Module 4 Part 1, Question 1

How did the readings influence your perception of your own clinical decision-making?

The readings influenced my own clinical decision-making in various ways. Anderson & Willson (2008) brought up several interesting points, (1) we as clinicians do not adhere to CPG,(2) the system where I currently work is one of those systems that is used for evaluating the decisions that nurses make, not as a tool for helping nurses make clinical decisions, (3) we lag behind medicine, and I so wish we didn’t.
Above, I mention the system where I currently work. The beauty of this system is that it has potential. Recently we put in a new tool called the CIWA scale. It is a CDSS that allows the nurse to make a decision on how much Ativan an ETOH addicted patient needs in order to stay out of DT the danger zone, and when to call the physician. We have used it several times and so far it works awesome. The nurses feel empowered, the patient receives appropriate care and the physician is not called as frequently. Hopefully this will catch on in our hospital. I think nurses want to stick to CPG but are not empowered to do so by the facilities they work in or they have no time to see what CPG would determine as appropriate care because it is time consuming to find. Nurses may lack adequate computers and/or researching skills and the culture they work in may not support evidence-based change (Thompson, 2003). I know many physicians that use the Up-To-Date software program on a regular basis, I too have utilized this software and like it. If physicians are taking the time to find timely information in regard to patient care then so should nurses. Hopefully, with the advent of new nurses graduating from nursing schools who desire to practice using evidence-based nursing practice, our culture of not sticking with CPG guidelines will change.