PERCEIVED EFFECTIVENESS OF TRIAGE SYSTEM IN TRAUMA MANAGEMENT AMONG NURSES IN EMERGENCY DEPARTMENT OF UNIVERSITY OF BENIN TEACHING HOSPITAL

TOPIC IS SUITABLE FOR:
1. Department of Nursing Science

2. Department of Public Health

3. Department of Medical-Surgical Nursing

4. Department of Emergency and Critical Care Nursing

TOPIC: PERCEIVED EFFECTIVENESS OF TRIAGE SYSTEM IN TRAUMA MANAGEMENT AMONG NURSES IN EMERGENCY DEPARTMENT OF UNIVERSITY OF BENIN TEACHING HOSPITAL

TABLE OF CONTENT
Abstract

CHAPTER ONE: INTRODUCTION

1.1 Background of the Study

1.2 Statement of the Problem

1.3 Objectives of the Study

1.4 Research Questions

1.5 Research Hypotheses

1.6 Significance of the Study

1.7 Scope of the Study

1.8 Definition of Terms

CHAPTER TWO: REVIEW OF LITERATURE

2.1 Conceptual Framework

2.2 Theoretical Framework

2.3 Empirical Review

2.4 Summary of Literature Review

CHAPTER THREE: METHODOLOGY

3.1 Research Design

3.2 Research Setting

3.3 Target population

3.4 Sample size 

3.5 Sampling technique

3.6 Instruments for data collection

3.7 Validity and Reliability of Instrument

3.8. Pilot Study

3.9 Method of data collection

3.10 Method of data analysis

3.11 Ethical consideration  

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

4.0 Introduction

4.1 Data Presentation

4.2 Demographic Analysis 

4.3 Analysis of nurses’ perception of the effectiveness of the triage system in trauma management in the emergency department of the University of Benin Teaching Hospital

4.4 Analysis of factors influencing the effectiveness of the triage system in trauma management among nurses in the emergency department of the University of Benin Teaching Hospital

4.5 Analysis of challenges faced by nurses in the use of the triage system during trauma management in the emergency department of the University of Benin Teaching Hospital

4.6 Test of Hypotheses

CHAPTER FIVE: DISCUSSION OF FINDINGS

5.1 Discussion of Findings    

5.2 Implications of findings to nursing

5.3 Limitations of the study

5.4 Summary of the study  

5.5 Conclusion

5.6 Recommendations

5.7 Suggestions for further studies

REFERENCES

APPENDIX

ABSTRACT
This study was carried out to examine the perceived effectiveness of triage system in trauma management among nurses in the emergency department of University of Benin Teaching Hospital. The study was specifically carried out to assess nurses’ perception of the effectiveness of the triage system in trauma management in the emergency department of University of Benin Teaching Hospital, identify factors influencing the effectiveness of the triage system in trauma management among nurses in the emergency department, and determine the challenges faced by nurses in the use of the triage system during trauma management in the emergency department of University of Benin Teaching Hospital. The study employed the descriptive research design. The population of the study consists of nurses comprising nurses in Medical Emergency, Surgical Emergency, and Triage units of the emergency department of University of Benin Teaching Hospital. Hence, questionnaire was used for data collection, while the data collected were analyzed using frequency tables, percentages, and logistic regression statistical analysis. The hypotheses test was conducted using logistic regression statistical tool. A total of 54 respondents were selected as sample size using Taro Yamane formula, while 41 validated questionnaires were used for the final analysis through multi-stage sampling technique involving stratified and convenience sampling methods. From the responses obtained and analyzed, the findings revealed that nurses perceived the triage system as effective in trauma management, as majority agreed that triage improves patient prioritization, decision-making, and organization of trauma care. The study also revealed that availability of triage equipment significantly influences the effectiveness of the triage system at B = 0.842, Wald = 5.590, P = .018. Adequate staffing level was also significant at B = 0.674, Wald = 4.494, P = .034, while nurses’ training and professional development significantly influenced triage effectiveness at B = 0.731, Wald = 4.593, P = .032. The study further revealed that shortage of trained nurses significantly affects the use of the triage system at B = 0.816, Wald = 5.104, P = .024, high patient workload was significant at B = 0.893, Wald = 5.356, P = .021, and availability of essential emergency resources was significant at B = 0.754, Wald = 5.068, P = .024. The study therefore recommends that hospital management should provide adequate triage equipment, ensure continuous training of nurses, improve staffing levels, and strengthen emergency department resources to enhance effective trauma management.

