My Own Clincal Decision-Making

How did the readings influence your perception of your own clinical decision-making?

These readings were thought provoking and gave me a greater self awareness as I critiqued my RN practice and my attitude regarding Evidence Based Practice. As I considered these readings my opinion and value of EBP has improved and grown. I actually regret the many shifts I have not considered EBP as I coasted through my RN professional experience.

The power point “Decision Support for Care Delivery: A few high points…” by Katherine Sward had me consider where I fall on the levels of nursing experience. I find that I am a proficient nurse for the most part, even though I do exhibit intuition as a natural result from experience. It has been years since I evaluated and rated my own personal nurse level; and I have never stepped back and considered how I come to a professional decision. It was enlightening to discover that there are biases that are truly inconsistent as I make decisions and provide what I had hoped was the best possible patient care. I find that I have always appreciated the if-then application of logarithms that are commonly used in my RN practice settings (i.e. ACLS, neonatal hypoglycemia, and adult diabetic insulin sliding scales). These practical decision loops allow me to take my bias out of my practice and act with objectivity as I treat numbers that are dynamic levels. These dynamic levels represent what a patient is doing, and how a patient needs interventions. Considering my present practice as an RN had me realize the safety and consistency of Clinical Decision Support Systems and the relationship of Evidence Based Practice. I realized the power and validity of these combined tools for the bedside nurse and for the practicing Family Nurse Practitioner.

The article “Judgment under Uncertainty: Heuristics and Biases” by Tversky and Kahneman was quite informative and introduced me to heuristics---a world of beliefs I had not realized I was a part of. I was particularly impressed by my own overused bias that is “due to the retrievability of instances” and I was shocked as I reflected on my practice as a RN and realized how often I use this bias unknowingly out of habit and even professional laziness.

The article “Clinical Decision Support Systems in Nursing: Synthesis of the Science for Evidence-Based Practice” by Anderson and Willson was a strong demonstration to me of the need of RNs and NPs to incorporate Evidence Based Practice via logical decision making methods into practice via clinical decision support systems. I was impressed by the arenas where CDSSs demonstrated their effectiveness (i.e. Toowoomba Adult Triage Trauma Tool (TATTT) and the Pressure Ulcer Prevention and Management System (PUPMS)). This article had me consider if I would use such tools to make effective and consistent decisions in the future as a FNP.

The article “Infusing Clinical Decision Support Interventions into Electronic Health Records” by Brokel had me consider what areas of clinical decision support I have used in my past years of experience as a RN. I was not aware how the clinical knowledge I received via numbers that represented levels I was monitoring (i.e. glucose or hormone levels) was the beginning of a complex system of patient related information in which I was actively participating. My participation in these systems, or CDS interventions, allowed me to unknowingly “support nursing care processes across shifts and settings” (Brokel, p.350, 2009).

My greatest understanding I received from the readings was my need to be a more conscientious bedside nurse and nurse practitioner. My clinical decisions, clinical decision making techniques, and practice need to be crisper and need to be more knowledge-based, i.e. need to be evidence based practice. This consistency will benefit my practice, my patients and nursing as a whole.