Intuition: nursing knowledge and the spiritual dimension of persons

Intuition in Clinical Decision Making: Differences Among Practicing Nurses

PURPOSE

To examine the relationships and differences in the use of intuition among three categories of practicing nurses from various clinical units at a medical center in the Midwest.

DESIGN

Descriptive, correlational, cross-sectional, prospective design.

METHOD

Three categories of nurses were based on the clinical unit: medical/surgical nurses ( n = 42), step-down/progressive care nurses ( n = 32), and critical care nurses ( n = 24). Participants were e-mailed the Rew Intuitive Judgment Scale (RIJS) via their employee e-mail to measure intuition in clinical practice. Participants were also asked to rate themselves according to Benner's (novice to expert) proficiency levels.

FINDINGS

Nurses practicing at higher self-reported proficiency levels, as defined by Benner, scored higher on the RIJS. More years of clinical experience were associated with higher self-reported levels of nursing proficiency and higher scores on the RIJS. There were no differences in intuition scores among the three categories of nurses.

CONCLUSION

Nurses have many options, such as the nursing process, evidence-based clinical decision-making pathways, protocols, and intuition to aid them in the clinical decision-making process. 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.

Intuition: A Concept Analysis

PURPOSE

The purpose of this article is to conceptually examine intuition; identify the importance of intuition in nursing education, clinical practice, and patient care; encourage acceptance of the use of intuition; and add to the body of nursing knowledge.

BACKGROUND

Nurses often report using intuition when making clinical decisions. Intuition is a rapid, unconscious process based in global knowledge that views the patient holistically while synthesizing information to improve patient outcomes. However, with the advent of evidence-based practice (EBP), the use of intuition has become undervalued in nursing.

REVIEW METHODS

Walker and Avant's framework was used to analyze intuition. A literature search from 1987 to 2014 was conducted using the following keywords: intuition, intuition and nursing, clinical decision making, clinical decision making and intuition, patient outcomes, EBP, and analytical thinking.

RESULTS

The use of intuition is reported by nurses, but is not legitimized within the nursing profession. Defining attributes of intuition are an unconscious, holistic knowledge gathered without using an analytical process and knowledge derived through synthesis, not analysis. Consequences include verification of intuition through an analytical process and translating that knowledge into a course of action.

CONCLUSION

This article supports the use of intuition in nursing by offering clarity to the concept, adds to the nursing knowledge base, encourages a holistic view of the patient during clinical decision making, and encourages nurse educators to promote the use of intuition.

Factors that impact on emergency nurses’ ethical decision-making ability

Background:

Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered.

Research purpose:

Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability.

Research design and context:

A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions.

Participants:

A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected.

Ethical considerations:

Approval to conduct this study was obtained by the Adelphi University Institutional Review Board.

Findings:

A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study.

Discussion:

This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability.

Conclusion:

This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.

Continued Psychometric Evaluation of an Intuition Instrument for Nursing Students

Purpose: The purpose of this study was to evaluate the psychometric properties of a revised intuition instrument developed for nursing students. Method: Principal component factor analysis was used to establish construct validity, and the Cronbach’s alpha was used to examine reliability. Findings: Statistical analysis resulted in a 26-item intuition instrument with 6 factors accounting for 62% of the variance. The factors were labeled as Feelings That Reassure (27.7%), Spiritual Connections (10.9%), Feelings That Alert (8.4%), Feelings That Forewarn (5.8%), Physical Sensations That Alert (4.7%), and Reading Physical Cues (4.2%). Eigenvalues ranged from 1.100 to 7.225, and factor loadings ranged from .572 to .848. The overall Cronbach’s alpha was .89 with a range of .73 to .85 for each factor. Conclusions: The 26-item intuition instrument showed evidence of construct validity and reliability. Implications: The intuition instrument can serve as a stimulus to foster students’ intuitive abilities.

