Use of intuition by nursing students: instrument development and testing

How clinicians recognise people who are dying: An integrative review

BACKGROUND

Timely recognition of dying is important for high quality end-of-life care however, little is known about how clinicians recognise dying. Late recognition is common and can lead to futile treatment that can prolong or increase suffering and prevent a change in the focus of care.

AIM

To explore how clinicians caring for dying people recognise that they are in the last days or hours of life, as well as the factors that influence the recognition of dying.

DESIGN

A systematically constructed integrative review of the literature.

METHODS

Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycInfo and Allied and Complementary Medicine were searched in July 2022. Papers were included if they were original research, discussed how clinicians recognise dying, available in English language and published in 2012 or later. A constant comparison approach was applied to the analysis and synthesis of the literature.

RESULTS

24 papers met the inclusion criteria. There were 3 main categories identified: 'Clues and signals' refers to prompts and signs that lead a clinician to believe a person is dying, incorporating the sub-categories 'knowing the patient over time', and 'intuition and experience'. 'Recognition by others' is where clinicians come to recognise someone is dying through others. This can be through a change in the context of care such as a tool or care plan or by communication with the team. 'Culture, system and practice' refers to the cultural beliefs of a setting that influences awareness of dying and denial of death as a possibility and avoidance of naming death and dying directly. System and practice of the setting also impact on recognition of dying. This involves work pace and intensity, shift systems and timing of senior reviews of patients. Uncertainty and its impact on recognition of dying are evident throughout the findings of this review. The seeking of certainty and the absence of the possibility of dying contributes to late recognition of dying.

DISCUSSION

Recognition of dying is a complex process that occurs over time, involving a combination of intuition and gathering of information, that is influenced by contextual factors. A culture where dying is not openly acknowledged or even named explicitly contributes to late recognition of dying. A shared language and consistent terminology for explicitly naming dying are needed. Uncertainty is intrinsic to the recognition of dying and therefore a shift to recognising the possibility of dying rather than seeking certainty is needed.

REGISTRATION

(PROSPERO) CRD42022360900. Registered September 2022.

Nursing Staff's Observations of BPSD Amongst Older Adults with Dementia Living in a Nursing Home: A Qualitative Study

The majority of older adults with dementia living in a nursing home exhibit behavioral and psychological symptoms of dementia (BPSD). This behavior is difficult for residents to cope with. Early recognition of BPSD is important in order to implement personalized integrated treatment, and nursing staff are in the unique position to consistently observe residents' behavior. The aim of this study was to explore nursing staff's experiences observing BPSD of nursing home residents with dementia. A generic qualitative design was chosen. Twelve semi-structured interviews were conducted with nursing staff members until data saturation. Data were analyzed using inductive thematic analysis. Four themes were identified: "group harmony" observations from a group perspective, focused on the disturbance of group harmony; an "intuitive approach", which involves observing unconsciously and without a set method; "reactive intervention", which refers to immediate removal of observed triggers without exploring the causes of behaviors; and "sharing information", which is delayed sharing of observed behavior with other disciplines. The current way in which nursing staff observe BPSD and share observations within the multidisciplinary team explain several existing barriers to achieving high treatment fidelity for BPSD with personalized integrated treatment. Therefore, nursing staff must be educated to structure their daily observations methodologically and interprofessional collaboration improved to share their information in a timely manner.

The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study

The aim of this study is to examine the influence of nurses’ self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses’ self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses’ CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

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.

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.

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.

Continued Psychometric Evaluation of an Intuition Instrument for Nursing Students

Purpose: The purpose of this study was to evaluate the psychometric properties of a revised intuition instrument developed for nursing students. Method: Principal component factor analysis was used to establish construct validity, and the Cronbach’s alpha was used to examine reliability. Findings: Statistical analysis resulted in a 26-item intuition instrument with 6 factors accounting for 62% of the variance. The factors were labeled as Feelings That Reassure (27.7%), Spiritual Connections (10.9%), Feelings That Alert (8.4%), Feelings That Forewarn (5.8%), Physical Sensations That Alert (4.7%), and Reading Physical Cues (4.2%). Eigenvalues ranged from 1.100 to 7.225, and factor loadings ranged from .572 to .848. The overall Cronbach’s alpha was .89 with a range of .73 to .85 for each factor. Conclusions: The 26-item intuition instrument showed evidence of construct validity and reliability. Implications: The intuition instrument can serve as a stimulus to foster students’ intuitive abilities.

