Ashley Evans
11/20/2025
Decision Making-DBX-DL01
Prof. Nora Hernandez-Pupo
Discussion Week 4
Describe the Dual Process Theory and Reasoning Process and how it applies to making decisions for the advanced practice nurse.
The Dual Process Theory helps advanced practice nurses understand the cognitive processes involved in decision-making, allowing them to optimize their approach to patient care by balancing intuitive and analytical thinking. “The dual processes, or system 1 and system 2, work together by enabling a clinician to think both fast and slow when reasoning through a patient’s presentation” (E, Team, 2024). System 1
is intuitive, efficient, and based on pattern recognition. Reasoning using system 1 often occurs so quickly that we do not explicitly recognize it as a distinct cognitive process. System 2 is an analytical cognitive process that is time intensive and deliberate. It involves the conscious, explicit application of an analytical approach to arrive at the correct diagnosis.
What are cognitive dispositions to respond? How are these applied in the APN setting?
Cognitive dispositions refer to an individual’s tendency or inclination to perceive, think, or behave in a particular way in response to specific stimuli or situations. These dispositions are primarily related to mental processes such as perception, attention, memory, and problem-solving. They reflect an individual’s cognitive biases, heuristics, and schemas that influence their thinking and decision-making.
Cognitive dispositions are the tendencies or inclinations to perceive, think, or behave in a certain way in response to specific stimuli or situations. They are related to mental processes such as perception, attention, memory, and problem-solving. These dispositions reflect an individual’s cognitive biases, heuristics, and schemas that influence their thinking and decision-making.
On the other hand, social-personal dispositions refer to an individual’s tendencies or preferences for specific social and personal behaviors, such as their attitudes, beliefs, values, and emotions. These dispositions are influenced by an individual’s social and cultural context, personal experiences, and relationships. They shape an individual’s social interactions, self-concept, and overall behavior in various social situations.
Describe cognitive debiasing.
Cognitive biases are flaws in our decision-making processes, often leading to negative outcomes. In a recent article in states “these biases, if not addressed, can block much-needed change efforts, including those addressing moral distress, burnout, and unhealthy work environment” (T. Stephens, 2020). Resistance to change is a common problem in nursing and health care in general. We often cling tightly to our policies, precedent, and hierarchical structures, preferring the comfort of familiarity over the benefits of change. This article describes the use of cognitive debiasing strategies to effectively “change our mind” about long-held traditions, beliefs, and/or cultural norms.
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.
Using the System 1 and System 2 process can be applied to each scenario. The NP in scenario one can start off with using system 1 which is an intuitive approach, with the c/o pain to the right side even with no n/v should alarm the NP that extra diagnostic should be done, no shortness of breath was reported at that time but an Xray or CT Scan could have been ordered to rule out if the right side needs special attention. The end of the scenario reveals that the 40-yr old suffered a pulmonary embolism and needed anti-coagulant therapy. “Acute pulmonary embolism is a common clinical condition with a variable clinical presentation, making the diagnosis challenging” (A, Goyal, et al., 2024). The NP should have not sent the patient home without diagnostic to confirm their intuitive thinking. System 2 is the rational part of thinking after the intuitive phase. This phase was not well carried out in the first scenario. The second scenario is a little more complex since the 3-yr old is not at the point where they can fully explain how they are feeling. With children, diagnostics should be used more although parents are very good with intuition, to deliberately diagnose both system 1 and system 2 most come into play. The rapid flu test was negative and per assessment no inflammation of the tonsils, nor ears nor throat was noted. This should have prompt further diagnostics since the pulse was slightly elevated and temp was low grade, there was compensation in the body. The np should have sent for further testing. The child was resting her head on her mother’s chest, which is a common stance with 3 yrs old at a doctor’s appointment but if head was examined maybe the stiff neck may have been noted during assessment and prompt further testing.
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?
Fo both scenarios further testing should have been done to properly diagnose the patients in each scenario and possibly prevented hospitalization. Case 1 diagnostics should have been done before discharging the patient and recommending a one week follow up. This was delay of care. Also, case 2 the child could have been assessment thoroughly around the neck area and maybe the NP would have gotten closer to a more accurate diagnosis.
In conclusion, decision making is crucial for proper diagnosis and even lifesaving. Utilizing the Dual process theory for an intuitive and then rational approach to coming to a diagnosis can assure a more accurate diagnosis and prevent hospitalization in some cases.
References
Team, N. E. (2024, September 15).
Dual processing psychology: Exploring the two systems of thinking. NeuroLaunch.com.
Stephens, T. (2020, August 4) ScienceDirect.
Vyas V, Sankari A, Goyal A. Acute Pulmonary Embolism. [Updated 2024 Feb 28]. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2024 Jan-. Available from:
