Accuracy of intuition in clinical decision‐making among novice clinicians

• Published in: Journal of advanced nursing Vol. 73; no. 5; pp. 1147 - 1157
• Main Authors: Price, Amanda, Zulkosky, Kristen, White, Krista, Pretz, Jean
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2017
• Subjects: Accuracy; Adult; analytical reasoning; Between-subjects design; Clinical competence; Clinical Competence - standards; Clinical Decision-Making; Clinical nursing; Complications; Cues; Decision making; Female; Humans; Intuition; Licensing; Male; Medical diagnosis; Medical Staff, Hospital - psychology; Medical Staff, Hospital - standards; Novices; nurse education; Nurse managers; Nurse tutors; Nurses; nursing; nursing models; Patient assessment; Physician's Role; Physician-Patient Relations; Professional development; Recognition (Psychology); Reliance; Simulation; Young Adult; United States > US; decision-making; simulation; nursing models; analytical reasoning; nurse education; nursing; clinical decision-making; intuition
• ISSN: 0309-2402; 1365-2648; 1365-2648
• DOI: 10.1111/jan.13202

Aims To assess the reliance on intuitive and analytical approaches during clinical decision‐making among novice clinicians and whether that reliance is associated with accurate decision‐making. Background Nurse educators and managers tend to emphasize analysis over intuition during clinical decision‐making though nurses typically report some reliance on intuition in their practice. We hypothesized that under certain conditions, reliance on intuition would support accurate decision‐making, even among novices. Design This study utilized an experimental design with clinical complication (familiar vs. novel) and decision phase (cue acquisition, diagnosis and action) as within‐subjects’ factors, and simulation role (observer, family, auxiliary nurse and primary nurse) as between‐subjects’ factor. Methods We examined clinical decision‐making accuracy among final semester pre‐licensure nursing students in a simulation experience. Students recorded their reasoning about emerging clinical complications with their patient during two distinct points in the simulation; one point involved a familiar complication and the other a relatively novel complication. All data were collected during Spring 2015. Results Although most participants relied more heavily on analysis than on intuition, use of intuition during the familiar complication was associated with more accurate decision‐making, particularly in guiding attention to relevant cues. With the novel complication, use of intuition appeared to hamper decision‐making, particularly for those in an observer role. Conclusion Novice clinicians should be supported by educators and nurse managers to note when their intuitions are likely to be valid. Our findings emphasize the integrated nature of intuition and analysis in clinical decision‐making.