Module 4, Question 1

I remember when I was in nursing school, the further I got into the program, the more I realized how much more there was to learn and how little I really knew. The readings helped bring up that memory for me. I think this attitude is what Thompson was referring to in discussing over-confidence and how to combat it. In this regard, and in many others, the readings greatly influenced my perception of my own clinical decision making. Where I work, the nurses are extremely independent in their decision making. And since I have been at that same place since I graduated from nursing school, it is the only way I know. It is probably true that after almost 12 years of experience in one place, that I have gotten a little "cocky" in my clinical confidence and need to re-adopt my attitude from when I was in nursing school. Don't get me wrong, I think there's a lot to be said for years of experience, but we need to realize that we can't solely depend on that when it comes to our decision making.

I can also see some of Kahneman's points in my own practice. Again, since I have been in the same place, with basically the same patient population for a long time, I have actually been quite sheltered. There are a lot of heuristics that I use, and so far, (knock on wood), I have not seen any "bad outcomes" as a result of these, but I realize now that I need to be aware of my own perceptions when I make judgements, especially in circumstances that I have never been in before.

I hate to say it, but I think heuristics is a fancy way of saying "human laziness." We get content and complacent in our own little worlds and don't make the extra effort to research and think things through all the time. Sometimes, we do things because it's the way we've always done them, or it's the only way we know how. Being back in school has really helped revitalize my way of thinking, and this module is a perfect example of that. I think heuristics are always going to be present, but I think the biggest way to combat them is to even be aware of them.

I recently got into a heated discussion with a doctor about a decision he made that I did not agree with. Granted, the final call was not mine to make, but I went home and researched the situation, and was pleased to find good evidence in support of my opinion of the situation. I think this would have been a perfect example of how a doctor (and patient) would have benefited from some evidence based research, and not relied on "the way he had always done things."