{'fraction_non_alphanumeric': 0.022481265611990008, 'fraction_numerical': 0.0020815986677768525, 'mean_word_length': 5.39095744680851, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Did we interpret the same thing?

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 different 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 development. 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 framework may guide nurse educators to promote higher levels of thinking when educating 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.