern recognition (a core mechanism associated with intuition). These hypotheses were sometimes made as soon as the patient was registered at the emergency desk reception and even before talking to them. These hypotheses were based on the patient’s main presenting complaint, their facial expression, and the time reported for the onset of symptoms.
Conclusion
Triage nurses operate in a complex environment and use rapid clinical reasoning processes that draw on readily available cues and prior experience. These findings may inform triage education by highlighting the early, experience-based processes involved in hypothesis generation and the potential value of explicitly addressing intuitive reasoning in triage training.
- Faculty
- Faculté des sciences et de médecine
- Department
- Section de médecine
- Language
-
- English
- Classification
- Pathology, clinical medicine
- Other electronic version
- License
-
CC BY
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.ienj.2026.101824
- ISSN 1755-599X
- Persistent URL
- https://folia.unifr.ch/unifr/documents/335167
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