Preventing Clinical Reasoning Bias in Nursing: A Case Study

Running head: NURSING
NURSING
Name of the Student:
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Author Note:

1NURSING
The given case is based on the health condition of a 47-year-old female who was
currently shifted to the medical rehabilitation for the purpose of the ongoing physiotherapy needs
mainly because she had had a left knee tibial plateau fracture following a mechanical fall with
the non-operative management in Westmead hospital. When the patient was admitted to the
hospital she had no past medical history neither any allergies. Initially no such problem was
assessed with the patient, however after two days the patient showed symptoms like sore throat
and headache. Till then no such signs of the actual health condition has been identified by the
health professionals. Only after the temperature of the patient spiked up to 39. 5 degree Celsius
while the vital signs was checked for, then a note was made of the deteriorating health condition.
At that time no such observation or assessment was made which helped in the detection of the
occurrence of influenza A. when the temperature had spiked so high, the nurse on duty had
provided the patient with 1-gram pandadol PO, which only helped the patient ton get an
intermittent sleep. About three hours after this incident, it was noticed that the patient has
become febrile with high temperatures 37.2-degree Celsius along with which she complained of
symptoms like sore throat, headache and shivering. This was the time when the nurse
professionals present on duty realised that the signs might be of influenza that too since a day
before there had been a case where another patient had shown similar symptoms like Mrs M,
which made the nurses on duty to think that she too might be suffering from influenza A.
The staff failed to identify the fluA in the first instance itself mainly because the nurses
failed to assess the cues properly. This was mainly because of the presence of overconfidence on
the part of the nurses which was accompanied along with ignorance which was a result of the
overconfidence. One of the significant errors in clinical reasoning that had been conducted by the
nurses was that the fluid balance chart of the patient had not been checked properly. Another

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error that had been conducted was that no such physical or laboratory assessment have been
conducted on the patient immediately after the symptoms have occurred. This was mainly a
result of the judgement overconfidence which is an important bias in clinical errors. The lack of
proper identification of the flue A in the first instance can fall under the clinical reasoning bias of
anchoring. According to Guerrasio and Aagaard (2014), tendency to fixate on the first
impression or selected signs or symptoms results in mis-diagnosis or late diagnosis and falls
under the category of anchoring bias. As per the case study, the escalating body temperature was
thought to be a manifestation of the tibial plateau fracture. Thus at first instance flue A was not
considered. After the symptoms have emerged and the temperature of the patient had spiked up
to as high as 39.5 degree Celsius accompanied with the conditions like headache, muscle aches,
loss of appetite, dehydration and general weakness, the fluid charts of the patient was viewed.
While viewing it was come across that the say before the fluid intake of the patient was quite less
and no urine has been passed out since midnight. In terms of nutrition too, the patient was seen to
consume in very less amounts. This condition although was observed was neglected by the
nurses and was thought to be a result of the upper respiratory tract infection, which had led to the
occurrence of inflammation. However later this was understood to be a result of the viral
infection that had led to the immune response and reaction to the viral infections which produces
the viral syndrome like high fever, coryza and body aches (Belongia et al. 2015).It was after this
realization that the nurse in change decided to conduct tests like urine test, blood test and nasal
swab and conduct certain clinical reviews. All the above cues were not detected properly which
was a result of the overconfidence that led to biasness. This results in erroneous inflation of the
probability of being correct and taking the right clinical judgement. Overconfidence occurs when
perceived confidence exceeds judgment correctness.