Errors of diagnostic reasoning contribute significantly to patient harm. Students, novice diagnosticians, and even experienced clinicians often have difficulty understanding or describing the processes of diagnostic reasoning. Inappropriate use of cognitive heuristics and poor logical reasoning by novice or experienced diagnosticians may result in missed or delayed diagnoses. Reduction of diagnostic errors through knowledge acquisition, self-reflection, and check lists has individually demonstrated some improvements in diagnostic reasoning. Implementing the diagnostic and reasoning tool (DaRT), a method of reasoning which integrates the evidence-based strategies of knowledge acquisition, metacognition, and logical reasoning skills throughout the patient encounter, results in improvement in diagnostic reasoning in advanced practice nurses. Use of the DaRT in one university setting resulted in significant improvement in advanced health assessment skills and diagnostic reasoning abilities as demonstrated by improvements of 28–55% end-of-program Health Education Systems Incorporated scores. Translation into practice settings may further support the use of this multiple-modality tool.

BackgroundEvaluating the growth of leadership competencies of Doctor of Nursing Practice (DNP) students in academic and organizational settings has been a challenge.ObjectiveThe purpose of developing a method of evaluating DNP student leadership focused on a strategy to assess DNP student growth in the areas associated with leadership and change.MethodsCompetencies of leadership that were evidenced based and effective in healthcare environments were employed as a basis for the leadership narrative. The resulting tool served both as structure for the student's development and as a method of instruction and evaluation in the academic setting.ResultsUsing a descriptive and experiential leadership narrative as one method of evaluation is an effective strategy for fostering DNP student leadership development in both the direct patient and system-focused settings. Moreover, the leadership narrative is easily generalizable and transferable in environments where growth in leadership and competency development is valued.ConclusionsThe process of developing leadership narratives is a transformational experience for the doctoral student and future nursing leader.Implications for NursingEasily incorporated into the DNP practicum structure and beyond, the leadership narrative is an effective method for formative and summative evaluation of DNP student leadership development. Moreover, consistent with the accrediting body for DNP education, the leadership narrative can be used as one method of demonstrating program effectiveness.