Nursing Intuition as an Assessment Tool in Predicting Severity of Injury in Trauma Patients

Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition and Severity Assessment

OBJECTIVE

To analyze relationships between provider-documented signs prompting sepsis evaluations, assessments of illness severity, and late-onset infection (LOI).

STUDY DESIGN

Retrospective cohort study of all infants receiving a sepsis huddle in conjunction with a LOI evaluation. Participants were ≥3 days old and admitted to a level IV neonatal intensive care unit (NICU) from September 2018 through May 2021. Data were extracted from standardized sepsis huddle notes in the electronic health record, including clinical signs prompting LOI evaluations, illness severity assessments (from least to most severe: green, yellow, and red), and management plans. To analyze relationships of sepsis huddle characteristics with the detection of culture-confirmed LOI (bacteremia, urinary tract infection, or meningitis), we utilized diagnostic test statistics, area under the receiver-operator characteristic analyses, and multivariable logistic regression.

RESULTS

We identified 1209 eligible sepsis huddles among 604 infants. There were 111 culture-confirmed LOI episodes (9% of all huddles). Twelve clinical signs of infection poorly distinguished infants with and without LOI, with sensitivity for each ranging from 2% to 36% and area under the receiver-operator characteristic ranging 0.49-0.53. Multivariable logistic regression identified increasing odds of infection with higher perceived illness severity at the time of sepsis huddle, adjusted for gestational age and receipt of intensive care supports.

CONCLUSIONS

Clinical signs prompting sepsis huddles were nonspecific and not predictive of concurrent LOI. Higher perceived illness severity was associated with presence of infection, despite some misclassification based on objective criteria. In level IV NICUs, antimicrobial stewardship through development of criteria for antibiotic noninitiation may be challenging, as presenting signs of LOI are similar among infants with and without confirmed infection.

Mental Health Risk Assessments of Patients, by Nurses Working in Mental Health Settings: A Qualitative Study Using Cognitive Continuum Theory

Mental health risk-assessments are an important part of nursing in mental health settings, to protect patients or others from harm. Even so, nurses often have difficulty identifying patients posing a credible risk (either to self or others), so guidance is recommended. However, despite an extensive and growing body of risk-oriented literature, comparatively little expands upon contemporary knowledge of nurses and patient risk assessment. Therefore, it remains unclear how nurses understand risk and undertake their risk assessments. To address this knowledge gap in nurses' decision-making processes, this study used the established Cognitive Continuum Theory as a novel means to explore the risk-assessment of patients by nurses working in mental health settings.

USAR decision-making: the role of hazard-specific expertise and risk assessment

The accepted detrimental effects of climate change and the anticipated increased frequency of cascading disasters means there is a pressing requirement to equip search and rescue teams with the capability to perform effective and complex risk assessments. This paper investigates risk-based decision-making expertise in the aftermath of the 2011 earthquake and tsunami in Japan. It compares the actual decisions made by an Urban Search and Rescue (USAR) commander, with the decisions that a cohort of people working within search and rescue made, when provided with the same decision context using 3 vignettes. Variations in the results are explored in terms of the complexity of the risk decision and the type of expertise required. The findings indicate that as the risk becomes more complex, the percentage of answers that were the same as the USAR commander (that we deem as ‘correct’ as they did not result in any adverse outcomes for the USAR team) decreased. Training entities need to provide decision-makers with the necessary human capabilities so they can perform the complex risk assessments required to make decisions in low-probability yet high-consequence disasters.

Nurse managed patient focused assessment and care: A grounded theory of qualified nurses in acute and critical care settings assessing the mental capacity of adult patients

AIMS

To explore processes used by qualified nurses in assessing mental capacity of acutely and critically ill hospitalised adult patients.

BACKGROUND

Mental capacity is the ability to understand, reason and make decisions. Acute and critical illness may impact upon the decision-making abilities of hospitalised adult patients but little is known about how qualified nurses across a range of acute settings assess the capacity of such patients in their care.

