Saturday, November 3, 2007

This presentation is part of : Healthcare Practice Initiatives
“I Just Knew”: Nurses' Early Perceptual Recognition of Life Threatening Clinical Events
Janine M. Catalano, PhD, RN-BC, FNP, CNS, Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA
Learning Objective #1: define early perceptual recognition (EPR).
Learning Objective #2: list the three phases of early perceptual recognition and discuss methods that may enhance the skill of early perceptual recognition.

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). This study’s purpose 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 guiding methodology. A networked sample of 32 nurses submitted written narratives describing their EPR experiences. Fourteen respondents participated in semistructured in-depth 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. 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 Feeling 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 indicated that they believe that their EPR skills emerged from a combination of experiences, in everyday life and 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.