Intuition in psychiatric-mental health nursing

Barriers and Facilitators of Intuitive Decision-Making among Psychiatric Nurses: A Cross-sectional Study

Introduction

Due to the type and nature of hospitalized psychiatric patients, nurses encounter many ambiguous and complex clinical situations that require intuitive decision-making. The present study was conducted to determine the use of intuition and its barriers and facilitators among psychiatric nurses.

Methods

This study adopts a descriptive cross-sectional design and employs 123 nurses using convenience sampling in 2022. Demographic characteristics, the use of intuition in clinical practice, and the barriers and facilitators of intuition in clinical practice questionnaires were used for data collection.

Results

The results of this study showed that the mean (SD) of intuitive decision-making among psychiatric nurses was 58 (13.07) out of a range from 25-125. The use of intuition had a statistically significant correlation with age and work experience in the psychiatry ward. The use of intuitive decision-making has a statistically significant difference in gender, work shift, and education level. The biggest barrier to the use of intuitive decision-making among psychiatric nurses was "The limitations of nursing role which restrict the use of intuition in the clinical setting". The most common facilitator in the use of intuition among psychiatric nurses was "having experience and clinical knowledge leads to the use of intuition in patient care".

Conclusion

Given the low level of the use of intuition and the important role of intuitive decision-making in the quality of nursing care, nursing managers should provide some strategies for reducing the barriers to the use of intuition among nurses.

The informational basis for nursing intuition: philosophical underpinnings

In a previous paper, I argued that expert nursing intuition is a form of what James J. Gibson termed 'direct perception' and, as such, is information-based and can be accepted as part of nursing science. In this paper, I explore the philosophical basis for these claims. I begin by describing analogous problems in philosophy and psychology related to how we know the world. After describing the various solutions proposed and the problems they engender, I summarize Gibson's theoretical solution together with some of the supporting empirical evidence, but emphasizing the ecological realism on which it relies. I then use these insights to reconsider nursing intuition and the implications for its further exploration.

A review of clinical decision making: models and current research

AIMS AND OBJECTIVES

The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model.

BACKGROUND

Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition.

DESIGN

Literature review.

METHODS

Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005.

RESULTS

The characteristics of the three models of decision making were identified and the related research discussed.

CONCLUSIONS

Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed.

RELEVANCE TO CLINICAL PRACTICE

It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.

Intuition: an important tool in the practice of nursing

AIM

The aim of the study reported here was to evaluate the role of intuition, to examine nurses' understanding of intuition and their perceptions of their use of intuition, and to assess the impact of intuition on nursing practice.

BACKGROUND

When we read the dictionary definition of intuition, we have a sense of the meaning but there is also a sense of something still not quite defined. Yet we instinctively know what intuition is. That is, of course, an example of intuition in itself: an understanding of the concept based on our feelings, knowledge and experience. Intuition is a concept neither clearly articulated nor adequately theorized in nursing. There is evidence to suggest that practising nurses use intuition and that its use can change outcomes for patients. Because of its influence on patient well being, it needs to be recognized as an important tool in the practice of nursing. The very nature of intuition determines that there will be little agreement on a precise definition and little empirical evidence to support its existence or worth. Neither of these issues detracts from the fact that intuition is an important part of nursing.

METHODS

Grounded theory was used as the overarching theoretical and methodological framework for this study. Using focus group interviews and the Delphi survey technique, data were collected from 262 Registered Nurses who volunteered to take part in the study.

FINDINGS

The theory that emerged from this study provides nurses with a way of articulating their understanding of intuition and their perceptions of its use in nursing practice.

CONCLUSIONS

Intuition is not some mystical power that appears from nowhere, with no rational explanation or basis. The findings from this study show that it is a product of the synergy that occurs as a result of the interaction of a number of factors.

Assessing pain in people with profound learning disabilities

People with profound learning and multiple disabilities are at risk of pain because they experience complex and severe health conditions and frequently undergo surgical procedures that cause pain. Pain assessment in this client group requires a skilled approach, although there is little evidence available to guide nursing practice. In the absence of pain assessment measures specifically designed for use with people with profound learning disabilities, the nurse will need to rely on careful observation and interpretation of the client's communicative behaviour, clinical judgement and knowledge of the person during assessment. Intuition is also an important attribute and can be a valuable source of knowledge when assessing clients who are unable to verbalize their experience of pain. These issues, along with implications for nursing practice, are explored.

How do expert mental health nurses make on-the-spot clinical decisions? A review of the literature

An increasing number of writers have studied the work of Benner (1984) and Schon (1983) and have explored the concepts of expertise and 'intuitive' or 'tacit' knowledge. Efforts have been made to address the phenomenon of the theory--practice gap. Reborn interest in the craft of the professions is evident. A number of studies about the clinical decision-making process have suggested that clinicians are actually using a form of deductive reasoning known as hypothetico-abductivism whilst reflecting in action. Exploration of expert decision-making by psychiatric nurses requires first that the nature of psychiatric expertise be clearly described. However, literature shows that this is not an easy task. In order to facilitate the development of expertise in novice practitioners, further research is required into the nature of expertise and expert decision-making. Cultivating and recording reflection in action around expert decision-making has revealed greater insights into the gap between theory and practice. It is evident that there is a need for a model that makes sense of the informal theory that is generated through practice.

Acknowledging intuition in clinical decision making

The purpose of this study was to develop and validate a scale to measure nurses' acknowledgment of using intuition in clinical decision making. Development and validation of the scale was carried out in three phases. In Phase 1, scale items were generated from the published literature in nursing and management and a Content Validity Index (CVI) of .96 was computed on responses from a panel of five experts. In Phase 2, the scale was pilot-tested on a random sample of 106 psychiatric mental health nurses. In Phase 3, the revised scale was presented to a convenience sample of 112 nurses attending continuing education programs. Seven items were found to explain 40.6% of the variance in scores and were retained as the final unidimensional scale. Construct validity was supported by a difference in means of two groups that also differed on another measure of intuition.