Über den Autor und weitere Mitwirkende
GARY KLEIN, Ph.D., Chairman and Chief Scientist of Klein Associates, is the author of Sources of Power, named by Business & Strategy as one of the best books of the new millenium. He is renowned for his pioneering work with the U.S. Marines, firefighters, and business organizations in determining the role intuition plays in individual performance. He lives in Yellow Springs, Ohio.
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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.
Some infants spend only a couple of days in the NICU. Some are there for several weeks or more. And some do not survive. The nurses must also deal with this reality.
Some nurses find the challenges and the mission rewarding and choose to make neonatal intensive care their career. However, many nurses new to the NICU burn out in less than eighteen months, overcome by the complexities and unrelenting stress of caring for the tiny lives in the balance.
"Darlene" was a good example of someone who flourished in this environment. At the time of this incident she had become the assistant clinical coordinator for the NICU. This meant that in addition to working regular shifts on the ward, she was responsible for scheduling, hiring, and firing other nurses. Darlene had a bachelor of science degree in nursing. All of her nursing experience was with babies, and she had spent the last six years working in the NICU.
"Linda" was also an experienced nurse, although she was new to neonatal care and was, therefore, still considered a trainee. She had completed her orientation in the NICU and was working shifts on the floor, mentored one-on-one by Darlene, although they each had responsibility for different infants. The two had been working together this way for several months, so by now Darlene was doing more monitoring than instructing.
A Baby in Crisis
Linda had primary responsibility for an infant girl, "Melissa." By NICU standards, Melissa was not a particularly tough case. Melissa was a "preemie" and tiny like most of the babies in the NICU, but she had no major problems that had to be overcome. She simply needed a little support until she could grow herself out of danger. She was not on a ventilator. She was able to take small amounts of formula in a bottle--up to two ounces at a time--and her young parents had even been able to hold her during feedings. She was putting on weight, and all signs indicated she was on the road to becoming a healthy baby girl.
It was early in the morning, and Linda and Darlene were nearing the end of an uneventful shift. Thankfully, there had been no emergencies. If anything, Melissa had been less fussy than usual. Maybe this was a sign that she was getting better. The ward was quiet and deserted except for the infants and their nurses. Like most visitors, Melissa's exhausted parents had gone home after keeping vigil during the day. The lights on the ward were turned low, except for a small light at each station that allowed the nurse to do her work--an ongoing routine of taking temperatures, changing diapers, feeding, administering medicines, recording readings from the monitors, and adjusting settings on the equipment in accordance with the treatment prescribed by the physician. Frequently an alarm would sound from one of the babies' monitors, but almost invariably it was a false alarm--usually a lead had come loose, interrupting the data input. A nurse would appear, calmly check the situation, and reset the monitor. Occasionally, a baby would fuss, and a nurse would respond. Otherwise, the ward was quiet.
During her scheduled feeding Melissa had seemed a little lethargic, but who wouldn't be at that hour? Linda had regularly checked Melissa's body temperature and found it a little low over several checks, though still well within the normal range. She turned up the thermostat in the isolette each time to make Melissa more comfortable. Late in the shift a medical technician had come in to take a routine blood sample for testing. This had been done by a heel stick, a small prick made in Melissa's heel. The technician had covered it with a small, colorful Band-Aid. A good med tech will make an almost imperceptible heel stick that closes up almost immediately. A sloppy heel stick might bleed for a few minutes. Melissa's heel stick was bleeding a little bit, creating a dark blot on the Band-Aid.
Melissa was Linda's...
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