How does nursing data quality relate to decision support? Anderson & Wilson (2008) looked at evidence-adaptive CDSSs at the point of care (eg.; ED triage). Nurses learn by the age-old "hands-on" approach and base their decisions on objective data (which is subject to bias) or based on what someone else verbalized (heresay). This is the second stop point for practice errors and the need for decision support use (bias being the first). We've come to live with a certain amount of error and have built it into our statistical data as a p-score.
Anderson & Wilson discuss the use of CPGs (Collaborative Practice Guidelines) as a useful tool to bridge evidence and practice. If nurses were able to quickly find specific CPGs, accuracy in treatment and improved outcomes would most likely improve. Correct/quality nursing data (minimize cognitive errors)and education on use of decision support systems (CPG or other CIS tools) were shown to "significantly increase...diagnoses and management care." Why? There's no need to carry around drug books, diagnostic helps, flip charts. We have handheld PDAs that offer evidence-based information at the touch of a single finger now...
Monday, October 19, 2009
Module IV -
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?
Kahneman (1974) and the concept of anchoring is, as it were, a starting point for our subjective analysis...of ourselves. The reading discussed cognitive biases based on probability, historical repetition, and our own judgmental heuristics. Particularly in the ED where repetition sometimes taints our perception of probability, I have had to consistently re-evaluate my own biases and beliefs and realign them on an individual basis. Why? We are human. We base our opinions and perceptions on what we have seen or learned previously. We are susceptible to systematic errors in our thinking. We never have ALL the data to make an accurate judgment call 100% of the time. Kahneman's lecture and PPT showed a number of visuals that seemed to be one thing, but were quite another. As humans, we rely on our imperfect senses, primarily sight.
How do we reconcile the value of nursing experience based on this knowledge? As in personal life, we must be willing to look past our own noses. Yes, experience gives us foundational information by which we make decisions, but comfort lulls us into complacency and contributes to further cognitive errors. Reconciliation is based only on our willingness to allow our other senses to collect information, encourage communication, continually learn, and be open to introspective analysis about who we are and why we do what we do.
Kahneman (1974) and the concept of anchoring is, as it were, a starting point for our subjective analysis...of ourselves. The reading discussed cognitive biases based on probability, historical repetition, and our own judgmental heuristics. Particularly in the ED where repetition sometimes taints our perception of probability, I have had to consistently re-evaluate my own biases and beliefs and realign them on an individual basis. Why? We are human. We base our opinions and perceptions on what we have seen or learned previously. We are susceptible to systematic errors in our thinking. We never have ALL the data to make an accurate judgment call 100% of the time. Kahneman's lecture and PPT showed a number of visuals that seemed to be one thing, but were quite another. As humans, we rely on our imperfect senses, primarily sight.
How do we reconcile the value of nursing experience based on this knowledge? As in personal life, we must be willing to look past our own noses. Yes, experience gives us foundational information by which we make decisions, but comfort lulls us into complacency and contributes to further cognitive errors. Reconciliation is based only on our willingness to allow our other senses to collect information, encourage communication, continually learn, and be open to introspective analysis about who we are and why we do what we do.
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