DESIGN

A qualitative grounded theory approach informed by the Corbin and Strauss (Basics of Qualitative Research (Third Edition). London, UK: Sage, 2008) methodological pathway.

METHODS

Data were collected through digitally recorded, semi-structured interviews to explore assessment of capacity processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales, UK. Data were analysed using iterative constant comparative processes leading to a core category and grounded theory. The study is presented in accordance with the COREQ checklist.

RESULTS

Informal, intuitive, holistic nurse-led processes were used to assess the mental capacity of patients which combined processes for the assessment of their physiological and mental capacity status, recognising the need to support their rights, dignity and autonomy. The assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi-professional assessment was necessary and ongoing, and in which qualified nurses had a co-ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care.

CONCLUSION

This theory provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness.

RELEVANCE TO CLINICAL PRACTICE

This framework may inform related clinical practice and can serve as a basis of an assessment tool in what has been identified as a fundamental role of the qualified nurse.

Development and Psychometric Evaluation of an Instrument to Measure the Use of Intuition in Clinical Practice by Critical Care Nurses

BACKGROUND

The current study was conducted to develop and validate an instrument to measure the use of intuition in clinical practice by critical care nurses.

METHODS

Item generation and psychometric evaluation were developed. In the psychometric, content validity index and content validity ratio were calculated to establish initial instrument validity through the use of expert ratings, as well as, construct and criterion validity.

RESULTS

The original items reduced to 25. Using principal components analysis and orthogonal varimax rotation, three factors had an eigenvalue >1, with 60.05% variance (Factor 1: 47.9%; Factor 2: 7.56%; and Factor 3: 5.05%). The tool had an acceptable correlation to criterion of the instrument (r = .769, p < .001), a Cronbach alpha consistency of 0.953, and a stability level of r = .945 and p < .001.

CONCLUSION

In this study, a valid and reliable instrument was developed to measure intuition.

Gut feeling: A grounded theory study to identify clinical educators' reasoning processes in putting students on a learning contract

AIM

To develop a substantive theoretical explanation that makes sense of the decision-making process that clinical instructors use to place students on a learning contract.

BACKGROUND

Clinical instructors are challenged with the task of objectively evaluating students using subjective tools such as anecdotal notes, diaries, unstructured observations and verbal feedback from other nurses. Clinical instructors' assessment decisions have a considerable impact on a variety of key stakeholders, not least of all students.

DESIGN

Grounded theory method and its heuristic tools including the logic of constant comparison, continuous memoing and theoretical sampling to serve conceptualisation were used in the process of data collection and analysis.

METHODS

Seventeen individual semi-structured interviews with clinical instructors in one university in Western Canada were conducted between May 2016-May 2017. Data were analysed using open, axial and selective coding consistent with grounded theory methodology. The study was checked for the Standards for Reporting Qualitative Research (SRQR) criteria (See Appendix S1).

FINDINGS

Three subcategories, "brewing trouble," "unpacking thinking" and "benchmarking" led to the study's substantive theoretical explanation. "Gut feeling" demonstrates how clinical instructors reason in their decision-making process to place a student on a learning contract.

CONCLUSION

Placing a student on a learning contract is impacted by personal, professional and institutional variables that together shift the process of evaluation towards subjectivity, thus influencing students' competency. A system-level approach, focusing on positive change through implementing innovative assessment strategies, such as using a smart phone application, is needed to provide some degree of consistency and objectivity.

RELEVANCE TO CLINICAL PRACTICE

Making visible the objective assessments currently being done by clinical instructors has the potential to change organisational standards, which in turn impact patient and clinical outcomes.

Relationship between the use of intuition in clinical practice and the clinical competence of critical care nurses

INTRODUCTION

Clinical competency has been the main focus of nurse educational systems. To further it, the concept of intuition was introduced into nursing in the 1970s. Benner's theory proposed that greater use of intuition was linked to higher clinical competence; however, there is still a paucity of data to verify this theory. Therefore, the current study was conducted to assess the relationship between the use of intuition in clinical practice and the clinical competence of critical care nurses.