Attributes of Spiritual Care in Nursing Practice

Nurses are increasingly being called on to engage in spiritual care with their patients. A diverse body of theoretical and empirical literature addresses spirituality as it relates to nursing practice, yet there is little consensus about what spiritual nursing care entails. The purpose of this article is to conceptualize spiritual care in relation to nursing practice. A brief historical review indicates that our current understandings of spiritual nursing care have been shaped by three eras characterized by particular approaches: the religious approach, the scientific approach, and the existential approach. We draw elements from each of these approaches to propose attributes of spiritual care in the context of nursing practice. We propose that spiritual nursing care is an intuitive, interpersonal, altruistic, and integrative expression that is contingent on the nurse’s awareness of the transcendent dimension of life but that reflects the patient’s reality.

What lies within: phenomenology and intuitive self-knowledge

This article discusses the significance of intuitiveness as a component of phenomenological knowing and demonstrates how this way of knowing may exist independently of or coexist collaboratively with rationality and evidence-based practice. By using a holistic approach to knowing, nurses use clinical reasoning skills to prevent adverse patient outcomes from failure to diagnose problems, to establish appropriate treatments, and/or to deal with complications. As the complexity of health care escalates, health care providers must strive to think holistically to advance knowledge and contribute to their discipline. The discipline of nursing requires holistic thought and innovative interventions.

Holistic nurses' stories of healing of another

The purpose of this study was to uncover the essence and meaning of healing through narrative accounts of holistic nurses, using a qualitative, descriptive design integrating narrative and story inquiry. Twenty-five stories were collected. Seven stories revealed personal healing and have been published in a prior article. Eighteen stories, the focus of this analysis, revealed healing of another. A hybrid method blending narrative and story guided the overall process for the study. Nine themes emerged describing healing of another within three story segments: The Call to Healing, The Experience of Healing, and Insights. The theme within The Call to the Healing Encounter was Drawn by Compassion to the Vulnerability and/or Suffering of Another. Five themes describe the Experience of Healing: Connection: Cocreating Relationships; Taking Risks and Dealing With Skeptical Colleagues; Use of Modalities and Actions as Tools in Developing Self as an Instrument of Healing; Profound, Ineffable Events; and Using Metaphor and Rituals to Describe Healing. Three themes describe Insights: Mutual Transformation, Change, and Reciprocity; Gratitude for the Healing Encounter; and Leaving a Legacy. The metastory, a reconstructed story created by the researchers, was the final phase of research synthesizing and demonstrating themes of healing of another. Results were compared to existing healing literature.

Particularizing the general: Sustaining theoretical integrity in the context of an evidence-based practice agenda

Proliferation of demands for accountability and health care quality places nurses under constant pressure to ensure professional practice is evidence-based. The corresponding emphasis on knowledge that pertains to general populations challenges nursing's traditional focus on the uniqueness of each individual patient. Considering how nurses engage with professional systematic thinking processes, we reflect on ways competing agendas in the evidence-based practice environment compromise the professional vision aspired to by an earlier era of nursing model and framework builders. Exploring the scientific thinking underpinning practice evidence, we contemplate implications for applying general knowledge to particular practice, reconsidering options for conceptualizing nursing praxis.

Kaleidoscopes of Reality

This article addresses the broad context of shifting definitions of how knowledge and reality can be described, including the transition from positivism to postpositivism in the 20th century. It provides an exploration of ways of knowing, from ancient Greek and yogic traditions to Barbara Carper’s Fundamental Patterns of Knowing in Nursing (1978). It examines three reported components of modern care (intuition, cultural knowing, and spirituality) which are simultaneously present and absent in nursing. It concludes with an imaginative exploration of how nursing might be changed by transdisciplinary scholarship and education, new knowledge creation through interactive online communities, and the emergence of collective wisdom.

Cultural validation of the "use of intuition by nursing students scale - Turkish version"

PURPOSE

It is well known that intuition ability directly affects patient care quality and outcomes in nursing practice and is therefore an important aspect of nursing education. This study tests the validity and reliability of the Turkish version of the Scale of Use of Intuition by Nursing Students.

DESIGN

The sample for this methodological study was composed of 250 nursing students. Each item of the scale was translated into Turkish by the researchers and validated for Turkish use.

RESULTS

The item-total correlation was between .30 and .56 and its Cronbach α coefficient was .86. There was a statistically significant positive relationship between the level of clinical experience and the total points scored on the physical awareness, emotional awareness, and physical sensations subscales and from the total scale.

CONCLUSIONS

Based on these results, the Turkish version of the Scale of Use of Intuition by Nursing Students is valid and reliable.

