Module 4, Question 2

Outcomes based on decisions made from data that is gathered and documented by humans depends greatly on the accuracy of the data. Thompson (2003) states that the least reliable and valid form of evidence is the use of professional opinion without supplementary support or input. The article suggests and supports evidence based nursing practice for informed decision making via the use of clinical decision support systems. Androwich and Kraft describe a “push system” of clinical support where information is provided at the request of the clinician. These systems require current and expert information. If decision support systems are not based on current data based on valid and reliable studies, then decisions based on these systems will be outdated and inaccurate. Accuracy of patient diagnosis and recommended interventions suffers.

Nurses must also become proficient in summarizing, effectively phrasing, and capturing data in the appropriate location so that information can be retrieved for later use. This was been a problem at the Huntsman Cancer Hospital when a new computer charting system was implemented. In a “pull system” the clinician must enter data in order to initiate a request for information. Data that is entered inaccurately due to heuristics and biases generates information that cannot assist the patient as that patient has been represented inaccurately.

Module 4, Question 1

The readings on heuristics and biases helped me identify the root of potential flaws in human decision making. The biases that Tversky and Kahneman describe under “Representativeness” alone were enough to make me stop and think about various scenarios in which these biases can result in compromised patient care through poor assessment and diagnosis. For example insensitivity to sample size and misconceptions of chance can influence how we perceive statistics and the likelihood of outcomes. The article also describes insensitivity to predictability and the illusion of validity. Nurses can be influenced by a patient who is younger or appears physically fit, stoic, or is described favorably or positively by a previous practitioner instead of making a completely objective assessment. As a result, diagnoses can be delayed or incorrect. The remaining biases that were discussed that concern availability and adjustment and anchoring can also influence nursing decision in many aspects of daily work.

I feel that although years of experience can assist nursing in accelerated and more precise decision making, nurses must be aware of the potential of these innate biases to influence accuracy in decision making regarding patient care. Thompson (2003) discusses overconfidence which in my opinion can be more problematic as years of experience accumulate. I didn't give much thought to clinical decision support systems until now. I assumed that they were merely a short cut and a convenience. After researching one in detail and gaining an understanding of human biases and heuristics, I have come to appreciate their value as useful and important tools in health care.