Identifying feelings engendered during triage assessment in the accident and emergency department: the use of visual analogue scales

Feelings engendered during 585 triage nursing assessments made by a total of 10 nurses were studied. Marked differences in nurses' feelings were demonstrated towards patients attending the accident and emergency (A&E) department with 'primary care' needs compared with those assessed as having 'A&E' needs. In particular, nurses demonstrated more negative feelings, in the form of less sympathy, more irritation and less motivation to help, towards patients with 'primary care' needs. Nurses' feelings were adversely affected by delays in patient presentation following the occurrence of illness or injury. Nurses perceived patients' attendance as illegitimate when it had deviated from expected norms of health-care-seeking behaviour. These findings were elicited using visual analogue scales completed immediately following the triage assessment of the patients. This work is part of a larger study into developing the primary care role of accident and emergency nurses. The culture of the A&E department is discussed, and the need to challenge and change this culture to ensure it becomes more responsive to individual patients' needs is advocated. This paper calls for development of triage training and education and further investigation into the effects of nurses' attitudes on patient assessment.