The clinical decision support readings definitely made me aware of how I make a lot of my clinical decisions. I definitely draw on experiential knowledge when I make clinical decisions. I realize that this knowledge is helpful and is not all bad, but that there is another dimension of knowledge to be utilized. The 5 typology medical categories of physician types of uncertainty do apply to nurse practitioner care, but is only the tip of the iceberg when compared to the uncertainties that apply to my philosophical approach as a nurse. For example, when prescribing a medication I certainly want to utilize the best evidence based data regarding the effectiveness, dosage and side effects, but then rely on experiential knowledge regarding taste, ease of administration, cost and patients ability to pay. However this experiential knowledge also could be evidenced based practice that isn’t always recognized as critical to the outcome, but the right medicine not being administered or not affordable ultimately does affect the final results. This is where quality nursing data could be invaluable and incorporate nursing interventions based upon research and evidenced based practice.
As a seasoned nurse practitioner this literature also made me recognize that I frequently do utilize heuristics in making clinical decisions. I often use an approach of what has worked from patient feedback, a seminar I may have attended or a drug representative presentation. I then rationalize that this must be the best clinical decision because it has worked in the past.
Personally for me to reconcile the clinical decision gap between heuristics and biases used in human decision making is to be more committed to an evidenced based practice by utilizing the research available to me through the skills I have acquired to access and retrieve the information more efficiently. I can no longer use the excuse that the practice I am employed by doesn’t value the use of technology or provide available resources. It is up to me to be proactive and fundamental that I lead the way to achieve this goal.
2 comments:
These readings also opened my eyes to how easy it is to slip into your own way of doing and percieving things. I was glad to look at my decision making processes from another perspective to help me improve.
I was appalled at some of the biases I use in making decisions. I had never thought about probability before and these articles have caused me to seriously reflect on how I do make decisions. I also had never thought of the condition of "uncertainty" and on first reading the articles, couldn't imagine how they would pertain to me! I have spent alot of time in this course eating my words, repenting for past behaviors, and anxiously looking to the future to redeem myself!
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