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PubMed2000

Acknowledging intuition in clinical decision making.

The purpose of this study was to develop and validate a scale to measure nurses' acknowledgment of using intuition in clinical decision making. Development and validation of the scale was carried out in three phases. In Phase 1, scale items were generated from the published literature in nursing and management and a Content Validity Index (CVI) of .96 was computed on responses from a panel of five experts. In Phase 2, the scale was pilot-tested on a random sample of 106 psychiatric mental health nurses. In Phase 3, the revised scale was presented to a convenience sample of 112 nurses attending continuing education programs. Seven items were found to explain 40.6% of the variance in scores and were retained as the final unidimensional scale. Construct validity was supported by a difference in means of two groups that also differed on another measure of intuition.

Adult↗
PubMed2002

Serial assessment of mortality in the neonatal intensive care unit by algorithm and intuition: certainty, uncertainty, and informed consent.

OBJECTIVES: Does predictive power for outcomes of neonatal intensive care unit (NICU) patients get better with time? Or does it get worse? We determined the predictive power of Score for Neonatal Acute Physiology (SNAP) scores and clinical intuitions as a function of day of life (DOL) for newborn infants admitted to our NICU. METHODS: We identified 369 infants admitted to our NICU during 1996-1997 who required mechanical ventilation. We calculated SNAP scores on DOL 1, 3, 4, 5, 7, 10, 14, 21, 28, and weekly thereafter until either death or extubation. We also asked nurses, residents, fellows, and attendings on each day of mechanical ventilation: "Do you think this child is going to live to go home to their family, or die before hospital discharge?" RESULTS: Two thousand twenty-eight SNAP scores were calculated for 285 infants. On DOL 1, SNAP for nonsurvivors (24 +/- 8.7 [standard deviation]) was significantly higher than SNAP for survivors (13 +/- 6.1). However, this difference diminished steadily and by DOL 10 was no longer statistically significant (12.7 +/- 4.9 vs 10.0 +/- 4.8). On each NICU day, at all ranges of SNAP scores, there were at least as many infants who would ultimately survive as would die. Consequently, the positive predictive value of any SNAP value for subsequent mortality was <0.5 on all NICU days. Prediction profiles were obtained for 230 ventilated infants reflecting over 11 000 intuitions obtained on 2867 patient days. One hundred fifty-seven (81%) of 192 survivor profiles displayed consistent accurate prediction profiles-at least 90% of their NICU ventilation days were characterized by 100% prediction of survival. Twenty-five (13%) of 192 surviving infants survived somewhat unexpectedly; that is, after at least 1 day characterized by at least 1 estimate of "death." Thirty-three (60%) of the 55 nonsurvivors died before DOL 10. Eighty-two percent of the prediction profiles for these early dying infants were homogeneous, dismal, and accurate. Twenty-two (40%) of the 55 nonsurvivors died after DOL 10. Seventeen (78%) of these 22 late-dying infants were predicted to live by many observers on many hospital days. Sixty-one (30%) of 230 profiled patients had at least 1 NICU day characterized by at least 1 prediction of death; 26/61 (43%) of these patients were incorrectly predicted; that is, they survived. Seventeen infants who were predicted to die during but survived nonetheless were assessed neurologically at 1 year. Fourteen (82%) of these 17 were not neurologically normal-8 were clearly abnormal, 1 suspicious, and 5 had died. CONCLUSIONS: If absolute certainty about mortality is the only criterion that can justify a decision to withhold or withdraw life-sustaining treatment in the NICU, these data would make such decisions difficult on the first day of life, and increasingly problematic thereafter. However, if we acknowledge that medicine is inevitably an inexact science and that clinical predictions can never be perfect, we can ask the more interesting question of whether good but less-than-perfect predictions of imprecise but ethically relevant clinical outcomes can still be useful. We think that they can-and that they must.

Age Factors↗
PubMed1999

[Intuition and surgical responsibility].

The vast majority of surgical tasks can be managed by using basic, special and experts' knowledge gained during many years of clinical training and by applying solid surgical skills. This refers to elective cases as well as to emergency surgery and to general surgeons as well as to subspecialists. Consensus statements and standards of care derived from objective study results are aimed to be helpful as practice guidelines and in the decision making process. Only rare, non-foreseeable, unexpected and suddenly occurring exceptional situations require actions based on intuition, which results from a quick, sharp and brilliant decision founded on huge knowledge and experience. But in the scope of surgical work an overstatement or a mystic glorification of intuition should always be avoided.

