Towards an alternative to Benner’s theory of expert ...

1 International Journal of Nursing Studies 45 (2008) 129 139 Towards an alternative to benner s theory of expert intuitionin nursing: A discussion paperFernand Gobet , Philippe ChassySchool of Social Sciences, Brunel University, Uxbridge, Middlesex, UB8 3PH, UKReceived 24 September 2006; received in revised form 26 December 2006; accepted 12 January 2007 AbstractSeveral authors have highlighted the role of intuition in expertise. In particular, a large amount of data has beencollected about intuition in expert nursing, and intuition plays an important role in the influential theory of nursingexpertise developed by benner [1984.]

2 From Novice to expert : Excellence and Power in Clinical Nursing Wesley, Menlo Park, CA]. We discuss this theory , and highlight both data that support it and data thatchallenge it. Based on this assessment, we propose a new theory of nursing expertise and intuition, which emphasizeshow perception and conscious problem solving are intimately related. In the discussion, we propose that this theoryopens new avenues of enquiry for research into nursing Elsevier Ltd. All rights :Care; Decision-making; Expertise; Intuition; Memory; Nursing; Pattern recognitionWhat is already known about the topic? While the role of intuition in nursing has been thetopic of considerable debate, studies have establishedthat this is a genuine phenomenon.

3 Definitions of experts intuition emphasize fivefeatures: rapid perception, lack of awareness of theprocesses engaged, presence of emotions, holisticunderstanding of the situation, and overall goodquality of the proposed solutions. The literature often refers to Patricia benner s theoryof nursing expertise, which proposes that the road toexpertise encompasses five this paper adds A detailed discussion of benner s theory , which leadsto the conclusion that the theory is too simple toaccount for the complex pattern of phenomena thatrecent research on expert intuition has uncovered. A new theory of expert intuition in nursing, whichprovides mechanisms for explaining how intuitive,perceptual decision-making is linked to more analy-tical problem solving.

4 The suggestion that standard research on expertise(mostly based on the natural sciences) and that onnursing expertise (often based on phenomenology)should start a constructive IntroductionIntuition is often proposed as one of the definingcharacteristics of expertise. From chess masters able toARTICLE IN $ - see front matterr2007 Elsevier Ltd. All rights Corresponding author. Tel.: +44 1895 265484;fax: +44 1895 (F. Gobet).understand a position nearly instantaneously, to physi-cists automatically seeing the deep physical implicationsof a problem, to nurses having a gut feeling about theprognosis of a patient, what impresses the bystander isthe suddenness and nearly magical nature of thesebehaviours.

5 While this last characteristic has sometimesled critics to doubt the psychological reality of intuition,there is currently good evidence that this phenomenon isgenuine. Indeed, empirical support comes from severaldomains including games (De Groot, 1965), sciences(Simon, 1995), the military (Klein, 2003), business(Prietula and Simon, 1989), and nursing ( , benner ,1984; benner et al., 1992;McCormack, 1993;McCutch-eon and Pincombe, 2001;Polge, 1995). Given thepervasiveness of the phenomenon, not the least in fieldswhere intuitive decisions may be a matter of life ordeath, it is crucial to understand the mechanismsunderpinning are some differences in the way intuition isdefined in the literature, but there is also a fair degree ofagreement in that most definitions include rapidperception, lack of awareness of the processes engaged,concomitant presence of emotions, and holistic under-standing of the problem situation.

6 It should be notedthat emotions have long been emphasized as part andparcel of intuition, even in domains that may seem toengage only cold cognitions such as chess (Tikhomir-ov and Vinogradov, 1970); the key role of emotion inintuition has recently been buttressed by investigationswith neurological patients showing how the lack ofemotions negatively affects intuitive decision-making(Bechara et al., 1997). To these four features, one canadd the idea that intuitions, while not necessarily alwayscorrect, must be correct more often than not (De Groot,1965, 1992). This last definitional requirement, whichwas developed by de Groot so that intuition can be seenas an adaptive and rational process yielding behaviourbetter than chance, implies that novices gut feelings areunlikely to count as essential role of perception was identified justafter World War II by the Dutch psychologist Adriaande Groot in the domain of chess (De Groot, 1965).

7 Hehypothesized that the crucial difference between grand-masters and amateurs would be in the way they searchthe maze of possible positions, with grandmastersexpected to search more deeply and consider moremoves. To test this hypothesis, he collected verbalprotocols where players had to try to find the best movein an unknown position while thinking aloud. Contraryto his expectations, De Groot found that there were onlysmall differences in the structure of search, but thatgrandmasters, in a matter of seconds, were able literallyto see potentially good moves and grasp the meaningof the position.

8 The importance of perception, even in agame such as chess that many would describe as logicaland intellectual, was supported by grandmasters abilityto memorize nearly perfectly a position that had beenpresented for a few seconds. It was also supported laterby the detailed analysis of the eye movements of strongand weaker chess players looking at a novel position (DeGroot and Gobet, 1996).The goal of this paper is not so much to review theextensive literature dealing with intuition and expertisein nursing (for pointers to this literature, seeField, 2004;King and Appleton, 1997) as to discuss two theories ofexpert intuition critically.

9 We start by briefly consideringthe role of intuition in nursing practice. Then, we discussBenner s (1984)influential theory , highlighting itsstrengths and weaknesses. We then argue that thetemplate theory of expertise (Gobet and Simon, 1996b)presents the basis for a theory of expert nursing intuitionthat explains all the key phenomena. In the discussion,we provide a direct comparison between benner s theoryand template Intuition in nursing practiceThe role of intuition in nursing has been the topic ofconsiderable debate, with some authors (such asEnglish,1993) considering that this concept should be subjectedto critical scrutiny at best and rejected at worst, whileothers (such asDarbyshire, 1994;Effken, 2001;Kingand Appleton, 1997) considering it central to ourunderstanding of nursing expertise.

10 In particular, thework of Patricia benner and her colleagues ( benner ,1984; benner et al., 1992, 1996) has done much toconvince the field of nursing of the importance number of studies have established that intuition innursing is a genuine phenomenon ( , benner , 1984; benner et al., 1992;McCormack, 1993;McCutcheonand Pincombe, 2001;Polge, 1995). These studies haveused methods such as group interviews, personal historyinterviews, surveys, and detailed observation, and haveoften been carried out within the frameworks ofgrounded theory and phenomenology. A strikingcharacteristic of this research, in comparison to researchon expertise in general (see for example the contribu-tions inChi et al.)