Why providing information for evidence based decision making by nurses is a bad idea
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Why providing information for evidence based decision making by nurses is a bad idea…. Carl Thompson UK Department of Health, Senior Research Fellow. What is he talking about…?. That the context for EBN means that information (no matter how good the quality) is never enough

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Why providing information for evidence based decision making by nurses is a bad idea

Why providing information for evidence based decision making by nurses is a bad idea…

Carl Thompson

UK Department of Health, Senior Research Fellow


What is he talking about
What is he talking about…? by nurses is a bad idea…

  • That the context for EBN means that information (no matter how good the quality) is never enough

  • 10 information myths that illustrate the reality of EB decision making

  • Nurses vary enormously in their handling of even experientially-generated, relevant, knowledge – so what hope for research info.

  • That using evidence involves costs, benefits, trade-offs: it’s a PURCHASING decision made by members of a COMMUNITY (of practice)


context (errors, information, combination and unknowns) by nurses is a bad idea…

Patient

Safety and decision

making


context (research ) by nurses is a bad idea…

  • 2 multi site case studies (1997 – 2002)

    • theoretically sampled

    • 200 in depth interviews

    • 400 hours observation (decision making and information use in action)

    • 4000 documents audited

    • Q methodological modelling (242 nurses)

  • Social judgement modelling (critical care and community nurses, 2003 – pres)

    • “Think aloud” and video

Thompson et al. 1999, 2000, 2001

2002, 2004, in press


context (information to knowledge) by nurses is a bad idea…

10001000110011010… if X then Y and Z


Context (learning) by nurses is a bad idea…

Behavioural trends,

Changes and

Incremental

modification

Repetition

Activity

Behaviour

Practice

Training

Observation

experience

Learning

Observable…unobservable…observable

Hilguard, Marquis 1961


Typology of decision related uncertainty
Typology* of decision related uncertainty by nurses is a bad idea…

  • Intervention/effectiveness

    • Targeting

    • Timing

    • Prevention

  • Referral

  • Communication (risks and benefits)

  • SDO

  • Assessment

  • Dx

  • Information seeking

  • Experiential, understanding or hermeneutic

* Kappa 0.82 Thompson et al. IJNS 2004

Thompson et al. 2000, 2001

2002, 2004; McCaughan et al. 2002


The information response
The information response by nurses is a bad idea…

  • 270 hours of PCO observation ‘external’ resources used:

    • 19/115 patients (district nurses);

    • 57/224 patients (practice nurses and nurse practitioners);

    • 15/55 patients (health visitors).

  • 75% of these for pharmaceutical information needs.

  • 85% of ‘external sources’ other colleagues or PCO members otherwise BNF (x2 on-line)

  • 180 hours of acute care observation (circa 1080 decisions) only 2 forms of text based information used (local guidelines x 4 and BNF x 50)


The 10 information for nurse decision making myths
The 10 information for nurse decision making ‘myths’ by nurses is a bad idea…

  • Only objective information is valuable

  • More information is always better

  • Information can be transmitted without context

  • Information can only be acquired from formal sources

  • Relevant information exists for every need

  • Every information need has a solution

  • Information can always be made accessible

  • Functional units of information fit the functional units of individuals

  • Time and space don’t matter

  • External information and internal reality can be united without conflict


Only objective information is valuable
only objective information is valuable by nurses is a bad idea…

  • Normatively – possibly

  • Descriptively - untrue


More information is better
more information is better by nurses is a bad idea…

  • Problem is making sense of existing information rather than adding to it.


Objective information can be transmitted out of context
objective information can be transmitted out of context by nurses is a bad idea…

  • Nurses reject ‘acontextual’ information sources in favour of context-rich advice

  • Lack the appraisal skills to inject context into information


Information can only be acquired from formal sources
information can only be acquired from formal sources by nurses is a bad idea…

  • Information is ‘differences that makes a difference’ (Bateson 1979)

  • Differences that made a difference (with the exception of drug-reference material) are informally located


Relevant information exists for every need
relevant information exists for every need by nurses is a bad idea…

  • Nurses don’t recognise (or cannot verbalise) information needs

  • Satisficing

  • [over] confidence quickly acquired (Urquhart 1999).


Every information need situation has a solution
every information need situation has a solution by nurses is a bad idea…

  • Information seeking = transforming need into workable format

  • unfitness for purpose = negative feedback


Information can always be made accessible
information can always be made accessible by nurses is a bad idea…

  • Physical sense = yes

  • Intellectual/cognitive = no


Functional units of information sources fit the needs of individuals
functional units of information sources fit the needs of individuals

  • EBN functional units = systems, synopses, syntheses and studies (Haynes 2001)

  • Nurses functional units = colleague advice, ideas and consultation


time and space ignored individuals

+

Time,

Visibility

Of process

-

good

Task

Structure

poor

‘pure’ scientific experiment

System aided judgement

Peer aided judgement

intuition

(cf. Hammond, Hamm, Dowie 1963-2002)

Mode of decision making

intuition

Analysis


Conflict free connections between external information and internal reality
conflict free connections between external information and internal reality

  • Defensiveness and conflict

  • We simply do not know!


What is sjt
What is SJT? internal reality

‘ecology’


Intra group variation
Intra-group variation internal reality


Information utility
Information utility internal reality


High school internal reality

College

graduate


Purchasing behaviour internal reality

Post purchase

feelings

Felt

need

Pre-purchase

activity

Purchase decision

Use behaviour

Post use

evaluation

Info need

recognition

Info search

behaviour

Evaluation of

Info alternatives

Use behaviour

Information behaviour

Kotler 1967;

Case 2002


Knowledge
knowledge internal reality

knowledge

  • Lives in the human act of knowing

  • Is tacit as well as explicit

  • Social as well as individual

  • Is dynamic


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