Journal of Nursing Education

The articles prior to January 2012 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

Intuition in Nursing Practice: Sharing Graduate Students' Exemplars With Undergraduate Students

Cheryl Tatano Beck, DNSc, CNM, FAAN

Abstract

ABSTRACT

Failure to acknowledge ways of knowing in nursing education curricula other than linear reasoning hinders the development of the full extent of mental abilities brought to learning situations by nursing students. Nurse educators are challenged to develop creative methods to facilitate nursing students' intuitive thinking. In this article, a teaching strategy is described in which graduate students' exemplars of intuition in clinical practice are shared with undergraduate nursing students. Implications of using this teaching approach to demystify the intuitive process and address its legitimacy are discussed.

Abstract

ABSTRACT

Failure to acknowledge ways of knowing in nursing education curricula other than linear reasoning hinders the development of the full extent of mental abilities brought to learning situations by nursing students. Nurse educators are challenged to develop creative methods to facilitate nursing students' intuitive thinking. In this article, a teaching strategy is described in which graduate students' exemplars of intuition in clinical practice are shared with undergraduate nursing students. Implications of using this teaching approach to demystify the intuitive process and address its legitimacy are discussed.

Intuition has been defined as knowledge obtained in an immediate way and perceived as a whole. A linear reasoning process is not used to arrive at this knowledge (Rew, 1988). Prietula and Simon (1989) describe intuition not as a magical sixth sense but as a sophisticated type of reasoning based on "chunking" (or organizing) information into patterns and bypassing separate analytical steps. The ability to chunk information develops as experience builds.

Ruth-Sahd (1993) chastised academia for focusing so long on rational calculations and excluding intuitive judgment. Nursing faculty need to acknowledge that intuitive thinking and analytical reasoning can work together. Once nurse educators internalize this belief, they can begin to encourage creative thinking and problem solving in nursing students. Miller and Rew (1989) warn that failure to value ways of knowing other than linear reasoning in nursing schools hinders the development of nursing students.

In this article, a teaching strategy is described in which written exemplars of intuitive experiences of graduate nursing students were shared with undergraduates. The purpose of this sharing was to develop undergraduates' intuitive thinking and to acknowledge intuition as a valid method of knowing in nursing.

REVIEW OF THE LITERATURE

Only one study was found in which nursing students' intuitive thinking was investigated. Using case studies, diary keeping for a 3-week period, and a group semistructured interview, McCormack (1993) investigated 10 nursing students' intuitive decision making. The Intuitive Knowledge Scale (Young, 1987), which qualitatively evaluates the degree of intuition used in a judgment process, was used to analyze their diaries. McCormack reported that the students in the study seemed to experience difficulty in acknowledging their intuitive thinking, and even when they did recognize it, the students doubted its existence and use. The students related using intuition as "cutting corners," and they believed that to use intuition safely, experience was needed. Sometimes students did not act on their intuitive thoughts because they lacked confidence. The students did not clearly understand the holistic nature of intuitive thinking.

The few remaining articles located in the literature review specifically focusing on intuition in nursing students urged nurse educators to value and nurture students' intuitive thinking. Some strategies for developing nursing students' intuition were addressed.

Blomquist (1985) emphasized that in the evaluation of students' clinical performance nurse educators have devalued intuition. To remedy this situation, she proposed four objectives to be included in clinical evaluations to foster understanding and development of nursing students* intuition. These objectives include:

* "[Identifying] factors affecting the development of inferences about a client, student, or situation from knowledge, experience, and the context of the situation" (p. 10).

* Describing how the student derived the nursing care plan by identifying the knowledge base used, listing the patients' cues, and specifying alternative interventions considered.

* Specifying factors in the students' approaches to patients that affected the information collected and the responses of patients.

* Describing the students' commonly used cognitive styles.

Rew (1989) also acknowledged that students' clinical evaluations should be guided by a qualitative model that focuses on the complementary nature of intuition and analytical thinking.

Paul and Heaslip (1995) stress that intuition and critical thinking are related to expertise in nursing. These authors warn that if intuitive thinking is performed in an automatic way without criticism and vigilance, it can lead to misinformed patterns of nursing practice. Paul and Heaslip (1995) believe that nursing students need to develop their intuitive nursing practice by using reasoning about nursing knowledge and using reflective, critical thinking in clinical practice. Nursing students can increase their intuitive knowledge by learning to accurately describe commonly occurring patient responses in nursing practice situations. Eventually, if the nursing student has learned correctly, an in-depth understanding of the total nursing care situation is achieved. When needed, the nurse has that knowledge available without needing to consciously reason to gain this knowledge. Paul and Heaslip (1995) warn that nursing students' intuitive thinking should be continually monitored by self-assessment and critical thought.

