The Experience of Knowing:

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1 The Experience of Knowing: A hermeneutic study of intuitive emergency nursing practice. by Joy Irene Lyneham R.N., B.App.Sci., GradCert.E.N., GradDip.C.P., M.H.Sc., F.R.C.N.A. Submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy University of Tasmania June, 2004 i

2 DECLARATION The material in this thesis is original except where due acknowledgement is given, and has not been accepted for the award of any other degree or diploma. This thesis may be made available for loan. Copying of any part of this thesis is prohibited for one year from the date this statement was signed; after that time limited copying is permitted in accordance with the Copyright Act Joy Lyneham 18 June, ii

3 ABSTRACT This study described the nature and component themes captured within the intuitive practice of emergency nursing; it also explicates the nature of expert practice as define by Patricia Benner in The history of intuitive practice or as noted in this study the experience of knowing has to this point only been anecdotal. The experience of knowing needed to either be validated or refuted so that its place in emergency nursing could be found. The study was informed by the philosophy and method of phenomenology. The participants in the study were fourteen experienced emergency nurses with between emergency nursing years. These participants through their stories and experiences of emergency practice expressed their experience of knowing. Through a van Manen process and Gadamerian analysis six themes associated with the ways in which my participants experienced knowing, were identified. These were named, knowledge, experience, connection, feeling, syncretism and trust. Further analysis uncovered a developmental relationship between the themes in general and with each other. Culminating in the reconstruction of Benner s expert stage into three distinct phases, Cognitive intuition, transitional intuition and embodied intuition. To enable the full expression of these findings a mathematical theory has been put forward. iii

4 DEDICATION This work is dedicated to my father the late L. M. Jack Lyneham B.E.M. ACKNOWLEDGEMENTS With special thanks to: My Academic Guides Dr Camillus Anthony Parkinson and Assoc. Professor Carey Denholm My Family Supports Daughters Heidi and Amanda Grandson Killian who kept laughter, play and crocodiles in my life My Participants To you a special thanks as without your stories and honesty this work would never been written. iv

5 CONTENTS Declaration ii Abstract iii Dedication iv Acknowledgements iv Prologue 1 Chapter 1. Concepts and Links Introduction The Context of Emergency Practice The Emergency Nurse Introduction The Practice The person The language Personal Reflections of emergency practice Tacit knowledge Thinking as a Process Research Question and Purpose of study Significance of study The Structure of the Thesis. 22 Chapter 2. Unfinished Concepts and Faulty Links: A Review of the Literature Introduction The Theoretical Influences on Ways of Knowing Decision-Making Decision theory Decision Errors The Effect of Experience on Decision-making Intuitive Decision Making Practice Development Five Steps from Novice to Expert Stage 1: Novice Stage 2: Advanced Beginner Stage 3: Competent Stage 4: Proficient Stage 5: Expertise Interpretations of Practice Development 43 v

6 2.8. Critical thinking and Practice Development Cognitive Processes in Practice and Decision-making Conscious Processes Unconscious Processes Non-Conscious Processes Consciousness: A Precursor of Intuition Intuition The Nature of Intuition Consciousness and the Patterns that Connect Research and Intuition Nursing and Intuition Intuition as Authoritative Knowledge Unfinished Concepts and Faulty Links The Practice Development Curve Challenging the Truth in Definition Conclusion 105 Chapter 3. Philosophical Concepts and Intuitive Links: The Phenomenological Tenet Introduction The Development of Phenomenological Thought Edmund Husserl ( ) Martin Heidegger ( ) Hermeneutics Jean-Paul Sartre ( ) Maurice Merleau-Ponty ( ) Hans-Georg Gadamer ( ) Phenomenology and Intuition From Philosophy to a Research Method Conclusion 139 Chapter 4. Methodological Concepts and Pragmatic Links Introduction The Structure of Hermeneutical Phenomenological Research The Nature of Lived Experience Setting Aside Self Investigating Experience as We Live It Hermeneutic Phenomenological Reflection Hermeneutic Phenomenological Writing Maintaining a Strong and Oriented Relation Balancing the Research Context 149 vi

7 4.3. A Missing Link Searching for the Stories Gaining Access to the Participants Study procedures The Story Tellers: the participants New Connections Preparing for the Interviews The Relationship with the Participants The Verbal Transcriptions Quandary Ethical Considerations The Structure of Interpretation and Analysis of Texts Establishing Trustworthiness Credibility Transferability Dependability Confirmability Conclusion Summation 171 Chapter 5. Thematic Concepts and Interpretative Links Introduction Intuition: The Participant s Experience Pre Understandings of Intuition Knowledge: All Encompassing Wisdom Experience: A Tacit Teacher The Essential Nature of Intuition Connection: Beyond the Walls of the Department Feeling: The Physical Voice Syncretism: Outside the Rational Self Trust: Accepting the Inner Self Conclusion 207 Chapter 6. New-found Concepts and Creating Links Introduction Contextual Background Cognitive Intuition Transitional Intuition Embodied Intuition Conclusion 230 vii

8 Chapter 7. Revisiting Concepts and Links Introduction Discussion Decision Making and Intuition Summary Decision Error and Intuition Opposing Views: Current Australian Critics of Intuition Practice Development and Intuition Comparative Research Intuition: A Reality of Practice Intuition: The Mathematical Relationship Challenges and Support Conclusion 267 Chapter 8. Final Concepts and Future Links Summative Impressions of Intuition Significance of this Study Limitations Further Research Research as a consequence of this study Research associated directly with the findings Research questions that arose during this study Implications for Practice 274 Epilogue 276 References 278 Appendix I Text of Advertisement 292 Appendix II Information Sheet 293 Appendix III - Consent Form 295 Appendix IV Interview Schedule 296 Appendix V Conference Presentations and Publications of this Thesis. 297 viii

9 LIST OF FIGURES Figure 1: Relationship of Concepts 25 Figure 2: Information Processing Model of Cognition 56 Figure 3: Information-Processing Model of Conscious and Unconscious Cognition. 60 Figure 4: Framework for Reflective Inquiry 73 Figure 5: Practice Development Curve 102 Figure 6: The Practice Development Curve 212 Figure 7: Graphic Representation of Practice Capacity 215 Figure 8: Practice Development Curve Explicating Expert Practice. 220 Figure 9: Cognitive Intuition 223 Figure 10: Transitional Intuition 227 Figure 11: Embodied Intuition 229 LIST OF TABLES Table 1 Comparison of the Experiential and Rational Systems 57 Table 2: Functional Categorisation of Intuitive Experience. 69 Table 3 Comparison of Vaughan and Goldberg s Categories of Intuition. 69 Table 4: Factors that Impede the Development and Use of Intuition 77 Table 5 Mathematical Expression of Practice Development 220 ix

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