Professional Documents
Culture Documents
a, 1998; Lin,
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E18 ADVANCED IN NURSING SCIENCE/JANUARYMARCH 2007
Table 2. Scientific data set of intuition in nursing, by research design, setting, and sample size
(Continued)
Study design (number of studies) Setting Sample size
Grounded theory studies (N = 8)
Andrews T, Waterman H. Packaging: a grounded theory of
how to report physiological deterioration effectively. J
Adv Nurs. 2005;52(5):473481.
Hospital 30 nurses, 7
physicians, and 7
support workers
Cader R. Criteria used by nurses to evaluate
practice-related information on the World Wide Web.
CIN Comp Inf Nurs. 2003;21(2):97102.
University 7 graduate student
nurses Internet
Gray M, Smith LN. The professional socialization of
diploma of higher education in nursing students
(Project 2000): a longitudinal qualitative study. J Adv
Nurs. 1999;29(3):639647.
NS, Scotland 17 nursing students
Grossman SC, Wheeler K. Predicting patients
deterioration and recovery. Clin Nurs Res.
1997;6(1):45467.
Hospital 33 ICU nurses
Hogston R. Evaluating quality nursing care through peer
review and reflection: the findings of a qualitative study.
Int J Nurs Stud. 1995;32(2):162172.
England 18 RNs
McCutcheon HHI. Intuition: an important tool in the
practice of nursing. J Adv Nurs. 2001;35(3):342348.
NS & Health
Agencies,
Australia
262 RNs
Trenoweth S. Perceiving risk in dangerous situations: risks
of violence among mental health inpatients. J Adv Nurs.
2003;42(3):278287.
London 10 mental health
nurses
Young CE. Intuition and nursing process. Holistic Nurs
Pract. 1987;1(3);5262.
7 healthcare
agencies
39 RNs and 2
nonnurses
Phenomenology studies (N = 8)
Beck CT. Perceptions of nurses caring by mothers
experiencing postpartum depression. J Gyn Neonat
Nurs. 1995;24(9):819825.
Private homes 10 mothers
Fernandes JRH. The experience of a broken heart. Crit
Care Nurs Clin N Am. 2005;17(4):319327.
Private homes 10 parents (5
couples)
Kenny C. Nursing intuition: can it be researched? Br J
Nurs. 1994;3(22):11911195.
England 11 nurses with 5
years experience
Kosowski MM. When protocols are not enough: intuitive
decision making by novice nurse practitioners. J
Holistic Nurs. 2003;21(1):5272.
Educational
program
10 novice nurse
practitioners
Meehan DR. Mothering a 3- to 6-year-old child with
hemiparesis. J Neuro Nurs. 2005;37(5):265271.
Community 5 mothers
Minick P. The early recognition of patient problems
among medical-surgical nurses. Medsurg Nurs.
2003;12(5):291297.
Urban hospital 14 RNs
Ohrling K. Student nurses lived experience of
preceptorship. Part 1in relation to learning. Int J
Nurs Stud. 2000;37(1):1323.
University NS,
Sweden
17 student nurses
Turkel MC. A journey into caring as experienced by nurse
managers. Int J Hum Caring. 2003;7(1):2026.
Hospital 6 nurse managers
(continues)
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Table 2. Scientific data set of intuition in nursing, by research design, setting, and sample size
(Continued)
Study design (number of studies) Setting Sample size
Ethnography studies (N = 4)
Bailey PH, Colella T, Mossey S. COPD-intuition or template:
nurses stories of acute exacerbations of chronic
obstructive pulmonary disease. J Clin Nurs.
2004;13(6):756764.
Canada 10 nurses
King L, Clark JM. Intuition and the development of
expertise in surgical ward and intensive care nurses. J
Adv Nurs. 2002;37(4):322329.
4 surgical wards
and 2 ICUs,
England
61 nurses
Leners DW. Intuition in nursing practice: deep
connections. J Holistic Nurs. 1992;10(2):137153.
Regional Medical
Center, Colorado
40 nurses
Stockhausen L. M etier artistry: Revealing
reflectionin-action in everyday practice. Nurse Educ
Today. 2006;26(1):5462.
3 Universities
Acute Care
Wards, Australia
11 RNs and 40
students
Methodological studies (N = 5)
Lauri S, Salantera S. Decision-making models in different
fields of nursing. Res Nurs Health. 1998;21(3):443452.
15 Health Facilities,
Finland
500 nurses
Miller VG. Characteristics of intuitive nurses. West J Nurs
Res. 1995;17(3):305316.
Community, Texas 228 registered
nurses
Miller VG. Measurement of self-perception of intuitiveness.
West J Nurs Res.1993;15(5):595606.
