Thinking strategies used by Registered Nurses during emergency department triage Katarina E. Go ¨ ransson, Margareta Ehnfors, Marsha E. Fonteyn & Anna Ehrenberg Accepted for publication 15 August 2007 Correspondence to K. Go ¨ ransson: e-mail: katarina.goransson@karolinska.se Katarina E. Go ¨ ransson PhD RN Nurse Manager of Research Department of Health Sciences, O ¨ rebro University, O ¨ rebro, Sweden and Emergency Department, Karolinska University Hospital, Solna, Sweden Margareta Ehnfors PhD RNT FACMI Professor Department of Health Sciences, O ¨ rebro University, O ¨ rebro, Sweden Marsha E. Fonteyn PhD RN Nurse Scientist Dana-Farber Cancer Center, Boston, Massachusetts, USA Anna Ehrenberg PhD RN Associate Professor and Post-doctoral Fellow Department of Health Sciences, O ¨ rebro University, O ¨ rebro, Sweden and Department of Health and Social Sciences, Dalarna University, Falun, Sweden GORANSSON K. E., EHNFORS M., FONTEYN M.E. & EHRENBERG A. (2008) GO ¨ RANSSON K. E., EHNFORS M., FONTEYN M.E. & EHRENBERG A. (2008) Thinking strategies used by Registered Nurses during emergency department triage. Journal of Advanced Nursing 61(2), 163–172 doi: 10.1111/j.1365-2648.2007.04473.x Abstract Title. Thinking strategies used by Registered Nurses during emergency department triage Aim. This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. Background. Sound clinical reasoning and accurate decision-making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contex- tual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical expe- rience. Furthermore, no study has shown the relationship between Registered Nurses’ thinking strategies and their triage accuracy. Method. Using the ‘think aloud’ method, data were collected in 2004–2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. Findings. The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, gener- ating hypotheses or allocating acuity ratings. Comparison of participants’ use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. Conclusion. The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision-making is complex. Further research is needed to ascertain which skills are most important in triage decision-making. Keywords: decision-making, emergency department, Registered Nurses, think aloud method, thinking strategies, triage Introduction Emergency department (ED) triage is the point of the care process where ED care begins. During triage, the patient is assessed, often by a Registered Nurse (RN), and given an acuity rating, indicating how long the patient can wait to see a physician without their health being in serious jeopardy (Australasian College for Emergency Medicine 2000). The ORIGINAL RESEARCH JAN Ó 2007 The Authors. Journal compilation Ó 2007 Blackwell Publishing Ltd 163