2026 Volume 46 Pages 540-550
Objective: To qualitatively elucidate the cognitive process through which mid-career nurses notice subtle changes suggesting the onset of an acute consciousness disturbance, confirm these cues as abnormalities, and derive implications for clinical-judgment education.
Methods: A qualitative descriptive study was conducted. Ten ward nurses (≥5 years’ experience, clinical-ladder level III) were recruited using purposive sampling supplemented by snowball sampling and participated in semi-structured interviews between January and March 2025. Verbatim transcripts were thematically analysed, and credibility was enhanced through member checking and peer debriefing.
Results: From 60 codes, 11 subcategories, and 4 categories, we extracted two core categories: an intuitive initial grasp of “different from usual,” and an analytical initial grasp that verifies this “different from usual” perception. Analytical verification was triggered partway through the intuitive process, and intuition and analysis operated in parallel and iteratively to confirm the abnormality.
Conclusion: Nurses’ noticing of the onset of acute consciousness disturbance was characterized by a dual cognitive process in which intuition and analysis interacted reciprocally. As an educational implication, the need for learning that helps nurses verbalize intuitive feelings of discrepancy and confirm them using objective indicators was suggested.
