Assessment of Knowledge Regarding Emergency Severity Index (ESI) Triage among the 4^thyear B.Sc. Nursing Students Studying at KLEU’S Institute of Nursing Sciences, Belgaum, Karnataka

Mr. Honnagouda Patil

Lecturer, K.L.E. University’s Institute of Nursing Sciences, Belgaum, Karnataka.

Corresponding Author Email: rajuipatil@gmail.com

ABSTRACT:

Background: Triage began with the military during World War I. The military leaders needed a process they could use to determine which soldiers could returns to duty and when, the concept of triage was born. At the time, no scientific method of triage existed. Emergency Severity Index triage is a modified triage system, it is an emergency department triage algorithm that provide clinically relevant stratification of patients into five group from most argent on the basis of acuity and resource needs (AHRQ).

Problem statement: “A study to assess the knowledge regarding Emergency Severity Index (ESI) triage among the 4^thyear B.Sc. Nursing students studying at KLEU’ s Institute of Nursing Sciences in Belgaum, Karnataka.”

Objectives: To assess the knowledge of 4^thyear B.Sc. Nursing students regarding ESI triage system.

· To develop information booklet on ESI triage.

Method: The study considered descriptive design as the most suitable for investigation so as to describe, record, analyze and interpret the existing knowledge of 4^th year B.Sc. Nursing students studying in KLEU’s Institute of Nursing Sciences, Belgaum Karnataka. The sample size comprised of 50 students. The non probability purposive sampling technique was use for the present study. The knowledge was assessed in ESI triage by use of 25 Multiple Choice Questionnaires. Through the structured knowledge questionnaires it to overall 1 hours to conduct the test. The data was tabulated and analyzed.

Result: Demographic characteristics of sample: The characteristics of the study were Age, Religion, Source Of Information. In this study 62% were of the age group 21-22 years, 34% were of the age group 23-24 years, 4% were of the age 25 and above. Regarding religion were 66% were Hindus, 30% were Christian, 4% were Muslims. Among source of information, were got information from books, 12% were got information from hospitals, 4% were got information from teacher, 2% were got information from any other of means. The knowledge score of ESI triage among students, the mean is 13, median is 25.5, mode is 7.5, standard deviation is 7.35 and range is 13. The average level of knowledge is 49(98%) and only 01(2%) has good knowledge.

Conclusion: Based on the present study, the following conclusions were drown. Most of the students had average level of knowledge in ESI triage. Some area in the knowledge aspect were neglecting, this fact has to be taken into consideration and it is very essential an important to create an awareness and developed a standard policy and procedure manual and in service education strategies to upgrade and update knowledge of the students.

KEY WORDS:

INTRODUCTION:

“Put your heart, mind and soul in to even your smallest acts. This is the secrets of success.”

Emergency as situation as which patient requires urgent and high quality medical and nursing care due to increase number of road traffic accident, rapid industrialization bioterrorism and other terroristic natural and manmade disasters are increasing and which are to be complex in nature.In over country health sector always face the research crunch the government of India utilizes only of 0.9% of Gross Domestic Product (GDP) on health system¹.

Triage is the process of determining the priority of patient’s treatment based on the severity of their condition. The principle of first come first treated is not followed in mass emergencies. Triage consist of rapidly classifying the injured on the basis of the severity of their injuries and the likelihood of their survival with prompt medical intervention triage is only approach that can provide maximum benefit to the greatest number of injured in a major disaster situation².

The term triage originate from the French word “trior” which means to sort, pick out classify or choose the triage principle of prioritizing care to large group of people has been adapted from its military origin for use in the civilian context of initial emergency department care. In the emergency department context triage is formal process of immediate assessment of all patient who present seeking emergency care³.

