Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Int J Older People Nurs. 2023 May;18(3):e12538. doi: 10.1111/opn.12538. Epub 2023 Apr 3.
Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations.
To examine nursing practice with older people through the lens of unconscious bias.
In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care.
Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow.
Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice.
Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.
二元或分类思维是一种思维方式，大脑会在无意识中将接收到的大量信息分类。这有助于我们快速处理信息，并通过对可能威胁的模式识别来保护我们的安全。然而，它也可能受到无意识和有意识偏见的影响，这些偏见会影响我们对他人和情况的判断。
通过无意识偏见来审视老年人的护理实践。
在这项批判性分析中，我们使用卡尼曼的快速和慢速思维，认为在繁忙的工作环境中，与住院老年人一起工作的护士通常依赖快速思考，这可能导致无意识和有意识偏见、使用二元语言来描述老年人和护理任务，以及最终护理资源的分配。
二元语言简单地描述老年人及其护理工作为护理任务。一个人要么重，要么轻，要么有能力控制大小便，要么没有能力控制大小便，要么困惑，要么定向。尽管这些描述部分是基于护士的经验，但它们也反映了护士对老年患者或护理任务的有意识和无意识偏见。我们借鉴快速（直觉）和慢速（分析）的解释来解释护士如何在不被支持或鼓励进行慢速思考的环境中，倾向于快速思考作为生存机制。
护士在使用快速思考来完成轮班工作时的生存努力，可能会受到无意识和有意识偏见的影响，这可能导致使用捷径和护理资源的分配。我们认为，至关重要的是，鼓励和支持护士在临床实践中进行慢速和分析性思考。
护士可以通过记录和反思自己对老年人的护理实践，来检查可能存在的无意识偏见。管理人员可以通过人员配备模式支持反思性思维，并鼓励在单位实践中进行以人为中心的护理对话，为护士提供支持。
