6 Intuition
Intuition a Cognitive Skill for Novice Nurses
Intuition, a concept often shrouded in ambiguity and skepticism, is gaining recognition as a valuable cognitive skill in nursing practice, particularly for novice nurses. While traditionally viewed as a characteristic of experienced nurses, research suggests that intuition can be a powerful tool for novice nurses to enhance patient care and facilitate their professional growth (Miller & Hill, 2018).
Defining Intuition in Nursing
Intuition is frequently described as an immediate understanding or knowing without conscious reasoning or logical inference (Turan et al., 2019). It is often referred to as a “gut feeling” or a sense of knowing something is right or wrong without a clear explanation. In the nursing context, intuition can manifest as feelings, thoughts, physical sensations, or a sense of alarm (Melin-Johannson, 2018). Although difficult to define and measure, intuition represents a form of knowledge that can complement analytical thinking and enhance decision-making (Melin-Johannson, 2018).
Benner et al.’s (2009) definition of intuition is used: “By intuition, we mean a judgment without a rationale, a direct apprehension, and response without recourse to calculative rationality” (p. 208). Furthermore, Benner et al. (2009), found that intuition is not considered “thoughtless or automatic, knowing the patient and involvement with the patient” supports the intuition that expert nurses use this as a “deliberative rationality” to check out those gut feelings or hunches (p. 210).
The Cognitive Basis of Intuition
Intuition is not simply a mystical or supernatural phenomenon; it is a cognitive process grounded in experience, knowledge, and pattern recognition (Turan et al., 2019). As novice nurses gain clinical experience, they begin to recognize patterns and develop a tacit understanding of patient behavior, physiological responses, and clinical situations. This accumulated knowledge forms the basis for their intuitive insights, allowing them to make connections and draw conclusions that may not be immediately apparent through conscious reasoning.
The cognitive processes underlying intuition can be understood through the lens of Benner’s novice-to-expert model (Benner et al., 2009). This model describes how nurses progress through stages of skill acquisition, from novice to expert, with increasing reliance on intuitive judgment as they gain experience. While novice nurses primarily rely on analytical thinking and established protocols, expert nurses develop an intuitive grasp of situations, allowing them to make rapid and accurate clinical judgments.
Literature Review: Nursing Intuition
Contrary to the belief that intuition develops solely through years of experience, recent research suggests that even novice nurses experience intuitive insights (Melin-Johannson, 2018). While these insights may initially be subtle or difficult to articulate, recognizing and acknowledging them can be crucial for early detection of patient deterioration, enhanced assessment skills, and improved decision-making. This early recognition of potential problems can be vital in preventing negative patient outcomes and promoting patient safety.
Melin-Johansson et al. (2017), conducted a mixed-studies review (MSR) using an integrative process that included sixteen studies that were undertaken and published between 1987 and 2001. The studies included were non-interventional, quantitative, and qualitative studies, overall, most participants were working registered nurses in a hospital setting rather than nursing students. The aim of the study sought to review not only the characteristics of nursing intuition used in clinical settings but also in relationships and how these characteristics interrelate with the nursing process (Melin-Johansson et al., 2017). The researchers recognized a linkage between the use of intuition and the nursing process and that it plays a key role in all five of the steps that make up the nursing process, including assessment, diagnosis, planning, intervention, and evaluation. Nurses in a multitude of settings identified intuitions with an emphasis on certain phases of the nursing process and not necessarily all the phases (Melin-Johansson et al., 2017).
Interestingly, unique findings included the fact that the nurses’ ability to use intuition in dual process with analysis is affected by not only personal experiences and skill level but by the nurses’ relationship with the patient namely its presence or absence (McCutcheon & Pincombe, 2001; Melin-Johansson et al., 2017). The subcategories of the MSR under the nurse’s intuition in relationships included unique connections; energy, mental and bodily responses; and personal qualities.
