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?

I teach community health in the undergraduate program at the University of Utah CON. Community or public health is a very diverse, ever-changing, dynamic, political and interesting subject matter. It touches almost every aspect of our daily lives. One of the subject matters we discuss is inequity in health care or more commonly known as health care disparities. On this particular subject matter, it is always very interesting to me to compare and contrast the comments, biases, and beliefs of my students. I found Dr. Kahneman’s lecture regarding intuition and biases very applicable to myself and my students. When answering the above question regarding heuristics, biases and nursing experiences, I find myself most drawn to the observation that people often derive their decisions based on availability of experiences and prior conceptions of people. When talking about health care disparities, it is a fact that African Americans have a higher incidence of hypertension. It is also true that there is a higher incidence of low birth weight babies among African American women. But why? Before I go on, ask yourself this question and see what your answers are. Often health care providers believe it is because of genetics, poor diet, poverty, low socioeconomic status, etc. These are common beliefs because this is the available information and description or biases about African American people. Based on this heuristic decision making, the health care provider would probably advise and /or prescribe interventions based on these assumptions or biases. For example, a dietary change or weight loss may be prescribed. In fact some of these may be contributory causes but studies have shown that a primary cause of hypertension and low birth weight babies in African Americans is due to high cortisol levels as a result of years of chronic stress due to social stigma and discrimination. Therefore a much great social change needs to occur to begin to reuce or eliminate this health care problem.
On another note, a very interesting book to read is How Doctors Think by Dr. Jerome Groopman. It indirectly talks about making decisions based on intuition, bias and availability of experiences versus evidenced-based practice and insensitivities to probabilities, etc. I think you would all enjoy it. (But not until you are done with school!)

How Does Nursing Quality Data Relate to Decision Support?
Science is the collection and analysis of data that we build and make our decisions with, whether it is in nursing, chemistry, physics, social sciences etc. If the data quality is not good or accurate then we risk making the wrong decision and therefore the wrong treatment is given, or the incorrect intervention is made and the results of the treatment could be worse than the original disease or problem. Quality nursing data is imperative to making the right decisions regarding patient care and is very important in providing consistency of care. In the article, Clinical Support Systems in Nursing by Anderson and Willson, it was interesting to learn that there was a low compliance among clinicians with clinical practice guidelines (CPG). One of the goals of this study was to discover how computerized decision support systems could bridge the gap between evidence and practice. They found that with a well managed and user friendly data management system, communication was improved among interdisciplinary teams, there was an improved consistency of care, issues related to care of pressure ulcers were more quickly identified and that available resources for information was more readily used.
I bring this up in my posting, because I also teach first semester nursing students and I am constantly stressing to them, the importance of evidenced-based practice. For example, I ask them how they know if a patient is at risk for a pressure ulcer and what the nursing interventions are to prevent one. They need to make the assessment and nursing intervention consistent from patient to patient. Without quality data this would not be possible.
This module’s readings have presented convincing evidence that decision support systems are effective in improving consistent and quality nursing care, when used in conjunction with quality scientific data.