Did We Interpret the Same Thing? Sharie L. Falan, PhD, RN, INS-BC, CPHIMS, and Bernard T. Han, PhD Sharie L. Falan, PhD, RN, INS-BC, CPHIMS, is Assistant Professor at Western Michigan University, Bronson School of Nursing, Kalamazoo, Michigan; Bernard T. Han, PhD, is Professor at Western Michigan University, Department of Business Information Systems, Kalamazoo, Michigan. Search terms: Similarity, similarity framework, terminology, concepts, think-aloud, classification, nursing, similarity determination, information consistency, information sharing Author contact: Sharie.Falan@wmich.edu PURPOSE: Motivated by the potential application of ″similarity theory″ in nursing communication, the primary objectives of this paper are (a) to seek an in-depth understanding of how nurses identify like concepts when comparing two similar but different images, and (b) to pinpoint the thinking process nurses use to determine ″similarity″ as a pretest of a framework that is meant to improve nursing communication for better patients’ care. METHODS: A think-aloud approach is used to elicit both written and verbal responses from six participants, who are medical-surgical registered nurses with an associate degree, by comparing two specifically designed images for similarity determination. Data collected from participants include responses about four levels of similarities, a similarity rating using a 1–10 Likert-type scale, and a most meaningful concept shared by the image pair. FINDINGS: Collected data indicate noticeable variability in the level and quality of details, which in turn demonstrates inconsistencies. The findings from analyzing the collected think-aloud responses indicate that the proposed framework of thinking process was undertaken by at least three participants (i.e., 50%) before they reached the similarity rating and a meaningful concept. This study shows how misunderstandings in interpretation can occur simply because nurses used differ- ent similarity approaches. Anomalies are also found in the collected data (i.e., think-aloud responses). Possible causes and explanations are given, along with suggestions for further investigation and validation of the proposed framework. CONCLUSIONS: In this study, a communication framework based on similarity theory was proposed to highlight the thinking process of nursing concept devel- opment. A think-aloud pilot study was conducted. Results suggest that similarity theory and the proposed framework can be used to explain how nurses classify and determine similarities, though an in-depth validation is needed. This frame- work may guide nurse educators to promote higher levels of thinking when edu- cating students and nurses in the process of extracting quality information during patient care. The limitations of current research have been addressed. Additional research issues and extensions to this study are also provided in order to further improve nursing communication education. Introduction Communication is one of the key elements in nursing care that strongly impacts patients’ recovery and wellness. Patients seek health care for a variety of reasons, and their experience is contingent upon information shared with nurses and members of the healthcare team. Key qualities of good information include its accessibility, completeness, preciseness, timeliness, and shareability. These qualities are essential to nurses’ decision making that will assist patients in achieving health outcomes through better care and patient safety (Hughes, 2008; Institute of Medicine, 2000; Jefferies, Johnson, & Griffiths, 2010; Waegemann et al., 2002). Nurses’ decision making is important to patients, families, clinicians, and other stakeholders because it can minimize errors, improve patients’ recovery experience, and reduce costs of the care. However, before ideal decisions can be made, quality information must be available. Currently, information quality in health care is inconsistent (Pricewa- terhouseCoopers, 2008) and can result in missed informa- tion and poor communication (Törnvall, Wahren, & Wilhelmsson, 2009). Nurses make important contributions to the production of quality information by identifying the most relevant concepts that represent (a) human responses to illness, (b) strategies to improve health, and (c) outcomes or effects of caring on patients’ health. Identifying the most relevant concepts is a cognitive process, and it can be cap- tured and analyzed based on similarity theory (Falan, 2010a, 2010b). Motivated by the potential application of “similarity theory” in nursing communication, the primary objectives of this article are (a) to seek an in-depth understanding of 2 © 2012, The Authors International Journal of Nursing Knowledge © 2012, NANDA International International Journal of Nursing Knowledge Volume 24, No. 1, February 2013