The unknown known: deepen our understanding of uncertainty in nursing practice

• Author(s): Cunha, Lara Daniela Matos ; Santos, Márcia Noélia Pestana dos ; Lomba, Maria de Lurdes Lopes de Freitas ; Santos, Margarida Reis
• Date: 2024
• Origin: Repositório Científico da Escola Superior de Enfermagem de Coimbra
• Subject(s): Uncertainty
• Document Type: Other
• Language: English

Description

In the realm of nursing, decision-making often hinges on non-analytic, intuitive processes, akin to an autopilot mode. Nurses frequently rely on unconscious reasoning to guide their actions, a method supported by Kahneman & Henik's concept of "scripts" used for normative judgments. This intuitive approach, however, is challenged by the pervasive uncertainty inherent in clinical practice. Uncertainty, defined as the metacognitive awareness of ignorance, requires nurses to navigate known unknowns and unknown unknowns, fostering a sense of ownership over their reasoning paths. Drawing from Russell's assertion that philosophy teaches us to live without certainty and yet without paralysis, this paper explores how nurses can embrace and manage uncertainty. The framework of semiotic analysis, rooted in Saussure's and Peirce's theories, aids in understanding how signs convey meaning in the face of ambiguity. Saussure's emphasis on the arbitrary nature of linguistic signs and Peirce's triadic model highlights the complexity of interpreting clinical signs and symptoms. Moreover, the concept of the human being as a complex adaptive system underscores the unpredictability of patient responses and the need for nurses to adapt dynamically. Descartes' cogito argument and Peirce's pragmatism provide a balanced approach to managing clinical uncertainty, emphasizing critical evaluation and practical outcomes. Embracing uncertainty fosters self-reflection and critical inquiry, vital for professional growth and evidence-based practice. By adopting a position of doubt and reflexivity, nurses can unravel the layers of complexity in their practice, recognizing the social, cultural, and historical contexts of their actions. Ultimately, this exploration aims to transform uncertainty into a catalyst for innovation and improvement in nursing care. By embracing the unknown and fostering a culture of self-questioning, nurses can enhance their clinical reasoning, leading to more nuanced and effective patient care.