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.

Caregiver daily impression could reflect illness latency and severity in frail elderly residents in long-term care facilities: A pilot study

AIMS

To propose a caregiver daily impression (CDI) rating instrument for personal caregivers of residents living in long-term care facilities (LTCF) to comprehensively evaluate residents' daily health condition, and to investigate whether the CDI reflects illness latency and severity in residents transferred emergently.

METHODS

We carried out a retrospective review of facility care records from 20 LTCF in Hyogo, Japan. The participants were 169 LTCF residents with episodes of transfer to emergency hospitalization facilities during a 3-month period. We determined specific CDI variables by interviewing experienced LTCF caregivers, and then carried out a principal component analysis to determine the major parameter set. The generated components were incorporated into a regression model to investigate the association with hospitalization.

RESULTS

The mean age was 87.9 ± 6.5 years, 68% were women and 28% of transfers resulted in hospitalization. The interview procedure identified 12 specific CDI variables, and the principal component analysis generated five distinct components: "change in feeding," "change in emotion," "disengaged or listless gaze," "decrease in eye reactivity" and "change in movement." By multivariate logistic regression, hospitalization was associated with "decrease in eye reactivity" (adjusted OR 1.78, 95% CI 1.07-2.97) and poor vital signs (adjusted OR 2.84, 95% CI 1.15-6.98), but not with body temperature (adjusted OR 1.29, 95% CI 0.52-3.21).

CONCLUSIONS

The CDI might reflect underlying illness severity beyond quantitative physical findings. Once the CDI can be appropriately validated, quantified and linked to physical findings, it could be used by caregivers for daily resident assessments and as a practical triage tool in emergency situations. Geriatr Gerontol Int 2016; 16: 612-617.

Relationship between intuition and emotional intelligence in occupational therapists in mental health practice

OBJECTIVE

Clinical reasoning studies have acknowledged tacit aspects of practice, and recent research suggests that clinical reasoning contains intuition informed by tacit knowledge. Intuition also appears to be influenced by awareness and understanding of emotions. This study investigated the relationship between intuition and emotional intelligence among occupational therapists in mental health practice.

METHOD

We mailed a survey containing measures of cognitive style and of use of emotional competencies at work and demographic questions to 400 members of the national occupational therapy association; 134 occupational therapists responded.

RESULTS

A moderate relationship was found between intuitive cognitive style and emotional intelligence. Experienced therapists scored higher on the use of emotional competencies at work and reported a preference for an intuitive cognitive style to a greater extent than novices.

CONCLUSION

This study represents the first attempt to explore occupational therapists' preferred cognitive style and self-reported emotional intelligence. Findings suggest that exploring emotions through reflective practice could enhance intuitive aspects of clinical reasoning.

Family physicians' diagnostic gut feelings are measurable: construct validation of a questionnaire

Background

Family physicians perceive that gut feelings, i.e. a ‘sense of reassurance’ or a ‘sense of alarm’, play a substantial role in diagnostic reasoning. A measuring instrument is desirable for further research. Our objective is to validate a questionnaire measuring the presence of gut feelings in diagnostic reasoning.

Methods

We constructed 16 case vignettes from real practice situations and used the accompanying ‘sense of reassurance’ or the ‘sense of alarm’ as reference labels. Based on the results of an initial study (26 family physicians), we divided the case vignettes into a group involving a clear role for the sense of reassurance or the sense of alarm and a group involving an ambiguous role. 49 experienced family physicians evaluated each 10 vignettes using the questionnaire. Construct validity was assessed by testing hypotheses and an internal consistency procedure was performed.

Results

As hypothesized we found that the correlations between the reference labels and corresponding items were high for the clear-case vignettes (0.59 – 0.72) and low for the ambiguous-case vignettes (0.08 – 0.23). The agreement between the classification in clear sense of reassurance, clear sense of alarm and ambiguous case vignettes as derived from the initial study and the study population’s judgments was substantial (Kappa = 0.62). Factor analysis showed one factor with opposites for sense of reassurance and sense of alarm items. The questionnaire’s internal consistency was high (0.91). We provided a linguistic validated English-language text of the questionnaire.

Conclusions

The questionnaire appears to be valid. It enables quantitative research into the role of gut feelings and their diagnostic value in family physicians’ diagnostic reasoning.

