Turkish version of the Nurse Intuition Patient Deterioration Scale: cross-cultural adaptation and validation study

Abstract

Aims and objectives

This study aimed to adapt the Nurse Intuition Patient Deterioration Scale into Turkish and to evaluate its validity and reliability among nurses working in medical-surgical wards.

Background

Unrecognized clinical deterioration is a critical patient safety issue in hospital settings. Although structured monitoring tools such as the National Early Warning Score are widely used, they do not fully capture the complexity of bedside assessments. Nurses’ intuition—the ability to rapidly recognize deterioration—plays an indispensable role in early detection.

Methods

This was a methodological study focusing on evaluating the measurement properties of the scale, including its reliability and validity. The translation and cultural adaptation process followed the stages of forward translation, synthesis, back translation, expert committee review, and pretesting.

Results

For 98 patients, a total of 776 patient assessments were conducted by 40 nurses in this study. The overall scale-level content validity ratio (average) was 0.822, indicating strong overall expert consensus and satisfactory content validity. The overall Cronbach’s alpha coefficient for the scale was 0.797, suggesting good internal consistency. For criterion validity, the relationship between the Nurse Intuition Patient Deterioration Scale scores and the National Early Warning Score-2 was examined; higher Nurse Intuition Patient Deterioration Scale scores were associated with higher National Early Warning Score-2 scores.

Conclusion

The Turkish version of the Nurse Intuition Patient Deterioration Scale demonstrated strong psychometric properties, confirming its reliability, construct validity, and criterion-related validity.

Relevance to clinical practice

This study contributes to the theoretical advancement of nursing science by bridging the gap between intuitive expertise and empirical measurement. In practice, the Nurse Intuition Patient Deterioration Scale can serve as an evidence-based tool to support clinical decision-making.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-026-04384-7.

Background

Unrecognized clinical deterioration is a critical patient safety issue in hospital settings. Worldwide, a substantial proportion of in-hospital adverse events—including unplanned transfers to intensive care units (ICUs), cardiac arrests, and preventable mortality—are attributed to delays in detecting deterioration on general wards [1, 2]. Health professionals need to adopt robust, up-to‐date skills and competencies in observing and assessing patient deterioration [3]. Early recognition and timely intervention reduce morbidity and mortality, but diagnosis remains challenging due to the subtle and nonspecific nature of early warning signs. Hospital-wide early warning scores (EWS) based on nursing surveillance patterns have been shown to be associated with reduced in-hospital mortality, length of stay, and sepsis risk [4]. Although structured monitoring tools such as the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS) are widely used, they do not fully capture the complexity of bedside assessments [1]. Moreover, state-of-the-art trend-based early warning scores lack clinical observations [5]. On the other hand, in practice, nurses often notice that “something is wrong” before measurable changes occur in physiological parameters, highlighting the importance of intuitive judgment in clinical surveillance [6].

“Nurses’ worry” is an important early indicator of clinical deterioration. Intuition-based nursing assessments may be particularly valuable in the early phase, when vital signs have not yet reached thresholds for rapid response team activation [1, 7]. Nurses’ intuition—the ability to rapidly recognize deterioration based on experiential knowledge, subtle cues, and holistic patient assessment—supports early detection and timely escalation of care and may be associated with improved outcomes such as reduced ICU transfers [8–11]. Qualitative and observational studies have consistently shown that nurses rely on gut feelings, behavioral changes, and nonverbal indicators to predict deterioration, which often precede measurable changes in vital signs [1, 10].

Despite its importance, intuition has historically been undervalued in evidence-based frameworks, partly due to difficulties in operationalizing and measuring this construct. Without standardized tools, intuition risks being dismissed as subjective rather than recognized as a valid component of clinical judgment.

To address this gap, Haegdorens and colleagues developed the Nurse Intuition Patient Deterioration Scale (NIPDS), which quantifies nurses’ intuitive recognition of patient decline [12]. The instrument provides a structured means of capturing intuitive judgments, transforming subjective impressions into measurable data. The NIPDS consists of items reflecting the cognitive, affective, and experiential components of intuition in clinical practice, and responses yield a score indicating the degree of perceived patient risk. Initial validation studies demonstrated acceptable psychometric properties, supporting its use in both research and practice as a complementary tool to traditional early warning [12].

