The triaging of men and women for coronary artery disease: Knowledge, experience, or bias.

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. Yet, controversy continues as to the underlying reasons for these disparities. Therefore, the purpose of this study was to examine if emergency department (ED) nurses triage decisions were substantively different when the nurse was presented with similar cues for MI, but different patient gender. Hammond's (1964) lens model for clinical inference and Evan's (1984) two-stage reasoning model provided the theoretical underpinnings. This non-experimental, descriptive investigation was conducted using methodological triangulation. A random sample of 500 ED nurses received a clinical vignette questionnaire (CVQ) that described simulated patient presentations that differed only by patient sex. Of the 500 CVQs distributed, 260 were returned (52%). The results indicated that ED nurses perceived respiratory, demographic, and medication cues as more relevant in the 43 year-old male vignette patient than the age-matched female patient. Additionally, the male vignette patient was perceived to be in need of more urgent triage, an admission to an ICU bed, and more likely to have a cardiac diagnosis considered than the female. However, no differences were found in the triage decisions that ED nurses rendered for the 66 year-old male or female vignette patients. The quantitative findings were supported by the qualitative data. Content analysis of four focus group sessions (n = 12) revealed several important issues influencing triage decisions: patient presentation, nursing knowledge and experience, practice environment, intuition, the fear of liability, and gender specific behaviors. Nurses held different perceptions regarding the significance and likelihood of coronary artery disease (CAD) for male and female patients seeking evaluation and treatment. Nurses admitted that CAD is not the first diagnosis considered for middle-aged females who come to the ED. Although middle-aged women may not suffer the same number of MIs as middle-aged men, their increased morbidity and mortality warrants its consideration. 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 CAD.Ph.D.Health and Environmental SciencesMedicineNursingSocial SciencesWomen's studiesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132064/2/9959696.pd