Journal of Nursing Education, 2018;57(4):203–208
Cite this articlePublished Online:March 22, 2018https://doi.org/10.3928/01484834-20180322-03Cited by:11
Abstract
Background:
Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature.
Method:
A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning.
Results:
Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm. Relevant cognitive biases are discussed, followed by debiasing strategies and application of the dual process theory to reduce diagnostic error and harm.
Conclusion:
The accuracy of diagnostic reasoning of nurse practitioners may be improved by incorporating these items into nurse practitioner education and practice. [J Nurs Educ. 2018;57(4):203–208.]
- American Association of Nurse Practitioners. (2015). Scope of practice for nurse practitioners. Retrieved from https://www.aanp.org/images/documents/publications/scopeofpractice.pdf > Google Scholar
- Appel S.J., Wadas T.M., Talley M.H., Williams A.M. (2013). Teaching diagnostic reasoning: Transitioning from a live to a distance accessible online classroom in an adult acute care nurse practitioner program. Journal of Nursing Education and Practice, 3(12).
10.5430/jnep.v3n12p125 > CrossrefGoogle Scholar - Brosinski C.M. (2014). Implementing diagnostic reasoning to differentiate Todd's paralysis from acute ischemic stroke. Advanced Emergency Nursing Journal, 36, 78–86.
10.1097/TME.0000000000000007 > Crossref MedlineGoogle Scholar - Caron C.D., Bowers B.J. (2000). Methods and application of dimensional analysis: A contribution to concept and knowledge development in nursing. In (Eds.), Concept development in nursing: Foundations, techniques, and applications (2nd ed., pp. 285–319). Philadelphia, PA: W.B. Saunders. > Google Scholar
- Chiffi D., Zanotti R. (2015). Medical and nursing diagnoses: A critical comparison. Journal of Evaluation in Clinical Practice, 21, 1–6.
10.1111/jep.12146 > Crossref MedlineGoogle Scholar - Croskerry P. (2009). A universal model of diagnostic reasoning. Academic Medicine, 84, 1022–1028.
10.1097/ACM.0b013e3181ace703 > Crossref MedlineGoogle Scholar - Croskerry P., Singhal G., Mamede S. (2013a). Cognitive debiasing 1: Origins of bias and theory of debiasing. BMJ Quality & Safety, 22(Suppl. 2), ii58–ii64.
10.1136/bmjqs-2012-001712 > Crossref MedlineGoogle Scholar - Croskerry P., Singhal G., Mamede S. (2013b). Cognitive debiasing 2: Impediments to and strategies for change. BMJ Quality & Safety, 22(Suppl. 2), ii65–ii72.
10.1136/bmjqs-2012-001713 > Crossref MedlineGoogle Scholar - Durham C.O., Fowler T., Kennedy S. (2014). Teaching dual-process diagnostic reasoning to doctor of nursing practice students: Problem-based learning and the illness script. Journal of Nursing Education, 53, 646–650.
10.3928/01484834-20141023-05 > LinkGoogle Scholar - Elstein A.S. (2009). Thinking about diagnostic thinking: A 30-year perspective. Advances in Health Sciences Education, 14(Suppl. 1), 7–18.
10.1007/s10459-009-9184-0 > Crossref MedlineGoogle Scholar - Gehlhar K., Klimke-Jung K., Stosch C., Fischer M.R. (2014). Do different medical curricula influence self-assessed clinical thinking of students?GMS Zeitschrift für Medizinische Ausbildung, 31(2), Document 23.
10.3205/zma000915 > Crossref MedlineGoogle Scholar - Graber M.L., Kissam S., Payne V.L., Meyer A., Sorensen A., Lenfestey N., Singh H. (2012). Cognitive interventions to reduce diagnostic error: A narrative review. BMJ Quality & Safety, 21, 535–557.
10.1136/bmjqs-2011-000149 > Crossref MedlineGoogle Scholar - Ilgen J.S., Eva K.W., Regehr G. (2016). What's in a label? Is diagnosis the start or the end of clinical reasoning?Journal of General Internal Medicine, 31, 435–437.
10.1007/s11606-016-3592-7 > Crossref MedlineGoogle Scholar - Kellogg A.R., Coute R.A., Garra G. (2015). Diagnostic reasoning for ST-Segment Elevation Myocardial Infarction (STEMI) interpretation is preserved despite fatigue. Journal of Graduate Medical Education, 7, 27–31.