In 1998 Emergency physicians Richard Wuerz and David Eitel developed the original ESI concept and initiated pilot testing. In 1999 Pilot testing of the ESI completed- results promising. Drs. Wuerz and Eitel brought together a number of emergency professionals interested in triage and further refined the algorithm. In May 1999-Initial ESI implementation Chapel Hill, North Carolina and at Brigham and Women’s Hospital in Boston. Post-implementation and refinement study at UNC and Brigham and Women’s Hospitals .In 1999-2001 Refinement and implementation of the ESI in 5 additional hospitals. AHRQ-funded study of ESI reliability and validity in 7 emergency departments in 3 states. In 2003 ESI Version 3 released. ESI Handbook first published by the Emergency Nurses Association⁴.

One benefit of the ESI is the rapid identification of patients that need immediate attention. The focus of ESI triage is on quick sorting of patients in the setting of constrained resources. ESI triage is a rapid sorting into five groups with clinically meaningful differences in projected resource needs and, therefore, in associated operational needs. Use of the ESI for this rapid sorting can lead to improved flow of patients through the ED. For example, level 1 and 2 patients can be taken directly to the treatment area for rapid evaluation and treatment, while lower acuity patients can safely wait to be seen. Expected to provide consults for level-2 and level-3 patients with psychiatric complaints within 30 minutes of notification and for level-4 and level-5 patients within 1 hour. At another site, the ESI has been incorporated into a policy for patients greater than 20 weeks pregnant who present to the ED. Patients rated at ESI levels 1 and 2 are treated in the ED by emergency medicine with an obstetrical consult. Those rated 3, 4, or 5 are triaged to the labor and delivery area of the hospital⁵.

NEED FOR THE STUDY:

The ultimate goal of triage system is to improve triage process. It is imperative that patient acuity be rapidly assessed and reassessed to ensure that only stable patient wait that to be treated.

Actually need of triage system is connect every patient to the right resources at the right place and it on the right amount of time. When the quantity and severity of injuries overwhelm the operative Capacity of health facilities, a different approach to medical treatment must be adopted.

According to World Health Organization, road traffic accident caused an estimated 1.24 + million deaths worldwide in the year 2010, 1down from 1.26 million in 2000.half of all road traffic deaths are among pedestrians, cyclists+ and motorcyclists, and adult aged between 15 and 44 years account 59%of deaths. The average rate was 18 per 100 000 people. 92% occurs in middle income countries. Asia and Africa have the highest rates⁶.

The total facilities number, comes from the WHO (report and is often an estimated number of road traffic deaths based on method used in the report. Country road fatalities per 1,00,000 inhabitants per year. Road facilities per 1,00,000 motor vehicles, road facilities per 1 billion vehicle km. total facilities latest year source world 18 93.31 240⁷.

India is no.1 in road accident. Last updated: Friday, May 06 2011, 00:52. India suffers from the highest and number of deaths around 1,05,000 in absolute terms annually due to road accidents in the world owing to poor infrastructure and dangerous driving habits. According to WHO of RTA take the lives of nearly 1.3 million every year, and injure 20 to 50 million more. Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the likelihood and of their survival with prompt medical intervention⁷.

The Indian subcontinent has a history of devastating earthquakes. The major reason, for the high frequency and intensity of the earthquake is that the Indian plate is driving into Asia at a rate of the approximately 47mm/yr. geographical statistic of India show that almost 54% of the land is vulnerable to earthquakes. A World Bank and united nations report estimates that around 200 million city dwellers in India will be exposed to storms and earthquakes by 2050⁸.

India- disaster statistic data related to human and economic losses from disasters that have occurs between 1980 and 2010. Natural disaster from 1982-2010 overviews:

1. No. of events: 431

2. No. of people killed: 143,039

3. Average killed per year: 4,614

4. No. of people affected: 1,521,726,127

5. Average affected per year: 49,087,940

6. Economic damage: 48,063,830

7. Economic damage per year: 1,550,446

The number of death due to road accident in the state of Karnataka stood at 6,195 in the year 2003. Since then there has been a rise in the death toll, topping off at 9590 in the year 2010. In the year 2011, the number of deaths fell by over 500 when compared to 2010.⁹