Keywords: Triage System, Trauma Management, Nurses, Emergency Department, Effectiveness.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background of the Study
Healthcare services are an essential part of human development and welfare as they have a direct impact on health outcomes, life expectancy and the quality of life. In the modern health care systems, emphasis is on the process of patients receiving timely, safe and effective health care through organized clinical processes and evidence-based practices. The delivery of healthcare has changed from providing treatment to taking a more coordinated approach to improve efficiency and patient-centeredness (Enemuo, 2022). With the increasing variety of patients' needs in healthcare institutions, healthcare workers must be equipped to make quick and precise clinical decisions for patient management. The effective healthcare system is greatly dependent on structured mechanisms that promote timely assessment and prioritization of care, as put by Reynolds et al. (2024). In the same way, Bahlibi et al. (2022) found that systematic frameworks are needed to guide clinical actions, particularly as healthcare delivery has become increasingly complex. As a result, healthcare organizations have implemented different methods that focus on enhancing patient evaluation, resource usage, and healthcare delivery in acute care settings.

Triage is one of the systematic methods used in health care and has become an important mechanism for assessing and prioritizing patients. Triage: the methodical process of assessing patients and determining the priority of their treatment by the seriousness of their injuries or illnesses and the need for treatment. Triage is a process used in healthcare systems to prioritize patients based on their level of urgency, helping to allocate available resources effectively, according to Adhikari et al. (2024). This idea has evolved into an integral part of the practice of emergency care, especially in the departments where patients arrive in a variety of conditions, ranging from that of the very sick to the very injured. According to Zhang et al. (2025), standardized triage systems help to ensure consistency in evaluating patients and to make effective decisions among healthcare workers. Moreover, Alhalal and Alhalal (2025) reported that the use of triage systems helps to streamline patient flow and improve efficiency in the ED. The use of triage systems in healthcare institutions has been increasing, highlighting the importance of these systems in managing patient care and allocating clinical resources accurately.

In trauma management, for example, the importance of triage becomes especially apparent, and the assessment and management of trauma patients form an integral part of their treatment. Trauma Management involves the holistic evaluation, stabilization, treatment and monitoring of a person who has suffered trauma due to an accident, fall, violence or external factors. They cite Rovati et al. (2025) to say that in the case of trauma, it is essential to identify life-threatening factors quickly so that clinical intervention could be timely and have a better outcome. According to Oghuvwu et al. (2025), a triage system is a tool that will aid in trauma management by allowing healthcare workers to prioritize trauma patients according to their need for urgent care. Moreover, Okoye et al. (2023) found that good triage makes it easy to coordinate the members of the health care team, and helps to ensure organized and systematic care of trauma. With emergency departments (ED) being the front line of care in the management of injured patients this incorporation of triage has become a growing priority to support efficiency, patient evaluation and treatment prioritization.

Nurses are often the first health care workers to evaluate a patient in an emergency department and the successful implementation of triage systems is tightly linked to that of trauma. Some nurses may need to help out with triage, check conditions, and act as a liaison between members of the health care team. Eyeson et al. (2026) posited that nurses' perceptions about the effectiveness of triage can offer insights into the practical operation of emergency care systems and their role in the care of patients. Their experiences and evaluations can help shed light on the role of triage in clinical decision making and delivery of trauma care in the real world. The Emergency Department, University of Benin Teaching Hospital is one of the referral centers that renders emergency/trauma services to a vast population in and outside Edo State. Enemuo (2022) pointed out that tertiary healthcare institutions are very important in the development of Emergency care service because of their use of patient management system. Hence, the study of the perceived effectiveness of triage system in trauma management by Emergency Department nurses of the University of Benin Teaching Hospital therefore, would be an important context to consider the application of triage in a specialized healthcare environment.

