A Continuum of Ways of Knowing: Intuition, Pattern Recognition and Symptom Cluster Analysis

2.50
Hdl Handle:
http://hdl.handle.net/10755/152648
Type:
Presentation
Title:
A Continuum of Ways of Knowing: Intuition, Pattern Recognition and Symptom Cluster Analysis
Abstract:
A Continuum of Ways of Knowing: Intuition, Pattern Recognition and Symptom Cluster Analysis
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Raingruber, Bonnie, PhD
P.I. Institution Name:University of California
Title:Professor
Objectives: The purpose of the study was to examine the lived experience of expert emergency room nurses to explicate their skilled practices and explore the maxims that guide their work. Design: A phenomenological study was completed that involved interpretative interviews and observations of nurses' practice. Sample and Setting: Thirteen emergency room nurses working in a 500 bed, urban teaching hospital participated in the study. The hospital is a level one trauma center with magnet designation and a diverse patient population. Each nurse had worked five or more years in the emergency room and was identified by his/her nurse manager as being clinically skilled. Nurses who had incorrectly triaged a patient in the last three months were eliminated from the study. Three male and ten female nurses between the ages of 27 and 58 participated. Two of the nurses were Hispanic and the remainder were Caucasian. Concept Studied: The skilled practices of emergency room nurses were studied to determine the continuum of ways nurses recognize and treat patient problems. Methods: The researcher spent at least 5 hours observing each nurse as he/she worked in addition to interviewing each nurse individually. After each patient was seen the nurse was asked to describe what was most significant about that person's presentation and care. During slow periods nurses were also asked to describe emergency room nurses they admire and what rules of thumb they employ in practice. Participant's transcribed comments and field notes of the researcher were interpreted using the methods of searching for paradigm cases, analysis of exemplars and identification of common threads of meaning (Benner, 1994). Participant validation was used as a bias control strategy. Nurses reviewed and agreed with the identified themes and threads of meaning. Findings: Practice exemplars of nurses demonstrated a continuum of ways that nurses recognize patient problems including: 1) intuition, 2) observable patterns, and 3) analysis of symptom clusters. Nurses perceived intuitive understandings by noticing physical sensations as well as overall impressions and strong emotions. When recognizing patient problems, nurses also perceived observable but not physiologically based patterns by noting patient behaviors, assessing the look in a patient's eye, and tracking slight color changes. When presented with common diagnoses, nurses considered critical aspects of physiology and how it shaped a patient's treatment or prognosis by first identifying classic symptom clusters. Each of the above-described ways that nurses noted patient problems occurred along a continuum of recognition. Intuition and analysis of symptom clusters represented opposite ends of the continuum in that intuition occurred in an immediate, holistic fashion and analysis involved a linear, deliberate approach to patient care. Midway along the continuum of recognition, nurses noted observable patterns of presentation and behavior in patients. Conclusions: Picking up on patient problems early by using intuition provided nurses with additional time to prepare to manage complex situations and to assess more carefully using a deliberate approach. When nurses perceived situations in an intuitive manner he/she recalled the experience for a longer period of time. The vivid nature of the memory and the fact that the nurse reflected on it assisted in enhancing the nurse's skill progression. The spectrum of ways that emergency room nurses assessed patient problems allowed nurses to triage patients more efficiently, to advocate for expedient transfers, and to advocate effectively for patient needs in a timely fashion. Implications: Because nurses in this study reported that intuitive events were more memorable than other aspects of their practice, it is important to continue to study to what extent intuition enhances skill progression because the nurse retains a vivid memory of the incident. Further research is needed to determine if intuition enables the nurse to anticipate the patient's trajectory of healing more effectively because of the 'early warning' nature of intuitive understandings. Additional research is also needed to explore to what extent nurse's intuitive impressions are shaped by the emotional climate of the emergency room and the particular patient situation. Results of this study indicate that both male and female nurses experience intuition in similar ways. Further research is needed to confirm this possibility. Whether it is possible to teach nurses to enhance intuitive skills by having them read about other nurses intuitive experiences or by having nurses work with a preceptor who trusts their intuition needs to be examined.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleA Continuum of Ways of Knowing: Intuition, Pattern Recognition and Symptom Cluster Analysisen_GB