Cultural validation of the "use of intuition by nursing students scale - Turkish version"

PURPOSE

It is well known that intuition ability directly affects patient care quality and outcomes in nursing practice and is therefore an important aspect of nursing education. This study tests the validity and reliability of the Turkish version of the Scale of Use of Intuition by Nursing Students.

DESIGN

The sample for this methodological study was composed of 250 nursing students. Each item of the scale was translated into Turkish by the researchers and validated for Turkish use.

RESULTS

The item-total correlation was between .30 and .56 and its Cronbach α coefficient was .86. There was a statistically significant positive relationship between the level of clinical experience and the total points scored on the physical awareness, emotional awareness, and physical sensations subscales and from the total scale.

CONCLUSIONS

Based on these results, the Turkish version of the Scale of Use of Intuition by Nursing Students is valid and reliable.

The impact of intuition and supervisor-nurse relationships on empowerment and affective commitment by generation

AIM

  This article reports a generational cohort and leader-member exchange theoretical frameworks-guided study of the influence of the supervisor-subordinate relationship on three generational nurse cohorts' use of intuition, perceptions of empowerment and affective commitment.

BACKGROUND

  Within a global context of nurse shortages, knowledge about factors influencing nurse retention is urgently sought. We postulated that nurses' use of intuition is the key to their empowerment and consequent commitment to the organization, and that impact would vary among the three large nurse generations.

METHODS

  A self-report survey was used to gather data in 2008, which were then analysed using correlations, regression analysis, manova and path analysis. Data were obtained from 900 Baby Boomer and Generations X and Y nurses, randomly chosen from seven private hospitals across Australia.

RESULTS

  The findings confirm the important impact of supervisor-nurse relationships upon all three generations' use of intuition. The findings add new knowledge about the differing importance of using intuition for Generation X, Generation Y and Baby Boomer nurses' perceptions of empowerment, suggesting it is more important to Baby Boomers and Generation X than to Generation Y. Further, the impact of using intuition differs significantly among the generational cohorts.

CONCLUSIONS

The findings suggest the need for a more differentiated tailored style - sensitive to varying needs of the generations. Improving supervisor-nurse relationships is also critical, because of their impact upon nurses' use of intuition, perceptions of empowerment and affective commitment. Poor relationships lead to increased nurse replacement costs.

Nursing experience and preference for intuition in decision making

AIMS AND OBJECTIVES

This article examines the relationship between domain-specific and domain-general intuition among practicing nurses and student nurses to determine the role of intuition in nurses' decision making.

BACKGROUND

Measures of nursing intuition have not been compared with one another or to measures of general preference for intuition in the psychological literature. Prior research has shown that experienced nurses rely on intuition in clinical judgement, but the various aspects of intuition associated with experience have not been fully explored.

DESIGN

A correlational design was used to examine the factor structures and interrelationships of self-reported measures of intuition, as well as their relationship to experience.

METHOD

A web-based survey was given to 175 practicing nurses and student nurses in the fall of 2007 using measures of intuition from the nursing and psychological literatures. Quantitative analyses employed descriptive and inferential statistics.

RESULTS

Measures of preference for intuition were combined, resulting in the identification of two independent aspects of nursing intuition uniquely related to general intuition and nursing experience. Results revealed that preference for intuition in nursing was not solely due to general preference for intuition and that use of nursing intuition increased with experience.

CONCLUSION

These results strengthen the knowledge base of decision making in clinical practice by examining differences in preference for use of intuition among nurses. Further interdisciplinary collaboration is recommended.

RELEVANCE TO CLINICAL PRACTICE

Understanding the use of intuition in clinical judgement will promote professional practice and favourable patient outcomes. If experience simply leads to increased self-confidence and preference for the use of intuition, this may not actually be related to accuracy in judgement. However, if experience provides valuable information on associations between patient symptoms and outcomes, then the use of intuition in clinical practice should be encouraged.

Knowledge mobilized by a critical thinking process deployed by nursing students in practical care situations: a qualitative study

AIM

This paper is a report of a qualitative study of mobilization of knowledge within the critical thinking process deployed by female undergraduate nursing students in practical care situations.

BACKGROUND

Holistic practice is based on variety of knowledge mobilized by a critical thinking process. Novices and, more specifically, students experience many difficulties in this regard. Therefore, a better understanding of the knowledge they mobilize in their practice is important for nurse educators.

