Intuitive Intelligence in Clinical Practice

Intuitive knowing is a quality that is highly regarded by many nurses but with the current focus on evidence-based practice, it’s an ability that is becoming overlooked and undervalued.

According to Rovithis et al. (2018), intuition is simply the non-linear creation of knowledge where experiences are stored deeply in the mind and re-emerge when needed in the form of ‘intuitive knowing.’

Intuitive intelligence is, by its very nature, difficult to investigate and quantify, and because of this, it’s often viewed as unreliable, unscientific and unsuitable for use in clinical practice. However, as Turan et al. (2016) suggests, intuition, like caring, cannot be subjected to measurement and shouldn’t be ignored as a valuable nursing tool.

Many practitioners report using their intuition to bypass in-depth analysis and come up with a quick solution, or just sense when a problem might develop.

It’s usually thought of as an unconscious process, often referred to by terms such as a ‘sixth sense’, ‘hunch’ or ‘gut feeling’. Most dictionaries define intuition as a ‘quick and ready insight’ or ‘the act of coming to direct knowledge without reasoning or inferring.’

In the view of McCutcheon and Pincombe (2001):

‘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.’

‘Knowing Without Knowing’

Most people would agree that intuition is a sudden insight: a feeling of knowing or certainty that arrives without effort.

Unlike facts, which rely on external information, intuition is a direct experience that is self-evident and self-validating. It is either meaningful, or it is not. The experience of intuition can also vary from episode to episode with information conveyed by means of inner-sight, hearing and feeling, or even a variety of sensory experiences combined together.

Pearson (2013) points out that although intuition is widely used in clinical decision-making, it is often de-valued compared to scientific decision-making methods because it is so difficult to research using valid and reliable measures.

Payne (2015) suggests that intuitive intelligence is essentially a somatic state that creates a measurable physiological biasing signal (skin conductive response) that helps in making an advantageous decision.

For others, intuition is so much more than this, extending into the realms of the unconscious, even spiritual knowing.

Perhaps a more balanced perspective comes from Turan et al. (2016) who simply describes intuition as knowing something, or deciding to do something without having a logical explanation. For example, the nurse who can sense the unspoken distress of a patient, or the midwife who just ‘knows’ that an apparently normal labour is likely to develop complications.

Should Intuitive Intelligence Have a Place Alongside Evidence-Based Practice?

Intuitive intelligence is usually thought of as a higher level skill belonging in the realms of the expert practitioner. Yet, Melin‐Johansson (2017) suggests that intuitive knowledge is relevant, even for novice nurses, as it plays a key role in more or less all of the steps in the decision-making process leading to safe patient care.

Should intuition have a place alongside measurable evidence-based practice? Parissopoulos (2005) argues that it should, as intuitive knowing usually occurs in response to knowledge and is an important component of clinical decision making.

For others, the lack of valid and reliable evidence supporting its use has resulted in intuition going underground.

‘Intuitive Intelligence’ or Just Years of Experience?

It can be argued that intuitive intelligence is something that evolves with experience allowing practitioners to perceive a situation as a whole and draw on past learning to come to a decision quickly.

Pearson (2013) also suggests that intuition can be explained simply by pattern recognition, where experts use a rapid, automatic process to recognise familiar problems instantly. If this is true, intuition could be thought of as a cognitive skill rather than a perception or ‘knowing without knowing how.’

Is the Use of Intuitive Intelligence Supported by Research?

There have been many attempts to introduce intuition into nursing practice but despite a wealth of anecdotal evidence, it has largely been dismissed as a valid skill due to lack of valid and reliable research.

In the view of Meadows (2006) due to the difficulty in quantifying and researching intuition, it tends to be viewed as unreliable, unscientific and unsuitable for nursing practice. In practice, it is often regarded as a mystical quality that cannot be trusted.

Yet, McCutcheon and Pincombe (2001) argue differently, suggesting that intuition is far from being a mystical power that appears from nowhere, with no rational explanation or basis. In fact, many researchers conclude that nurses value their intuition highly and that denying its value also devalues an important part of experience-based nursing practice.

As Parissopoulos and Rovithis (2005) report, developing intuitive intelligence is associated with many practical benefits. For example:

  • Enhanced clinical judgment
  • Effective decision making
  • Crisis aversion

To date, the limited body of knowledge available on nursing intuition reveals a need for more studies that explore both the nature and use of intuition on every level (Turan et al. 2016). A conclusion echoed by Lise Holm and Severinsson (2016), who call for new research methodologies to measure intuition in a variety of clinical settings.

Could Intuitive Thinking Become a Legitimate Form of Decision-Making?

It’s unlikely, given the lack of high-quality research, that intuition will be adopted formally as a decision making skill.

Yet, as Rovithis et al. (2018) says, it can be used in combination with other cognitive functions to arrive at a sound judgment during decision making.

Even though there is significant interest in the topic of intuition in clinical practice, there is clearly a great deal still to be learned. Much of the literature is based on qualitative studies which are often valued less than the more traditional randomised controlled trials of quantitative research.

Yet, in spite of the difficulties in researching the elusive qualities of intuition, it remains an important part of nursing and midwifery care.

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