Critical Need to Address Accuracy of Nurses' Diagnoses

Article excerpt

Abstract

Studies published from 1966 to 2006 describe how nurses' interpretations of clinical data vary widely, thus significant percentages of nurses' diagnoses may be of low accuracy. This is important because data interpretations, or diagnoses, serve as the basis for selection of interventions and the subsequent achievement of patient outcomes. Accuracy of nurses' diagnoses is defined as a rater's judgment of the match between a diagnostic statement and patient data. Low accuracy can lead to wasted time and energy, harm to patients, absence of positive outcomes, and patient and family dissatisfaction. The purpose of this article is to appeal to nurses in both practice and education to address the accuracy of nurses' diagnoses. This appeal is based on three factors: (a) research evidence indicates the need for greater consistency among nurses in making nurses diagnoses, (b) accuracy of nurses' diagnoses will always be an issue of concern because diagnosis in nursing is complex, and (c) with implementation of electronic health records, the degree of accuracy of nurses' diagnoses will have broad-based implications. In this article, the need for nurses to be accountable for addressing diagnostic accuracy is explained and strategies to improve accuracy related to the diagnostician, the diagnostic task, and the situational context are recommended. Some of these strategies include a greater focus on educational methods and content for development of nurses as diagnosticians, adoption of partnership models of nurse-patient relationships, an increase in opportunities for critical thinking and clinical decision making, selection of software with appropriate structures and content libraries, and a change in health care policies.

Key words: administration, clinical judgement, education, evidence-based practice, nursing diagnosis

Citation: Lunney, M., (Jan. 31, 2008) "Critical Need to Address Accuracy of Nurses' Diagnoses" OJIN: The Online Journal of Issues in Nursing. Vol. #13 No. #1. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/AccuracyofNursesDiagnoses.aspx

The research evidence is strong that it is time to address the accuracy of nurses' diagnoses... Accuracy of nurses' data interpretations (diagnoses) should be a serious concern of nurses in both practice and education because interpretations of patient data serve as the basis for selecting the nursing interventions that will achieve positive patient outcomes. Accuracy of nurses' diagnoses is defined as a rater's judgment of the match between a diagnostic statement and patient data (Lunney, 1990, 2001).

The research evidence is strong that it is time to address the accuracy of nurses' diagnoses and consider strategies to improve accuracy. In an analysis of 20 studies published from 1966 to 2000, Lunney (2001) reported that in all clinical simulation studies, and also in a study involving clinical cases, nurses' interpretations of the same data varied widely. Since 2000, investigators of nurses' clinical reasoning and critical thinking abilities have also indicated that interpretations from the same data vary from nurse to nurse (Brannon & Carson, 2003; Ebright, Patterson, Chalko, & Render, 2003; Ferrario, 2003; Hicks, Merritt, & Elstein, 2003; Junnola, Eriksson, Salantera, & Lauri, 2002; Puntillo, Neighbor, O'Neill, & Nixon, 2003; Redden & Wooten, 2001; Reischman & Yarandi, 2002). When interpretations vary, some of the interpretations represent low accuracy. This is serious because low diagnostic accuracy contributes to harm to patients through: wasted time and energy, implementing ineffective interventions, absence of positive outcomes, and patient and family dissatisfaction.

...diagnosis in nursing is complex [and]...low diagnostic accuracy contributes to harm to patients...A concern about the accuracy of nurses' diagnoses relates to all nursing care whether or not standardized nursing diagnoses, such as NANDA International (NANDA-I, 2007), are used. …