Price et al. (2017) conducted an experimental design with 126 fourth-semester nursing students working through a simulation that included both novel and familiar conditions. The findings indicated that students were able to use intuition in addition to analysis with accuracy in familiar conditions, which is a “synthesis of relevant previous experiences” (Price et al., 2017, p. 1154). According to the authors, educators can suggest the importance of using intuition in conjunction with pattern recognition and is a worthwhile skill for novice nurses to utilize in clinical environments (Price et al., 2017). Furthermore, the authors state, “examinations of the accuracy of intuition and analysis are needed, given that nurses frequently utilize intuition during clinical decision-making, failure to fully appreciate the nature of intuition hampers, the legitimacy of clinical decision making among nurses” (Price et al., 2017, p. 1155).
Price et al. (2017) “examined the degree to which pre-licensure nursing students relied on intuition and analysis during clinical decision-making in a realistic clinical simulation scenario and assessed how reliance on these strategies was associated with decision-making accuracy” (p. 1149). The experimental design included a clinical complication (familiar vs. novel) and a decision phase (cue acquisition, diagnosis, and action), the students played a simulation role (observer, family, auxiliary nurse, and primary nurse), during two points in the simulation students recorded clinical decisions and impressions of the extent that the decisions made were based on analysis or intuition.
The students relied more on analysis, but it was not correlated with accuracy, as was intuition. Novice students seemed to utilize intuition effectively when some degree of familiarity with the complication existed. A correlation was made that when multiple streams of data are analyzed, intuition can be more accurate than analysis due to the multiple demands of the nurse’s role in clinical practice (Price et al., 2017). The findings also included that pattern recognition, rapid holistic decision-making, and enhancement of student engagement encouraging both intuitive and analytical approaches should be integrated and made part of the nursing curriculum by educators (Price et al., 2017). In conclusion, this study demonstrates empirical evidence of the value of intuition in clinical decision-making negating some voiced views of intuition’s unreliability. Furthermore, Price et al. (2017) purport that “nursing education should engage students in the structured reflection of their decision-making processes and include learning opportunities that encourage reliance on the holistic and contextualized processes of intuition” (p. 1148).
A study conducted by Turan et al., (2019) looked at Turkish Nursing Students in the 2nd-4th year, a total of 295 students were included of which 110 were 2nd year and no first-year nursing students were included. The study proposed linking the use of intuition with emotional intelligence (EI). The findings included the use of intuition by nursing students was stated as “quite low”, regarding emotional intelligence the students were able to use empathy, but it was also found to be “not enough” (Turan et al., p. 8). Spiritual connection was higher than any of the EI subscales and indicated the students do perceive the patients’ psycho-social aspects, this fact may reflect or refer to patient connection previously discussed (Turan et al., 2019).
In addition, students’ physical awareness scored low, however, the subscale of recognizing verbal and non-verbal behavior was high. Overall, the total scores comparing intuition and emotional intelligence, the findings included that as emotional intelligence increases intuition also increases positively with experience. Furthermore, according to Turan et al. (2019), “students who know themselves, and their emotions well are a key element in nursing care” (p. 9). The 2nd year students scored lower than the higher education levels on intuition and emotional intelligence, and this supports Turan et al.‘s (2019) assumption based on the study results that nursing students will benefit from the incorporation of intuition and emotional intelligence in “nursing curriculum, clinical decision-making, and scientific problem-solving processes…all interventions in this context will contribute to the increase of professional commitment, motivation, and quality of patient care” (p. 10). These results also mirror Benner et al.’s (2009) findings that intuition is recognized as used by nurses with more experience in practice as they navigate opportunities in the clinical areas on the way to expert practice (Benner et al., 2009).
Miller and Hill’s (2018) quantitative research examined the “relationships and differences” in the use of intuition among experienced nurses in a hospital across three units. The Rew Intuitive Judgment Scale (RIJS) was utilized in a descriptive, correlational, cross-sectional, prospective design that discovered no differences in intuition scores among the categories or units within the hospital and the nurses that self-rated higher nursing proficiency also had more years of clinical experience and higher scores on the RIJS. The study researchers concluded that “Nurse educators and development professionals have a responsibility to recognize and embrace the multiple thought processes used by the nurse to better the nursing profession and positively affect patient outcomes” (Miller & Hill, 2018, p. 318). In addition, Miller and Hill (2018) call out that nursing students or nurses at a lower proficiency level can tell when something is wrong and can at the very least use intuition to decide to investigate further (Miller & Hill, 2018). Miller and Hill (2018) state more research is required to discover:
… how to teach intuition and reference how the intuitive thought process is used in decision-making. Nursing students should be taught the nursing process as the first line in critical thinking but also be provided with different pathways of how the experienced or expert nurse came to his or her decision (p. 328).
