The nurses in the cancer ward where Hanna Marie Ihlebæk did her field work didn’t think to tell her that they used their sense of smell at work.
Ihlebæk recognized the smell of vitamins from her childhood vitamin supplements, and spontaneously asked if there were other things nurses could detect by smell.
Of course, they answered.
“For example, a urinary tract infection, or clostridium (an intestinal infection that causes diarrhoea). It’s super easy to smell!” one nurse replied.
“A urinary tract infection is very distinct. I can recognize that smell out in the corridor,” another said.
And, “With experience, the smell is so obvious that I almost don’t have to test for it. But of course we always test to confirm,” said a third.
A natural part of the job
“For nurses, using their sense of smell was simply a natural part of how they made patient assessments,” Ihlebæk says.
“It wasn’t something they told me as a part of how they did their job, because it was so obvious. It was also a type of knowledge that was difficult to put into words.”
As part of her doctoral research, Ihlebæk spent five months at a cancer ward in a hospital that had roughly 5,000 employees. The nurses she observed were aged 25 to 50, and had anywhere from two to 25 years of experience.
Ihlebæk is employed at Østfold University College, and is doing her doctoral thesis at OsloMet. She studies how nurses use knowledge on the job, and became particularly interested in how senses like smell played a big role in their work.
“They use all their senses, more or less consciously,” Ihlebæk says.
“Looking at patients is a very conscious action, hence the term ‘the clinical eye’. Watching and touching, feeling the patient — these are things the nurses were more aware of and were able to explain. Nurses explicitly learn to look for certain things. The sense of smell, on the other hand, is just ‘on’. They do not use it actively unless they smell something wrong. So there is a more unconscious use of that sense,” Ihlebæk says.
Senses as a source of knowledge
Using senses in nursing undeniably sounds vague. The clinical eye is then also surrounded by a certain mysticism.
“Some people call it intuition, or the sixth sense. It often seems a bit mystifying, as if it’s a trait you just suddenly get,” says Ihlebæk.
In reality, the clinical eye is not mysterious at all.
“The clinical eye is a way to put together information from all the senses when assessing a patient. When nurses say ‘I feel like something is not quite right here’, it means they have combined what they intuitively have seen, smelled, know and felt in relation to the patient, linked to the theoretical knowledge they have about illness and the body,” says Ihlebæk.
“To be good at this, nurses have to have a conscious relationship with it, and they have to have time to discuss it with other colleagues and have time for their patients. It’s just like other types of knowledge that have to be acquired,” she says.
Intuition and knowledge
Edith Gjevjon, a nurse and editor of the Norwegian nursing journal Sykepleien Forsking, recognizes herself in Ihlebæk’s descriptions.