DESIGN

A qualitative study, guided by grounded theory, was carried out. Sixteen nursing students, registered in an undergraduate programme in an Eastern Canadian university, were recruited. Descriptions of practical care situations were obtained through explicitation interviews in 2007. A sociodemographic questionnaire, semi-structured interviews and field notes were also used. Data were analysed using an approach based on grounded theory. An additional stage of analysis involved data condensation.

FINDINGS

Various types of knowledge guide nursing students' practice. These include intrapersonal, interpersonal, perceptual, moral/ethical, experiential, practical, scientific and contextual knowledge. The mobilization of these types of knowledge is only possible when the process of critical thinking has attained a higher level, giving rise to a new knowledge that we have termed combinational constructive knowledge rather than aesthetic knowledge.

CONCLUSION

Clarification of the types of knowledge guiding the practice of student nurses and of the role of critical thinking in their mobilization could lead to innovative educational strategies. The findings provide guidance for the revision and development of both academic and clinical training programmes.

A hermeneutic phenomenological analysis of midwives’ ways of knowing during childbirth

OBJECTIVE

to explore the ways of knowing used by the midwife while attending women during childbirth through textual analysis of poems written by American midwives.

DESIGN

a hermeneutic phenomenology and human science research method inspired by van Manen was used. Midwifery ways of knowing during childbirth were thematically derived from 10 poems written by midwives about attending childbirth or the experience of being a midwife. Textual analysis included examination of the poems as a whole, via verse and metaphor, and via individual lines of prose.

PARTICIPANTS

10 American midwives wrote the poems used in this study. The poems were discovered through online searches of many databases using the key words 'poetry, poems, midwifery and childbirth' and through a national call for poetry by the researcher over a period of 4 years (1996-2000), undertaken in order to publish an anthology of poetry written by midwives.

FINDINGS

three authoritative ways of knowing that guided the care given by the midwife to women during childbirth were discovered. They were self-knowledge from the belief system of the individual midwife, grounded knowledge from the midwife's personal lived experience with childbirth, and informed knowledge from objective and scholarly sources.

KEY CONCLUSIONS

midwives must continue to develop their own body of knowledge in order to move the profession forward. Multiple ways of knowing including the use of experiential/contextual and intuitive knowledge is legitimate and humane, if provision of care is holistic. Care of women during childbirth can be enhanced with the use of multiple knowers and multiple ways of knowing. This study captured a unique and fresh interpretation of the lived experience of midwifery knowledge. Midwifery educational programmes should offer opportunities for students to explore the artistry as well as the science of midwifery practice.

A review of clinical decision making: models and current research

AIMS AND OBJECTIVES

The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model.

BACKGROUND

Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition.

DESIGN

Literature review.

METHODS

Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005.

RESULTS

The characteristics of the three models of decision making were identified and the related research discussed.

CONCLUSIONS

Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed.

RELEVANCE TO CLINICAL PRACTICE

It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.

The content validity index: are you sure you know what's being reported? Critique and recommendations

Scale developers often provide evidence of content validity by computing a content validity index (CVI), using ratings of item relevance by content experts. We analyzed how nurse researchers have defined and calculated the CVI, and found considerable consistency for item-level CVIs (I-CVIs). However, there are two alternative, but unacknowledged, methods of computing the scale-level index (S-CVI). One method requires universal agreement among experts, but a less conservative method averages the item-level CVIs. Using backward inference with a purposive sample of scale development studies, we found that both methods are being used by nurse researchers, although it was not always possible to infer the calculation method. The two approaches can lead to different values, making it risky to draw conclusions about content validity. Scale developers should indicate which method was used to provide readers with interpretable content validity information.

Diagnostic practise in nursing: A critical review of the literature

The purpose of this article is to critically review and synthesize the literature related to the general concepts and the process of diagnosing the client's condition, and the possible variables which influence diagnostic practise in nursing. It is suggested that statistical theories are capable of capturing the diagnostic process and offer an effective means to predict diagnostic decisions. Studies underpinned by information-processing theory argue that diagnosing a patient's condition follows a hypothetico-deductive model that consists of specific stages. Those who hold a phenomenological perspective remark that there is yet another form of diagnostic practise: intuitive reasoning, which plays an important role in diagnosing the patient's clinical condition. Other related studies suggest that diagnostic practise is contingent on some personal, psychosocial, and structural variables. Regrettably, these studies offer no conclusive explanation to delineate diagnostic practise in nursing. Based on the literature reviewed, a conceptual framework is suggested to help articulate the underlying structures and processes of diagnostic practise in nursing.