Nursing Research Challenge: “Intuition in emergency nursing: a phenomenological study.”

One of an ongoing series, prompted by Rob Fraser’s (@rdjfraser) Nursing Research Challenge, which I encourage my colleagues to join. Admittedly I have been a bit challenged (i.e. lazy) the last few weeks, but seeing both Terri Schmitt (@onlinenursing) and Joni Watson (@joniwatson) posting recently has made me leap spring into action want to be more diligent. Terri, incidentally, highlights a cool way of engaging your colleagues: the Journal Club.

APA Citation: Lyneham, J., Parkinson, C., & Denholm, C. (2008). Intuition in emergency nursing: a phenomenological study. International Journal of Nursing Practice, 14(2), 101-108. Retrieved from EBSCOhost.

The Skinny: Nurses often talk about the “sixth sense”, the intuition that comes when caring for patients in evaluating their progress.  We all know (or think we know) when a patient is about to go south. Is it real? The authors attempt to qualify and validate what exactly “nursing intuition” means and offer an “intuitive framework” built around six themes: knowledge, experience, connection, feeling, syncretism and trust.

Money quotes:

“[Miller] supports the establishment of five characteristics of intuition: willingness to act on intuition, the skilled clinician, having a connection with clients, interest in the abstract and, a risk taker. Not only do intuitive nurses display these characteristics but tend to be extroverted, perceptual and interestingly tend to delay making a final decision until satisfied with all the information.

It is apparent that intuition in clinical practice remains a polarized and polarizing issue. As King and Appleton suggested, there is covertness about intuitive practice and a general lack of recognition of its continued use by many nurses in all clinical areas. . .

The literature is not clear on the place of intuition in nursing; research to date has failed to establish its existence or utility in the clinical area. The question arising from the existence of an intuitive component of practice comes from its esoteric nature. Intuition is complex and therefore difficult to articulate; however, anecdotally, practising emergency nurses continue to identify a sense of knowing within their practice. The research into intuitive nursing has not considered the nature of practice and has been focused on more general areas of intuition, and as a result not explored the nature of the experience itself.”

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“The issue of error when making an intuitive decision continues to be used as a reason for discarding intuitive decision-making. Participants in this study went to extraordinary lengths to either prove or disprove the intuitive thought. Thus, intuitive decision-making as described by the participants was not high in terms of error per se as they searched for supportive evidence before acting, and did not exclude traditional assessments for the presenting problem.

Participants admitted to occasions when their intuition thoughts were not warranted; however, as normal procedure was also followed patient outcomes were unchanged, and the participants acted in a manner that was protective of the patient. For instance, the participant who, despite the lack of clinical evidence, knew that she must not send him [a patient] back out on the streets. Rejecting intuitive decision-making remains unsupported.”

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[R]ather than being haphazard, intuition appears to be an ordered logical development of practice.

[Emphasis mine.]

New insight: That intuition might harm a patient had not occurred to me, but the authors suggest nurses validate their intuition by obtaining objective evidence of changes in patient condition. In other words, intuition is the “canary in the coal mine,” the early warning that your patient is about to crash, and needs to be acted upon.

Why You Should Care: Intuition is an undervalued and underappreciated skill not only for emergency department nurses, but for all nurses in general. Putting intuition to its proper place — while recognizing its limitations and need for supporting evidence — can only enhance nursing practice in general.

Next time:  “Nursing management of common oncological emergencies.”

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  1. #1 by Susan on Wednesday 04 May 2011 - 2014

    Interesting article. As an educator for several years – especially in the ED, I have come to believe that my intuition is less a feeling, and more an unconscious recognition of symptoms or clusters in the ED database that my brain has become. I will never forget the sound or look of the first patient that went into flash pulmonary edema right in front of me. The catch in the back of her throat when she was speaking. Whenever I hear that sound, I know it can’t be good. The ED docs think that it is my intuition, but it is really really well honed pattern recognition.

    Sometimes, I think that my pattern recognition is hasty, and I will also look for other objective evidence – so that does mirror what the authors say.

    Anyone else have thoughts – pattern recognition that is unconscious – or something else?

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