10.4300/JGME-D-14-00056.1 > Crossref MedlineGoogle Scholar - Kools S., McCarthy M., Durham R., Robrecht L. (1996). Dimensional analysis: Broadening the conception of grounded theory. Qualitative Health Research, 6, 312–330.
10.1177/104973239600600302 > CrossrefGoogle Scholar - Lambe K.A., O'Reilly G., Kelly B.D., Curristan S. (2016). Dual-process cognitive interventions to enhance diagnostic reasoning: A systematic review. BMJ Quality & Safety, 25, 808–820.
10.1136/bmjqs-2015-004417 > Crossref MedlineGoogle Scholar - Mamede S., van Gog T., van den Berge K., Rikers R., van Saase J.L., van Guldener C., Schmidt H.G. (2010). Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA, 304, 1198–1203.
10.1001/jama.2010.1276 > Crossref MedlineGoogle Scholar - Mamede S., van Gog T., van den Berge K., van Saase J.L.C.M., Schmidt H.G. (2014). Why do doctors make mistakes? A study of the role of salient distracting clinical features. Academic Medicine, 89, 114–120.
10.1097/ACM.0000000000000077 > Crossref MedlineGoogle Scholar - Monteiro S.D., Sherbino J.D., Ilgen J.S., Dore K.L., Wood T.J., Young M.E., Howey E. (2015). Disrupting diagnostic reasoning: Do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians?Academic Medicine, 90, 511–517.
10.1097/ACM.0000000000000614 > Crossref MedlineGoogle Scholar - Monteiro S.M., Norman G. (2013). Diagnostic reasoning: Where we've been, where we're going. Teaching and Learning in Medicine, 25(Suppl. 1), S26–S32.
10.1080/10401334.2013.842911 > Crossref MedlineGoogle Scholar - Pirret A.M., Neville S.J., La Grow S.J. (2015). Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: A comparative study. International Journal of Nursing Studies, 52, 716–726.
10.1016/j.ijnurstu.2014.08.009 > Crossref MedlineGoogle Scholar - Sherbino J., Kulasegaram K., Howey E., Norman G. (2014). Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: A controlled trial. Canadian Journal of Emergency Medicine, 16, 34–40. > CrossrefGoogle Scholar
- Shimizu T., Matsumoto K., Tokuda Y. (2013). Effects of the use of differential diagnosis checklist and general de-biasing checklist on diagnostic performance in comparison to intuitive diagnosis. Medical Teacher, 35(6), e1218–e1229.
10.3109/0142159X.2012.742493 > Crossref MedlineGoogle Scholar - Stolper C.F., Van de Wiel M.W., De Vet H.C., Rutten A.L., Van Royen P., Van Bokhoven M.A., Dinant G.J. (2013). Family physicians' diagnostic gut feelings are measurable: Construct validation of a questionnaire. BMC Family Practice, 14, 1.
10.1186/1471-2296-14-1 > Crossref MedlineGoogle Scholar - Thammasitboon S., Cutrer W.B. (2013). Diagnostic decision-making and strategies to improve diagnosis. Current Problems in Pediatric and Adolescent Health Care, 43, 232–241.
10.1016/j.cppeds.2013.07.003 > Crossref MedlineGoogle Scholar - Thammasitboon S., Thammasitboon S., Singhal G. (2013). Diagnosing diagnostic error. Current Problems in Pediatric and Adolescent Health Care, 43, 227–231.
10.1016/j.cppeds.2013.07.002 > Crossref MedlineGoogle Scholar - Thompson C.C. (2003). Clinical experience as evidence in evidence-based practice. Journal of Advanced Nursing, 43, 230–137.
10.1046/j.1365-2648.2003.02705.x > Crossref MedlineGoogle Scholar - Wiswell J., Tsao K., Bellolio M.F., Hess E.P., Cabrera D. (2013). “Sick” or “not-sick”: Accuracy of System 1 diagnostic reasoning for the prediction of disposition and acuity in patients presenting to an academic ED. American Journal of Emergency Medicine, 31, 1448–1452.
10.1016/j.ajem.2013.07.018 > Crossref MedlineGoogle Scholar - Zwaan L., Thijs A., Wagner C., Timmermans D.R.M. (2013). Does inappropriate selectivity in information use relate to diagnostic errors and patient harm? The diagnosis of patients with dyspnea. Social Science and Medicine, 91, 32–38.
10.1016/j.socscimed.2013.05.001 > Crossref MedlineGoogle Scholar
