Intuition at Work Why Developing Your Gut Instincts Will Make You Better at What You Do

1 A Case Study of Intuition I don't think you can make effective decisions without developing your intuition. To illustrate why intuition is so important, I've selected an incident that contrasts two nurses, each facing the same crisis. One of the nurses has developed intuitive decision-making skills and one is trying to acquire these skills. The example describes the decision making of nurses working in an NICU. That stands for neonatal intensive care unit, the hospital ward where they keep close watch on newborns in critical condition. Background Most of the infants in an NICU have been born prematurely. Some weigh a pound or less, and many are born with underdeveloped respiratory, circulatory, or immune systems. Each infant is placed in its own isolette or medical bassinet, and attached to little adhesive leads that provide data to a bank of monitors displaying heart rate, blood pressure, respiration, blood oxygen level, and other vital statistics. Nourishment might be provided through an IV (intravenous feed) or through a drip tube snaked down the esophagus directly into the stomach. A thermostat precisely controls the temperature in the isolette. One of the risks in the NICU is the danger of infection. To gain access in order to see and hold their babies, parents perform a five-minute surgical scrub from hands to elbows. Children are strictly prohibited because they are exposed to so many germs and can easily transmit them to the babies. Homemade get-well cards and photos of Mom and Dad, brothers and sisters, cousins, and family pets are often taped to the glass walls of the isolettes. A small rubber toy, such as a Mickey Mouse or Winnie the Pooh figure, might be placed in the isolette as a companion, but only after first being sterilized by the nurses, because a stuffed animal might carry dust mites. Feedings have to be carefully calculated. The goal is obviously to help the baby grow, but it is equally important to make sure the baby does not add body weight faster than heart and lungs can support. Not only is nutrition intake carefully measured, but so is the waste coming out the other end. Every diaper is weighed to gauge the baby's metabolism. Practically every aspect of intensive care in the NICU involves continuous monitoring and adjustments to maintain a precarious balance in these fragile human systems until the babies can grow themselves into stability. During the day a steady procession of medical technicians comes through to take blood for routine testing, perform sonograms or other procedures, administer respiratory therapy, or deliver medications. But it is the primary NICU nurses who are on the front lines. They are responsible for administering the treatments established by the physicians, monitoring the baby's condition, and being alert to any signs of change. With infants in these fragile conditions, many things can go wrong, and practically all of them can become life threatening. One of the greatest and most common dangers is sepsis, a systemic infection that spreads throughout the infant's circulatory system. Sepsis can be deadly, especially for low-birth-weight babies. Premature babies come into the world with an underdeveloped immune system, making them particularly vulnerable. The first line of defense against infection is the baby's intact skin and mucous membranes, but in the NICU, that defense has been penetrated by IVs, catheters, and other invasive measures. Sepsis can be detected by a blood culture, but this test takes twenty-four hours and by then the baby might be overwhelmingly infected and beyond help. The onset of sepsis is often accompanied by very subtle changes in the baby's status. The nurses' ability to recognize these subtle changes is the key to early detection of sepsis and appropriate intervention. The nurses in the NICU must be continuously on guard against the potential danger of infection. SomKlein, Gary is the author of 'Intuition at Work Why Developing Your Gut Instincts Will Make You Better at What You Do', published 2002 under ISBN 9780385502887 and ISBN 0385502885.