To our knowledge, no validated instrument is currently available in Turkish to assess nurses’ intuition specifically in the context of patient deterioration, although intuition has previously been examined in Turkish nursing students through a validated scale—highlighting the need for a clinical tool such as the NIPDS for practicing nurses [13, 14]. While Turkish hospitals have widely adopted physiological early warning scores, these instruments do not capture the pre-analytic, experience-based judgments made by nurses. The lack of an adapted, validated tool limits both clinical practice—where intuition could complement structured monitoring—and research, where the construct cannot be quantified. Similar cross-cultural adaptations of nursing scales in other countries have demonstrated that culturally adapted tools can retain strong psychometric properties, providing a precedent for such work [15]. Furthermore, a Turkish version of the NIPDS could foster greater recognition of intuition in nursing education, clinical protocols, and multidisciplinary discussions on patient safety.

Methods

Aim of the study

The aim of this study was to adapt the Nurse Intuition Patient Deterioration Scale into Turkish and to evaluate its validity and reliability among nurses working in medical-surgical wards. Specifically, we sought to ensure conceptual, semantic, and operational equivalence of the instrument; to assess its structural validity using factor analysis; and to evaluate its internal consistency. We hypothesized that the Turkish version would demonstrate a factor structure comparable to the original instrument, Cronbach’s alpha coefficients ≥ 0.70, and acceptable content validity as judged by expert panels.

Study design

This was a methodologic study focusing on evaluating the measurement properties of the scale, including its reliability and validity. The study consisted of two phases. In phase 1, the NIPDS was translated and culturally adapted into Turkish following guidelines [15]. In phase 2, the psychometric properties of the Turkish version of the NIPDS were evaluated through a cross-sectional survey.

Reporting standards

This study was conducted in accordance with internationally recognized methodological guidelines for cross-cultural adaptation and psychometric evaluation of measurement instruments. The translation and cultural adaptation processes followed the stages proposed by Beaton et al. [16] which include forward translation, synthesis, back translation, expert committee review, and pretesting.

The study was conducted and reported in accordance with the COSMIN standards for evaluating measurement properties [17, 18]. In addition, to ensure methodological rigor and transparent reporting of reliability analyses, the study adhered to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) [19].

Setting

We used a convenience sampling method to recruit eligible patients who were hospitalized in medical-surgical inpatient wards of a tertiary teaching and research hospital in Türkiye between March and July 2025. Recruitment was conducted during the predefined data collection period, and all patients who met the inclusion criteria and were available during the study period were invited to participate. Four wards were selected by an expert committee comprising the research team and the nurse administrator of the hospital, considering patient characteristics. These wards were purposefully chosen as they care for patients who require continuous inpatient follow-up, enabling nurses to monitor clinical trends and detect early signs of deterioration. Patients requiring preoperative and postoperative care, long-term follow-up and treatment, and inpatient treatment of acute illnesses are admitted to these wards. The primary nursing care model is being applied at this facility by two shifts (day and night). Each shift has its own nurse-patient ratio and is planned by the charge nurse according to the nursing staff profile and patient characteristics.

Sampling

In the application of a scale to another culture, it is recommended to reach a participant number 5–30 times greater than the number of items in the scale [20, 21]. As the scale, which was to be tested for validity and reliability, contained nine items, the sample size was planned as 45–270 patient assessments. A total of 40 nurses participated in the study, and 98 patients were evaluated 776 times using the NIPDS during the data collection period. In addition, the same patient could be assessed by more than one nurse across shifts. Therefore, the dataset contained repeated assessments and potential clustering at both the patient and nurse-level. However, the number of assessments per patient varied, as nurses completed the NIPDS at different time points based on clinical need and patient status. The NIPDS consists of nine items, and our sampling size met this criterion with a ratio of approximately 86:1, which exceeds the recommended range.

Participants

Inclusion criteria for participants were as follows: patients age > 18, verbally confirmed to be assessed by their primary nurse. Exclusion criteria for participant patients were as follows: same-day surgery or outpatient, pregnancy, and having mechanical ventilation support.

Inclusion criteria for participant nurses were willingness to participate and actively working as a bedside nurse in the medical-surgical wards during the study period. Nurses with different levels of clinical experience were eligible to participate. Exclusion criteria for participant nurses were being a nursing student/trainee nurse.