Challenges and Strategies for Cultivating Intuition
Despite its potential benefits, several challenges hinder the acceptance and integration of intuition into nursing practice. The abstract nature of intuition makes it difficult to define, measure, and teach. The emphasis on evidence-based practice, while essential, may unintentionally overshadow the value of intuition as a legitimate form of knowledge. Additionally, novice nurses may hesitate to express their intuitive insights due to fear of criticism or being perceived as unprofessional.
To overcome these challenges, nursing education should explicitly acknowledge and validate intuition as a valuable cognitive skill. Incorporating reflective practices into nursing curricula can help novice nurses connect their intuitive experiences with their theoretical knowledge and develop a deeper understanding of their intuitive processes. Creating supportive learning environments where students feel safe to share their intuitive insights without fear of judgment is crucial for fostering their growth and development as intuitive practitioners.
Conclusion
Far from being a mystical ability, intuition is a cognitive skill that novice nurses can cultivate and utilize to enhance patient care and facilitate their professional development. By understanding the cognitive processes underlying intuition, recognizing its connection to emotional intelligence, and addressing the challenges to its acceptance, nursing education can empower novice nurses to embrace intuition as a valuable tool in their practice. Integrating intuitive insights with analytical thinking and evidence-based practice can contribute to a more holistic, compassionate, and effective approach to nursing care.
Glossary
Intuition: An immediate understanding or knowing without conscious reasoning. It can be described as a “gut feeling,” and it can manifest as feelings, thoughts, physical sensations, or a sense of alarm.
Novice Nurse: A nurse who is in the early stages of their career and is still developing their skills and knowledge.
Expert Nurse: A nurse who has extensive experience and has developed a deep understanding of patient care. Expert nurses rely heavily on intuition in their practice.
Benner’s Novice-to-Expert Model: A model that describes the stages of skill acquisition in nursing, from novice to expert. The model highlights how nurses increasingly rely on intuitive judgment as they gain experience.
Tacit Understanding: Knowledge that is gained through experience and is difficult to articulate or explain. Intuition is often based on tacit understanding.
Pattern Recognition: The ability to recognize patterns in data or situations. Nurses develop pattern recognition skills as they gain experience, which contributes to their intuitive abilities.
Emotional Intelligence (EI): The ability to understand and manage emotions, both in oneself and others. Studies have shown a connection between emotional intelligence and intuition in nursing students.
Reflective Practices: Activities that encourage nurses to think critically about their experiences and learn from them. Reflective practices can help nurses develop their intuition.
References:
Benner, P., Tanner, C., & Chesla, C. (2009). Expertise in Nursing Practice: Caring, clinical judgment, and ethics. Springer.
Hassani, P., Abdi, A., & Jalali, R. (2016). State of science, “intuition in nursing practice”: A systematic review study. Journal of Clinical and Diagnostic Research, 10(2), JE07-JE11. https://doi.org/10.7860/JCDR/2016/17385.7260
Melin-Johansson, C., Palmqvist, R., & Rönnberg, L. (2017). Clinical intuition in the nursing process and decision-making—A mixed-studies review. Journal of Clinical Nursing, 26, 3936–3949. https://doi.org/10.1111/jocn.13814
Miller, E. M., & Hill, P. D. (2018). Intuition in Clinical Decision Making: Differences Among Practicing Nurses. Journal of holistic nursing : official journal of the American Holistic Nurses’ Association, 36(4), 318–329. https://doi.org/10.1177/0898010117725428
Turan, N., Aydın, G. Ö., Özsaban, A., Kaya, H., Aksel, G., Yılmaz, A., Hasmaden, E., & Akkuş, Y. (2019). Intuition and emotional intelligence: A study in nursing students. Cogent Psychology, 6(1), 1633077. https://doi.org/10.1080/23311908.2019.1633077
