Applying triage in an emergency room beneficence

When a disaster strikes, normal thinking and routine procedures no longer apply. A disaster disrupts everything, including the triage system that is used successfully every day in the emergency department. This disruption applies both to clinical procedures and to the ethical foundation of those procedures. ED triage nurses traditionally practice using 4 ethical principles of autonomy, beneficence, nonmaleficence, and justice, along with the attendant moral rules of fidelity and veracity, for example. Disaster triage operates according to a different ethical approach, the utilitarian ethical theory. A lack of standards and distinct guidelines in applying this theory adds to the moral distress felt by the triage nurse during a disaster. Making a life or death decision that a patient will consume too many resources and must go into the dead or dying category runs counter to the moral intuition of most people and most nurses, as well as counter to the typical ethical principles that normally inform daily nursing practice. The nurse’s instinct is to help and nurture the patient. To ignore this instinct causes great consternation with extreme and potentially long-lasting moral distress for the triage nurse. An understanding of the ethical basis of disaster triage can help nurses reconcile the personal and professional difficulties, including moral distress, that can result from the decisions that must be made in such a situation.

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Biography

Jacqueline M. Wagner is Educator, Emergency Department, AtlantiCare Regional Medical Center, Pomona, NJ.

Biography

Michael D. Dahnke is Associate Teaching Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, PA.

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