Ethical considerations

Ward nurses voluntarily participated in this study and were recruited by the principal investigator following approval from the ward charge nurse. The nurses were informed about the possible implications of participation and their right to withdraw at any time. Individuals who participated in the study were informed that their responses would remain confidential and would be used for academic research purposes only. The authors ensured confidentiality throughout the data collection and processing. All NIPDS forms were registered by nurses working on the study wards and nicknamed for data collection. The dataset was pseudonymized before data analysis. The researchers were never in contact with any patients.

Measures/instruments

Nurse Intuition Patient Deterioration Scale (NIPDS): The NIPDS is a validated tool designed for nurses to assess patient deterioration, comprising nine items: decreased ability to verbally communicate, feeling unwell, altered facial expressions, lethargy, restlessness, behavioral changes, abnormal skin color (pale, red, yellow, or gray), a staring or penetrating gaze, and reduced responsiveness. The instrument involves scoring each item on a 3-point Likert scale, ranging from “not present” to “very present.” Previous studies have demonstrated its excellent construct validity and internal consistency, as well as its high accuracy in predicting urgent physician assistance, resuscitation team calls, patient death, and unplanned transfers to intensive or medium care [12].

The National Early Warning Score (NEWS-2): The NEWS-2 is a risk assessment tool developed to improve the detection of clinical deterioration in adult patients within acute care environments. It aims to facilitate prompt critical care interventions and enhance patient outcomes [22]. The NEWS-2 evaluates six fundamental physiological parameters: Respiratory rate, oxygen saturation, blood pressure, heart rate, temperature, and level of consciousness. The tool generates a cumulative score to identify and monitor patients at risk of deterioration. The original NEWS-2 development report did not report a Cronbach’s alpha because NEWS-2 is an aggregate physiological scoring system rather than a psychometric questionnaire [22]. Cronbach’s alpha values have been reported in later cross-cultural adaptation studies (e.g., Spanish NEWS-2 α = 0.70) [23].

Nurses’ Demographics Data Collection Form: The data collection form was developed by the authors for this study to obtain background information about participants. It included items on age, gender, education level, professional title, ward (inpatient clinic code), working duration (in the current clinic and in the profession), working schedule, and employment type. An English version of this form has been provided as Supplementary File 1.

Data collection

Following a brief one-hour training session by the primary researcher on how to utilize the NIPDS, nurses were instructed to complete the scale during each patient admission whenever feasible. Additionally, the NIPDS could be documented whenever a primary nurse had concerns about their patients. The NEWS, along with all demographic and administrative data, was collected with paper-based forms as part of the standard procedures during patient admission and routine care (e.g., routine patient rounds).

Translation and adaptation process

The cross-cultural adaptation process was carried out in four steps, which were completed in 4 weeks with no significant difficulty.

Step 1—Forward translation: After the approval from the developer of the original NIPDS, the scale was translated into Turkish. Three bilingual experts (a nurse professor, an English lecturer at the university, and a freelance worker who provides consulting, training, and translation services to hospitals and other healthcare facilities), all fluent in English, independently translated the original scale into Turkish. A panel including an independent nurse professor and the research team reviewed forward-translated versions to achieve the most accurate translation. After resolving ambiguities and disagreements, a preliminary initial translated version (Version 1) was created.

Step 2—Back translation: Version 1 of the scale was independently back-translated into English by three scholars who had not seen the original NIPDS. Two of the translators had experience with health-related terminology, and both were qualified in nursing research and education. The back-translated versions were compared with the original English version of the NIPDS by an expert committee composed of the researchers and translators. In this meeting, the committee thoroughly reviewed each item to eliminate major discrepancies and ensure the highest possible semantic and conceptual equivalence. Comprehensibility and cognitive equivalence of the translation were further validated. Once consensus was achieved, the committee finalized a prefinal draft.

Step 3—Pretesting and cognitive interviewing: The prefinal Turkish draft of NIPDS was piloted with five senior nurses at the medical units where the study will be conducted, and they were asked to review all items of the scale. Each participant was then interviewed individually to gather feedback on the clarity and comprehensibility of the questions. All nurses reported that the items were clear and easy to understand for patient assessment. As no modifications were deemed necessary, the prefinal Turkish draft of NIPDS was retained without changes.

