1. Powell, Suzanne K. MBA, RN, CCM, CPHQ

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The intellect has little to do on the road to discovery. There comes a leap in consciousness, call it intuition or what you will, the solution comes to you and you don't know how or why. The truly valuable thing is the intuition. - -Albert Einstein


The nurse aide came out of Mrs. Brown's room pale and flustered. Twenty minutes ago, Mrs. Brown asked him for help getting to the bedside commode. Fifteen minutes ago, she said, "Oh, you had better put me back to bed. I'm going to die now." She did.


I held back turning right even when my light changed to green[horizontal ellipsis] something about a trailer. First, the pickup truck hauling an empty trailer sailed through the red light. I cautiously turned but kept a safe distance as I watched the trailer unhitch, cross all lanes to the left side of the road, take out a sign or two, veer to the right side of the road, mow down desert bushes, and stop to rest after running over a "Bus Stop" sign.


Mothers' intuition is a well-documented, frequent event-most recently, the mother of the Quaid twins (Dennis Quaid being the father) knew "something" was very wrong and rushed to the hospital, only to be told that everything was fine. It was not, as the twins had been given a dose of heparin 100 times stronger than prescribed; however, this fact was, as yet, unbeknownst to the hospital staff.


Where did the "knowing" come from? And why does intuition matter to case management? There may be no easy answer to the first question. Intuitive knowing has been defined as the "immediate knowledge about a fact, or truth, as a whole and the awareness of past, present, or future events without the conscious use of such processes as linear reasoning, rationality, or analytics" (Rovithis & Parissopoulos, 2005, p. 7). Nurses have "known" when a patient will crash and code, often called nurses' intuition. While the above stories leave no rational hints, an experienced nurse may subconsciously put together a subtle, almost imperceptible, patient picture: a change in skin color, a look in the eye, a different breathing pattern, an anxiousness. Is it possible that intuitive events may be triggered by a vast amount of experience that has moved from the conscious realm to somewhere deeper-and, in a flash-back into conscious thought?


Some insist intuition is knowledge from beyond. Jung describes intuition as "a perception of realities which are not known to the conscious, and which goes via the unconscious" (Jajko, 2008, p. 2). Others, such as Bruce Henderson in 1977 characterize it as the subconscious integration of all the experiences, conditioning, and knowledge of a lifetime (Jajko, 2008). In the book, Blink, Malcomb Gladwell talks about how we think without thinking; about choices that seem to be made in an instant-in the blink of an eye. Drawing on cutting-edge neuroscience and psychology, Gladwell coined the term, "thin-slicing"-quickly filtering the very few variables that really matter from the almost limitless amount of data/information (Gladwell, 2005).


If I look objectively at the story of the woman who knew she was dying and my trailer experience, I can probably make a case for the "knowledge of a lifetime" theory. Mrs. Brown may have known enough about bodily signs and subjective symptoms to know this was "IT." Or not-but we will never know. I may have heard the truck with a trailer rattling behind it without being cognitively aware that I heard it. In a split second, I may have decided that this truck pulling a trailer could not possibly stop going that speed. Furthermore, as the truck and trailer passed me, I may have seen a wobbling of the trailer that was just below my conscious mind and typical eyesight[horizontal ellipsis] and I decided to listen to the "message." Did I "thin-slice?" I probably also figured, "oh, what the heck; what's five seconds on my way to work. Hold back."


Why does all this matter to case management? For a couple of reasons. Simply put, it is an important tool to use. A feeling that a discharge is destined to fail may move us to put a few key pieces together for "Plan B": without this "warning," you may be caught off guard at the moment of discharge. This, in turn, will give you the equanimity to handle a major turn-of-events with grace-hopefully also adding to patient/family satisfaction.


Perhaps more importantly, it is about respecting our patients' feelings and intuitions. I can intellectualize my way through the trailer incident, but there is no good explanation for Mrs. Quaid's story, or many other "Mother Intuition" stories. It is just "best practice" to listen to, honor, and investigate what family members are feeling-especially if they are persistent that something is not right with their loved one.


Einstein was certainly extraordinarily intelligent, but, according to some, he was, by no means, an intellectual genius. Whether that is true or not is difficult to say; Einstein never took an IQ test. He was also said to be an intuitive genius. The quote at the top of the page reveals his universal method for discovery; reading his biography, one becomes aware that sometimes weeks, months, or years passed before a moment of truth, a sudden emergence of a new insight came to him-usually when he was taking a walk and not thinking of the problem. Jonas Salk, MD, also kept intuition as his clinical assistant and said, "It's always with excitement that I wake up in the morning wondering what my intuitor will toss up to me like gifts from the sea." Perhaps if Dr. Salk did not listen to his "intuitor," the history of polio would have a different ending.


I agree with Einstein's quote: intuition is in an entirely different realm than the "intellect." Had I listened to my "intellect," I could have been involved in a major traffic accident. The nurses in the Quaid story, however, did listen to their intellect (the babies appeared fine), but had they moved into a space where they saw the distress of the mother and acknowledged a different possibility, they might have picked up the medication error earlier. Not only do we need to use our intuition and cultivate it, but we also need to respect the intuition of others.


Intuition is a component of our healthcare life-whether yours or the patients/families. When we receive intuitive information from any source, check it for validity, use your decision-making skills, and above all, use common sense. We cannot simultaneously talk about "activating patients" in their own care and disregard what they are feeling and telling us about their experiences. Several months ago, I read that an Intel chip can now process one trillion calculations per second. I believe anything Intel can do, the human brain can do better[horizontal ellipsis]therefore, I will sit back, let my brain "Google" its vast database, and listen for instructions: it is so much easier than trying to figure it all out myself!!




Gladwell, M. (2005). Blink. New York: Little, Brown and Company. [Context Link]


Jajko, B. (2008). Intuition-A Brief Overview. Retrieved April 21, 2008, from[Context Link]


Rovithis, M., & Parissopoulos, S. (2005). Intuition in nursing practice. ICUS Nursing Web Journal, 22, 1-10. [Context Link]

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