Impact of Competency Based Critical Thinking attitude and Clinical Judgment Skill on Triage among Nurses.

Triage is the first step in emergency nursing, where patients are categorized according to the urgency and severity of their condition to decide the order of care and ensure prompt treatment. Triage skills are vital for emergency nurses, and regular audits and monitoring can help reduce errors in the triage process. Triage competency involves more than just accuracy; it also includes deciding patient disposition, providing appropriate emergency care, assessing clinical impressions, and performing ongoing re-evaluations. Effective decision-making based on quick clinical reasoning is essential in emergency care, starting from the triage stage. Clinical reasoning skills play a major role in determining the overall competency of emergency nurses⁽¹⁾.

Various training strategies have been developed to enhance triage nurses ability to make accurate and timely clinical decisions. The commonly used methods include short lectures combined with case studies, simulation exercises, live-actor scenarios, computer-based modules, and game-based learning activities. As the main goal of triage education is to strengthen emergency nurses' competency in making precise and prompt judgments, there is a growing need to design more effective and learner centered educational approaches ⁽²⁾.

In a quasi-experimental study, 66 emergency nurses were assigned to an intervention group (n = 31) using the Competency-Based Triage Education Application (CTEA) and a comparison group (n = 35) with traditional book-based learning. The CTEA included lectures, text-based cases, and video-based scenarios. Post-intervention, the intervention group showed significant improvements in triage competency and performance, along with a reduction in under triage errors compared to the comparison group ⁽³⁾.

Effective triage is critical in emergency settings to ensure patients receive timely and appropriate care. Improving nurses’ critical thinking and clinical judgment through targeted training reduces errors, enhances patient safety, and supports better decision-making during high-pressure situations. Competency-based education equips nurses with the skills needed to accurately assess, prioritize, and manage patient care efficiently ⁽⁴⁾.

Statement of the problem

A Descriptive Study to assess the Impact of Competency Based Critical Thinking attitude and Clinical Judgment Skill on Triage among Staff Nurses in selected unit, at Panimalar Medical College and Hospital Research Institute.

Objectives of the Study

1.       To assess the Impact of Competency Based Critical Thinking attitude and Clinical Judgment Skill on among Staff Nurses.

2.       To determine the correlation between Critical Thinking attitude and Clinical Judgment Skill on Triage among Staff Nurses.

3.       To determine the association between selected back ground variables and competency based critical thinking attitude on Triage among Staff Nurses.

Null Hypotheses

H0₁: There will be no significant difference between the impact of competency based critical thinking attitude and clinical judgement skill on Triage among Staff Nurses.

H0₂: There will be no significant association between selected demographic variables and the impact of competency based critical thinking attitude and clinical judgement skill on Triage among Staff Nurses.

Study design and setting

A cross-sectional study was conducted in Emergency and Critical care unit at selected hospital. The study focused on assessing the impact of competency-based critical thinking attitude and clinical judgment skills on triage performance among staff nurses working in emergency and critical care units.

Sample size and sampling method

A total of 50 staff nurses working in the Emergency and Critical Care Units were included in the study. Participants were selected using a purposive sampling technique based on their availability and willingness to participate.

Data collection tool and technique

Data were collected using a structured questionnaire that consisted of three sections.

Section I included a demographic proforma to gather information such as age, gender, educational qualification, years of experience, and previous triage training.

Section II comprised Structured questionnaire of knowledge regarding critical thinking attitude and clinical judgment skill on Triage.

The tools were validated by experts in nursing and emergency care. After obtaining formal permission from the hospital authorities and ethical approval from the Institutional Ethics Committee, the data were collected through a self-administered questionnaire method. The confidentiality of the participants was strictly maintained throughout the study.