Community, Texas 228 registered
nurses
Rew L. Acknowledging intuition in clinical decision
making. J Holist Nurs. 2000;18:94108.
Community 218 registered
nurses
Smith AJ, Thurkettle MA, dela Cruz FA. Use of intuition by
nursing students: instrument development and testing. J
Adv Nurs. 2004;47(6):614622.
National 20 senior students
and 349 BSN &
ADN students
Delphi survey studies (N = 2)
Panniers TL, Walker EK. A decision-analytic approach to
clinical nursing. Nurs Res.1994;43(4):245249.
National 31 staff nurses
Scheffer BK. A consensus statement on critical thinking in
nursing. J Nurs Educ. 2000;39(8):352359.
9 Countries 55 expert nurses
Correlational studies (N = 2)
Polge J. Critical thinking: the use of intuition in making
clinical nursing judgments. J NY State Nurses Assoc.
1995;26(2):49.
Critical care 179 RNs
Ruth-Sahd LA, Hendy HM. Predictors of novice nurses use
of intuition to guide patient care decisions. J Nurs Educ.
2005;44(10:450458.
Nursing schools 323 student
nurses
*NICU indicates neonatal intensive care unit; ICU, intensive care unit; and NS, not significant.
2003; Miller, 1993, 1995; Minick, 2003; Polge,
1995; Ruth-Sahd, 2005). Walthews (2004) ex-
ploration of nurse educators critical thinking
was based on a definition of intuition by John
Dewey. The remaining 6 authors defined intu-
ition as shown in Table 3.
Nearly one half (n = 21; 46.6%) of the
investigators in the scientific sample did not
provide definitions of the concept, or they
did not define intuition directly although
intuition appeared in the title, in the abstract,
or as a major term in the CINAHL (Andrews
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State of the Science E21
Table 3. Definitions of intuition in scientific data set of intuition in nursing practice and edu-
cation, arranged chronologically
Investigators (date) Definition of intuition
Young (1987) Clinical intuition is defined as a process whereby the nurse knows
something about a patient that cannot be verbalized, that is
verbalized with difficulty or for which the source of knowledge
cannot be determined.
(pp5253)
Kenny (1994) Cognitive intuitive experiences are initially low key, as the thinker
quietly draws together the various threads of theory in order to
understand.
(p1192)
Offredy (1998) Intuition is an individuals opinion justified by their authority of
experience.
(p992)
Scheffer et al (2000) Intuition: insightful sense of knowing without conscious use of
reason.
(p358)
McCutcheon et al (2001) . . .knowledge, expertise and experience are mutually dependent and
have mutual and reciprocal effects, as well as interacting to yield an
effect greater than their sum, referred to as syner gy. The synergy
that occurs through the interaction of knowledge, experience and
expertise results in intuition and is the core category that links the
other categories.
(p345)
Smith et al (2004) Intuition was conceptualized as a non-linear process of knowing,
perceived through emotional and physical awareness or through the
making of connections at the physical andor spiritual level
(p615)
& Waterman, 2005; Arslanian-Engo, 2000;
Beck, 1995; Cader et al, 2003; Carroll, 1988;
Cone, 2002; Crandall & Getchell-Reiter, 1993;
Fernandes, 2005; Gray & Smith, 1999;
Grossman & Wheeler, 1997; Haines, 2005;
Hogston, 1995; James, Simpson, & Knox,
2003; McCormack, 1993; Meehan, 2005;
a de-
veloped an instrument for Finnish nurses to
identify their decision-making models in a va-
riety of clinical settings. Rews Acknowledge-
ment of the Use of Intuition in Nursing in-
strument was designed to measure the use of
intuition by nurses in clinical decision mak-
ing. The fifth report was of an instrument
for measuring the use of intuition in nurs-
ing students (Smith and colleagues). Each of
these studies included a rigorous description
of item development and psychometric test-
ing, and all the instruments were found to be
valid and reliable. Further studies were recom-
mended to provide additional evidence of the
validity of these tools, and authors urged oth-
ers to develop and use instruments to mea-
sure the use of intuition by nurses in clinical
practice and strategies for teaching intuition
to students and novice nurses.
Delphi studies
Delphi studies sought consensus on deci-
sion making in nursing and the nature of crit-
ical thinking. The purpose of Panniers and
Walkers study was to explore how useful
nurses found a decision analysis process in
dealing with a complex emergent problem.
The researchers concluded that decision anal-
ysis allows nurses to quantify their intuitive
choices and document and incorporate them
in practice. The aim of Scheffers study was to
define critical thinking and focused on input
from a panel of expert nurses from 9 coun-
tries and 23 states in the United States. Results
were a consensus definition of critical think-
ing in nursing and 10 habits of the mind, one
of which was intuition.
