Cook Paul F, Schmiege Sarah J, Reeder Blaine, Horton-Deutsch Sara, Lowe Nancy K, Meek Paula
Paul F. Cook, PhD, is Associate Professor; Sarah J. Schmiege, PhD, is Associate Professor; Blaine Reeder, PhD, is Assistant Professor; Sara Horton-Deutsch, PhD, RN, PMHCNS, FAAN, ANEF, is Professor; Nancy K. Lowe, PhD, CNM, FACNM, FAAN, is Professor; and Paula Meek, PhD, RN, FAAN, is Professor, College of Nursing, University of Colorado, Aurora.
Nurs Res. 2018 Mar/Apr;67(2):108-121. doi: 10.1097/NNR.0000000000000265.
Health promotion and chronic disease management both require behavior change, but people find it hard to change behavior despite having good intentions. The problem arises because patients' narratives about experiences and intentions are filtered through memory and language. These narratives inaccurately reflect intuitive decision-making or actual behaviors.
We propose a principle-temporal immediacy-as a moderator variable that explains which of two mental systems (narrative or intuitive) will be activated in any given situation. We reviewed multiple scientific areas to test temporal immediacy as an explanation for findings.
In an iterative process, we used evidence from philosophy, cognitive neuroscience, behavioral economics, symptom science, and ecological momentary assessment to develop our theoretical perspective. These perspectives each suggest two cognitive systems that differ in their level of temporal immediacy: an intuitive system that produces behavior in response to everyday states and a narrative system that interprets and explains these experiences after the fact.
Writers from Plato onward describe two competing influences on behavior-often with moral overtones. People tend to identify with the language-based narrative system and blame unhelpful results on the less accessible intuitive system, but neither is completely rational, and the intuitive system has strengths based on speed and serial processing. The systems differ based on temporal immediacy-the description of an experience as either "now" or "usually"-with the intuitive system generating behaviors automatically in real time and the narrative system producing beliefs about the past or future.
The principle of temporal immediacy is a tool to integrate nursing science with other disciplinary traditions and to improve research and practice. Interventions should build on each system's strengths, rather than treating the intuitive system as a barrier for the narrative system to overcome. Nursing researchers need to study the roles and effects of both systems.
健康促进和慢性病管理都需要行为改变，但人们发现尽管有良好的意愿，行为改变仍很困难。问题的出现是因为患者关于经历和意图的叙述是通过记忆和语言过滤的。这些叙述不准确地反映直观决策或实际行为。
我们提出一个原则——时间即时性——作为一个调节变量，用以解释在任何给定情况下将激活两个心理系统（叙述性或直观性）中的哪一个。我们回顾了多个科学领域，以检验时间即时性作为研究结果的一种解释。
在一个迭代过程中，我们利用来自哲学、认知神经科学、行为经济学、症状科学和生态瞬时评估的证据来发展我们的理论观点。这些观点各自提出了两个在时间即时性水平上不同的认知系统：一个直观系统，它根据日常状态产生行为；一个叙述系统，它在事后解释和说明这些经历。
从柏拉图时代起的作家们就描述了对行为的两种相互竞争的影响——通常带有道德色彩。人们倾向于认同基于语言的叙述系统，并将不利结果归咎于较难触及的直观系统，但两者都不完全理性，而且直观系统基于速度和串行处理具有优势。这两个系统基于时间即时性而有所不同——将一种经历描述为“现在”或“通常”——直观系统实时自动产生行为，而叙述系统产生关于过去或未来的信念。
时间即时性原则是将护理科学与其他学科传统相结合并改善研究与实践的一种工具。干预措施应基于每个系统的优势，而不是将直观系统视为叙述系统需要克服的障碍。护理研究人员需要研究这两个系统的作用和影响。
