Module 4 - Part 1

1. How did the readings influence your perception of your own clinical decision-making? How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?

The Health Evaluation through Logical Processes (HELP) hospital information system so permeates throughout my practice at Primary Children’s Medical Center that it is difficult to know where it starts and where it leaves off. But it is a reassuring fact that the clinical decision support system will trigger a pharmacy order change when a clinician miss-orders the dose of a drug. Does it take away from the utilization of my clinical expertise? Absolutely not, this system augments my ability to accurately deliver care. This and other systems like it, decrease medical errors. Anderson & Willson (2008) note that there is no indication of improvement in nurses’ knowledge or clinical decision making with the use of clinical decision support systems yet Dong et al. (2005) reported a significantly improved implementation of triage methods when compared with memory-based triage methods. How could a clinician’s learning not benefit from consistent implementation?

The Tversky and Kahneman article, Judgement under Uncertainty: Heuristics and Biases, blew my mind. What blaring examples. We make “judgments under uncertainty,” with certainty, all of the time! These judgments are commonly made on irrelevant evidence. The demonstration of intellect by these authors leads me to believe that most of us bumble through life without using half of our brains as a matter of economy. For example, despite having learned about probability, we may fail to apply it to common situations. We anchor decisions on irrelevant input...unknowingly. Only 15% of our practice is based on evidence. As Thompson (2003) notes, evidence-based practice is the systematic means to combat that bias. Practice based on evidence should be the gold standard. That being said, that evidence must continually undergo rigorous analysis for subtle biases to maintain integrity.