METHODS

In this correlational study, 88 critical care nurses were recruited as convenience. The tools included a 'use of intuition in clinical practice' scale devised by the researcher, and a 'clinical competence' instrument. The gathered data were analyzed by SPSS version 20.0 software, using descriptive and inferential statistics.

RESULTS

Of the 88 participants, 73.9% were women and 93.2% were at undergraduate level. The mean and standard deviation of participants' age and work experience was 32.29 ± 6.75 and 7.40 ± 5.68 years, respectively. The Pearson correlation test revealed no significant connection between the use of intuition in clinical practice and the clinical competence of critical care nurses (r = 0.091, P = 0.398), and produced similar results from the various demographic groups (P > 0.05).

CONCLUSION

In this study, no significant correlation between the use of intuition and clinical competence in critical care nurses was found. This could be attributed to intuition as a nursing skill being almost excluded from the educational curriculum of nursing schools, and some background factors.

Nurses' Early Recognition of Neonatal Sepsis

OBJECTIVE

To determine nurses' perceptions of the most common physiologic and behavioral indicators of neonatal sepsis.

DESIGN

Descriptive correlational study.

SETTING

A women's and children's hospital in an academic medical center in the southwestern United States.

PARTICIPANTS

Nurses (N = 181) who cared for neonates in the mother-infant and NICU settings.

METHODS

Participants completed an e-mail survey developed from the literature to ascertain their perceptions of which physiologic and behavioral indicators were most often associated with neonatal sepsis. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Participants identified six signs and symptoms as indicators most often associated with sepsis: two were physiologic and four were behavioral. Recognition of these indicators was not related to level of nursing education but was associated with working in the NICU. Seventy-three percent of participants reported that they suspected that newborns were septic before evaluation and diagnosis of septicemia.

CONCLUSION

Nurses can identify the physiologic and behavioral indicators related to neonatal sepsis. Early recognition, expressed as their intuitive knowing, should be considered a valuable clinical tool. Understanding that different practice settings influence identification of signs and symptoms is important. Integration of this knowledge into formal care surveillance could potentially lower the threshold for early evaluation and treatment and thereby improve outcomes.

Trauma Tactics: Rethinking Trauma Education for Professional Nurses

According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes.

Intuition: A Concept Analysis

PURPOSE

The purpose of this article is to conceptually examine intuition; identify the importance of intuition in nursing education, clinical practice, and patient care; encourage acceptance of the use of intuition; and add to the body of nursing knowledge.

BACKGROUND

Nurses often report using intuition when making clinical decisions. Intuition is a rapid, unconscious process based in global knowledge that views the patient holistically while synthesizing information to improve patient outcomes. However, with the advent of evidence-based practice (EBP), the use of intuition has become undervalued in nursing.

REVIEW METHODS

Walker and Avant's framework was used to analyze intuition. A literature search from 1987 to 2014 was conducted using the following keywords: intuition, intuition and nursing, clinical decision making, clinical decision making and intuition, patient outcomes, EBP, and analytical thinking.

RESULTS

The use of intuition is reported by nurses, but is not legitimized within the nursing profession. Defining attributes of intuition are an unconscious, holistic knowledge gathered without using an analytical process and knowledge derived through synthesis, not analysis. Consequences include verification of intuition through an analytical process and translating that knowledge into a course of action.

CONCLUSION

This article supports the use of intuition in nursing by offering clarity to the concept, adds to the nursing knowledge base, encourages a holistic view of the patient during clinical decision making, and encourages nurse educators to promote the use of intuition.

Factors that impact on emergency nurses’ ethical decision-making ability

Background:

Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered.

Research purpose:

Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability.

Research design and context:

A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions.

Participants:

A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected.

Ethical considerations:

Approval to conduct this study was obtained by the Adelphi University Institutional Review Board.

