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.
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I find your statement, "I was appalled at my own clinical judgement..." to be refreshingly honest as well as humorous. I, too, have found that I often rely on my past experiences (nothing bad has happened when I tried that, so let's do it again!) to implement the work-around solutions so common to nurses. I think, though, that we must cut ourselves a little bit of slack...we are taught in nursing school to be critical thinkers and do get introduced to pathophysiology and instruction for providing care based on evidence. However, I can't even count the number of times I have come across a completely new situation, one that nursing school never prepared me for - except in using critical thinking skills. So in a way, we are actually taught to use heuristic thinking, and critical thinking - as opposed to just random guessing about a situation.
ReplyDeleteBut, of course, I do see know that we must be better at accessing and utilizing the evidence based research.
Monte,
ReplyDeleteI loved your point taken from the article, "Judgment under uncertainty," where they stated, "People tend to have great confidence in predictions based on redundancy of input variables. Elementary statistics tell us redundancy among inputs DECREASE accuracy even if confidence is increased." I had not really thought about the possible effects of relying on our "rules of thumb", intuitive judgments, or educated guesses, even though I had seen the point you made above in my Statistics class this summer. I had also seen this same message through our other readings where they said that while using our heuristics may work well under most circumstances, it can also lead to errors! Good to keep in mind. I feel that using EBP to guide us and also NOT discounting the worth of our experience and knowledge would be the perfect balance, don't you?