Evidence-Based Medicine↗
PubMed2002

Intuition and visual art: student nurses' projection into experiences of elderly women.

The aim of the present study was to determine the degree to which student nurses in Sweden were able to predict responses of elderly women to 12 paintings. The result showed that the students were able to enter into situations and experiences of the elderly women. They used intuitive knowing-they were emotionally involved and used cognitive knowing during the prediction process. It could be concluded that nurse educators concerned with finding new directions to develop intuition skills might consider visual art of considerable value.

Adult↗
PubMedDate not supplied

Intuition. A critical way of knowing in a multicultural nursing curriculum.

For nurse educators to provide a multiculturally sensitive curriculum for a diverse student population, there needs to be recognition and inclusion of a wide variety of ways of knowing, cultural beliefs, and values. Nurse educators, however, continue to teach from a Western orientation that emphasizes scientific, rational, linear ways of thinking and knowing. Although intuition is a valid and valued way of knowing in nursing practice, it is rarely included in the nursing curricula. This article suggests pedagogical strategies to inculcate intuition as a valued means of knowing in the multicultural curriculum.

Cultural Diversity↗
PubMed1997

The intuition of the negative in Playing and reality.

The author draws some parallels between his own conceptions on the work of the negative with some ideas presented by Winnicott in the ultimate version of his paper on 'Transitional objects and transitional phenomena'. He underlines the germs of the intuition of the negative in Winnicott's general theory ('not me possession', transitional object as not being the breast, the decathexis of the representation of the object). He then goes on to examine in detail the clinical material of a patient, in the last part of the paper, which has been published posthumously. In this last part the negative is mentioned explicitly and the idea is openly presented. We have here a concept of which Winnicott had the intuition without having the possibility of considering its full development and implications. It so happened that the patient whose clinical material is published in 'Playing and Reality' came to the author to continue her analytic experience. One can compare the material presented in these two analytical relationships. The author comments about his relationship with the patient and of the way she meets his own hypotheses.

Adult↗
PubMed1998

[Intuitive dialogue--a way out of emotional blockages with defocusing imagination].

Intuitive dialogues allows to loose trauma-, conflict-, and subject-fixations. The defocusing imagery plays an important part role in this method. The metaphorical method is oriented on Winnicott, M. Balint, and on Ernesto Grassi and on the theory and praxis of modern art-therapy. A specific Balint group in the dying scene is described, in which role- and relationship conflicts are defocused in form of a mood oriented sensory-metaphorical process. Finally the theory and method of the intuitive dialogue is discussed, especially in the therapy with tortured patients.

Art Therapy↗
PubMed2006

Probabilistic index: an intuitive non-parametric approach to measuring the size of treatment effects.

Effect sizes (ES) tell the magnitude of the difference between treatments and, ideally, should tell clinicians how likely their patients will benefit from the treatment. Currently used ES are expressed in statistical rather than in clinically useful terms and may not give clinicians the appropriate information. We restrict our discussion to studies with two groups: one with n patients receiving a new treatment and the other with m patients receiving the usual or no treatment. The standardized mean difference (e.g. Cohen's d) is a well-known index for continuous outcomes. There is some intuitive value to d, but measuring improvement in standard deviations (SD) is a statistical concept that may not help a clinician. How much improvement is a half SD? A more intuitive and simple-to-calculate ES is the probability that the response of a patient given the new treatment (X) is better than the one for a randomly chosen patient given the old or no treatment (Y) (i.e. P(X > Y), larger values meaning better outcomes). This probability has an immediate identity with the area under the curve (AUC) measure in procedures for receiver operator characteristic (ROC) curve comparing responses to two treatments. It also can be easily calculated from the Mann-Whitney U, Wilcoxon, or Kendall tau statistics. We describe the characteristics of an ideal ES. We propose P(X > Y) as an alternative index, summarize its correspondence with well-known non-parametric statistics, compare it to the standardized mean difference index, and illustrate with clinical data.

Clinical Trials as Topic↗
PubMed2006

Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience.