Correnti (1992) called for intuitive thinking to be taught at all levels of nursing education, i.e., undergraduate, graduate, and continuing. One strategy Correnti (1992) suggested to facilitate intuitive skills is planned discourse among nurses at various levels. Expert nurses can share, either orally or in written descriptions, their intuitive experiences with nursing students and novice nurses to help demystify intuitive thinking. Ruth-Sahd (1993) also suggested that intuitiveness can be fostered in the novice by educators sharing intuitive experiences with nursing students.

Instead of the regimentation of nursing students which hinders their intuitive thinking, Rew (1986) suggested "group brainstorming sessions, group visualization, and quiet thinking time" (p. 27) to help nursing students respond creatively to the changing needs of their patients. Rew (1989) challenged educators to develop methods to teach nurses how to enhance their intuitive abilities, such as cue assessment and interpretation. Skilled pattern recognition, one component of intuition, cannot be taught by breaking down the clinical situation into its parts but instead by focusing on the whole situation. Benner and Tanner (1987) suggested the use of case studies as one method to develop pattern recognition.

Nursing students need to feel comfortable sharing their own intuitive experiences with each other and also to support their peers who act on their intuition. Acting on intuitive feelings, however, involves risk taking, a strong sense of conviction, and a willingness to trust information other than empirical data alone (Schraeder & Fischer, 1986). Based on Correnti's (1992) strategy of planned discourse among nurses at various levels and Benner and Tanner's (1987) case study approach to develop pattern recognition, a teaching strategy was developed to foster nursing students' use of intuitive knowledge.

TEACHING STRATEGY

A two-part teaching strategy focusing on intuition is described. The first part involved graduate nursing students, while the second part concentrated on undergraduate nursing students.

Graduate Level

As part of the author's graduate nursing course entitled, The Theoretical Study of Nursing Phenomena, each student was required to do a concept analysis using the Hybrid Model (Schwartz-Barcott & Kim, 1993). To explain to the students the value of qualitative research in conducting a concept analysis, the author involved the students in a class exercise on the concept of intuition. Twenty-one graduate nursing students, enrolled in two sections of the course, voluntarily participated in this exercise. Students were asked to anonymously write an in-depth description of an experience they had using intuition in their clinical practice.

The settings where the graduate students' intuitive experiences occurred varied from a drug and alcohol detoxification unit to a pediatrician's office to outpatient surgery. The specialty areas described most often in their intuitive exemplars were the emergency department, labor and delivery, coronary care unit, and the community.

The author used content analysis (Krippendorff, 1980) to analyze the graduate students' written descriptions of intuitive thinking. The following four themes were identified:

* A gut feeling swept over the nurses as they knew something was not right.

* Listening to one's intuition involved a conscious commitment to persistently follow up on the patient's status.

* Intuition involved astute observation of subtle nonverbal cues and changes in a patient's normal pattern of behavior.

* Intuitive experiences resulted in positive, as well as some negative, consequences.

During one class seminar, the faculty member read the exemplars along with the results of the content analysis to the graduate students. The remainder ofthat seminar was spent first having the graduate students identify empirical indicators of the concept of intuition present in their written descriptions. Next, the students compared the results of the content analysis with definitions of intuition published in cross-disciplinary literature to assess the empirical adequacy of these conceptual definitions.

Though initially the sole purpose of this exercise was to explain by example to graduate students the use of qualitative data in concept analysis, the written descriptions were such exemplars of intuition that the author was struck with the idea of sharing these exemplars with undergraduate students. With the permission of the graduate students, the author read their written descriptions of intuition to the students in her undergraduate nursing research course.

Undergraduate Level

A portion of one of the classes in the undergraduate nursing research course was devoted to sharing the graduate students' exemplars of intuition in clinical practice. The purpose of this sharing was threefold:

* To show the undergraduate students the steps involved in content analysis.

* To expose these students to exemplars of nurses' use of intuition to develop undergraduates' intuitive thinking.

* To acknowledge intuitive knowledge as a valid method of knowing in nursing.

The nursing students paid close attention to the faculty member's reading of the graduate students' descriptions of intuition. An example of one such description is presented in the Sidebar. Once the descriptions were read, the faculty member explained how content analysis was used to analyze the qualitative data and arrive at the four themes.

