The Healthcare Attribution Error Model was proposed to explain how clinician cynicism, learned helplessness, and organizational inertia result from punitive cultures that silence clinician communication in the context of patient safety and speaking up in the context of error reporting. Given the serious effects that bias has on nurses' clinical judgment, and thereby patient outcomes, a concerted, systematic effort to identify and test debiasing strategies in real-world nursing settings is needed.īias affects nurses' clinical judgment - we need to know how to fix it. Furthermore, survey and vignette studies make it difficult to quantify the impact of these biases in the healthcare system. This could be a serious oversight because contextual factors such as cognitive load, which have a significant impact on judgment and decision-making, are not necessarily captured with vignette or survey studies. 61 of the studies relied on vignettes, surveys, or recall methods, rather than examining real-world nursing practice. Only 5 studies tested interventions to overcome or correct biases. Some articles examined heuristics and were included if they described the process of, and the problems with, nurse decision-making.
Most research focused on implicit biases related to racial/ethnic identity, obesity, and gender other articles examined confirmation, attribution, anchoring, and hindsight biases. Over half of these items were published in the last 12 years. We found 77 items that met the inclusion criteria. No date or geographic limitations were set. Inclusion criteria were primary research about nurses' bias evidence of a nursing decision or action and English language. In November 2020 we searched CINAHL, PsychInfo, and PubMed databases to identify relevant literature. We conducted a scoping review using Joanna Briggs methodology. The aim of this study was to map the evidence and key concepts related to bias in nurses' judgment and decision-making, including interventions to correct or overcome these biases. As the largest component of the workforce, nurses make numerous decisions that affect patient outcomes however, literature on nurses' clinical judgment often overlooks the potential impact of bias on these decisions. Most research on the impact of these systematic errors in judgment has been focused on diagnostic decision-making, primarily by physicians. Cognitive and implicit biases of healthcare providers can lead to adverse events in healthcare and have been identified as a patient safety concern.
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