How did the readings influence your perception of your own clinical decision making?
I thoroughly enjoyed the readings on heuristics, particullarly the video by Kahneman. This module helped me analyze how I come up with decisions,a nd why do I make them (based on my knowledge and past experiences). I liked the fact that I can combine my nursing knowledge with intuition, and experience in order to help a patient solve a heal problem.
As a school nurse I saw a particular student come into my office every day right after lunch because she felt ill. I used my knowledge and assessed the student, listened to bowel sounds, talked about what the student had eaten, and questioned her about hand-hashing prior meals. Everything seemed to be in order, and I could not find anything physically wrong with this student. Then, I used my intuition and began asking the student what class she had after lunch and she replied Math. We talked about her group of classmates in math class and if there was anything that was bothering her or making her uncomfortable. After a long chat, the student admitted that she hated math, and did not want to go because she was "dumb" and could not solve math problems as fast or as well as everyone else. Finally, my experience kicked in and I was able to help the student by talking to the teacher and getting some tutoring help for her; I also talked to the school counselor about helping this child with her self esteem and to offer her healthy coping skills when she encounters difficulty in school . Nursing is not balck and white, I was reassured that using my experience, and intuition along with knowledge is beneficial for the patient. Not everything is learned from a textbook, heuristics also plays an inportant role in nursing practice.
In my practice, I have seen the benefit of using clinical decision support systems because it offers evidence based clinical information at my fingetips. Thanks to reliable and up to date information, I can offer my patients quality health care that is patient centered, and also provide teaching that will help the patient make the best decisions for their health.
Great comments. I say from your experienced you did not only use intuition. You actually applied your clinical skills in ruling out the student;s problem. If the problem was not physical then what else could it be? And from taking her "history" you managed to arrive at the problem. In this case a CDSS may have helped you figure out that she may not have a physical problem with data from your assessment, but the critical part of talking to the student and still would require your clinical expertise as you have clearly shown, making the point that CDSS do not replace clinical judgement. Nice job!
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