Here is a useful table identifying some of the more common thinking errors (and checks to help you flag them) that nurses are prone to make during their clinical reasoning processes.
|Anchoring||Tendency to lock onto features of the patient’s presentation too early during the clinical reasoning process||Have I considered all the factors yet?|
|Ascertainment Bias||Thinking coloured by prior assumptions and preconceptions.||Am I stereotyping, stigmatising or labelling my patient?|
|Confirmation Bias||Looking for evidence to confirm what you think is going on rather than looking for evidence to refute it.||What else might be going on here?|
|Diagnostic momentum||Once you begin to think you know what is going on, it becomes harder and harder to change track. Even when the evidence suggests otherwise||Am I remaining open to other alternatives?|
|Fundamental attribution error||The tendency to be attribute blame to the patient for their situation instead of focusing on root causes||Am I behaving judgementally here?|
|Overconfidence bias||Placing too much emphasis on hunches, opinion or prior experience||Does the evidence support my reasoning? Am I looking at this through beginners eyes?|
|Premature closure||Closing down your thinking processes, accepting a diagnosis before it has been fully verified||Am I still paying attention to what is going on right now?|
|Psych-out-error||When clinical conditions are wrongly attributed to mental health issues||Could this situation be due to a medical condition (hypoxia, delirium, electrolyte imbalance, head injury etc)|
|Unpacking principle||Failure to ‘unpack’ all the medical history and clinical signs ( for example: rushed assessment, poor handover, poor documentation)||Do I have everything I need to see the complete picture?|
If you are interested in reading a little deeper into clinical reasoning as nursing practice, I recommend you read this paper by Tracy Levett-Jones et al (pdf): Learning to Think Like a Nurse. from which this table has been modified.
Competent professional practice requires not only psychomotor and affective skills but also sophisticated thinking abilities. Nurses are responsible for a significant proportion of the judgments and decisions made in healthcare. Even new graduate nurses are required to make increasingly complex decisions about patients with diverse health needs. Effective clinical reasoning skills are a key factor in the prevention of iatrogenic harm. When cognitive errors occur nurses’ clinical decisions may be inaccurate and associated with inappropriate interventions that can lead to increased and untimely patient mortality.
Reference: Levett-Jones, T., Sundin, D., Bagnall, M., Hague, K., Schumann, W., Taylor, C., & Wink, J. (2010). Learning to Think Like a Nurse. HNE Handover: For Nurses and Midwives, 3(1). Retrieved from http://journals.sfu.ca/hneh/index.php/hneh/article/view/65