Step 4—Final version: In the final stage, the scale underwent proofreading by a Turkish linguist to check for typographical, spelling, and grammatical errors. No revisions were required, and the final Turkish version of the NIPDS was confirmed. The final Turkish version of the NIPDS is provided as Supplementary File 2, and the original English version is provided as Supplementary File 3 (Permission to use and translate the instrument was obtained from the copyright holder.)

Content validity ratio

Lawshe’s Content Validity Ratio (CVR) technique was applied to determine the essentiality of each item [24]. A panel of 10 independent experts reviewed and evaluated each item individually. The panel consisted of six nurse academics with clinical backgrounds, two nurse academics specialized in intensive care nursing, one faculty member with expertise in nursing education, and one faculty administrator experienced in scale development and adaptation. The clarity and relevance of each item were evaluated by the experts using a three-point rating scale (1: clear/relevant/appropriate, 2: requires modification to be appropriate, 3: not clear/relevant/appropriate). CVR values were calculated for each item, and items with CVR values below the minimum threshold for ten experts (0.62) were considered for revision or elimination. The overall Scale-Level CVR (S-CVR/Ave) was 0.822, demonstrating strong overall expert consensus and satisfactory content validity for the NIPDS.

Statistical analysis

Data analyses were performed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Reliability and validity analyses were performed to evaluate the psychometric properties of the NIPDS. Internal consistency was assessed using Cronbach’s alpha, and item analysis included corrected item–total correlations and alpha if the item was deleted. Interrater reliability was not evaluated because assessments were not performed simultaneously under standardized conditions.

The construct validity was examined through exploratory factor analysis (EFA). A confirmatory factor analysis was not conducted in the present study. Because this is the first adaptation of the NIPDS into Turkish, we used Exploratory Factor Analysis to examine the factor structure in our sample without imposing the original model. Sampling adequacy for factor analysis was assessed using the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s test of sphericity. Criterion validity was tested by Pearson’s correlation analysis of NIPDS scores with NEWS scores. The results were evaluated at 95% confidence intervals, and findings were considered statistically significant at p < 0.05.

Results

Demographic and clinical characteristics

The patients’ mean age was 64.6 ± 17.7 years, ranging from 26 to 97 years. Overall, 56 (57.1%) patients were female and 42 (42.9%) were male. The most frequently documented reasons for hospitalization included respiratory conditions (e.g., pneumonia, bronchopneumonia, COPD, and respiratory distress), gastrointestinal problems (e.g., acute gastroenteritis, gastritis, and pancreatitis), urinary tract infections, cerebrovascular events, and cardiovascular conditions and procedures (e.g., hypotensive episodes, congestive heart failure, and CABG). In addition, several admissions were related to oncologic diagnoses and orthopedic or surgical interventions.

A total of 40 nurses participated in the study. Table 1 shows the socio-demographic characteristics of the nurses.

Table 1.

Demographic characteristics of the participants (N = 40)

Variable	n	%	Mean ± SD (Range)
Age (years)	40	–	25.9 ± 2.0 (22–30)
Gender
Female	25	62.5
Male	15	37.5
Education level
Vocational high school	10	25.0
Associate degree	14	35.0
Bachelor’s degree	13	32.5
Postgraduate	3	7.5
Professional title
Nurse	40	100.0
Ward
A	8	20.0
B	10	25.0
C	12	30.0
D	10	25.0
Working duration (months)	–	–
In the current unit	–	–	25.1 ± 22.5
In profession	–	–	52.8 ± 30.1
Working schedule
Day shift	2	5.0
Night shift	3	7.5
Both shifts	35	87.5
Employment type
Full-time	40	100.0
Part-time	0	0.0

Reliability

Item analysis of the Nurse Intuition Patient Deterioration Scale (NIPDS) is presented in Table 2. Corrected item–total correlations for the nine items exceeded 0.770, indicating strong homogeneity among items. Cronbach’s alpha if an item was deleted ranged between 0.771 and 0.776, demonstrating that none of the items decreased the internal consistency of the scale. The overall Cronbach’s alpha coefficient for the scale was 0.797, suggesting satisfactory reliability.

Table 2.

