Triage nurses in Tanzanian district hospitals are expected to identify psychological injury alongside physical trauma, yet the cognitive conditions under which they do so remain poorly specified. The model treats triage as a sequential signal-detection task in which the nurse's threshold for flagging psychological injury drifts upward across a shift as executive resources deplete, and in which this within-nurse drift is amplified or buffered by ward-level staffing and supervision. The analysis is theoretical and methodological: no primary data were collected. Instead, the paper formalises the threshold-drift mechanism, derives testable propositions about the interaction between shift position and ward context, and specifies how a multilevel survival model with a time-varying threshold parameter would identify the mechanism in routine screening records. To anchor the parameterisation in observable quantities, the paper draws on published DHS Program survey indicators on household decision-making, using the indicator 'family planning use decisionmaking mainly by wife' across 35 African countries and 95 country-survey observations from 1999 to 2022 (mean 25.946, SD 11.643). These values illustrate the between-country heterogeneity that any cross-national calibration of decision-autonomy covariates must accommodate. Under-triage of psychological injury is better understood as a predictable threshold phenomenon than as a knowledge deficit, and that referral delay is a structural property of shift design rather than an individual failing.
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Mwanri et al. (2026) studied this question.
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