6.2.2 Does whether a choice is perceived as “easy” or “hard” make a difference to heart failure nurses’ clinical judgements?
Carl Thompson, Senior Lecturer, Health Sciences, Centre for Evidence Based Nursing, York, United Kingdom Co authors: Karen Spilsbury & Dawn Dowding, Jill Pattenden, Ros Brownlow
Abstract:
Background
Heart Failure Specialist Nurses (HFSNs) exemplify modern nursing roles. They face diagnostic, prognostic, and treatment decision uncertainties in practice and varying degrees of complexity associated with the choices they face. Little is known about nurses’ cognitive handling of this complexity.
Aims
- To construct a decompositional model of nurses’ decision making for two clinical judgement tasks
- To explore whether decisions classed as “easy” or “hard” by nurses are characterised by differing cognition.
Methods
Judgement analytic lens models for 29 HFSNs faced with two judgement tasks: a cognitively “easy” drug titration decision and a “hard” palliative care referral choice. Regression models and paired comparisons provided measures of agreement between the nurses, the linearity and non-linearity in information processing by nurses, and the degree of cognitive control exercised by them. Differences between nurses with varying degrees of education were explored using paired t-testing. The relationship between experience and measures was explored using bivariate correlations.
Results
Nurses varied significantly in their judgements and their weighting of information. The self reported difficulty of the decision tasks was less important for the cognitive handling of information and agreement between the nurses than we predicted. Nurses had high degrees of cognitive control in the drug task and far less (as expected) in the palliative referral condition. However, there was no change in the linear or non-linear processing of information of the two tasks. Education and clinical experience were not related to agreement or information processing.
Conclusions
Nurses self reported difficulty in decisions should not be relied upon as an indicator of decisional complexity. The title specialist nurse should not be assumed to default to clincial “expertise”. Thinking in a more sophisticated way about the relationship between experience, uncertainty, decision structure and information available may help nurses make better and more consistent choices.
Source of Funding: UK - Higher Education Institution
Amount in Funding: 10,001 - 50,000
Biography:
Carl Thompson is Senior Lecturer in the Department of Health Science at the University of York. He is a registered nurse with experience in adult acute, mental health and learning disability settings. He is Editor of the journal Evidence Based Nursing (BMJ/RCN publications) and has authored more than 80 peer reviewed papers, conference papers, professional articles and book chapters. He has co-edited two text books on evaluation and clinical decision making, with a 3rd due in 2008 to be published by Elsevier. He has (as a principle investigator or co applicant) attracted more than £1.4 million in research income from funders as diverse as the Medical Research Council and the Department of Health's post doctoral award scheme. He has presented as an invited keynote speaker or workshop organiser at a number of international research conferences (most recently Sigma Theta Tau in Vienna) and is especially interested in clinical decision making, evidence based practice and the ways in which nurses use information in clinical practcice.