Correlational studies
Polges descriptive correlational study was
based on Benners
1
model of novice to ex-
pert. The purpose of the study was to exam-
ine the relationship between using intuition
in making clinical judgments and attributes of
the nurse, including years of experience and
clinical proficiency. Findings supported Ben-
ners model with nurses increasing the use
of intuition with increases in years of expe-
rience and proficiency. The study conducted
by Ruth-Sahd and Hendy was similar but sam-
pled novice nursing students and incorpo-
rated multivariate analyses. The researchers
completed multiple regression analyses and
found that nursing students were more likely
to use intuition in practice if they were
older, had experienced more hospitalizations,
and had more social support. Although we
classified Millers 1995 article as instrument
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E24 ADVANCED IN NURSING SCIENCE/JANUARYMARCH 2007
development, this author also included corre-
lations as part of the validation process and
confirmed that nurses who perceived them-
selves as intuitive were skilled, interested in
the abstract, willing to act on their intuition
and take risks, and felt a spiritual connection
with their clients.
The majority of research articles (95.6%)
provided at least some support for the value
of intuition in nursing education and clinical
practice. Conclusions from 2 studies (4.4%)
were equivocal. Many of the studies were
based on previous definitions of intuition in
nursing
2
and on Benners conceptualization
of nursing expertise.
1,3
DISCUSSION
Despite the systematic nature of this re-
view, we acknowledge that there were lim-
itations. We searched only 1 database, the
CINAHL, and we used only 1 term, intuition.
Other significant studies may have been in
other databases such as Medline or PubMed.
Our approach could have prevented us from
reviewing other publications of related phe-
nomenon. Because we limited our review to
papers published only in English, we may
have missed a broader international perspec-
tive on this state of the science. We also
may have missed studies of nurses or nursing
published in nonnursing or interdisciplinary
journals.
Overall, our analysis shows that studies of
intuition in nursing have remained primarily
at a descriptive, exploratory level for more
than 20 years. Although many of the stud-
ies were based on Benners conceptualization
of novice to expert
1
and Rews
2
defining at-
tributes, there is little other evidence that
recent studies have built on the findings of
earlier ones. As shown in Table 3, there is
a broadly based, working definition of intu-
ition, but researchers have generally found it
difficult to assess and measure in a quanti-
tative way that would support comparisons
across disciplines or environments. Many of
the researchers acknowledged the limitations
of their studies that included difficulty in ar-
ticulating subjective experiences.
It is promising that there are at least 3 valid
instruments measuring various aspects of in-
tuition. These are self-reports that can be used
with samples of nurses and nursing students.
These instruments could be used to advance
the science by conducting more correlational
and predictive studies and, therefore, building
a more solid theoretical base for further study.
Unlike the research of McCraty and
colleagues,
25,26
we found no reports of
physiologic measures that correlated with
the self-reports of nurses intuitions or per-
ceived intuitiveness. Such studies would help
validate the use of intuition in nursing and
provide objective evidence that this skill
can be taught, increased, or facilitated. The
correlation of subjective perceptions with
objective physiological changes in both the
brain and the heart would help us advance
the study of this phenomenon and lend it
scientific credibility.
Much of the evidence from this body of re-
search indicates that nurses value their intu-
ition in a variety of clinical settings. Several
of the studies provide support for Benners
1
work indicating that intuitive experiences in-
crease with experience and expertise. Re-
searchers continue to affirm that intuition
should be combined with objective, empiri-
cal evidence when evaluating a patients con-
dition and in planning care. They also af-
firm that nurses need to communicate clearly
about how they incorporate their intuitive
judgment in making decisions in clinical
practice.
It is clear that nurses are publishing many
accounts of their clinical intuitions through
anecdotes and informational articles. What re-
mains unclear is how nurses can be taught
to differentiate intuitions that are based on
truth from vague, subjective feelings that do
not represent this phenomenon. Our recom-
mendations for further study are that the next
generation of research should move beyond
description, be based on representative sam-
ples of nurses and nursing students, and in-
clude physiologic measures as correlates of
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State of the Science E25
subjective experiences. We also recommend
that nurses collaborate with members of
other disciplines such as psychology, educa-
tion, and medicine to design more complex
studies that will further our understanding of
this unique phenomenon.
CONCLUSION
The nursing discipline is complex and re-
quires that its members apply knowledge and
skills in a variety of settings. Nurses under-
stand and define intuition as a way of know-
ing something immediately as a whole that
improves with experience, informs their judg-
ments and decisions, and leads them to take
action within the caring relationship. Fur-
ther interdisciplinary study is needed to ex-
pand the state of this science and art. Intu-
ition remains a hallmark of nursing knowl-
edge, but no longer neglected in nursing
literature.
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