Theory of Correspondences

Clinical experience as evidence in evidence-based practice Background. This paper’s starting point is the recognition (descriptive not norma-tive) that, for the vast majority of day-to-day clinical decision-making situations, the ‘evidence ’ for decision-making is experiential knowledge. Moreover, reliance on this knowledge base means that nurses must use cognitive shortcuts or heuristics for handling information when making decisions. These heuristics encourage systematic biases in decision-makers and deviations from the normative rules of ‘good ’ decis-ion-making. Aims. The aim of the paper is to explore three common heuristics and the biases that arise when handling complex information in clinical decision-making (over-confidence, hindsight and base rate neglect) and, in response to these biases, to illustrate some simple techniques for reducing the negative influence of heuristics. Discussion. Nurses face a limited range of types of uncertainty in their clinical decisions and draw primarily on experiential knowledge to handle these uncer-tainties. This paper argues that experiential knowledge is a necessary but not suf-ficient basis for clinical decision-making. It illustrates how overconfidence in one’s knowledge base, being correct ‘after the event ’ or with the benefit of hindsight, and ignoring the base rates associated with events, conditions or health states, can impact on professional judgements and decisions. The paper illustrates some simple strategies for minimizing the impact of heuristics on the real-life clinical decisions of nurses. Conclusion. The paper concludes that more research knowledge of the impact of heuristics and techniques to combat them in nursing decisions is needed