Module 4: Question 1

WOW- what an eye opener. I will admit that this module was a brain stretcher for me. Three of the articles were eye-openers, one was sadistically brutal to endure (I much preferred watching Daniel Kahneman speak on YouTube for an hour than read the Tversky/Kahneman article). If your brain is exploding as you start to read it- go watch the video, then pick it up again. Okay- now lets answer the REAL question and stop editorializing......
This particular module has given me a one of the most profound experiences of self-reflection about how I practice as an NP! I spent the last three days working 10 hour shifts paying very close attention to what I was doing and how I was making my clinical decisions (except the flu shots which required little mental effort). I was amazed at how I picked up on what cues were directing me toward the "expected" diagnosis and how my formation of questions affected the patients responses. I became very aware of how I made assumptions based on (truly) very little information. I will even confess to finally giving in to pressure to write an antibiotic RX for a guy who I KNOW ( from an EBM standpoint) was probably too early for a sinus infection- but I allowed other cues to interfere. Social cues, social expectations, overconfidence, and a host of other problems definitely interfere with accuracy in clinical diagnoses. Having been an ICU nurse for many years, I have had experience of "sensing" something was wrong with a patient, even when I could not put my finger on it. I understand that, in a sociological sense, we nurses place a value on the experienced nurse and the "intuition" that comes with years of exposure to patients and disease conditions.
In my self-asssessment, I found evidence of what Tversky and Kahneman called the "representative heuristic", and the "illusion of validity". My errors of judgment, although not intentional (and probably not medically deleterious), are still worrisome. Understanding that these fundamental prolems in how humans process information ( Intuition versus Reasoning) was somewhat depressing in that it blatently exposed how fallible even the "experts" are! I looked up the book "Blink" that Kahneman referred to in his lecture to get the other point of view on this issue and thought to myself "nurses woud really like to have their experiences validated" but the evidence is just not there. I think that if at the core, nurses are advocates for patients, then we must be advocates for evidence-based medicine and nursing practice. This will mean reconciling the "touchy-feely" part of our profession with the realities of what we are tasked to do on a daily basis with regard to patient care and decision-making.