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.

Nurses' acceptance of the decision support computer program for cancer pain management

This article describes nurses' acceptance of a decision support computer program for cancer pain management and explores the relationships between the nurses' acceptance and their sociodemographic characteristics. A feminist perspective was used as a theoretical guide for the research process. This was an Internet intervention study among 122 nurses working with cancer patients. Nurses' acceptance of the decision support computer program was measured using the Questionnaire for User Interaction Satisfaction. The data were analyzed using descriptive and inferential statistics, including analysis of variance and correlation analyses. There were significant differences in the total scores of user satisfaction by sex, religion, ethnicity, job title, and specialty. The results suggest that nurses do welcome decision support systems and that nurses' sociodemographic and professional characteristics should be considered in the development of decision support systems.

Predictors of Novice Nurses' Use of Intuition to Guide Patient Care Decisions

Nurses routinely report using intuition to guide decisions about patient care, although they use it covertly because of difficulty explaining the sources of their intuitions to colleagues. To help nurse educators guide students toward open discussion and appropriate use of intuition, this study compared personal, interpersonal, and professional experiences suggested by past research for their association with the use of intuition by nurses. A questionnaire completed by 323 novice nurses measured use of intuition with an 18-item subscale identified by Miller from the Miller Intuitiveness Instrument. Measures of personal experience included age, gender, hospitalizations, self-esteem, and religiosity. Interpersonal experience included parenthood and social support from family and friends. Professional experience included grade point average and months of on-the-job experience. Multiple regression revealed that novice nurses use intuition more to guide patient care if they are older, have had more hospitalizations, and experience more social support.

Understanding personal narratives: an approach to practice

AIM

This paper explores the need for and nature of personal narratives and their relevance to nursing practice. It proposes that the co-creative aesthetic process can be used to understand and co-create personal narratives through an emphasis on self-defining memories and metaphor.

BACKGROUND

Many authors in nursing and other human sciences have recognized the need for and importance of personal narrative, its relationship to aesthetic knowing and its value in qualitative research and in practice. The role of memory and metaphor in the creation of meaning in personal narratives, however, has not been sufficiently explored in nursing literature.

DISCUSSION

The nature of personal narrative is explored, focusing on the way meaning is created from self-defining memories using metaphor. Then, the importance of personal narratives in nursing practice is considered, followed by discussion about how meaning in personal narratives may be co-created between clients and nurses using an aesthetic process developed by the author.

CONCLUSION

The co-creative aesthetic process is an example of nursing as art and can be used to co-create personal narratives in practice. The experience of co-creating a self story with a nurse can be healing, as the self story is heard by a caring person, memories are understood in new ways, and the self story is both confirmed and recreated.

Use of intuition by nursing students: instrument development and testing

BACKGROUND

Intuition has been described as an important type of nursing knowledge and has gained acceptance as a valid way of knowing in clinical nursing. Use of intuition has become one way of explaining professional expertise. Measures of the use of intuition have been developed primarily for experienced nurses, but few measures of intuition use among nursing students exist.

AIM

The aim of this paper is to describe the development and psychometric testing of an instrument to measure use of intuition by nursing students.

METHODS

Instrument development consisted of concept clarification, item development, and psychometric testing. Intuition was defined as a non-linear process of knowing perceived through physical awareness, emotional awareness, and/or through physical or spiritual connections. Initial measurement items were derived inductively from the literature and informal interviews with senior nursing students. Seven content experts established a content validity index of 0.86 for the initial 33-item measure. It was pretested with a sample of 20 senior nursing students prior to its nationwide validation with a random sample of 1000 senior bachelor of science and associate degree nursing students.

RESULTS

Postal mail data collection resulted in 349 responses (35% response rate). Principal component analysis with orthogonal varimax rotation resulted in seven factors accounting for 66.2% of the variance: physical sensations (28.4%); premonitions (9.7%); spiritual connections (7.7%); reading of cues (6.1%); sensing energy (5.7%); apprehension (4.3%); and reassuring feelings (4%). Eigenvalues ranged from 1 to 7.1 and factor loadings ranged from 0.534 to 0.858. The validation resulted in a revised 25-item measure that demonstrated an overall Cronbach's alpha of 0.89 and a range of 0.69-0.84 for each factor. The study is limited by the use of a self-report measure and the attrition in the randomized sample.