1.2 Statement of  the Problem

Trauma is a big public health problem worldwide, with a large proportion of emergency department visits and deaths. Adhikari et al (2024) estimated that injuries account for nearly 8% of deaths worldwide and that there are a large number of injuries in emergency care settings that require immediate triage. Emergency departments of high-volume centres see thousands of trauma presentations every day, research has shown that as high as 60-80% of the presentations require structured prioritisation using a triage system (Reynolds et al., 2024). Well-developed triage systems should provide quick and efficient classification and better survival rates by using uniform procedures. Nevertheless, Bahlibi et al. (2022) noted that there is still a lack of uniformity in how triage is applied and health workers' perceptions across the world, resulting in the variability of trauma outcomes in different parts of the world. This represents a disconnect between perceived and actual effectiveness of triage and suggests that it is important to explore the perceptions of effectiveness of triage by frontline health care providers.

Trauma-related emergencies carry a disproportionately large burden of preventable deaths in Sub-Saharan Africa and the WHO has estimated that the region accounts for more than 90 per cent of all road traffic deaths in the world although it only has about 3 per cent of the vehicles (Oghuvwu et al, 2025). A study of 26 African countries by Zhang et al. (2025) found that many of these countries have a patient overcrowding rate in emergency departments of more than 150–300% of the bed count, causing delays in patient triage and treatment initiation. Okoye et al., (2023) also reported that only 40-55% of emergency departments in the region are using standardized triage protocols, which is attributed to limited workforce and training. The goal of a triage system is to be uniform in order to immediately identify life-threatening injuries. But implementation gaps and staff perceptions persist and continue to undermine the effectiveness of providing trauma care in the region. This ongoing discrepancy suggests that a study about nurse perceptions of the effectiveness of triage in their clinical settings is needed.

In Nigeria, trauma cases constitute a major proportion of emergency department admissions, with studies indicating that emergency units handle an estimated 20–40 trauma cases daily in major tertiary hospitals (Enemuo, 2022). The emergency department of Edo State especially at the University of Benin Teaching Hospital is a unit that constantly receives huge numbers of patients with sometimes overflowing the capacity of the department during peak hours (Eyeson et al, 2026). In trauma management, although triage systems have been adopted, the nurses' understanding and perception of its effectiveness is a concern. An ideal triage system should provide timely categorisation of patients within minutes of arrival which will enhance the survival outcome and efficiency of the system. Inconsistencies in perceptions and applications, however, show that there is a gap between policies and practices. Therefore, the aim of this study is to establish the perceived effectiveness of triage by nurses in trauma management of the University of Benin Teaching Hospital for the purpose of providing evidence to enhance effective delivery of emergency services.

1.3 Objective of the Study

The main purpose of this study is to investigate perceived effectiveness of triage system in trauma management among nurses in emergency department of university of benin teaching hospital. The specific objectives of the study seek to:

1.To assess nurses’ perception of the effectiveness of the triage system in trauma management in the emergency department of the University of Benin Teaching Hospital.

2.To identify factors influencing the effectiveness of the triage system in trauma management among nurses in the emergency department.

3.To determine the challenges faced by nurses in the use of the triage system during trauma management in the emergency department of the University of Benin Teaching Hospital.
Other parts of chapter one include:
1.4 Research Questions

1.5 Research Hypotheses

1.6 Significance of the Study

1.7 Scope of the Study

1.8 Operational Definition of Terms

CHAPTER TWO
REVIEW OF LITERATURE (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter therefore focuses on the concept of triage system, types of triage systems, principles of triage in emergency care, concept of trauma management etc. the chapter covers the following subheadings:
Conceptual Framework

Theoretical Framework

Empirical Review

Summary of Literature Review

CHAPTER THREE
RESEARCH METHODOLOGY (Preview)
Research Design: The study adopted a descriptive research design.

