Arslanian-Engoren’s Decision-Making Program of Research Featured in Journal of Cardiovascular Nursing
A review of the literature showcases Dr. Arslanian-Engoren's outstanding impact in the study of decision-making science and triage of patients with ACS.
Dr. Cynthia Arslanian-Engoren is changing the way nurses think.
For more than a decade, her research has addressed how emergency department nurses make triage decisions for women presenting with possible acute coronary syndromes (ACS). “It focuses on explicating how nurses think about the presentation of acute myocardial infarction (MI) in women and the mental template that has been used to assess, evaluate and ultimately triage women for this life-threatening condition,” Arslanian-Engoren said of her research.
Emergency department nurses are in a key position to promptly triage women and to initiate the life-saving recommendations of the American Heart Association and American College of Cardiology. However, because nurses do not always recognize women’s cardiac symptoms or cues and do not always adhere to treatment guidelines, the quality of care delivered to women with myocardial infarction may be compromised. Traditionally, triage decision-making research has been focused on the decisions of physicians, with few studies specifically examining the decisions of nurses, even though they are often the first healthcare professional to evaluate women for complaints suggestive of ACS.
Her work was recently spotlighted in a literature review (abstract) published in the September/October 2011 issue of the Journal of Cardiovascular Nursing. Of the eight studies analyzed in this review of 20 years of literature of factors affecting nurses’ ACS triage decisions, seven were authored by Arslanian-Engoren. “This is very exciting for me because it really does show the impact [of my work]” she said.
Through her research, Arslanian-Engoren has revealed an urgent need for intervention in the area of nurses’ triage decisions. According to her research, gender and age biases and inadequate knowledge of evidence-based practice guidelines negatively influence nurses’ cardiac triage decisions. In a recent study, she noted that only 20% of nurses had triage goals congruent with American Heart Association/American College of Cardiology practice goals designed to facilitate timely reperfusion interventions.
Surprisingly, her study also found that the likelihood of nurses meeting goals was not associated with age, experience, educational level, or certification status. The trend of failing to meet goals of timely care to patients with MI was noted amongst one-third of nurse participants.
This trend poses an imperative problem given the crucial role played by triage nurses. “My premise has always been that the nurses are the linchpin because they are the ones evaluating patients when they first enter the healthcare system,” she explained. Emergency department nurses are in a key position to promptly triage women and to initiate life-saving recommendations. However, because nurses do not always recognize women’s cardiac symptoms or cues and do not always adhere to treatment guidelines, the quality of care delivered to women with myocardial infarction may be compromised.
Over the years an important element of Arslanian-Engoren’s work has been the presentation of ACS in women specifically. She stresses the need for triage nurses to be aware of differences between men and women’s presentation and perceptions of their disease. Guided by a graduate certificate in women’s studies, she has applied a post-structural feminist perspective to her decision science work. “One component is how the nurses decide, but another component is how the women in the community perceive their risk and perceive their need for evaluation,” she said. For example, women may delay seeking evaluation of their symptoms due to socially constructed behaviors, such as caring first for children and grandchildren before themselves.
Beginning with the publication of her doctoral dissertation in 1999, Arslanian-Engoren’s research on nurses’ triage decisions has evolved from surveying nurses using static scenario vignettes to observing nurses in real-life situations as they assess emergency department patients, and more recently to an intervention to improve emergency department nurses’ cardiac triage decisions. She has synthesized elements of a decision science approach by drawing on the work of Nobel Prize winners Herbert Simon and Daniel Kahneman. She is currently working on developing a theoretically-driven instrument to capture emergency department nurses’ cardiac triage decision-making processes and on a proposal to improve nurses’ cardiac triage decisions and patient outcomes.
