ANSWER
Advanced Practice Nursing Decision-Making and Dual Process Theory
Two separate systems—Type 1 (System 1) and Type 2 (System 2)—are used by the Dual Process Theory to explain how human reasoning functions. Type 2 is slower, more analytical, and more purposeful than Type 1, which is quick, instinctive, and automatic. Accurate diagnosis and efficient patient care in advanced practice nursing depend on the ability to balance these processes. Type 1 thinking enables quick decision-making and is frequently used in familiar, everyday contexts, such as identifying typical flu symptoms. Type 2 thinking, on the other hand, is crucial in intricate situations that call for critical evaluation, like separating influenza from viral meningitis in a youngster exhibiting unusual symptoms. Advanced practice nurses (APNs) can effectively handle both ordinary and difficult clinical circumstances if they comprehend and utilize these systems.
Cognitive Predispositions for Reaction
Decision-making is influenced by mental shortcuts or tendencies known as cognitive dispositions to respond (CDRs). These can expedite procedures, but if not handled appropriately, they can also result in diagnostic errors. Anchoring (relying too much on first information) and confirmation bias (looking for evidence to corroborate an initial perception) are two examples. These biases may show up in the APN context while evaluating patient histories or diagnostic tests. In Case 1, for example, focusing on gallbladder problems might have caused a pulmonary embolism to go unnoticed. APNs can critically assess their logic and have an open mind to alternative diagnoses by being aware of CDRs.
Debiasing the Mind
Techniques to lessen the impact of cognitive biases are part of cognitive debiasing. Among the methods are team-based decision-making, systematic diagnostic checklists, and reflective practice. An APN may employ cognitive pushing techniques in practice, such as purposefully weighing alternate diagnoses or questioning their presumptions regarding a patient’s presentation. Cognitive debiasing for Case 2 may entail a methodical reassessment of the child’s symptoms, identifying unusual flu presentations, and making sure that hydration is properly assessed.
Utilizing Type 1 and Type 2 Procedures in Every Situation
In Case 1, localized RUQ discomfort was the initial basis for a provisional diagnosis of gallbladder disease using Type 1 reasoning. But applying Type 2 thinking, including evaluating the patient’s testosterone treatment and its link to clotting risk, would have identified the possibility of a pulmonary embolism earlier.
In Case 2, the patient’s symptoms were consistent with flu during flu season, according to Type 1 reasoning. When symptoms worsened and the rapid flu test came back negative, switching to Type 2 thinking might have led to a more thorough investigation of other possible diagnoses, such meningitis.
Modifications to Practice to Reduce Diagnostic Errors
APNs should think about the following adjustments to lower diagnostic errors:
Use organized diagnostic tools: Checklists guarantee thorough evaluations and lessen the need for heuristics.
Improve bias education: APNs who receive regular training on cognitive biases are better able to identify and lessen their effects.
Encourage reflective practice: Incorporating reflection time into clinical procedures encourages thoughtful analysis of challenging problems.
Encourage cooperation: interdisciplinary dialogues can offer a range of viewpoints and lower the possibility of mistakes.
APNs can improve patient outcomes and diagnostic accuracy by combining these tactics.
Citations
(2017) Croskerry, P. cognitive errors’ significance in diagnosis and methods for reducing them. 23–30 in Academic Medicine, 92(1). 10.1097/ACM.0000000000001363 https://doi.org
G. Norman (2020). Diagnostic errors and dual processing. 133–145 in Advances in Health Sciences Education, 25(2). 10.1007/s10459-019-09882-0 https://doi.org
The 350-word limit is met by this draft, which also contains academic references in the format of the APA 7th Edition. If you want to improve or add more, let me know!
QUESTION
Dual Processing Theory
To answer this week’s discussion questions will require that you read three articles on dual processing theory and reducing diagnostic errors. You are expected to apply the course readings mentioned below (these can be found in the Week 4 Assigned readings) YOU WILL NOT BE ABLE TO ANSWER THIS WEEK’S DISCUSSION QUESTION WITHOUT READING THE ASSIGNED ARTICLES, See the questions outlined below.
