Fostering the Development of Intuitive Decision-Making in Nursing: An Evidence-Based Model

Decision-making is a complex process involving interaction between many areas of the brain, and the physiology involved remains poorly understood. However, it is agreed, the making of a sound decision requires the integration of sensory, limbic, and autonomic information and is dependent on memory, pattern recognition, and cognition (Bechara, Damasio & Damasio, 2000; Segalowitz, 2007).

Nursing literature dealing with decision-making demonstrates the need for further empirical study. According to Thompson et al. (2013), the majority of educational interventions geared toward improving decision-making and judgment within nursing did not include decision-making theory as a foundation. Hence, the authors propose the need for innovative approaches to the development of judgment and decision-making skills that incorporate evidence-based theories of judgment and decision-making (Thompson et al., 2013).  A study by Ferro et al. (2008) showed new nursing graduates often do not exhibit competency in entry-level clinical judgment in their role as a graduate nurse (Ferro et al., 2008). This has profound implications for continuing nurse educators requiring educators to develop and utilize educational interventions promoting a higher level of clinical decision-making (Thompson & Stapley, 2011).

Nurses make numerous daily decisions impacting our society’s health. The ability of nurses to make sound decisions is the cornerstone of excellent nursing care and the goal of nursing educators.  Research has shown errors in decision-making by nurses can result in devastating consequences.  Therefore, a systematic approach to understanding the educational basis for improving the decision-making of nurses is required (Thompson et al., 2013; Traynor et al., 2010). Experienced nurses make fewer errors in decision-making when compared with novice nurses, and tend to report differences in their decision-making process. Specifically, when compared with recent graduates, expert nurses report a greater use of intuitive decision-making (Pretz & Folz, 2011; Rew & Barrow 2007). 

While many have posited enabling nurses to develop the ability to think critically is the goal of continuing education, research has shown that the ability to make decisions intuitively results in superior decision-making (Benner et al. 2009; Traynor, Boland, & Niels, 2010), and thus, should be the ultimate goal. Yet, the definition of intuition varies, resulting in a lack of clarity and coherence. Due to this ambiguity, there tends to be a belief that intuition is somehow irrational and inferior to purely analytical reasoning (Green, 2012; Pearson 2013). The majority of intuitive decision-making studies are exploratory in nature, lack a sound theoretical base and do not contain seminal research (Rew & Barrow, 2007). While this enables researchers to know about intuitive decision-making, it does not allow the researcher to know intuitive decision-making.

Accordingly, this presentation provides an evidence-based framework for continuing education in nursing focused on the development of intuitive decision-making.  It was created through the combination of evidence-based nursing theory (Benner’s Novice to Expert, NTE) with two decision-making theories; Damasio’s Somatic Marker Hypothesis (SMH) and Hammonds Cognitive Continuum Theory (CCT)(Benner, 1984; Damasio, 1996; Hammond, 2006). This innovative and evidence-based framework can be modified resulting in the ability to be applied to all areas of nursing with the intent of fostering the development of intuitive decision-making in nursing.

                  In accordance with NTE and the SMH, as nurses increase their nursing experience through the accumulation of memory integrated with pattern recognition, they progress through stages and ultimately develop a deep understanding of phenomena. Intuition can be defined as a non-conscious state of knowing and develops after understanding is firmly established. When a nurse is faced with the need to make a decision, intuition, if developed, enacts a somatic state that aids in the making of an advantageous decision. Intuitive decision-making is a non-conscious event orchestrated by the mind. The mind integrates memory and pattern recognition without cognitive direction. If intuition is not developed, the nurse is required to cognitively appraise the situation through conscious integration of memory and pattern recognition to reach a decision.  Based on the combination of the evidence-based theories presented, educators can aid nurses to make better decisions by designing interventions promoting pattern recognition and memory consistent with nursing experience.          

                  Nursing has long recognized intuition specific to nursing is grounded on nursing experience (Benner et al. 2009). The educational framework presented conceptualizes an educational model geared toward the development of intuitive decision-making in nursing. This model was created through the combination of educational, nursing, and decision-making theory, which, according to Thompson et al. (2013) is lacking in nursing decision-making models. This framework allows for adaptation of content, and is thus applicable to all areas of continuing nursing education. Although this framework needs empirical validation, it is evidence-based, theoretically sound, applicable to all areas of nursing, and its implementation could help reduce errors in decision-making by nurses, thus improving patient outcomes.