BACKGROUND: This study aimed to analyze retrospectively the authors' preliminary experience using the Da Vinci Intuitive Robotic System for gastric bypass in managing morbid obesity, and to determine its efficacy and safety in relation to other standardized laparoscopic surgical techniques. METHODS: From October 2000 to March 2004 the authors performed 146 laparoscopic gastric bypasses, 17 of which were robot assisted using the Da Vinci Intuitive Robotic System. The last patients were 7 men and 10 women with a mean age of 44 years. The mean weight was 139 kg, and the mean body mass index (BMI) was 49.8 kg/m at first postoperative recovery. The mean excess body weight (EBW) was 131%. Follow-up assessment, performed at months 1, 3, 6, and 12, then yearly thereafter, included evaluation of the variations in BMI and the percentage of excess body weight loss (EBWL%). All the patients were informed of the risks inherent with each surgical procedure as well as the potential benefits. RESULTS: The mean operative time was 201 min (range, 90-300 min). No intraoperative complications and no conversion occurred in this series. The mean hospital stay was 9 days (range, 6-18 days). The patients in this series experienced a normal postoperative course without anastomotic complications. The mortality rate was zero. No robot-related complications were noted. The analysis of follow-up assessment at months 1, 3, 6, and 12 showed a progressive decrease in BMI and an increment of EBWL%. CONCLUSIONS: The authors' early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.

Adult↗
PubMed2005

Cognitive ergonomics in virtual environments: development of an intuitive and appropriate input device for navigating in a virtual maze.

For patients suffering from mild cognitive impairments, the navigation through a virtual maze should be as intuitive and efficient as possible in order to minimize cognitive and physical strain. This paper discusses the appropriateness of interaction devices for being used for easy navigation tasks. Information gained from human centered evaluation was used to develop an intuitive and ergonomic interaction device. Two experiments examined the usability of tracked interaction devices. Usability problems with the devices are discussed. The findings from the experiments were translated into general design guidance, in addition to specific recommendations. A new device was designed on the basis of these recommendations and its usability was evaluated in a second experiment. The results were used to develop a lightweight interaction device for navigation in the virtual maze.

Cognition Disorders↗
PubMed1992

A Rexx-controlled developing environment for implementing intuitive user interfaces (IUI).

In [our companion paper] intuitive user interfaces as well as a method for developing and programming such interfaces have been described. The present article will improve and simplify this mode of action. The main tool for this undertaking is the programming and script language Rexx. Using Rexx, all software components described in [the companion paper] are linked to form a developing environment, which acts like an integrated software package. Moreover, with the aid of Rexx, source-code and data structure generation is greatly extended, further decreasing the expenditure of programming intuitive user interfaces. This paper first gives a brief introduction to Rexx. A description of the Rexx-controlled developing environment then follows. Finally, there are elucidated the details of the question of how each single software component is linked to the environment using Rexx.

Computer Systems↗
PubMed1997

Intuitive knowledge of linguistic co-reference.

The research reported here is a systematic investigation of what competent, native speakers of English, native to contemporary syntactic theory, judge to be grammatically acceptable patterns of co-reference involving names and pronouns. Its central goal is the specification of syntactic factors that influence co-reference within and between sentences. The results show that naive subjects have consistent intuitions of grammaticality that agree with some principles of contemporary binding theory. The results also show that naive subjects diverge substantially from syntactic theorists in other judgments of grammaticality. In particular, subjects have strong intuitions that reflexives and pronouns are in complementary distribution, a fact that supports contemporary syntactic theory. Beyond that domain, subjects' judgments of co-reference in name-pronoun, name-name, and pronoun-name sequences are systematically influenced by syntactic structure in ways that are not consistent with syntactic theory. Co-reference in name-pronoun sequences is generally quite acceptable but becomes more acceptable as the syntactic prominence of the name increases. Co-reference in name-name sequences is only moderately acceptable and becomes less acceptable as the syntactic prominence of the first name increases. Co-reference in pronoun-name sequences is generally unacceptable and is only weakly influenced by the kinds of syntactic prominence that affect other relations of co-reference. We account for these results through the elaboration of a model of the process by which syntactic representations are mapped onto a representation of discourse capable of expressing generalizations about co-reference both intra-sententially and inter-sententially.

Humans↗
PubMed1998

Use of an intuitive telemanipulator system for remote trauma surgery: an experimental study.

