Comparing Methods of Diagnostic Reasoning in Nursing

Intansari Nurjannah, Sri Warsini ., Jane Mills .


Background. Several methods of diagnostic reasoning
have been explained in the literature, but there has been no
research to date comparing one method of diagnostic reasoning
to another.
Aims. This study aimed to identify differences between the 4
steps method and the 6 steps method of diagnostic reasoning in
terms of what the possible diagnoses based on scenario provided
and in terms of ease of use, effectiveness, usefulness and the
possibility of implementation in a clinical setting.
Method. Forty four participants, including nurse practitioners
and academics participated in this study. All participants were
attending a diagnostic reasoning workshop. Participants were
taught the 4 steps method and the 6 steps method of formulating
a nursing diagnosis. Using three scenarios participants identified
possible diagnoses using each method, which were then
compared. The participants were subsequently given a
questionnaire with Likert scale. Statistical analysis with a
Wilcoxon signed-rank test was performed using SPSS version 20.
Result. Results of this study showed that the 6 step method of
diagnostic reasoning can identify more possible plausible
diagnoses and differential diagnoses (DDx) than the 4 step
method can. The 6 steps method of diagnostic reasoning also
reduced the possibility of identifying inaccurate nursing
diagnoses. The 6 steps method was considered easier to use, more
effective, more useful and more likely to be implemented in a
clinical setting than the 4 steps method (p<0.001).


method, diagnostic reasoning, nursing

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