Discovery of Nursing Gestalt in Critical Care Nursing: The Importance of the Gray Gorilla Syndrome

Abstract How do critical care nurses determine if a patient is developing cardiogenic shock? What assessment and decision‐making processes do they use, and how do they learn them? To find out, in‐depth interviews were conducted with 28 critical care nurses during a study that investigated the practice of critical care nurses in the early detection and prevention of cardiogenic shock in patients with acute myocardial infarction (AMI). Through the analysis and comparison of these interviews, we developed a theory of> Nursing Gestalt to explain the cognitive process used by experienced critical care nurses in making assessments and judgments. Moreover, we discovered that critical care neophytes learn to make assessments, diagnoses, and sound judgments about care from a more experienced nurse who supports and teaches the neophyte the Nursing Gestalt during a mentoring relationship. We call this mentoring relationship The Cray Gorilla Syndrome, for reasons we will explain later. This paper presents selected findings from the study. The origin and properties of Nursing Gestalt are discussed, as well as factors that enhance its development and use–namely, The Gray Gorilla Syndrome.