Item analysis and internal consistency of NIPDS scale

Item	Corrected Item-Total Correlation	Cronbach’s Alpha if Item Deleted	Cronbach’s Alpha
Item 1	0.908	0.772	0.797
Item 2	0.913	0.772
Item 3	0.905	0.771
Item 4	0.927	0.774
Item 5	0.898	0.772
Item 6	0.941	0.773
Item 7	0.880	0.776
Item 8	0.933	0.775
Item 9	0.930	0.775
NIPDS total score	1.0	0.978

Construct validity

The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was 0.934, and Bartlett’s test of sphericity was significant (χ²=11612.582, df = 36, p < 0.001), confirming the suitability of the dataset for factor analysis (Table 3).

Table 3.

Results of Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett’s test of sphericity

Test	Result
Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy	0.934
Bartlett’s Test of Sphericity (χ²)	11612.582
df	36
p	0.000

Exploratory factor analysis revealed a single-factor structure that accounted for 85.519% of the total variance (Table 4). The factor loadings of the nine items ranged between 0.805 and 0.897, indicating strong item contributions to the factor. The scree plot (Fig. 1) also supported the unidimensional structure of the scale.

Table 4.

Results of explanatory factor analysis of NIPDS (*)

Item	Factor1 Loading
Item 1	0.841
Item 2	0.845
Item 3	0.830
Item 4	0.879
Item 5	0.821
Item 6	0.897
Item 7	0.805
Item 8	0.892
Item 9	0.886

* Exploratory factor analysis (principal components) yielded a one-factor structure (eigenvalue = 7.697) explaining 85.52% of the total variance; all other factors had eigenvalues < 1.0

Fig. 1.

Scree plot of the Turkish version of the Nurse Intuition Patient Deterioration Scale

Criterion validity

For criterion validity, the relationship between NIPDS scores and the National Early Warning Score-2 (NEWS-2) was examined. NIPDS scores were weakly but significantly correlated with NEWS-2 (r = 0.129, p = 0.001), indicating that higher intuition scores tend to coincide with slightly higher early warning scores (Table 5).

Table 5.

Correlation between NIPDS and NEWS scores (Pearson’s r)

Scale	NEWS (r)	p
NIPDS	0.129	0.001

Discussion

This study aimed to translate, culturally adapt, and psychometrically evaluate the Turkish version of the Nurse Intuition Patient Deterioration Scale (NIPDS), an instrument originally developed to quantify nurses’ intuitive recognition of patient deterioration. Findings from this methodological study demonstrated that the Turkish version of the NIPDS possesses strong reliability and validity characteristics. Specifically, the scale exhibited satisfactory internal consistency (Cronbach’s α = 0.797), high corrected item–total correlations, and a unidimensional factor structure explaining 85.52% of total variance. Moreover, the significant positive correlation between NIPDS and NEWS scores (r = 0.129, p = 0.001) provided evidence of criterion validity.

Cronbach’s alpha is sometimes reported in later adaptation-validation studies of NEWS or NEWS-2 when authors treat the instrument as a multi-item scale during cross-cultural testing. Those adaptation studies report widely varying α values—for example, a Spanish NEWS-2 validation reported α = 0.70, and a recent Angolan Portuguese NEWS-2 adaptation reported α = 0.993. These differences may reflect methodological choices, sample characteristics, and whether authors consider internal consistency appropriate for a scale composed of physiological sub-scores.

This finding aligns with earlier research suggesting that nurses’ intuitive assessments often precede measurable clinical changes [7, 8]. In this sense, intuition may function as a perceptual “early warning system” that complements formal scoring tools. By quantifying this process, the NIPDS enables the integration of intuitive and analytical components of clinical reasoning into patient safety protocols, bridging experiential knowledge and evidence-based practice.

The psychometric results of this study are consistent with those of the original NIPDS validation by Haegdorens et al. [12] which similarly demonstrated excellent internal consistency (α = 0.82) and a single-factor structure. These findings reinforce the conceptual stability and theoretical coherence of the NIPDS across different linguistic and cultural contexts. Comparable psychometric properties have also been reported in another study on assessing nurses’ intuitive or surveillance-related decision-making [13, 25].

