Wednesday, March 4, 2009
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.
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Monte, I really like the way you said "using evidence cased instruments correctly decreases and nearly eliminates the personal accountability placed on the nurse in case of patient/protocol issues". I have always found protocols and guidelines to be a security in my practice. But there is the nurses responsibility to question the protocol when something seems out of range. For example the insulin protocol you mentioned. Part of it seemed wrong to you so you own heuristics made you question the program. I sometimes worry that too many nurses don't question the protocol or guidelines leaving their patients at risk. We always need to ask questions even if the questions are based on our heuristics and bias.
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