Anderson and Willson (2008) state, “The use of computers to aid in nurses’ decision making is a new and exciting area for the nurse theorist and one that is just beginning to be explored. Additional theoretical models for the development and testing of CDSSs in nursing are needed. More research is necessary to determine whether CDSSs offer an effective strategy for translating evidence from research into nursing practice.” Their data showed that CDSSs were more accurate than staff decisions. While it is a positive thing that decision support systems are unbiased, they can’t take place of specific cases and the individuality of each person seeking care. I found that my nursing experiences do play a role in determining diagnoses, even though technically I do not diagnosis as a Registered Nurse.
The Thompson paper states three common heuristics and biases: overconfidence, hindsight, and base rate neglect, and I have been bias in all three ways, especially with hindsight bias. Three more that are mentioned in the Kahneman and Tversky (1974) paper are representativeness, availability, and adjustment from anchors. I see this as I ask certain questions, anticipating what their answer is going to be, or based on past experience, I deem which patient will be more emergent to see than others, downplaying patients who do not seem to have typical symptoms of pain or discomfort. One way we can reconcile the value or nursing experience with known heuristics and biases used in human decision making is to simply recognize that we do enter the nurse practitioner field with biases. Just as Kahneman and Tversky (1974) state at the end of their paper, if we have a better understanding that these biases occur, our judgments will improve.
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Sue,
ReplyDeleteUnfortuantely we all have been guilty of biases, especially the hindsight version. You were correct in your statement that we need to be aware that we have our own biases prior to even entering the healthcare arena. By acknowledging the fact that we have biases, we will be better able to treat our patients.
Yes, as registered nurses we do not typically "diagnosis", but we are continually evaluating our patients and looking at differnetial diagnosis that may apply. Often we may not realize we are even doing this, but reflect back on how many times you have a patient with a diagnosis, but as their condition changes, you begin to look for other causes, or differential diagnosis. Often the nurse is the first one to pick up on these changes and notify the health care provider.
Thank you for your insight.
Sue, I also found that I have been bias in all of the three areas mentioned. I found it interesting as I read through this article, how I could relate almost every example to something I have seen in the clinical setting. I think for this reason, I liked this article the most of the three. The content was more relevant and familiar to my than the other two. It gave me a lot of insight to how we behave in certain situations and why. Now I just need to figure out how to change that! -JIll Wilson
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