The relevance of intuition in nursing has long been emphasized in both theoretical and empirical literature. Benner’s novice-to-expert model established that intuitive judgment develops as a hallmark of clinical expertise [26]. Since then, studies have shown that, experienced nurses rely on pattern recognition and holistic cue integration to make rapid and accurate assessments in complex clinical environments [27, 28]. Qualitative evidence revealed that nurses frequently sense patient deterioration based on subtle, nonverbal cues—such as changes in skin tone, restlessness, or “not looking right”—even before objective vital signs reveal abnormalities. This intuitive awareness has been described as a form of embodied, tacit knowledge that complements analytical reasoning [29–31].

The present study adds quantitative evidence supporting the notion that intuitive recognition can be reliably measured. The unidimensional factor structure of the Turkish NIPDS aligns with theoretical perspectives that conceptualize intuition as an integrated cognitive-perceptual process rather than discrete sensory, emotional, or cognitive domains [8].

The internal consistency results (Cronbach’s α = 0.797) indicate that the Turkish NIPDS achieves satisfactory reliability according to the widely accepted threshold for new instruments (≥ 0.70) [21]. The corrected item–total correlations, all above 0.77, demonstrate that each item contributes meaningfully to the total construct and that there is strong homogeneity among the nine items. These findings suggest that the items are theoretically coherent and empirically unified in measuring nurses’ intuitive perception of deterioration.

Exploratory factor analysis yielded a one-factor solution accounting for 85.52% of total variance, supported by a high Kaiser–Meyer–Olkin (KMO = 0.934) value and significant Bartlett’s test of sphericity. Factor loadings ranging between 0.805 and 0.897 indicate that all items had substantial loadings on the single latent factor. This outcome reinforces the theoretical assumption that intuition, in the context of clinical deterioration, represents a unified construct encompassing behavioral, perceptual, and affective cues perceived by nurses.

Criterion validity analysis demonstrated a weak but statistically significant positive correlation between NIPDS and NEWS scores. Although the magnitude of the correlation was modest, this result is conceptually meaningful because the two tools capture distinct yet complementary constructs. Combining intuition with objective data may improve early recognition. The NIPDS may complement NEWS by capturing nurses’ intuitive perceptions of early decline, whereas NEWS quantifies physiological deterioration using objective vital-sign parameters [32]. The NIPDS reflects nurses’ intuitive perception of early clinical decline, whereas the NEWS quantifies physiological derangement using objective vital-sign parameters [22]. The observed association therefore suggests that intuitive recognition may serve as an antecedent or parallel indicator of physiological deterioration.

In addition, the socio-demographic profile of the participating nurses should be considered when interpreting the study findings. The sample included nurses with varying levels of clinical experience. Differences in experience and familiarity with the clinical context may influence how nurses perceive subtle changes in patient status and rely on intuitive judgement. The patient population also consisted predominantly of older adults with diverse medical and surgical admission reasons, reflecting the clinical complexity of medical-surgical inpatient wards. Nevertheless, the satisfactory psychometric performance observed in this study suggests that the Turkish NIPDS may be applicable across different wards and among nurses with varying levels of clinical experience.

When the NEWS is used alone, its limitations become evident—registered nurses may face risks such as uncertainty from delegating observations to unregistered staff, over-reliance on numerical scores by junior nurses. These factors can result in missed or delayed recognition of patient deterioration and inappropriate management. Incorporating the Nurse Intuition Patient Deterioration Scale (NIPDS) alongside NEWS may help mitigate these risks by supporting nurses’ intuitive judgments and enhancing early recognition of clinical deterioration [33].

Practically, the Turkish version of the NIPDS offers a valuable tool for both educational and clinical applications. In nursing education, it can be employed to enhance students’ self-awareness of intuitive reasoning and to facilitate reflection on non-analytical aspects of clinical judgment. In practice, the instrument can complement early warning systems and clinical observation tools to strengthen nurses’ situational awareness and early detection of deterioration. Integrating the NIPDS into clinical protocols could encourage nurses to systematically record intuitive perceptions, fostering interdisciplinary communication and early escalation of care.

Furthermore, the validated instrument can serve as a foundation for research exploring how intuition interacts with other predictors of patient outcomes, such as surveillance behaviors, teamwork, and decision-making. Its inclusion in predictive modeling, digital monitoring systems, or artificial intelligence-based early warning platforms could potentially improve the sensitivity and timeliness of deterioration detection. In this way, intuition becomes not merely a subjective “gut feeling” but a measurable element within evidence-based patient safety systems.