This exercise received enthusiastic feedback from the undergraduate nursing students. They were impressed by the graduate students' use of intuition in their clinical practice. The presentation of the exemplars of graduate students' intuitive thinking showed the undergraduates that intuition is a valuable method of knowing. Students said that the graduate students' descriptions helped them understand the concept of intuition and its usefulness for them as novice nurses. One student said that listening to the descriptions of intuition in nursing practice was "relieving." When questioned what she meant by this, the student explained that it was a relief to hear these stories and know that intuition was valued because the student had been experiencing some of these intuitive feelings. Listening to the graduate students' exemplars gave this student the freedom and confidence to act on her own intuitive feelings. The undergraduate students suggested that the next time this teaching strategy was used, the graduate students themselves, if possible, should come to class so the undergraduates discuss these intuitive experiences with them.

This initial teaching strategy entailed the faculty member reading the exemplars to undergraduate students only one time. The faculty member acted as an intermediary between the graduate and undergraduate nursing students. New teaching strategies can focus on directly involving the graduate students with the undergraduates in not only sharing exemplars of intuition but also as role models for the undergraduates in their clinical rotations. The interaction and direct mentorship by graduate students of novice undergraduate students is an appealing approach where both can learn from each other.

In 1983, Pyles and Stern alerted nurse educators to the value of incorporating the concept of the Gray Gorilla Syndrome into the discipline of nursing. This syndrome refers to the silverback primate who acts as leader, teacher, and protector for the younger, less experienced primates. Plyes and Stern (1983) urge that mentoring can significantly influence the development of intuition in novice nurses. This mentoring relationship involves the teaching-learning process plus the important component of support from the mentor- the gray gorilla. For its application to nursing, Plyes and Stern (1983) identified additional roles of the mentoring gray gorilla: leader, role model, adviser, coach, guardian, expert clinician counselor, confidant, friend, motivator, and teacher. To fully enact the gray gorilla concept between undergraduate and graduate students, it would entail more than just a few visits to class. Perhaps this opportunity could be offered to graduate students enrolled in an education track as part of a practicum. The analogy of the Gray Gorilla Syndrome has important implications for expert graduate nurses mentoring less experienced, undergraduate nursing students in the use of intuition.

REFERENCES

  • Benner, P., & Tanner, C. (1987). Clinical judgment: How expert nurses use intuition. American Journal of Nursing, 87, 23-31.
  • Blomquist, K. (1985). Evaluation of students: Intuition is important. Nurse Educator, 10, 8-11.
  • Correnti, D. (1992). Intuition and nursing practice implications for nurse educators: A review of the literature. The Journal of Continuing Education, 23, 91-94.
  • Krippendorff, K. (1980). Content analysis: An introduction to its methodology. Newbury Park, CA: Sage.
  • McCormack, B. (1993). Intuition: Concept analysis and application to curriculum development. II. Application to curriculum development. Journal of Clinical Nursing, 2, 11-17.
  • Miller, V., & Rew, L. (1989). Analysis and intuition: The need for both in nursing education. Journal of Nursing Education, 28, 84-86.
  • Paul, R., & Heaslip, P. (1995). Critical thinking and intuitive nursing practice. Journal of Advanced Nursing, 22, 40-47.
  • Prietula, M., & Simon, H. (1989). The experts in your midst. Harvard Business Review, 67, 120-124.
  • Pyles, S., & Stern, P. (1983). Discovery of nursing gestalt in critical care nursing. The importance of the gray gorilla syndrome. Image, 15, 51-58.
  • Rew, L. (1986). Intuition: Concept analysis of a group phenomenon. Advances in Nursing Science, 8, 21-28.
  • Rew, L. (1988). Intuition in decision-making. Image, 20, 150153.
  • Rew, L. (1989). Intuition: Nursing knowledge and the spiritual dimension of persons. Holistic Nurse Practitioner, 3, 56-68.
  • Ruth-Sahd, L. (1993). A modification of Benner's hierarchy of clinical practice: The development of clinical intuition in the novice trauma nurse. Holistic Nursing Practice, 7, 8-14.
  • Schraeder, B., & Fischer, D. (1986). Using intuitive knowledge to make clinical decisions. Maternal-Child Nursing, 11, 161-162.
  • Schwartz-Barcott, D., & Kim, H. S. (1993). An expansion and elaboration of the hybrid model of concept development. In B. Rodgers & K Knafl (Eds.), Concept development in nursing: Foundations, techniques, and applications (pp. 107-133). Philadelphia: Saunders.
  • Young, C. (1987). Intuition and nursing process. Holistic Nursing Practice, 1, 52-62.

10.3928/0148-4834-19980401-07

Sign up to receive

Journal E-contents