One important Emergency Data element is triage acuity. Which has been defined by the data elements for emergency department system task force as classification of patient acuity characterize by degree to which the patient’s condition is life threatening and whether immediate treatment is needed to alleviate symptom.The five level triage acuity data are more reliable and valid than three level system. Triage is typically the first step in the evaluation of a patient presenting to an emergency department this process involves a brief assessment that focuses on the patient clinical need and priority for care. The triage nurse when assigns the patient a place in quick and to an appropriate treatment.¹⁰

Nursing students are the future care providers they are aware of the modified and advanced technique and modified versions of triage system. That should be the future emergency care on the basis of patient acuity level and resource need. The nursing students have particular attitude towards the emergency care as well as emergency severity index triage system.¹¹

Hence considering overall, the magnitude of consequences and review done by the investigators on Emergency Severity Index (ESI) triage, investigator developed a deep interest to study this significant, researchable and feasible problem.

PROBLEM STATEMENT:

“A study to assess the knowledge regarding Emergency Severity Index (ESI) triage among the 4^thyear B.Sc. Nursing students studying at KLEU’ s Institute of Nursing Sciences in Belgaum, Karnataka.”

OBJECTIVES OF THE STUDY:

1) To assess the knowledge of 4^th year Basic B.Sc. nursing student regarding ESI triage system.

2) To developed information booklet on ESI triage.

OPERATIONAL DEFINITIONS:

1) Assess: In this study assess refers to examine knowledge of 4^th year B.Sc. nursing students regarding Emergency Severity Index (ESI) triage.

2) Knowledge: In this study knowledge refers as to appropriate response from the 4^thyear B.Sc. nursing student about Emergency Severity Index (ESI) triage.

3) Emergency severity index (ESI) triage: The emergency severity index (ESI) is a five level triage scale developed by emergency department physicians Richard Wuerz and David Eitel in United States believed that a principal role for an emergency department triage instrument is to facilitate the prioritization of patients based on the urgency of treatment for the patients' conditions.

4) 4^th Year B.Sc. Nursing Students: The students studying B.Sc. nursing on four years recognized by KNC, INC in selected college of nursing.

5) Socio-Demographic Variables: Refers to the various distinguishing features like age, religion and source of information of the 4^thyear B.Sc. Nursing students refers to KLEU’s Institute of Nursing Science, Belgaum, Karnataka.

ASSUMPTION:

It is assumed that 4^th year B.Sc. Nursing Students have some knowledge regarding Emergency Severity Index (ESI) triage.

RESEARCH METHODOLOGY:

Research approach:

A descriptive research approach was considered to carry out in the present study.

Research design:

A non- experimental descriptive design was chosen for the present study.

Independent variable:

In the present study, independent variable was structured questionnaire on ESI triage.

Dependent variable:

In the present study, dependent variable is assessing knowledge of 4^th year B.Sc. Nursing Students

Research setting:

The research setting refers to the area where the study is conducted. In the present study the research setting was selected KLEU’s Institute of Nursing Sciences, Belgaum, Karnataka.

Population:

In the present study the population comprises of 4^th year B.Sc. Nursing Students studying in KLEU’s Institute of Nursing Sciences, Belgaum, Karnataka.

Sample:

In the present study, samples chosen were 4^thyear B.Sc. Nursing students studying at KLEU’s Institute of Nursing Sciences, Belgaum, Karnataka.

Sample size:

The sample size comprised of 50, 4^th year B.Sc. Nursing Students studying at KLEU’s Institute of Nursing Sciences, Belgaum Karnataka.

Sampling technique:

The non probability purposive sampling technique was used for the present study.

Criteria for selection of samples:

Inclusive criteria:

Ø Students who are studying in 4^th year B. Sc. Nursing.

Ø Students who are willing to participate in the study.

Exclusive criteria:

Ø Students who are not available during data collection.

