"I Just Knew" : Exploration of nurses' early perceptual recognition of life threatening clinical events

Despite the nurse's careful monitoring, anticipation, and planning, patient care emergencies requiring immediate intervention occur. Nurses, the health care professionals who spend the most time with patients, often "just know" that a problem is imminent, before objective evidence is available. This phenomenon is known as early perceptual recognition (EPR). The purpose of this study was to enhance understanding of EPR, identifying triggers for EPR, and how the skill of EPR is developed. Interpretative phenomenology was the philosophical orientation and methodology guiding this study. A networked sample of 32 nurses residing in the continental United States of America submitted written narratives describing their EPR experiences. Fourteen respondents participated in semistructured, in-depth telephone interviews. Data were analyzed using constant comparative analysis along with the method for hermeneutic analysis described by Diekelmann, Allen, and Tanner (1989). The Catalano Model of Early Perceptual Recognition emerged from data analysis. At the heart of the model is a theme called The Look. The Look triggered the rapid cognitive responses that characterize EPR. The Look refers both to the physical appearance of the patient as well as the look on the patient's face. After recognizing The Look, most nurses experienced The Feeling. The Look and The Feelin g occur nearly simultaneously. This visceral feeling, experienced in a variety of ways, propelled The Action. Depending on the nurse's assessment of the urgency of the situation, action was taken. Actions include: (a) Intervention, (b) Investigation, or (c) Impartation of their concern to colleagues. Respondents also indicated that they believe that their EPR skills emerged from a combination of experiences, in everyday life as well as professionally, and that EPR skills can be taught and developed. Early perceptual recognition is a complex construct composed of a variety of cognitive processes and is an acquired skill. EPR may also improve clinical outcomes. Implications of this research include the need to develop teaching strategies that will help nurses and nursing students develop their EPR skills. Methods to assess the affect of EPR on clinical outcomes must also be developed.