Gender and age differences in nurses' triage decisions using vignette patients.

BACKGROUND: Although evidence indicates that women who suffer a myocardial infarction (MI) are less likely than men to be diagnosed based on their presenting symptoms, to receive aggressive treatment, and to survive an acute cardiac event, most studies conducted to date are retrospective chart reviews that examine the triage decision-making practices of physicians.

OBJECTIVES: This study examined whether emergency department (ED) nurses' triage decisions were different when the nurse was presented with similar cues for MI, but different patient gender.

METHOD: A nonexperimental, descriptive study was conducted. Five hundred ED nurses were randomly selected to receive a mailed clinical vignette questionnaire. Data analysis included descriptive, bivariate, and multivariate analyses.

RESULTS: ED nurses perceived the middle-aged male vignette patient to be in need of more urgent triage (t = 2.58; df = 207; p = 0.01) and an admission to an intensive care unit bed (chi2 = 10.43; df = 1; p = 0.001) and were more likely to consider a cardiac diagnosis in the male than the age-matched female (chi2= 37.49; df = 1; p < 0.0001) with identical presentation. However, no such differences were noted in the elderly vignette patients.

CONCLUSIONS: The findings of this study suggest that gender bias and ageism may account for the disparities in triage decisions for middle-aged women with complaints suggestive of coronary artery disease. Although middle-aged women may have a lower incidence of MIs than middle-aged men, their increased morbidity and mortality warrants its consideration.