Population of the Study: The population of the study comprises nurses working in the Medical Emergency Unit, Surgical Emergency Unit, and Triage Unit of the Emergency Department of the University of Benin Teaching Hospital, Benin City, Edo State.

Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 54 participants.

Sampling Technique: The study employed a multi-stage sampling technique involving stratified sampling and convenience sampling to select the individual respondents.

Research Instrument: The study utilized a structured questionnaire titled “Perceived Effectiveness of Triage System in Trauma Management among Nurses in the Emergency Department of University of Benin Teaching Hospital” as the instrument for data collection.

Methods of Data Analysis: The collected data were analyzed using frequencies and percentages to summarize and present the demographic characteristics of the respondents and their responses. Inferential statistics, particularly logistic regression analysis, were used to test the hypotheses.

CHAPTER FOUR; DATA PRESENTATION, ANALYSIS AND DISCUSSION OF FINDINGS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables and charts. Based on the results obtained from the analysis, the following findings are made:

i. The study found that nurses generally perceive the triage system as effective in trauma management in the emergency department of the University of Benin Teaching Hospital, as evidenced by the majority of respondents agreeing that triage helps prioritize trauma patients according to the severity of their conditions (73.2%), enhances effective decision-making (73.1%), and improves the organization of trauma care (73.2%). This implies that the triage system plays an important role in prioritizing patients, supporting clinical decisions, and improving the organization of trauma care in the emergency department.

ii. The study found that the availability of triage equipment, adequate staffing, nurses’ training and professional development, and effective communication among emergency staff significantly influence the effectiveness of the triage system in trauma management. This was further confirmed by the corresponding hypothesis test, which showed that triage equipment had a coefficient (B) of 0.842, Wald value of 5.590, and p-value of 0.018; adequate staffing had a coefficient (B) of 0.674, Wald value of 4.494, and p-value of 0.034; nurses’ training had a coefficient (B) of 0.731, Wald value of 4.593, and p-value of 0.032; and effective communication had a coefficient (B) of 0.905, Wald value of 5.613, and p-value of 0.018 (p < 0.05), leading to the rejection of the null hypothesis. However, standardized triage guidelines (p = 0.070) and the availability of adequate resources (p = 0.124) were not statistically significant. This implies that adequate equipment, staffing, professional training, and effective communication are important determinants of the effectiveness of the triage system in trauma management.

iii. The study found that inadequate staffing, high patient workload, limitations in essential emergency resources, and management-related factors constitute significant challenges faced by nurses in using the triage system during trauma management. This was further confirmed by the corresponding hypothesis test, which showed that management support had a coefficient (B) of 0.628, Wald value of 4.564, and p-value of 0.033; shortage of trained nurses had a coefficient (B) of 0.816, Wald value of 5.104, and p-value of 0.024; high patient workload had a coefficient (B) of 0.893, Wald value of 5.356, and p-value of 0.021; and availability of essential emergency resources had a coefficient (B) of 0.754, Wald value of 5.068, and p-value of 0.024 (p < 0.05), leading to the rejection of the null hypothesis. However, availability of adequate triage space (p = 0.079) and coordination among healthcare workers (p = 0.092) were not statistically significant. This implies that addressing staffing shortages, excessive workload, resource limitations, and management-related challenges is essential for improving nurses’ effective use of the triage system during trauma management.

CHAPTER FIVE: DISCUSSION OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS
This chapter covers the following outline:
5.1 Discussion of Findings    

5.2 Implications of findings to nursing

5.3 Limitations of the study

5.4 Summary of the study  

5.5 Conclusion

5.6 Recommendations

5.7 Suggestions for further studies

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