ArticleBMC nursing2026
Heterogeneity in attitudes toward early recognition of clinical deterioration among emergency department nurses in China and its relationship with triage competence: a multicenter survey analysis.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEmergency department nurses' attitudes toward early disease deterioration affect their assessment behavior and triage ability. A negative attitude delays assessment, impacting patient prognosis. Analyzing attitude characteristics, cultivating positive attitude and enhancing triage abilities are crucial. This study aims to identify distinct profiles of attitudes toward the early recognition of clinical deterioration among emergency department (ED) nurses in China, analyze demographic and statistical factors associated with these profiles, and explore the relationship between these attitude profiles and ED nurses' triage competence.
methodsFrom June to July 2024, a questionnaire survey was conducted among ED nurses from 31 general hospitals across seven provinces and municipalities in China (Anhui Province, Hubei Province, Hunan Province, Henan Province, Zhejiang Province, Jiangsu Province, Shanghai). The Attitudes Toward Recognition of Early Nursing Deterioration (ATREND) questionnaire and the Triage Nurse Professional Competency Questionnaire for Emergency Departments (TNPCQ-ED) were used as research tools. Data were statistically analyzed using SPSS 28.0 and Mplus 8.7. Latent profile analysis was employed to identify attitude characteristics, while multivariate logistic regression was applied to explore influencing factors of attitude profiles and regression analysis was used to examine the relationship between attitude profiles and triage competence.
resultsThe Chinese versions of the ATREND and TNPCQ-ED questionnaires demonstrated good reliability and validity among ED nurses. A total of 942 valid questionnaires were collected. The overall mean score for the ATREND questionnaire was (39.50 ± 7.34) points. Among its subscales, the Beliefs About Monitoring Importance scored the highest, while the other two subscales followed. The overall mean score for the TNPCQ-ED was (149.19 ± 21.01) points. Among its subscales, the professional commitment dimension had the highest score, followed by the clinical comprehensive capability and psychological empowerment dimensions. Latent profile analysis revealed four distinct attitude profiles: "Skill-Proficient & Belief-Mismatch Profile" (11.25%); "Belief-Dominant & Skill-Developing Profile" (53.72%); "Neutral & Balanced Profile" (15.92%); "Belief-Advanced & Skill-Developing Profile" (19.11%). Univariate analysis showed significant differences in age, years of work experience, job title, trained in triage, years at triage station and hospital level among the four profiles (p < 0.05). Multivariate logistic regression revealed the following: 1. Nurses in the "Belief-Advanced & Skill-Developing Profile" were more likely to have received systematic triage training. 2. Nurses in the "Belief-Dominant & Skill-Developing Profile" were more likely to have <5 years of triage desk experience. 3. The "Belief-Advanced & Skill-Developing Profile" were also more likely to work in provincial tertiary hospitals (p < 0.05). There was a statistically significant association (p < 0.001) between attitude profiles and dimensions of triage competence.
conclusionsED nurses' attitudes toward early recognition of clinical deterioration can be categorized into four latent profiles: "Skill-Proficient & Belief-Mismatch Profile", "Belief-Dominant & Skill-Developing Profile", "Neutral & Balanced Profile" and "Belief-Advanced & Skill-Developing Profile". Multivariate logistic regression indicated that factors such as systematic triage training, <5 years of triage desk experience, and employment in provincial tertiary hospitals influenced attitude profiles. Moreover, nurses' attitudes significantly impacted their triage competence. Nurse managers should design targeted interventions tailored to the characteristics of these profiles to enhance ED nurses' triage competence and foster positive attitudes toward the early recognition of clinical deterioration. This approach could improve proactive assessment capabilities, prevent further patient deterioration, and ultimately enhance the quality of emergency nursing care.
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