Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study

Abstract

BackgroundThis paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses.Knowledge sources can support nurses in deriving diagnoses. A nurse’s disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses.MethodA randomised factorial design was used in 2008–2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n = 249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor.ResultsThe use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse’s age and the reasoning skills of `deduction’ and `analysis’.ConclusionsImproving nurses’ dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.

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“…From this process, the nurse could deepen their research and determine the best diagnosis that guide their practice and the therapeutic procedure. (7) The data also revealed the extent of the NAN-DA-I taxonomy in the identification of urinary disturbances in patients with Parkinson's disease and showed the complexity of them, since of the nine diagnoses in that class, seven were mapped. Studies related to the nonmotors symptoms not Parkinson's disease reported the high prevalence of bladder changes, revealing its existence in 38-71% of patients.…”

“…There was coexistence of accurate diagnosis and need for discussion on the need for organizing them hierarchically. (4,7) In this context, the diagnosis of "Urge Urinary Incontinence" was considered hierarchically superior in relation to 'impaired urinary elimination." (7) Data indicate that nurses in the area of rehabilitation, after identifying bladder change has tended to investigate specific signals and thus identify hierarchically higher diagnosis.…”

“…(4,7) In this context, the diagnosis of "Urge Urinary Incontinence" was considered hierarchically superior in relation to 'impaired urinary elimination." (7) Data indicate that nurses in the area of rehabilitation, after identifying bladder change has tended to investigate specific signals and thus identify hierarchically higher diagnosis. From this process, the nurse could deepen their research and determine the best diagnosis that guide their practice and the therapeutic procedure.…”

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