March 16, 2009
How do the readings influence your perception of your clinical decision making?
I think that the CDSS can be useful in my clinical decision making in a lot of areas but not all. The areas that would be helpful that were mentioned in the article "Clinical Decision Support System in Nursing" were the systems that aided in wound care assessment and treatment and pain treatment in cancer patients. We need to be careful about what we are using the system for. It seemed that the system that guided nurses in dosing of oral anticoagulation treatment of in-hospital patients is over stepping our scope of practice as nurses. This particular system may be helpful in guiding the dosing, but I don't think that we should be able to change a coumadin dose based on the systems recommendation. There are too many other factors involved, such as pharmicokinetics, drug-drug interactions and the patients current condition to just rely on a computer system throwing out a number based on just an INR. This particular example may have been relevant to APRN only. Over all I do think that CDSS can help us close the gap in evidence and practice, we just need to keep the nurse in the nursing practice to optimize patient care and critical thinking.
How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?
In the article "Clinical Experience as Evidence in Evidence-Based Practice", the authors talk about the different techniques health-care workers use to make their daily decisions when it comes to patient care. The most common mistakes made, according to the authors, when making clinical decisions were: overconfidence, hindsight and neglecting to use prior probabilities of disease or conditions in the population. Nurses tend to base their current decision on past experiences or other professionals opinions. I think this is most likely due to time constraints and the easiest answer is to either recall what worked best in the past or ask a trusted peer. This gives a quick and easy answer to our problem at hand. The article also mentioned that people fail to adhere to the normative model in real life decision making and I again think that we tend to take the easy way out. If it take less time and less effort, it sounds like the best choice. People are inherently lazy....including me!
How does nursing data quality relate to decision support?
According the the article "Judgement Under Uncertainty" the higher the data quality given, the better the decision that is made is supported. (that sounds so obvious) I found it interesting, as mentioned by the authors, that when given no evidence, we use prior probabilities and when poor or worthless evidence is given, we ignore prior probabilities. I would contribute this to the fact that our intuitive judgements are dominated and we rely on biases. We go with what we know and can recall quickly. This was not necessarily a good thing according to the authors. People rely on a limited number of heuristic principles and that decreases the complexity of the task when we are trying to solve problems. We try to simplify our problems or tasks. When given a set of data, we process it the easiest way, which did not always turn out to be the right way. It just seemed like the obvious way.