CONCLUSIONS

The intuition measure for use with students showed evidence of construct validity and reliability. With further testing, the measure could serve as a stimulus to foster students' intuitive abilities.

Why nurses need to understand the principles of bereavement theory

This article considers the value of bereavement theory to nurses. The contexts in which nurses care for the bereaved are identified and the terms "bereavement", "grief"and "mourning" are defined. A selection of psychological and sociological bereavement theory and models are considered in relation to their value in nursing practice. The increasing richness of bereavement theory strengthens potential understanding of the process of grief. Critical and creative use of this theory can offer valuable guidance to nurses caring for the bereaved and can help promote confidence, thus enabling them to provide appropriate support.

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.

Teaching spirituality in nursing: a literature review

Nurse educationalists have a poor record in preparing nurses adequately for providing spiritual care. Contemporary nursing philosophy embracing holism demands that nurses learn the appropriate skills to enable them to provide care in all domains, including the spiritual. Three questions are explored within this review: what is spirituality?; what should pre-registration nursing students be taught concerning spirituality?; and how can spirituality in nursing be taught? Although sources of literature stemmed from the West, a predominantly Judeo-Christian culture, this is balanced by reference to a synopsis of world religions provided by a number of texts. Research studies included in the review consider nurses' concepts of spirituality, nurses' awareness of spiritual aspects of care, assessment of patients' spiritual needs, and caring and coping strategies for nurses and patients. Some have demonstrated the need for educational input to better prepare nurses for spiritual care but none identify how this might be effectively achieved.

Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units

The purpose of this study is to develop a lecture on spiritual care for adult critical care trainees, and to evaluate the trainees' appraisal of the effectiveness of this lecture in preparing them to provide spiritual care for their clients in a critical care setting. A between-method triangulation research design encompassing a questionnaire and descriptive qualitative content analysis was used. A convenience sample consisting of 64 registered nurses who attended an adult critical care nurse training programme in a leading medical centre in northern Taiwan were invited to participate in this study. A total of 64 female participants completed the questionnaire. Ninety-two per cent (59) of the subjects considered the lecture on spiritual care to be helpful in assisting them to provide holistic care for critically ill patients in the Intensive Care Unit (ICU). Three types of help were identified by the subjects: (1) help in clarifying the abstract concepts related to spiritual care (86%); (2) help in self-disclosing the nurses' personal beliefs and values regarding life goals, nursing, and spiritual needs (67%); (3) help in learning how to provide spiritual care to patients in a critical care setting (34%). Twenty per cent of the subjects thought that inclusion of the following content in the lecture would have been helpful to provide a more comprehensive picture of spiritual care: religious practices and rituals (11%); the culturally bonded nursing care plan (9%); the development of human spirituality (3%); patients' families' spiritual needs in the ICU (3%); and resources for nurses in providing spiritual care (2%). Thirteen per cent of the subjects suggested that the instructor might employ the following strategies to improve the quality of teaching: providing more empirical examples (5%); discussion with the students in classes of smaller size following the lecture or extending the instruction time (5%); and providing a syllabus with detailed information (3%).

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

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.

Connection: an exploration of spirituality in nursing care

This paper aims to explore the meaning of spirituality in relation to nursing care using concept synthesis. Walker and Avant give three ways in which concept synthesis can occur: discovering new dimensions to old concepts, searching for similarities and discrepancies among sets of related concepts, and observing previously undescribed phenomena. It is the first two of these methods which have been used here. The phenomena that emerged from a reading of the literature around spirituality were meaning, presencing, empathy/compassion, giving hope, love, religion/transcendence, touch and healing. These phenomena were studied in order to sort them into fewer categories. They all appeared to be products of a relationship, some physical (presencing, touch and healing), and others emotional (meaning, empathy/compassion, hope, love, and religion/transcendence). Some of the phenomena appeared to fit in both categories, especially healing, which could be of a physical or emotional/spiritual nature. Once the two main categories had been arranged, it was obvious that a split between psyche and soma was not appropriate for labelling the spiritual dimensions of nursing care, as the original definition of spirit was something which motivated the body. Spiritual care is inseparable from physical, social and psychological care because together they form the whole (Bradshaw 1994 p. 282). The two categories were then collapsed into one and given the label 'connection'.

