Diagnostic Reasoning-A Comparison of Expertise in Nurses, Nurse Practitioners, Physicians

This presentation will include a discussion of differences and commonalities in diagnostic reasoning of nurses, nurse practitioners and physicians. It will incorporate a review of the literature related to diagnostic reasoning of each of these practitioners and then will present vignettes to look at some of the approaches each type practitioner might take to determining a diagnosis. This presentation will help address one hypothesis of why some nurse practitioner students make the transition from registered nurse to nurse practitioner easily while others struggle. In considering the differences in roles of the registered nurse vs. the nurse practitioner, it seemed one important difference was that nurse practitioners must independently determine a diagnosis different from the type of diagnosis made as a registered nurse. The diagnosis of the patient in primary care typically drives the management plan, billing and quality assurance. Skill is making a diagnosis greatly aids the practitioner in providing accurate and appropriate care. The presentation will address diagnostic reasoning skills identified in novice and expert practitioners in each group. The commonalities in medical, nursing and nurse practitioner diagnostic reasoning fields will be reviewed. These overlapping areas include: * a foundation based on the scientific inquiry process (generating hypotheses and testing them) * the identification of certain biases affecting diagnostic reasoning ability * observed differences in reasoning skills used by novices vs. experts One area of divergence in recognition as helpful in determining a diagnosis is intuition. Intuition has been identified as one tool employed by experts in nursing and nurse practitioner studies, but not in physician studies. This difference will be discussed in relation to the literature related to diagnostic reasoning in physicians, nurse practitioners and nurses. Understanding differences in diagnostic reasoning will help educators identify factors important for teaching and evaluation of diagnostic reasoning skill. This presentation will provide participants with more information about the diagnostic reasoning process, the development of expertise in diagnostic reasoning and will look at means for improving and measuring diagnostic reasoning. .