Exploring the Sixth Sense in Nursing: Intuition

Much of what makes up expert nursing is more qualitative and not easily measured. Yet for the nursing profession to advance it must be able to articulate its high worth. In this two part series examining expert nursing we will look at 2 components of expert nursing, intuition and evidence based practice. What are their respective roles in expert nursing. How much value should be placed on these aspects of nursing?

Expert nursing involves knowledge, skills, and clinical judgment all of which are developed by experience and reflection on that experience.

The discussion of intuition is being revived again after a hiatus of many years. There are various definitions of intuition. The ones most relevant to nursing involve using experience. It has been described as the interaction of knowledge, expertise and experience, encompassing direct perception of patient, family, and environment(1). It goes beyond the data gathered from technology, tests, and records, to an “immediate grasp of the importance of ambiguous patterns of data leading to action.” (2)

“When I came on shift that day something was wrong. All the data that we collected was OK but it was my gut feeling that this baby was septic. She just didn’t look good. Her general color was off from her normal color. Her perfusion was not as good. Her tone was not as good; she was a little bit floppy. She had ‘sick eyes’. Her eyes looked wimpy, the coloring around her eyes was different and they had a glassy watery look.” (3)

In the past intuition was viewed more negatively in the nursing profession and elsewhere. This is despite evidence that following one’s intuition produces accurate results. It is gaining validity as a part of expert nursing. Nursing scholars such as Benner and Dreyfus have discussed the components of intuition which they describe as pattern and similarity recognition, commonsense understanding, skilled know- how, sense of salience and deliberative rationality.

Pattern recognition is the ability to find relationships between data, for example patterns in patient response to illness. ”From your experience with cases like hers you know that the patient should be much more stable than she is.” (4) Similarity recognition makes inquiry and problem identification possible even if factors of the situation are vague. In the example involving the baby the physical symptoms of the baby were not definitive, yet the nurse had a sense that there was more to the story than the data showed.

Commonsense understanding involves knowledge of the illness experience beyond the disease or physiological state. The baby “just didn’t look good.” Skilled know how is embodied skill.

Salience is being able to judge what are the most pertinent facts of the situation at that moment. In one example of 2 nurses caring for a patient who had just had an abdominal aortic aneurysm repaired the new nurse was task oriented. However, the expert nurse noted the patient’s mottled knees and hard distended abdomen. These indicated a serious medical change that needed to be addressed immediately. (5)

Deliberative rationality is the nurse asking: If I changed my perspective of the situation how would my interpretation change? For example a woman who tells the ED nurse that her broken arm and bruises are a result of falling down the stairs. Should the nurse accept at face value what she is being told and treat only the physical injuries?

Of course a nurse in a given patient situation is not conscious of these aspects when making a decision in a compressed time frame due to the patient’s changing condition. Indeed intuition is often difficult or impossible to verbalize as it is abstract in nature. That does not decrease its legitimacy. It is still valid nursing knowledge. Intuition in other non medical environments displays the same lack of concreteness. Yet nurses need to trust it nonetheless. It can make the difference between a health or illness outcome. Remember the article on human trafficking and how the nurse can be the first line of defense in detection of this crime? That is because nurses could look below the surface of the facts being presented by the patient to use their experience, reflexive analysis, and acute observation skills to start a productive line of inquiry that could rescue a victim.

Intuition allows nurses to develop pattern recognition and a sense of salience. A sense of salience is based on evaluation skills to assess a given patient situation. The ability to immediately evaluate the important facts of a situation is based on mature reasoning. Intuition is accessing unconscious knowledge without inhibition or second guessing. It is a misnomer to call it gut instinct, more accurately it is a 6th sense.

Calling intuition just a hunch, instinct, and gut feeling, tend to diminish its validity and cast aspersion on its legitimacy as a critical thinking process. Intuition is a result of direct perception of information relevant at that point in time, therefore it is scientifically valid and should not be dismissed. Intuition is a cognitive skill that when a nurse trusts it is used to assist assessment, take clinical action leading to patient centered care.

Intuition is difficult to explain because it is abstract and in health care more importance has been placed on concrete empirical knowledge and facts. Yet intuition and evaluation skills are uniquely human, placing people skills above machines and technology. Intuition is part of nursing science.

Successful nursing involves more than physical diagnosis and healing of the body. Because nurses consider the patient, the patient’s family, and the environment or context, intuition is necessary part of expert nursing. Studies have shown that as a nurse acquires the experience necessary to become an expert nurse they use intuition more frequently. Additional research and discussion would give nurses even more confidence to make use of this vital skill.

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