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Intuition in action

4 August 2008

A research paper in emergency nursing finally names a remarkable phenomenon.

Emergency nurse Dr Joy Lyneham remembers the evening well, a New Year's Eve in a busy Sydney hospital. A babysitter brought an infant into the emergency department with no obvious symptoms of illness. All the usual tests gave no indications to cause concern. But Dr Lyneham's stomach turned.

"[I] informed the paediatric resident that I was taking him to the resuscitation area. When asked why, I replied that he needed to be there. The resident had no choice but to follow me. Two hours later the baby was admitted to the operating theatre requiring a repair to a large previously undiagnosed ventral septal defect," writes Dr Lyneham in a recent paper in the International Journal of Nursing Practice.

She had first heard expert nurses talk about intuition while completing her Masters degree. That astonishing New Year's Eve brought back their anecdotes, and triggered her exploration of an experience widely accepted in the profession.

"It's just certain instances where you see somebody walking through the door and you think: oh no... And all the observations, monitors are telling you everything's all right, but something's not," says the Monash Senior Lecturer from the School of Nursing and Midwifery.

"It's different for everyone. For me, my stomach just drops to my feet, like when you go over dips in road. One of the people I interviewed said the hair stood up on her neck. And another said it was like a bolt of lightning.

"A person might come in with a fall and they've broken their toe, and suddenly you're doing an ECG (electrocardiogram) on them. You're not overly aware that's what you're doing. You just think: ECG, that's a good idea. But often they've been in a dysrhythmia and that's why they fell and broke their toe."

Dr Lyneham interviewed 15 nurses from places as distant as Perth, Tamworth, Sydney and Tasmania. One nurse told a story about a young woman who came into hospital just days after the removal of several varicose veins, her symptoms 'clearly' pointing to deep vein thrombosis. For a reason that she can't explain, the nurse began asking obscure questions, and learnt that the patient also experienced slurred speech. Later that day, a doctor found a brain tumour.

Intuition creeps up on nurses when they start operating at expert level, explains Dr Lyneham.

"Knowledge and experience are the foundations. And then I think there has to be something within that person that's able to make connections with people," she says, describing the intuitive experiences as common to most clinicians, including vets.

But she stresses that, while intuition forms part of nursing practice, patients are at no risk.

"Emergency nurses don't just totally do what their gut is telling them to do. They do all the normal assessments as well, but they're actually adding to their workload by adding these assessments," she says.

"You might go weeks without it happening, but then it happens and you think: 'that's the patient I have to worry about'."

Dr Joy Lyneham

Dr Joy Lyneham

More information

In her next paper, Dr Lyneham breaks down intuition into three developmental stages.

  • Cognitive: the nurse makes an accurate snap decision that he or she can later rationalise based on obvious symptoms;
  • Transitional: the nurse experiences a gut feeling and doesn't know why he or she suddenly takes the particular course of action;
  • Embodied: the nurse understands the physical sensation of intuition and acts on it.