Reference no: EM133792908

Dual Process Theory in Advanced Practice Nursing
The DPT posits that two systems of cognition conduct decision-making: the fast, intuitive, and automatic System 1 and the slow, analytical, and deliberate System 2. In APNs, these systems complement each other but can also conflict and thus have the potential to lead to diagnostic errors. The following cases are examples of DPT in action and a call to integrate cognitive strategies to improve patient outcomes.
Cognitive Dispositions to Respond (CDRs)
CDRs are mental shortcuts or heuristics clinicians use to make quick decisions (Raeburn, 2024). While these simplifications help streamline thinking, they may lead to diagnostic errors when biases override careful reasoning. Examples include anchoring bias, which is the tendency predominantly to focus on first impressions or findings, and Availability Bias, which is based on decisions regarding recent memorable cases and not on statistical likelihoods. Confirmation Bias: Evidence is searched to support an initially set diagnosis, in which case conflicting data are discarded. Thus, anchoring bias may have played a part in misdiagnosing gallbladder disease because of the clinician anchoring onto classic RUQ pain and just not considering other possibilities like pulmonary embolism. Case 2: The flu diagnosis likely had to do with availability bias because many people have influenza during flu season.
Cognitive Debiasing in APN Practice
Cognitive debiasing strategies are ways to reduce the impact of biases on decision-making. Among them is Reflection (Shatz, 2020): Explicitly questioning initial assumptions and diagnoses for completeness of analysis. Cognitive Forcing Strategies: Using prompts or structured frameworks to consider alternative diagnoses. Checklists and Protocols: Embedded diagnostic checklists serve to ensure that no critical steps within the process are missed. Feedback and Continuous Education: Scrutinizing the outcomes of previous decisions may pinpoint an area for improvement (Djulbegovic et al., 2012).
In Case 1, for example, the cognitive forcing strategy might be to consider risk factors for PE: The patient had received testosterone therapy. Such a strategy would have identified a possible clot formation sooner. A diagnostic checklist for pediatric lethargy might include the symptoms of meningitis that would lead to an earlier diagnosis of the viral infection in Case 2 (Tsalatsanis et al., 2015).
Application of System 1 and System 2 Processes
Case 1. Pulmonary Embolism Misdiagnosis: The initial presentation of gallbladder disease depended on pattern recognition schemes of the RUQ pain, which is a joint presentation. System 1 rapid processing missed critical information such as the use of testosterone by a patient, a drug commonly known to be associated with thromboembolic events (Tsalatsanis et al., 2015). System 2 reasoning would have involved a more conscious and deliberate consideration of the history and risk factors of the patient, which would have indicated the need to consider a differential diagnosis of PE: A fuller examination, perhaps facilitated by decision aids or clinical guidelines, may have led to an earlier request for imaging or blood tests (Djulbegovic et al., 2012).
Case 2: Viral Meningitis Misdiagnosis: System 1: The doctor very likely used intuitive judgment based on recent flu cases and missed the atypical presence of signs such as lethargy and limited tearing that would point toward meningitis (Miller, 2024). System 2: Analytical reasoning might have pointed out inconsistencies with the flu diagnosis, especially in a negative rapid flu test with a lack of classic flu symptoms, such as cough. Structured approaches to pediatric lethargy may have led to an earlier impulse to investigate further.