Sample characteristics:

The data option to describe the sample characteristic included age, gender, religion and source of information exposure to any training programme.

Data analysis:

The data obtained was analyzed in terms of the objective of the study using descriptive statistics. The coordinator and supervisor directed for the development of data analysis which used as follows:

v Organizing data on master sheet.

v Computation of frequency, percentage, means to describe the data.

v Classified the knowledge score using the percentage of score.

Tools and techniques:

The structured questionnaire was prepared for assessing the knowledge.

Development of tool:

The structured knowledge questionnaire on the knowledge of ESI triage among 4^th year B.Sc. Nursing students was prepared for the present study. The various review of literature was done and carried out in preparing the tool and the necessary correction has been made by guidance of coordinator and supervisor.

DESCRIPTION OF TOOL:

Section-1:

It comprise of demographic variables such as age, gender, attended seminar or workshop, exposure to any training program.

Section-2:

It comprises of 25 multiple choice question items on knowledge of ESI triage, four choice options were given. A score of ‘1’ was awarded to the correct response, while a score of ‘0’ was awarded to the incorrect response.

RESULTS:

PRESENTATION OF THE DATA:

The data is presented under the following sections:

Section 1: Findings related to socio-demographic variables of subjects.

Section 2: Findings related to knowledge of students on Emergency Severity Index(ESI)triage.

The demographic characteristics of the study were Age, Religion, Source of Information. Table 2 reveals that Sixty two percentage were of the age group 21-22yrs. 34% were of the age group 23-24yrs., 4% were of the age 25 and above. Regarding religion, 66% were Hindus, 30% were Christian, 4% were Muslims. Among source of information, 82% were got information from Books, 12% were got information from hospitals, 4% were got information from teachers, 2% were got information from any other means.

DISCUSSION:

“A study on assessment of knowledge regarding Emergency Severity Index (ESI) triage among the 4^thyear B.Sc. Nursing students.”

In connection with the above a study was undertaken with the main purpose of assessing the level of knowledge regarding ESI Triage among 4^th year B.Scnursing students to achieve the set objective of the study, 50 student were studied such was the selection that the maximum number of students were distrubuted on different sample characteristics as follows.

Demographic Characteristics of sample:

The demographic characteristics of the study were Age, Religion, and Source of Information. In this study, 62% were of the age group 21-22yrs, 34% were of the age group 23-24yrs, 4% were of the age 25 and above. Regarding religion, 66% were Hindus, 30% were Christian, 4% were Muslims. Among source of information, 82% were got information from Books, 12% were got information from hospitals,4% were got information from teachers, 2% were got information from any other means.

Knowledge

ü To achieve the objective of this study, the respondents were assessed on the knowledge aspects of ESI triage.

ü Table 1 shows depicts the overall knowledge score graded as above good , average and poor .The average level of knowledge 49(98%)and only 01(2%) has good knowledge.

ü Table 2 shows that mean, median, mode, standard deviation and range of knowledge scores of Emergency Severity Index (ESI) triage among students. The mean 13, median 25.5, mode 7.5, standard deviation 7.35 and range 13.

SUMMARY:

This study was proposed to explore and describe the level of knowledge among 4^th year Basic B.Sc. Nursing students regarding Emergency Severity Index (ESI) triage. The knowledge was assessed in ESI triage by using Multiple Choice Questionnaires. The study was conducted on 50 students of 4^th year B.Sc. Nursing studying at KLEU’S Institute of nursing sciences, Belgaum, Karnataka. The study was conducted in the month March 2014. The study revealed certain facts regarding the knowledge. The average percentage of overall total knowledge was 98%.

The structure knowledge questionnaire was constructed by preparing blue print and reviewing the literature. In order to fulfill the objective data was analyzed using descriptive statistic. The knowledge scores of Emergency Severity Index (ESI) triage among students, the mean is 13, median is 25.5, mode is 7.5, standard deviation is 7.35 and range is 13. The descriptive statistic used were frequency and percentage distribution of sample characteristic and computation of good, average and poor standards deviation and range of knowledge scores.

