Module 5 A Wise Man Built His House Upon the Rock

As I was pondering on what to come up with in this blog in relation to our current module's focus on 'Decision Support for Care Delivery,' I immediately thought about the children's song for my title. It is quite fitting that the last step to completing this module is writing a blog about how the readings have influenced 'my perception of my own clinical decision-making' because I have learned a lot after going through each of the assigned readings and video by Daniel Kahneman. Our current topic was quite an abstract concept to me initially until slowly I got the gist of it and I have actually learned to appreciate the clinical decision support system! Graduating from a Philippine university about 5 years before the 2 'differential diagnosis systems' were even introduced (Meditel and DXplain as presented by Hammersley in a personal literature search), my concept of nursing management was based upon a theoretical framework of knowledge which, on many occasions, was not practical to implement because of limited resources and disconnect with what actually took place in hospital settings. I appreciated Tversky's study on how heuristic methods can lead to errors in judgment and this can impact our nursing decisions.

The combination of readings by Anderson, Brokel and Cortney  formidably build up a sound framework upon which a clinical decision support system can augment a clinician's ability to make sound decisions to effect quality care and patient safety. I remember writing a lot of nursing care plans based upon hours and hours of reading materials at school; I often  felt that these were just to satisfy the course requirements. How did  I reconcile what I've read about and what actually happened in the poverty-stricken hospital wards where aseptic techniques were more of the exception than the rule? Was I confident  that my patient's presenting symptoms were indicative of a particular diagnosis that the medical interns wrote down in the charts? Why was a patient being subjected to many lab tests and diagnostic procedures- was it because it was difficult to determine the principal diagnosis and a 'trial-and-error' method was the way to go, hoping that at some point we'd bump at the correct illness?

It was along these lines and  when I was reviewing for my US Nursing State Board in 1979 that I remember my husband coming up with the rudiments of  a clinical decision support system. He said that it would be really good if there was a computer application that can help with diagnosing illnesses based upon the input of symptoms. It was actually this idea that prompted me to critique DXplain for our assessment because my mind just went back to thirty years ago when he discussed this with me!

As I have expressed in my journal, the readings about clinical decision support systems have made me appreciate their role  in positioning nursing as an evidence-based practice. Speed and accuracy in obtaining information to make decisions in a clinical setting are crucial factors in delivering quality care and patient saftety. Unfortunately I have also read that inasmuch as medical and nursing clinicians and staff recognize the great help a CDSS provides, its adoption as a regular support system is not well taken because of several factors such as user competency and system acceptance as Cortney explained. I really hope that as nurses we can  recognize the role of informatics, an application of which is utilizing a decision support system,  in strengthening our knowledge base because it directly impacts our patient management. This way we can 'build' our nursing profession 'upon a rock' of evidence-based practice supported by a  vast knowledge base and consensus of experts. Nursing, then, becomes both an art and a science- a formidable tandem that impacts individuals, communities and  societies.