In contemplating my own clinical decision-making, these readings made me examine my decisions that I make on a daily basis at work. Many decisions I make about necessary treatments and evaluation are done based on past experiences. I found the information provided to be very interesting and informative. I can understand how overconfidence plays a large role in determining interventions. Perhaps those situations where overconfidence occurs is when a person has vast amounts of experience in any given situation. To combat overconfidence, I must constantly be thinking critically and support my decisions with evidence, not experience. Not to say that experience is not helpful, just that evidence and interventions change frequently with improved research.
Other considerations that must be taken when making clinical decisions include examining objective data to develop an accurate diagnosis while attempting to eliminate hindsight. Also, as important, is placing sufficient weight on prior probabilities associated with the condition. Reading this information will allow me to develop better decision making skills, provided I keep these concepts in mind.
Decision-making in clinical practice should not be based on bias or heuristics. They can be effective but can lead to errors in practice. Paying conscious attention to personal bias and heuristics will make us better practitioners.
A midnight breakdown
17 years ago
I agree Shawna that nurses must apply caution when seeking advice from colleagues. But I diagree with the authors in thinking that advice based on experience should be disregarded. In looking at the the decision types that Thompson describes in table 1 "Communication" jumps out as a skill that many of us have learned through role modeling. I know that I have learned my best patient education practices by listening to colleagues and adopting some of their phrasing,methods of teaching and even relationship building approach with patients.
ReplyDeleteI certainly agree that we should not just use "advice" from others as our main reason for clinical decision making but I do think asking a colleagues opinion helps all of us to synthesise information and help develop strong clinical decision making skills.
"Ignorance begets confidence much more than does knowledge," is a quote that is posted in the unit which I work and it is what I thought about when reading your post. I feel that this is a huge fator regarding biased decision making whether the RN knows it or not and implies that overconfidence is readily the basis of much decision making and is a less than scientific process. Not that knowledge is not beneficial; I see this a lot as over 50% of the staff I work with are brand new and their foundation to which they practice upon is greatly lacking in differing situations. We all have to start from square one coming into the intensive care arena, but not having the experience behind you makes this a more difficult process.
ReplyDeleteI agree that to combat the heuristics and biases that come naturally to us it takes constant conscience effort by the practitioner to evaluate what it driving their decision making.
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