dc.identifier.urihttp://hdl.handle.net/10755/152648-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Continuum of Ways of Knowing: Intuition, Pattern Recognition and Symptom Cluster Analysis</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Raingruber, Bonnie, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of California</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">bonnie.raingruber@ucdmc.ucdavi</td></tr><tr><td colspan="2" class="item-abstract">Objectives: The purpose of the study was to examine the lived experience of expert emergency room nurses to explicate their skilled practices and explore the maxims that guide their work. Design: A phenomenological study was completed that involved interpretative interviews and observations of nurses' practice. Sample and Setting: Thirteen emergency room nurses working in a 500 bed, urban teaching hospital participated in the study. The hospital is a level one trauma center with magnet designation and a diverse patient population. Each nurse had worked five or more years in the emergency room and was identified by his/her nurse manager as being clinically skilled. Nurses who had incorrectly triaged a patient in the last three months were eliminated from the study. Three male and ten female nurses between the ages of 27 and 58 participated. Two of the nurses were Hispanic and the remainder were Caucasian. Concept Studied: The skilled practices of emergency room nurses were studied to determine the continuum of ways nurses recognize and treat patient problems. Methods: The researcher spent at least 5 hours observing each nurse as he/she worked in addition to interviewing each nurse individually. After each patient was seen the nurse was asked to describe what was most significant about that person's presentation and care. During slow periods nurses were also asked to describe emergency room nurses they admire and what rules of thumb they employ in practice. Participant's transcribed comments and field notes of the researcher were interpreted using the methods of searching for paradigm cases, analysis of exemplars and identification of common threads of meaning (Benner, 1994). Participant validation was used as a bias control strategy. Nurses reviewed and agreed with the identified themes and threads of meaning. Findings: Practice exemplars of nurses demonstrated a continuum of ways that nurses recognize patient problems including: 1) intuition, 2) observable patterns, and 3) analysis of symptom clusters. Nurses perceived intuitive understandings by noticing physical sensations as well as overall impressions and strong emotions. When recognizing patient problems, nurses also perceived observable but not physiologically based patterns by noting patient behaviors, assessing the look in a patient's eye, and tracking slight color changes. When presented with common diagnoses, nurses considered critical aspects of physiology and how it shaped a patient's treatment or prognosis by first identifying classic symptom clusters. Each of the above-described ways that nurses noted patient problems occurred along a continuum of recognition. Intuition and analysis of symptom clusters represented opposite ends of the continuum in that intuition occurred in an immediate, holistic fashion and analysis involved a linear, deliberate approach to patient care. Midway along the continuum of recognition, nurses noted observable patterns of presentation and behavior in patients. Conclusions: Picking up on patient problems early by using intuition provided nurses with additional time to prepare to manage complex situations and to assess more carefully using a deliberate approach. When nurses perceived situations in an intuitive manner he/she recalled the experience for a longer period of time. The vivid nature of the memory and the fact that the nurse reflected on it assisted in enhancing the nurse's skill progression. The spectrum of ways that emergency room nurses assessed patient problems allowed nurses to triage patients more efficiently, to advocate for expedient transfers, and to advocate effectively for patient needs in a timely fashion. Implications: Because nurses in this study reported that intuitive events were more memorable than other aspects of their practice, it is important to continue to study to what extent intuition enhances skill progression because the nurse retains a vivid memory of the incident. Further research is needed to determine if intuition enables the nurse to anticipate the patient's trajectory of healing more effectively because of the 'early warning' nature of intuitive understandings. Additional research is also needed to explore to what extent nurse's intuitive impressions are shaped by the emotional climate of the emergency room and the particular patient situation. Results of this study indicate that both male and female nurses experience intuition in similar ways. Further research is needed to confirm this possibility. Whether it is possible to teach nurses to enhance intuitive skills by having them read about other nurses intuitive experiences or by having nurses work with a preceptor who trusts their intuition needs to be examined.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T11:44:17Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T11:44:17Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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