Examination of nurses' clinical decision impact of calculating TRISS score in patients with head trauma

This research has aimed to study the effect of TRISS (Trauma and Injury Severty Score) on nurses' clinical decision making in cranial traumatized patient. The research was carried out by 20 emergency department's nurses who has been participating in the study voluntarly between March the 1st and May the 30th , 2018 at ER Service at Ege University Hospital with a total of 225 trauma patients which sample size has been determined by power anlaysis. Informed consent form, patient identification form, nurse information form, trauma scoring system and clinical decision-making scale were used for the gathering of the research data. Percentage Analysis, Spearman's Correlation Analysis, Mann-Whitney U Test, Marked Wilcoxon Test, Two Sample t-Test and McNemar Test has been used for evaluating of the data. 70% of the nurses had previously been educated to approach the trauma patient and 50% of these nurses educated in the same institution which those are currently working. It has been determined that to be educated in approaching to trauma patient does not make significant impact on clinical decision making in applying TRISS (p=0,1). The average score of pre-trial clinical decision making was 95.15 ± 9.37 for nurses, and the average score after the research was 116.9 ± 7.63. The difference between the scores obtained before and after the research showed an increase of 21,75 ± 9,76 and this increase was statistically significant (t = 9,96, p <‰ 1). It was determined that there is a moderate, negative correlation between the total score of the nurses and the increase of score which is statistically significant (r = -0,50 p = 0,2). The nurses' average practice time by years were 4.85±2.30 and average practice time at emergency service by years were 3.95±2.30. It was found that there was a moderate, psoitive correlation between the total scores of the nurses before the research, the professional experience and the professional experience at emergency service which those are compared by the years they spend on (r=0,44 p=0,05; r=0,47 p=0.03). In addition, the correlation between the scores they got after the research and the score increase was moderately positive and statistically significant (r=0,48 p=0,02). It is inevitable to enrich the theoretical knowledge given during the nursing graduate education by supporting them in the approach to the trauma and resuscitation patients. Having continuity with in-service training in terms of quality and context that will enable nurses to be decision makers in the management of patients after graduation and renew their education with current approaches is essential. In the diagnostic evaluation, treatment and follow-up of multi-trauma patients; patient management algorithms in cooperation with health-care team must be established. Evaluation of the effect of these algorithms on time management, morbidity and mortality in patients requiring resuscitation or invasive intervention are required. Standards should be established to eliminate individual differences in patient management among emergency service nurses. Establishment of emergency trauma patients' approach protocols to multi-trauma patients will contribute to nurses to participate systematically and effectively on htese patients evaluation,treatment and follow-up. These protocols and legal regulations may raise the quality of patient care when monitoring is required. KEY WORDS: Trauma, Clinical-decision, Nurse