CONCLUSION:

Based on the present study, the following conclusions were drawn. Most of the student had average level of knowledge in ESI triage. Some area in the knowledge aspect were neglecting, this fact has to be taken into consideration and it is very essential and important to create an awareness and develop a standard policy and procedure manual to upgrade and update the knowledge of the students.

All the assumptions were proved and this clearly shows that there is a strong need to have adequate knowledge which in turn will influence the study of the students leading to quality of knowledge.

NURSING IMPLICATIONS:

The findings of the study have implication of nursing practice, nursing education, nursing administration and nursing research.

Nursing Practice

The present study showed that majority of the nursing students had average knowledge regarding Emergency Severity Index (ESI) Triage. The study will enable then to become aware of the ESI triage and their need, level of ESI triage, Algorithm, ESI resources and nursing responsibility.

Nursing education:

Nursing education curriculum should include more workshop and health education programmed based on the actual or potential problems at that particular time. Facility should be made for health care workers for in-service education regarding the advanced method and technologies for ESI triage. This will helpful for the nurses to train the student to implement practices for management of ESI triage.

Nursing Administration:

Nursing as a profession in unique because it address the response of individual and family to actual or potential problems in a humanistic and holistic manner. Nurses have many roles such as care giver, decision makers, advocates and teachers. Because of diversity of nursing role, nurses need to philosophy of nursing to guide their practices. As a nursing administrator should motivate the nursing staff and nurses working in hospitals to give health education to student regarding knowledge about ESI triage. She/he should plan for organization of workshops, regular ongoing in service education programmed and ensure that nurses keep their knowledge as per with recent development in nursing practice.

Nursing research:

Research is systemic search for answer to questions about facts and relationship between facts. So there is strong indication that every nurse should be involved in research. Research is an essential aspect of nursing as it unifies the profession and develops new nursing norms and a body of knowledge. Research to upgrade the knowledge on ESI triage among 4^thyear B.Sc. nursing students at KLEU’s Institute of nursing sciences, Belgaum, Karnataka.

RECOMMEMDATIONS:

Ø A similar study all a larger and wider sample would be more pertinent in making broad generalization.

Ø Provide information booklet on Emergency Severity Index(ESI) triage to the 4^th year B.Sc. nursing students of KLEU’S Institute of nursing sciences, Belgaum, Karnataka.

REFERENCES:

1. E journal (Mrs. Gargiroy) An Ideal Emergency Unit

2. K. Park Textbook of Preventive and Social Medicine. 22^nd edition. Ms. BanarsidasBhanot Publishers 1167, Preminger, Jabalpur-482001 (India).

3. Journal of Victoria’s Emergency Department. PMID: 19546272 [PubMed - indexed for MEDLINE]

4. American College of Emergency Physicians (2010). ACEP policy statements: Triage scale standardization. Dallas, TX: American College of Emergency Physicians. Retrieved June 1, 2011, from http://www.acep.org/Content.aspx?id=29828and terms=triage%scale .

5. http://ribbon.india.com.http://bits Wikimedia.org/static-1.23wmf13/extension

6. http://bits.wikimedia.org/static-1.23wmf13/extension/mobile fronted/less/common/image/menu.

7. www.preventionweb.net/English/countries/statistic/?cid=79

8. “International investigation standard “the investigation process research resource site 11 Oct 1994.retrieved 24 July 2012.

9. www.banglore traffic police. Gov. In

10. Journal of Academic emergency medicine

11. National center for injury prevention and control (NCIPC).Data elements For emergency department system, release 1.0 Atlanta GA: Centers for Disease control and prevention.

Sl.No.	Level of knowledge	Score range	Frequency	Percentage
1	Good	20-25	1	2%
2	Average	7-19	49	98%
3	Poor	0-6	0	0%

Mean	Median	Mode	Standard Deviation	Range
13	25.5	7.5	7.35	13