Table 1: Frequency and Percentage distribution of Level of knowledge on Critical Thinking attitude and Clinical Judgment Skill on Triage among Staff Nurses in selected unit at PMCHRI

(n=50)

The data in the Table 1 shows the level of knowledge among nurses regarding triage. A majority of nurses (84%) had an adequate level of knowledge, while 16% demonstrated a moderately adequate level of knowledge. None of the participants were found to have an inadequate level of knowledge, indicating a generally good understanding of triage among the nurses.

Table 2:  Comparison of mean and standard deviation on level of knowledge on Critical Thinking attitude and Clinical Judgment Skill on Triage among Staff Nurses.

(n=50)

***P<0.001

Table 2 depicts that the observed differences in mean scores for critical thinking attitude and clinical judgment skill were significant, with values of 2.84 ± 1.3 (t = 0.87) and 3.46 ± 2.8 (t = 0.61), respectively. Based on these findings, the null hypothesis (H01), which stated that “There will be no significant difference between the impact of competency-based critical thinking attitude and clinical judgment skill on triage among staff nurses,” was rejected. This indicates that competency-based critical thinking attitude and clinical judgment skill significantly influence triage performance among nurses.

Table 3: Association between selected demographic variable and level of knowledge on Critical Thinking attitude and Clinical Judgment Skill on Triage among Staff Nurses

(n=50)

P < 0.05

It could be inferred from Table: 3 that the association between selected demographic variables and nurses’ level of knowledge on critical thinking attitude and clinical judgment skill was analysed using the Chi-square test. No significant association was found for age, gender, educational status, experience, marital status, or religion, except the source of education (χ² = 0.0422, p > 0.05). Hence, the null hypothesis (H02) was rejected, indicating that demographic factors did not significantly influence competency-based critical thinking attitude or clinical judgment skill in triage.

This study reveals that the level of knowledge among nurses regarding triage. A majority of nurses (84%) had an adequate level of knowledge, while 16% demonstrated a moderately adequate level of knowledge. None of the participants were found to have an inadequate level of knowledge, indicating a generally good understanding of triage among the nurses.

A study by Chanif et al. found that the majority of emergency department nurses had a good level of knowledge regarding triage. The study also reported a significant correlation between nurses’ knowledge of triage and the accuracy of triage level interpretation (p < 0.001). These findings support the present study, where 84% of nurses demonstrated an adequate level of knowledge and 16% had a moderately adequate level (5).

The study found significant differences in mean scores for critical thinking attitude (2.84 ± 1.3, t = 0.87) and clinical judgment skill (3.46 ± 2.8, t = 0.61). Therefore, the null hypothesis (H01) was rejected, indicating that competency-based critical thinking and clinical judgment significantly influence triage performance among staff nurses.

A recent study by Song and Park (2025) found that triage competency among nurses was positively correlated with critical thinking disposition (r = 0.55, p < 0.001) and clinical judgment (r = 0.61, p < 0.001). The study also reported that critical thinking, clinical judgment, nurse–physician collaboration, education level, and years of experience significantly influenced triage competency, explaining 63.7% of the variance. These findings support the present study, highlighting that competency-based critical thinking attitude and clinical judgment skill significantly enhance triage performance among staff nurses (6).

This study analysed the association between demographic variables and nurses’ knowledge of critical thinking attitude and clinical judgment skill using the Chi-square test. No significant associations were found for age, gender, education, experience, marital status, religion except source of education (χ² = 0.0422, p > 0.05). Therefore, the null hypothesis (H02) was rejected, indicating that demographic factors did not significantly influence these competencies in triage.

Aghabarary et al. (2023) reported that demographic factors such as age, gender, and education did not significantly affect triage nurses’ professional capability. These findings support the present study, showing that demographic variables do not significantly influence nurses’ critical thinking and clinical judgment in triage (7).

The findings of this study indicate that staff nurses demonstrate an adequate level of knowledge and competency in critical thinking attitude and clinical judgment skills in relation to triage. Competency-based training was found to significantly enhance triage performance.  These results underscore the importance of structured training programs and ongoing professional development to optimize triage competency and ensure high-quality patient care in emergency settings.

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