Ultra processed foods_ what they are and how to identify them.pdf
Dual processing model of medical.pdf
Dual Processing Model for Medical DecisionMaking_ An Extension to Diagnostic Testing.pdf
Case: 1 :
Chief Complaint: “Pain in Right Side” A 40-year-old man presents to his primary care provider (PCP) with right upper quadrant (RUQ) pain for 2 days. The pain is described as “sore” and rated 4 on 1 to 10 pain scale. The pain is intermittent and not worsening. He reports food does not seem to make it better or worse. No nausea or vomiting or diarrhea or constipation are reported.
Vital signs: heart rate, 75; blood pressure, 122/78; respiration rate, 15; afebrile.
Examination: No acute distress. Abdomen: mildly tender on palpation at RUQ; no masses, hepatomegaly or splenomegaly.
Diagnosis: Gallbladder disease.
Plan: Abdominal ultrasound with reflexive cholescintigraphy (hepatobiliary iminodiacetic acid) scan within 1 week. Patient instructed to call provider if worsening symptoms occur. He is also told to avoid any fatty foods or alcohol consumption. The patient is agreeable to plan.
Follow-up: Two days after the initial visit, the patient calls his PCP with worsening RUQ pain. Ultrasound imaging was scheduled for later that day. Patient then started having shortness of breath while at home and went to the local emergency department (ED). Computed tomography angiography of the chest revealed a right-sided pulmonary embolism. Patient did not have any family history of clotting disorders and no recent surgery, immobilization, or travel. Patient had been on testosterone injections for several years for low testosterone levels, and this was not updated in his medical record at his PC
Case 2
Chief Complaint: “Fever and Sleepy” A 3-year-old girl presents with her mother to a walk-in clinic with fever, nasal drainage, and fatigue for 2 days. She was observed hiding her head in her mother’s chest during the examination.
The presentation occurred during flu season. The clinician had 6 positive flu tests that day, all with similar symptoms, but most included a cough.
Vital signs: heart rate, 125; respiration rate, 20; blood pressure, 100/72; temperature, 100.8F.
Examination: Lungs clear, heart rate regular, no murmur. Head, eyes, ears, nose, and throat: normocephalic, conjunctivae clear, tympanic membrane without bulging or redness, pharynx normal, nares normal with clear drainage, tonsils 1þ, no erythema or exudate. The patient did not want to look at the clinician in a brightly lit room. The patient was lethargic and had limited tearing when crying. Rapid flu test: Negative.
Diagnosis: Presumptive seasonal influenza.
Plan: Supportive care, including encouraging fluids, Over-the-counter acetaminophen for fever, and age-appropriate antiviral medication for the flu was prescribed.
Follow-up: Parents were unable to keep her fever down over the next 1 day, and she progressively became more lethargic. The patient was taken to the ED, and a diagnosis of viral meningitis and dehydration was made. The patient spent several days in the hospital but did completely recover.
1. Describe the Dual Process Theory and Reasoning Process and how it applies to making decisions for the advanced practice nurse.
2. What are cognitive dispositions to respond? How are these applied in the APN setting?
3. Describe cognitive debiasing.
4. Describe how Type 1 (System 1) and Type 2 (System 2) processes and strategies can be applied to each case to help the NP make decisions and to decrease potential diagnostic errors.
5. What considerations for change to practice should the NP consider in each situation as a way to decrease the chance of future diagnostic and care decisions?
Please remember for discussion posts: the initial post must be uploaded by the WEDNESDAY of the week and two replies to your peers by Saturday at 2359 EST.
Please note the grading rubric for the discussion board.
As a reminder, all discussion posts must be a minimum of 350 words initial and 250 words peer responses, references must be cited in APA format 7th Edition and must include a minimum of 2 scholarly resources published within the past 5 years.