It is evident that skills and professionalism of nurses are decisive for care process and, as a result, patient outcomes. Nevertheless, sometimes nurses have to apply intuition in their work. In the conditions of an emergence care unit, emergency charge nurses need to make sound decisions to activate a trauma code (Cork, 2014). The article under analysis presents the result of the study about nursing intuition as an assessment tool which can be used to predict severity of injury in trauma patients. This two-phase research discovers intuition which is a common phenomenon for nursing community. The purpose of this paper is to critically analyze the article, providing the assessment of the major research components such as research question and design, methods for data collection, limitations and findings of this study which contribute to the evidence-based practice.
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Although the research question is not formulated in the article, the core aspects are mentioned in the research objective. Thus, the objective of this investigation is “to explore the validity of nurses’ subjective use of intuition or “gut instinct” in trauma patients to predict the severity of their injuries, and whether it influences their decision to appropriately institute a trauma code” (Cork, 2014, p, 245). The research comprises a literature review which discovers previous investigations related to nursing intuition, peculiarities of emergency department nurses, the issue of trauma code, and explains injury severity code. The concept of intuition is not new in medical literature.
For example, Pearson (2013) studied the issues of both science and intuition and their place in clinical decision making. The author found roots of intuitive decision-making in the theory of hypothetico-deductive reasoning. Intuition is not based on evidence-based knowledge which is dominant in the contemporary healthcare. Instead, “intuition involves a person knowing without knowing how” (Pearson, 2013, p. 213). A later research by Chilcote (2016) provide a concept analysis of intuition in nursing, clinical practice, and patient care. An important implication of this study is the fact that intuition itself is not legitimized in the nursing profession. However, when such aspects of intuition as holistic, unconscious knowledge are verified through analytical processes, intuition can become a nursing tool and determine the course of action of a nurse and other specialists.
The researcher selected a descriptive, quantitative, cross-sectional approach to this study. The choice of this research design is justified by the necessity to assess nursing intuition as a tool and describe its role in predicting the severity of injury. The major strengths of quantitative research design are as follows. First of all, in case the study is properly designed and the sample is representative, there is an opportunity to generalize the results. Secondly, it is usually easier to analyze than the qualitative one. Finally, data obtained as a result of quantitative research are considered more reliable and precise. Still, there are some weaknesses of this research design. Thus, frequently there are problems with access to the necessary secondary data. Also, the context of the investigated phenomenon can be difficult to comprehend, but the researcher in the current study adds a descriptive component to address this problem.
Since the study comprised two phases, the sample was selected correspondently. During the first phase, the sample included eight charge nurses who were purposefully selected among the staff employed by a rural emergency department (Cork, 2014). All of the nurses included in the sample are Advanced Cardiac Life Support and Trauma Nurse Core Curriculum certified. Some of the participants are also Certified Emergency Nurses. This fact witnesses the high level of preparation due to continuous education and profound experience. Nurses working both day and night shifts were involved in the research. The sample selected for the phase two of the study “consisted of a retrospective chart review of all deidentified trauma records and prehospital reports” for the period of two years (Cork, 2014, 246). The idea was that the charge nurses selected during the first phase had to complete the prehospital records.
Although the sample size can seem small for a quantitative research, it can be justified by peculiarities of the presented study. Taking into consideration the fact that the setting was a trauma Level III hospital with 135 beds and that sample inclusion criteria comprised enough experience and certification, the sample size can be considered satisfactory. Certainly, the study would add in validity and reliability with a bigger sample, but in conditions of a rural location for the research and the fact that only emergency department nurses were involved, the sample can satisfy the research objectives.
Data Collection Methods
The research data were collected during both phases of the study. During the first phase, the principal investigator collected the demographic data of the study participants. It allowed to create profiles of people responsible for activating trauma codes. To provide privacy, the research participants were contacted through interdepartmental mail. One of the tools used during phase one was a questionnaire. Also, a recruitment cover letter and informed consent were the necessary documents to address the ethical issues. Phase two which lasted for two years, included a retrospective review of all trauma cases recorded by the charge nurses involved in the experiment from June 2010 to May 2012 (Clark, 2014). To address the ethical considerations of the patients whose personal information was included in the records, the hospital’s trauma coordinator deindentified the records. There were no ethical violations because both university and hospital institutional boards approved the research.
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One of the major limitations of the study is its small sample. Also, the limitations include a short questionnaire used to interview the nurses and initially subjective character of the notion of intuition. However, the number of patient records that were analyzed was only slightly smaller than the desired number identified with the help of the Cohen’s d power analysis (Cork, 2014). Nevertheless, these limitations can be eliminated in the consequent studies in case researchers involve a bigger sample and the necessary number of patient records. In every study, it is important to determine the limitations because they help to define the gaps of the study and avoid them in further research.
The major findings of both research phases can be described as follows. first of all, the nurses involved in the research had a minimum of 10 years’ work experience and from 6 to 10 years of experience as emergency department nurses (Cork, 2014). The research reveals the fact that the charge nurses who participated in the research were able to utilize their subjective intuition skills properly. Moreover, they managed to provide a higher level of emergency care, which positively influenced the patient outcomes because they received appropriate care which reduced morbidity and mortality. Thus, it can be concluded that the research findings answer the research question regarding the efficiency of nursing intuition in conditions of emergency department helping to predict the severity of injury in trauma patients. The research findings can be considered credible in the conditions of the selected setting and the formulated research objectives.
The most important aspects of the research include bringing together such issues as nursing practice and intuition which is not a scientific concept. The research question to answer was if the use of intuition by nurses is a valid tool to be used in trauma patients to predict the severity of their injuries, and if it has an impact on the appropriateness of decision-making about the application of a trauma code.
The research findings can be applied in practice. The implications are as follows. First of all, the research proves that experienced and well-trained nurses can make sound decisions based on their intuition. It can contribute to stimulation of continuous nursing education and their self-development. Nurses should be aware that their sound decisions regarding the activation of a trauma code are decisive for the patient outcomes. Thus, intuitive decisions should have sufficient practical experience and education. Another implication for nursing practice is paring experienced nursed with novice to share experience. Non-experienced nurses would thus have an opportunity to make observations and ask questions to obtain experience and practical skills necessary for correct intuitive decisions. On the whole, it can be concluded that nursing intuition can be used in practice, but it should have suitable experience and skill basis.
Chilcote, D. (2016). Intuition: A concept analysis. Nursing Forum, 52(1), 62-67. Web.
Cork, L.L. (2014). Nursing intuition as an assessment tool in predicting severity o injury in trauma patients. Journal of Trauma Nursing, 21(5), 244-252. Web.
Pearson, H. (2013). Science and intuition: Do both have a place in clinical decision making? British Journal of Nursing, 22(4), 212-215. Web.