Replenishing the spirit by meditative prayer and guided imagery

OBJECTIVES

To review relevant literature describing prayer and guided imagery, and to demonstrate via the use of a vignette, the use of both prayer and guided imagery as one approach to offer spiritual care to oncology patients.

DATA SOURCES

Review and research articles from multiple disciplines, and personal clinical experience.

CONCLUSION

Meditative prayer and guided imagery are two approaches that can be used to provide spiritual care to cancer patients and families. While research has focused on elements of spirituality, research related to clinical interventions is limited.

IMPLICATIONS FOR NURSING PRACTICE

Guided imagery, metaphors, meditative prayer, and prayers of silence are effective approaches the nurse can implement when caring for the patient with cancer.

Intuition--a problematic form of knowledge in nursing

The purpose of this article is to discuss the concept and phenomenon of intuition in nursing. With an overview of theories of intuition in philosophy and empirical research as the starting point, the authors discuss the conceptualization of intuition in nursing. Concept analyses, intuition as phenomenological nursing knowledge, intuition as clinical knowledge and intuition as spiritual connection are discussed. The authors conclude that the conceptions of intuition in nursing differ with respect to their philosophical underpinnings and that it can be questioned whether 'intuition' is always a proper term for the kind of knowledge investigated. Intuition is seen as an important concept in nursing, but there are still philosophical as well as empirical and practical problems to investigate.

Symbiosis of nurse and machine through fuzzy logic: improved specificity of a neonatal pulse oximeter alarm

This article describes the theoretical underpinnings that preceded the design of a new neonatal pulse oximeter alarm that differentiates true from false alarms based on an artificial intelligence theory called "fuzzy logic." The connection between the intuition and sense of advocacy gained through neonatal primary nursing and the application of fuzzy logic to solve the problem of false alarms--that is, the symbiosis between nurse and machine--are explained. Emphasis is placed throughout on the importance of involving nurses in the development of the technology for which they are responsible.

Characteristics of intuitive nurses

A description is provided of the process used to verify characteristics of intuitive nurses that had been reported in the literature. These characteristics supplied the framework for construction of the Miller Intuitiveness Instrument (MII) reported earlier (Miller, 1993). Evidence for validity of the MII was provided in the Miller (1993) study by examining factor analyses and correlations with the intuitive component of the Myers-Briggs Type Indicator (MBTI). The following characteristics were subsequently verified: Intuitive nurses are willing to act on their intuitions, are skilled clinicians, and incorporate a spiritual component in their practices. In addition, intuitive nurses express an interest in the abstract nature of things and are risk takers. Intuitive nurses prefer intuition to sensing (as reflected by the MBTI) as a way to take in information. They are extroverted and express confidence in their intuitions. Likewise, nurses who delay making decisions until all the information is in are more intuitive than those who make decisions abruptly.

The healing process of presence

Therapeutic relationships help provide the milieu for the nurse and the patient to gain insights into the essence of disease and the nature of healing. In building a foundation on which to be in optimally responsive relationships, nurses at Riverside Methodist Hospitals in Columbus, Ohio, participate in a 2-day course that explores and names how we bring ourselves as gifts to others as well as to ourselves in the dynamic of therapeutic presence. The following article reviews the literature on presence, provides a course description and contents on presence, and assists nurses in incorporating principles of presence into nursing practice.

The spiritual dimension of individuals: conceptual development

The concept of spirituality (the spiritual dimension of an individual) is discussed related to concept development using the Path Associated with Differences. Spirituality is discussed as being different from religion and the psychosocial dimension of individuals. Methods for concept development--e.g., concept derivation, intuition, and qualitative analysis--are explored.

Intuition and Nursing Practice Implications for Nurse Educators: A Review of the Literature

Intuitive knowledge is an essential component of the art of nursing and of the nursing process. This article provides an analysis and review of the literature on intuition. The author addresses the use of intuition in nursing science, characteristics of intuitive nurses, receptivity of intuitive knowledge, and the importance of expanding nursing's utilization of the intuitive process. Strategies are provided for promoting intuitive skills in continuing education/staff development settings.