Transcript Document 7452641

Lecture 2
Information processing and
intuitive decision making theory
Carl Thompson
Decision making theory



Descriptive approaches: how people
actually make decisions
Normative approaches: how people
ought to make decisions
NB. Most approaches have elements of
both
Information processing

Assumptions

Human reasoning as the interface between
short (stimuli) and long-term
(semantic/factual knowledge & experiential
(episodic knowledge) memory

Human reasoning is rational

Rationality is bounded
Information processing: the process

Elstein et al. 1978

Cue acquisition

Carnevali et al 1984



H° generation

Cue interpretation

H° evaluation
Exposure to pre-encounter data
Entry to the data search field and
shaping data gathering

Coalescing cues into chunks

Activating possible H°

H° directed search of the data field

Testing H°

Dx
he could not take the sleeping tablets as he could not
swallow…. the DN said that they might have to put up a
syringe driver for the night if he was not settling and could
not take anything orally.
….. he had a couple of dressings on his bottom and the
dressings were intact. The DN decided to leave them and
not to move him around too much as he had not slept
much that night…..
……she told her
that it would not be long until he died…… his breathing
would get shallower, occasionally it would seem as though
he would not breathe again…..it showed that he was nearer
to dying……
the DN said that the Marie Curie nurses could
work for up to 27 hours and she thought that it would be
better if they came at night
…..she would return in the afternoon to reassess
him
Information cues
Signs and
symptoms
Optimal
judgement
Test results
Nurses’
Judgements
Patient
preferences
Etc.
Brunswik’s lens model
Social judgement approaches to modelling cue use
23.00
25.00
Individual Subject Utilities
27.00
20
29.00
30.00
10
31.00
32.00
0
33.00
35.00
Utility
-10
40.00
42.00
-20
43.00
normal
glasgow coma score
equivocal
abnormal
Importance
Utility(s.e.)
Factor

4.59
SYSTOLIC
 
-
3.4298(9.3211)
 -2.9035(9.3211)

-
Summary of judgement
policy for
one clinician faced with the
Dx of shock
in critical care.
normal
equivocal

-.5263(8.9352)
systolic BP
abnormal


26.80
PULSE
 18.5965(9.3211)
----
 -18.404(9.3211) ----


-.1930(8.9352)
pulse
normal
equivocal
abnormal


13.13
RESPS
 -5.0702(9.3211)
resps
-
 -6.5274(8.9598)
-
 11.5976(8.9598)
--
normal
equivocal
Utilities
Importance
Internal consistency
abnormal


14.73
O2
 -12.070(9.3211)


oxygen sats
---
--
8.2632(9.3211)
3.8070(8.9352)
-
normal
equivocal
abnormal


21.64
URINE
 11.6393(8.9598)

---
6.5965(9.3211)
 -18.236(8.9598) ----
urine output
normal
equivocal
abnormal


GCS
19.11  -7.5702(9.3211)
 -9.4035(9.3211)
 16.9737(8.9352)
--
--
----
glasgow coma score
normal
equivocal
abnormal

53.5702(6.5013) CONSTANT
Pearson's R
=
.838
Significance =
.0000
Kendall's tau =
.570
Significance =
.0003
Other health
information:
smoker? Mobility?
Medication?…etc
Compliance?
History: how and
when ulcer
started; current
treatment;
pain… etc
Background
information
Leg exam: oedema,
temperature; ankle
and calf
circumference…
General
medical
condition:
diabetic? RA;
anaemic?… etc
Doppler ABPI
Ulcer: size,
odour, slough,
exudates?
Investigations: urine, FBC,
ESR, urea and electrolytes,
blood glucose, swab (if
appropriate)
general condition:
well? Pulse, BP,
weight
ARTICLES
DAILY VISITS
PHYSIOLOGY
PATIENT INFORMATION
PATIENT REJECTION OF
EXPERTISE
COLLEAGUE’S
‘EXPERIMENTS’
COST
ROLE CONFLICT, GP WISHES
REJECTION OF EXPERTISE
CNS
NEED FOR
VISIBILITY IN
DECISION
SHARED DECISION
MAKING VALUES
SEEING IS BELIEVING AND EXPERIMENTATION
WOUND FORMULARY
COST
DOWN TO WHAT I’VE USED OVER THE YEARS
Problems with info processing

Role of H°

Over emphasising positive findings

Excessive data collection
Intuition and expertise





Understanding without a rationale (Benner & Tanner 1987 p2)
A perception of possibilities, meanings and relationships by way of
insight (Gerrity 1987 p63)
Knowledge of a fact or truth, as a whole; immediate possession of
knowledge; and knowledge independent of the linear reasoning
process (Rew and Barron 1987 p60)
Immediate knowing of something without the conscious use of
reason (Schrader and Fischer 1987 p45)
[A] process whereby the nurse knows something about a patient
that cannot be verbalised, that is verbalised with difficulty or for
which the source of knowledge cannot be determined (Young 1987
p52)
Intuition

Type of knowledge vs mode of thought

Lack of visibility

Dubious morality?

Reflective ‘paradox’ and ?black box

Accurate sometimes (hindsight?)

Lack of power
Novice - expert
 Dreyfus’
and Benner
 Novice
 Advanced
beginners
 Competent
 Proficient
 Expert
performance


Whole situation

Orientation

Decision
Situation components

Perception

action
Level of
organisation
Lower
…
…
Higher
Sub process
Perception
Action
Orientation
Decision
Stage
Perceives the
elements of the
situation
Acts on those
elements
Recognises
Makes decisions
whole situations and plans to
attain goals in
the situation
Novice
Analytical
Analytical
Rely on others
Rely on others
Advanced
beginner
Intuitive
Analytical
Rely on others
Rely on others
Competent
Intuitive
Intuitive
Analytical
Analytical
Proficient
Intuitive
Intuitive
Intuitive
Analytical
Expert
Intuitive
Intuitive
Intuitive
Intuitive
‘the rules’

Realise that expertise is acquired step-by-step

Avoid trying to think like an expert (intuitively)


Practice intensively using the rules and logic that
are available
*NB the proponents’ discipline
(sociology/naturalistic research) does not
demand empirical testing so caution advised
Points of contact and
divergence

Communicability

Simplification

Context specificity

applicability