Perspectives of emergency triage nurses and evidence of bias in the assessment of people experiencing homelessness
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Background: Implicit bias can have a negative effect on patient assessments and treatment decisions in the emergency department (ED); patients experiencing homelessness (PEH) are particularly vulnerable. Purpose: The purpose of this study was to describe how the potential presence of cognitive biases in ED nurses may influence the triage process in PEH. Method: This qualitative descriptive study used ethnographic methods to guide observations and interviews of ED nurses during the triage process. Qualitative content analysis was used for observation data and thematic analysis was used for interview data. Findings were then compared to identify differences and similarities between the observed presence of bias and nurses' described experiences. Results: Twelve ED nurses were observed for over 128 patient encounters (n= 16, 13 percent PEH; n= 122, 88 percent housed patients); then participated in interviews. Observation findings included two themes, 1) Emergency Medical Services (EMS) Presentation: Words Matter and 2) Nurse Response: Taking Action. Interview findings identified four themes, 1) Objective Interpretation, 2) Subjective Interpretation, 3) Resulting Disparities, and 4) Busy Environment. Differences included nurses' observed actions of often disregarding PEH compared to their perceptions of remaining impartial. Similarities included presence of bias in both observation and interviews and reflected how personal labels and assumptions can influence nurse response. Conclusion: ED nurses may require additional bias awareness education specific to vulnerable populations such as PEH. These findings suggest an opportunity for future research to investigate implementation of bias awareness strategies to mitigate bias presence during the triage process.
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Ph. D.