Strengths of the study

Several methodological strengths enhance the credibility of this study. The translation and adaptation process adhered to internationally recognized methodological standards [15]. Multiple independent translators, expert review, and cognitive debriefing ensured conceptual and linguistic equivalence between the Turkish and original versions. Importantly, this is the first adaptation and validation of the NIPDS in the Turkish context, thereby expanding the instrument’s applicability for international comparative research on nurse intuition and patient deterioration. The validation of this tool in Turkish enables its use for both research and clinical applications within local healthcare contexts.

Limitations

This study has some limitations that should be acknowledged. The sample was limited to nurses from a single private tertiary teaching and research hospital, which may restrict generalizability to other settings, such as public hospitals. The methodological design did not allow the assessment of predictive validity or the stability of the scale over time. Additionally, data were collected using self-reported questionnaires, which may have introduced response bias. Although internal consistency was satisfactory, test–retest reliability was not evaluated and should be examined in future studies. Finally, confirmatory factor analysis was not performed in this study; therefore, future studies could conduct confirmatory factor analysis to further validate the factor structure.

Finally, while the correlation between NIPDS and NEWS supports criterion validity, further research is needed to explore predictive associations with actual clinical outcomes, such as unplanned ICU admissions or cardiac arrest events, as during our data collection period, none of these events were recorded for any of the participant patients.

Future directions

Future studies should aim to replicate these findings in larger and more diverse samples to verify the generalizability of the Turkish NIPDS. Cross-cultural validations in other languages and healthcare contexts are also recommended to establish international comparability. Longitudinal studies could examine whether higher NIPDS scores predict adverse patient outcomes or correlate with recognition of and intervention in clinical deterioration. Integrating the NIPDS into digital health systems such as electronic health records (EHRs) could further expand its practical value. Moreover, studies combining quantitative and qualitative approaches may enhance understanding of how intuition interacts with clinical reasoning, emotional intelligence, and contextual factors in nursing practice.

Conclusion

The NIPDS has been shown to effectively quantify intuition—an inherently abstract, experience-based form of clinical reasoning—into a quantifiable construct that can be systematically evaluated.

Implementing a psychometrically sound instrument to measure intuitive judgment is an important step that will help nurses integrate the knowledge they gain through their experiences into patient safety practices and early warning systems.

The Turkish version of the Nurse Intuition Patient Deterioration Scale demonstrated strong psychometric properties, confirming its reliability, construct validity, and criterion-related validity. The findings suggest intuition as a measurable and meaningful component of nurses’ clinical assessment of patient deterioration. This study contributes to the theoretical advancement of nursing science by bridging the divide between intuitive expertise and empirical measurement. In practice, the NIPDS can serve as an evidence-based instrument to support clinical decision-making, guide educational interventions, and inform patient safety strategies. Recognizing and validating the role of intuition not only honors the experiential foundation of nursing practice but also enhances the precision, responsiveness, and humanity of patient care.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

CVR

Content Validity Ratio

EFA

Exploratory Factor Analysis

EHR

Electronic Health Record

EWS

Early Warning Score

ICU

Intensive Care Unit

KMO

Kaiser-Meyer-Olkin

MEWS

Modified Early Warning Score

NEWS

National Early Warning Score

NIPDS

Nurse Intuition Patient Deterioration Scale

Author contributions

NAPA conceptualized the study design, conducted data collection, and drafted the manuscript. NO contributed to the study design and data collection, and revised the manuscript. VU contributed to the study design, performed the statistical analysis, and revised the manuscript. All authors read and approved the final manuscript.

Funding

No financial support was received from any institution, organization, or funding agency for the conduct of this research.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to institutional policy but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Helsinki Declaration and Good Clinical Practice Standards [34]. For adaptation of the NIPDS to Turkish, written permission of Prof. Dr. Filip Haegdorens, who developed the original instrument, was obtained. The ethics committee approval for the study was obtained from Acibadem University and Acibadem Healthcare Institutions Medical Research Ethics Committee (ATADEK) before recruitment (Approval no. 2024-18/695). All participants were informed about the purpose and procedures of the study, and consent was obtained prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.