BACKGROUND: Death from battlefield trauma occurs rapidly. Potentially salvageable casualties generally exsanguinate from truncal hemorrhage before operative intervention is possible. An intuitive telemanipulator system that would allow distant surgeons to remotely treat injured patients could improve the outcome from severe injuries. STUDY DESIGN: We evaluated a prototype, four-degree-of-freedom, telesurgery system that provides a surgeon with a stereoscopic video display of a remote operative field. Using dexterous robotic manipulators, surgical instruments at the remote site can be precisely controlled, enabling operative procedures to be performed remotely. Surgeons (n = 3) used the telesurgery system to perform organ excision, hemorrhage control, suturing, and knot tying on anesthetized swine. The ability to complete tasks, times required, technical quality, and subjective impressions were recorded. RESULTS: Surgeons using the telesurgery system were able to close gastrotomies remotely, although times required were 2.7 times as long as those performed by conventional techniques (451 +/- 83 versus 1,235 +/- 165 seconds, p < 0.002). Cholecystectomies, hemorrhage control from liver lacerations, and enterotomy closures were successfully completed in all attempts. Force feedback and stereoscopic video display were important for achieving intuitive performance with the telesurgery system, although tasks were completed adequately in the absence of these sensory cues. CONCLUSIONS: We demonstrated the feasibility of performing standard surgical procedures remotely, with the operating surgeon linked to the distant field only by electronic cabling. Complex manipulations were possible, although the times required were much longer. The capabilities of the system used would not support resuscitative surgery. Telesurgery is unlikely to play a role in early trauma management, but may be a unique research tool for acquiring basic knowledge of operative surgery.

Abdominal Injuries↗
PubMed1996

Individual differences in intuitive-experiential and analytical-rational thinking styles.

Two studies provide evidence for the reliability and validity of a new self-report measure of individual differences in intuitive-experiential and analytical-rational thinking based on cognitive-experiential self-theory (CEST). The Rational-Experiential Inventory (REI) was constructed to measure the 2 independent processing modes with a modified Need for Cognition Scale (NFC, J.T. Cacioppo & R.E. Petty, 1982) and a new scale, Faith in Intuition (FI). In Study 1, a factor analysis yielded 2 orthogonal factors corresponding to NFC and FI. Although heuristic processing was determined primarily by FI, NFC also contributed to heuristic responding, in line with CEST. The relation of FI and NFC to coping ability also was examined. In Study 2, the factor structure of the REI was replicated (N = 973). NFC and FI were differentially related to measures of personality, adjustment, achievement, and interpersonal relations.

Cognition↗
PubMed1997

Heuristics and biases in the "eyeballing" of data: the effects of context on intuitive correlation assessment.

For a wide variety of real-world decisions, people must examine numerical tables and intuitively assess the correlations that exist among meaningful variables. The normative properties of correlation coefficients suggest that such decisions should be unaffected by perceptual factors (e.g., changes in row and column locations), semantic factors (e.g., the referents of the numbers), or certain transformations of the variables (e.g., adding a constant or multiplying by a constant). Four experiments demonstrated that judgments based on perceived correlations violate these normative properties. A general model of intuitive covariation assessment was proposed to explain the observed biases. Estimation of this model at the aggregate and individual levels suggested that no single heuristic is consistent with all of the results. Instead, the existence of several qualitatively different types of heuristics was supported. The distribution of individual-level decision rules across types of heuristics was systematically related to contextual factors.

Adult↗
PubMed1996

Intuitive theories of human immunodeficiency virus transmission: their development and implications.

Explored the use of cluster analysis to characterize the development of intuitive theories of HIV transmission and examined relationships between children's theories and their attitudes regarding AIDS. In Study 1, analyses of interviews with 188 children and adolescents led to the identification of three relatively immature theories (undifferentiated thinking in which anything can cause AIDS, uncertainty about its causes, and a hybrid theory emphasizing germs as well as any form of drug use) and two relatively mature ones (both emphasizing true AIDS risk factors but differing in their understanding of blood exchange as a cause). Unwillingness to interact with persons with AIDS and worry about AIDS decreased with age and the former in particular was most closely associated with the belief that AIDS is spread through casual contact. In Study 2, analyses of data from a largely Mexican American sample of 306 third, fifth, and seventh graders yielded largely similar findings despite use of different risk factor subscales. Overall, the intuitive theories approach and the use of cluster analysis in its service appear to be promising ways of assessing children's knowledge of disease so that appropriate interventions for different subgroups of children can be designed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Intuition: concept analysis of a group phenomenon.

Intuition as a group phenomenon is clarified through the process of concept analysis using the analytical process outlined by Walker and Avant. Intuition as a respectable characteristic of creative and powerful groups is based on uses of the concept; identification of attributes, antecedents, and consequences; construction of various cases; and identification of empirical referents. Suggestions for applications in nursing education, nursing administration, and professional organizations follow.

Cognition↗