Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare professionals
Abstract Background: Dutch child and youth health care (CYHC) professionals monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-professionals use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-professionals when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines.Methods: A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which were followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results: The majority of CYHC-professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-professionals use intuition to: 1) sense that something is off, 2) differentiate between ‘normal’ and ‘abnormal’, 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn for its dangers as it may lead to ‘tunnel vision’ and false accusations. Conclusion: Intuition is experienced as an integral part of the work of CYHC-professionals. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC- professionals use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a ‘good care’ practice.