Module 4 Question # 1 part 1

How did the readings influence your perception of your own clinical decision-making?
The readings gave me a new perception of how I make my clinical decisions. I definitely need to get the support that Computer-based Clinical Decision Support System can offer. In reading the material I first had to understand the full meaning of the term Heuristics. After understanding it more clearly as being defined as: Educated guesses, optimal solutions, problem solving, trial and error, and rules of thumb; I felt I could understand the Captivate presentation and the readings. In the Captivate presentation that Mollie gave, I realized that I am one of those nurses who has felt that if I didn't know the answers I felt less than adequate and unsure of my education. Depending on intuition and experience, or asking a more experienced health care provider has been the way I have primarily done things. I have always attended re- certification classes and gone to seminars yearly and the fact that I have always continued my education has helped my practice as well. I also subscribe to several journals, but as much as I use the Internet, I do not have a CDSS. This may be due to my non-traditional clinical setting in occupational health where I am the only health care provider and the company I work for is very tight in spending money. They feel that having just the Internet is enough and I do use it extensively, but not as efficiently as I could with a CDSS. Since my company pays for my tuition I plan to present what I have learned to my employer and request we get a CDSS. I feel that I can help them see the importance of this.


In the Thompson article, I found the information on Combating overconfidence interesting. I have a physician who come once a month and I look forward to interacting with him, but he tends to ignore the detailed knowledge that I have concerning a patients I am having him see and often jumps to his own conclusion before giving me a chance to have input. He is not interested in consulting with me or teaching me from his more advanced knowledge base. For example, I see a particular patient several times a week and he may see him twice a year, but he jumps to a quick diagnosis upon seeing one elevated blood sugar for example and then leaves, disregarding the other signs and symptoms I present for his opinion. I ended up sending this patient out for a neurological consult. He has Meniere's disease. When my opinions and research has been disregarded because "I am just a nurse " it certainly undermines my confidence. I would like to be treated more professionally.


I also enjoyed the material on Hindsight that Thompson (2003) gives. I felt it was important advice to make sure that as nurses we make sure we do the work-up before we come up with our prognosis. If a patient has already been diagnosed with diabetes for example, we tend to look at everything from that point of reference having priori knowlege as Thompson (2003) explains.