How triage nurses generate initial hypotheses during the first patient encounter: A focused ethnographic study
type: Article
item type: journalArticle
is part of: Int Emerg Nurs
authors: Person
  surname: Noire
  given name: Y.
authors: Person
  surname: Guechi
  given name: Y.
authors: Person
  surname: Pelaccia
  given name: T.
authors: Person
  surname: Mazar
  given name: E.
authors: Person
  surname: Ribordy
  given name: V.
subject: *Clinical Reasoning
subject: *Nurses/psychology
subject: *Triage/methods/standards
subject: Adult
subject: Anthropology, Cultural/methods
subject: Clinical Competence/standards
subject: Clinical reasoning
subject: Emergency Nursing/methods
subject: Emergency Service, Hospital/organization & administration
subject: Emergency department
subject: Female
subject: Humans
subject: Intuition
subject: Male
subject: Middle Aged
subject: Pattern recognition
subject: Qualitative Research
subject: Qualitative study
subject: Triage
subject: Triage nurses
subject: Video-cued recall
subject: competing financial interests or personal relationships that could have appeared
subject: to influence the work reported in this paper.
abstract: 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.
date: 2026-04-11
pages: 101824
coverage: 41962352

Int Emerg Nurs
type: Journal
volume: 86
alternative: Int Emerg Nurs
identifier: DOI 10.1016/j.ienj.2026.101824
identifier: ISSN 1878-013X (Electronic)