Module 4 Question 1

Module 4 question 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?

In my current position as an RN, physical assessments are completed every two hours, more if required by patient status. Any obvious adverse changes are presented to the LIP and charted in the nursing narrative. Often times important changes in patient condition are very subtle. Some of these changes are often ‘non-reportable’ and rely more on nurse’s intuition or a ‘hunch’. After reading the article by Tversky and Kahneman (1974) I am lead to wonder if the ‘gut feeling’ some nurses have towards a change in patient status is more related to retrievability and availability of the situation. As a nurse becomes more experienced, he/she is able to recall an increasing number of similar situations. Nurses are then able to assess the appropriate reaction required for the situation. Another bias I thought was applicable to my clinical decision-making is, “Bias of imaginability” (Tversky & Kahneman, 1974, p. 1127). In acute care setting it is imperative that nurses continually evaluate the level of risk. In some instances risk may be over-reacted to while other situation may experience the opposite. In either situation patient safety may be impacted.
In my observation the value of nursing experience is invaluable. Nurses make many decisions based on heuristics and biases. Tversky and Kahneman (1974) found, “In general these heuristics are quite useful, but sometimes they lead to severe and systematic errors” (p.1124). To reconcile nursing experience and known biases in decision-making, understanding their influence is imperative. A very experienced nurse may, “unknowingly overestimate the ‘correctness’ of their knowledge” (Thompson, 2003, p. 232). By simply learning about biases we as nurses can learn to take a step back from our clinical situation and evaluate if our clinical decisions are based on biases or evidence based practice.

References
Thompson, C. (2003). Clinical experience as evidence in evidence-based practice. Journal of Advanced Nursing , 230-237.
Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and Biases. Science , 185 (4157), 1124-1131.