Findings:

A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study.

Discussion:

This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability.

Conclusion:

This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.

The perception of intuition in clinical practice by Iranian critical care nurses: a phenomenological study

Background

Intuition as a way of learning in nursing is applied to decision making and judgment in complicated clinical situations. Several studies have been conducted on intuition in clinical settings, but comprehension of this concept is unclear. Moreover, there is a lack of information about intuition in critical care nurses caring for more seriously ill patients. This study aimed to explore Iranian critical care nurses’ understanding of intuition in clinical practice.

Methods

In a descriptive–phenomenological study, 12 nurses employed in critical care units of the hospitals affiliated to Kermanshah University of Medical Sciences were purposively recruited to the study. A semistructured interview was administered, and then written verbatim. The data were managed by MAXQDA 10 software, and qualitative analysis was undertaken using the seven-stage approach of Colaizzi.

Results

Of the 12 nurses who participated in the study, 7 (58.3%) were female and married, and 10 (88.3%) held a bachelor’s degree in nursing. The mean and standard deviations of participants’ age, job experience, and critical care experience were 36.66±7.01, 13.75±6.82, and 7.66±3.36 years, respectively. Four main themes and eleven sub-themes were elicited from the qualitative analysis; the main themes including “Understanding intuition as a feeling”, “Understanding intuition as a thought”, “Understanding intuition as receiving signs”, and “Understanding intuition as an alarm”. Because they have trust in their own intuition, the nurses made further assessments and paid more attention to patients. They were also better prepared after receiving intuition alarms to perform the appropriate responses, and acting upon the alarms reduced the nurses’ physical and psychological signs.

Conclusion

The findings showed how intuition was understood by the critical care nurses; therefore, these results can be considered to form a theoretical basis for designing other studies. Because of the significant role of intuition in enhancing the nursing care of critically ill patients, it is suggested that more qualitative, quantitative, and trials studies be performed to reinforce intuition in nursing; moreover, to incorporate intuition into nursing curriculums, it should be debated in academic settings.

State of Science, "Intuition in Nursing Practice": A Systematic Review Study

INTRODUCTION

There were many attempts for introducing "intuition" to nursing practice, But despite the efficacy, it has been ignored as a valid way of knowing. Therefore the current study was conducted for evaluating the state of sciences to intuition in nursing practice.

MATERIALS AND METHODS

In a systematic review study, all researches, published from 1995 to 2014, were searched in the databases of "PubMed", using "intuition" and "nursing" keywords. The abstract of articles were read in scrutiny, then the related researches selected, thereafter the full text of them was assessed carefully.

RESULTS

From searching the databases, 144 articles with "intuition and nursing" were found, 53 as original research, and 15 with inclusion criteria were selected. Most of the studies had qualitative approaches design as phenomenology (N=4), content analyses (N=2) and grounded theory (N=1), six was done for developing the instrument, and two studies have been conducted as descriptive method.

CONCLUSION

The results revealed the researches about intuition in nursing mostly were conducted with qualitative and instrument developing methodology and there is a lack of quantitative and trial studies.

The assessment and management of pain in an orthopaedic out-patient setting: A case study

The management of pain is an important aspect of an orthopaedic nurse's role. The aim of this paper is to use an individual case study to demonstrate the role of an out-patient orthopaedic nurse in the identification, assessment and management of pain. This paper describes how pain was identified and managed for a patient in the orthopaedic outpatient department, highlighting that pain and its management are not isolated to the in-patient setting. The case study illustrates the importance of recognising pain and taking into account the numerous factors that can influence pain perception. The assessment of an individual patient's pain led to obtaining help from the Acute Pain Team which led to improvement in the patient's pain management and quality of life. The nursing team reflected and discussed the issues identified by this case study which led to changes in practice being introduced. This has resulted in an increased knowledge of and confidence in pain management within the nursing team and development and improvement of pain management practice within the orthopaedic out-patient department.