Module 4 Question 2

This is a difficult question, so, I am going to give two different spins off of how I perceive this question. One, several years back I worked for an intensive care unit that introduced an insulin drip protocol. This protocol was very aggressive and many of the nurse clinicians, including myself, struggled with compliance with the insulin protocol. The aggressive protocol continued to treat glucose levels with a continuous drip when glucose levels fell into the 60-70’s. As an experience clinician, I was highly critical of the suggested instruction by the protocol to continue the insulin drip, because of, “Redundant input variables,” from previous experience. I had a high probability of being right, knowing that before the next glucose check, my glucose would drop into the 40’s and 50’s, instigating the hypoglycemic protocol. I sought to thwart this negative experience of shutting off the insulin drip, pushing Dextrose 50, and starting a new cycle. This protocol data was evidence based, but lacked the consistency of providing accurate and intuitive guidelines to increase patient outcome. I found that by using the protocol I felt more at risk for negative outcomes than if I used the statistically wrong self probability scale based on past experience and current knowledge base. In this case, although there was intense ongoing research, the nursing data did not support accurate and consistent clinical decision support.

Second spin, computer based charting, medication administration, and information retrieval have greatly decreased medication error given to wrong patient, caught medication allergies to current or newly prescribed medications, provided an ongoing database for past medical history, and promoted consistency in care. These nursing or medical systems decrease the need for practitioners to have information overload, increase likelihood of prescribing the right medicine, treatment, performing the best intervention, and preparing for the best outcomes. However, each institution, clinic, unit, etc. need to evaluate and research how the intended nursing data will improve or relate to the decision made in that specialty. Not all data is universal, understanding the drawbacks, constraints, and ability to override guidelines are imperative to increasing the success, compliance, and attitude toward using informational technologies to guide decisions. The quality of the product has to be shown by the results, compliance, and success of the users, using the data.

Module 4 Question 1 Part 2

In answer to the second question, evidence based practice must be a priority in our practice when activating interventions based on past experience and/or positive probability of success. Most experienced nurses in specialized fields use a detailed instrument or guide to assist in their decision making process. Secondly, I am familiar with insulin protocols, blood pressure protocols, and emergency protocols that supplement the nursing practice. Using these protocols, interventions with evidence based practice and multiple research congruencies to increase validity, improve statistical data, and ultimately, improve patient care are imperative to increasing use by clinical practitioners. The nurse still relies on critical thinking to follow the guideline or make a clinical decision based on current patient situation, but the guideline or protocol is set in place to assist the nurse based on research, not just opinion, confidence, probability, or intuition. The introduction of new protocols can help reconcile poor human judgment heuristics, but may also undermine the autonomy and critical thinking of the nurse. However, teaching the nurse to base decisions after bouncing the idea through the guideline will greatly decrease the bias associated with poor predictions and increase the confidence level and trust level of the nurse using the guideline. Lastly, using an evidence based instrument correctly decreases and nearly eliminates the personal accountability placed on the nurse in case of patient/protocol issues.

Module 4 Question 1

I was appalled at my own clinical judgment based on the statistical knowledge and evidence based practice presented in the readings. Nursing schools stress clinical thinking and critical thinking throughout nursing school, with the intent of developing thinking and intervention skills based on pathophysiology, clinical experience, theoretical instruction, and improved clinical competence and confidence. However, the heuristics have human confidence and judgment decrease the effectiveness of critical thinking and nursing interventions based on non-evidence based practice, habitual experience, inflated self-confidence, and the reasoning for activating interventions. I thoroughly enjoyed the article, "Judgment under uncertainty: Heuristics and Biases," on page 1126, the article states, "People ten to have great confidence in predictions based on redundancy input variables. Elementary statistics tells us redundancy among inputs decreases accuracy even if confidence is increased. People that are often confident in predictions are often off the mark."

As I reflect on this statement, I clearly related how many times I act on a notion based solely on high probability of being correct, self-inflated confidence due to exceptional clinical experience, and more positive than negative result experience. Rather than searching tools that can improve my decision basis statistically more so than by experience or probability of being right.

Module 3 Question 1

I absolutely love to take tests that give insight on my personality, intelligence, or highlight strengths and weaknesses. I marvel that overtime personality changes to some degree and I become more rounded than prior tests, although I continue to excel in specific areas.

What strengths were highlighted in the results of your multiple intelligence test? How do you interpret these results?

The strengths that were highlighted in my multiple-intelligence test were linguistics, body kinesthetic, and a tie between intrapersonal and spatial-visual intelligences. These results imply that I am excellent at following instructions, strategically place myself in areas or situations that promote success, allow a wide variety of creativity, and do not restrict me to remain sitting or stay in one place. Secondly, I interpret these results as a way to align myself with research projects and team projects that would benefit from these strengths. Nursing is a team effort in every aspect and field, aligning my positives with others negatives may encourage some initial professional battles, but can ultimately; promote a more rounded and stronger work atmosphere, with many different accepted perspectives to enhance the end product.

What technologies might you incorporate to augment your personal learning based on these results?

Technologies that will improve my personal learning include: recent well written and well referenced books, papers, web-pages with excellent referencing, podcasts because they are tangible and portable, and video conferencing. Blogging is relatively new, to me, but also provides instant access from anywhere, clear instructions on use, and encourages extensive creativity. I struggle with online classes because of the lack of tactile or tangible material, there is no time to shine as a student, playing to my intrapersonal result, and educators and students alike can research material at their own pace creating a confusing environment where everyone is on a different page at any given time.