Have you ever worked with a nurse who could spot trouble before it happened? \u00a0 I remember a colleague telling me \u201cI don\u2019t like the look of that patient\u201d, which surprised me because the patient’s blood work and vital signs were normal.\u00a0 Yet, in only a short period of time the patient went into cardiac arrest.\u00a0 It\u2019s an impressive skill, one that I\u2019ve only been able to attribute to senior nursing staff.\u00a0 It isn\u2019t easily explained, but the impact can\u2019t be ignored. \u00a0It seems almost magical and it\u2019s sometimes called nursing intuition. \u00a0Do these intuitive assessments constitute, or arise from, evidence?\u00a0 I suppose that depends on your definition of evidence.<\/p>\n
We tend to think of evidence as the results of research studies, or clinical guidelines. However, a broader, richer understanding of evidence and evidence based nursing practice is warranted. \u00a0Evidence based practice is an approach to clinical care that incorporates current best evidence from methodically sound research studies, the clinician\u2019s professional expertise and the values and preferences of the patient.[1]<\/a> In other words, the expertise of the clinician is an important element in the recipe of evidence based nursing.<\/p>\n Patricia Benner[2]<\/a> carefully described the impact of experience in nursing practice.\u00a0 Novice nurses differ from expert nurses in the way they interpret complex clinical situations.\u00a0 \u201cThis difference can be attributed to the know-how that is acquired through experience.\u00a0 The expert nurse perceives the situation as a whole, uses past concrete situations as paradigms, and moves to the accurate region of the problem without wasteful consideration of a large number of irrelevant options (p.3)\u201d\u00a0 In other words, it wasn\u2019t magic or some other sort of mystical sense that led my colleague to predict the cardiac arrest before it happened.\u00a0 It was a culmination of years of experience wrapped up into a single glance.<\/p>\n We can\u2019t throw away the research articles.\u00a0 We need to continue to ensure that our nursing actions lead to the best possible patient health outcomes.\u00a0 However, we also can\u2019t deny that experience is evidence.\u00a0 We need to lobby for environments that promote expert nurses. \u00a0Nurses need to work extensively in their chosen clinical practice area without fear of layoff or re-assignments.\u00a0 Novice and beginner nurses need to be mentored by expert nurses. Finally, \u00a0research should continue to focus not only on the most effective nursing interventions, but also on the situations that foster the development of expert nurses.<\/p>\n Let’s redefine, and legitimize ‘nursing intuition’ to what it deserves to be called…the assessments of expert nurses based on years of experience. In other words, a form of ‘nursing evidence’.<\/p>\n Roberta Heale<\/p>\n
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