Nurse practitioner diagnostic reasoning : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, New Zealand
Loading...
Date
2013
DOI
Open Access Location
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Massey University
Rights
The Author
Abstract
Introduction: Nurse practitioners were introduced to increase patients’
access to healthcare, improve patient outcomes, and provide a sustainable
solution to ongoing workforce shortages. They provide a diagnostic role
previously delivered by doctors, however, their ability to perform this role
has been challenged.
Methodology: The study used a post-positivist mixed methods
convergent parallel design to explore nurse practitioner diagnostic
reasoning and compare it to that of registrars. Methods included a
complex case scenario using think aloud protocol to determine diagnostic
abilities, including identifying correct diagnoses, problems and actions; a
previously validated intuitive/analytic reasoning instrument to identify
diagnostic reasoning style; a maxims questionnaire to identify maxims
used to guide diagnostic reasoning; and a demographic data sheet to
identify variables influencing the results of the former.
The study included 30 nurse practitioners and 16 registrars. An expert
panel determined the correct diagnoses/problems and actions for the case
scenario using a Delphi technique. Registrar data provided normative data
and norm-referenced testing compared the nurse practitioner data to the
normative data.
Results: Nurse practitioners identified a mean of 10.30 (range=4-17,
Mdn=10, mode=9, SD=3.09) correct diagnoses, problem and action items
as identified by the expert panel whereas registrars identified a mean of
10.88 (range=6-21, Mdn=10, SD=3.88); there was no statistically
significant difference between the two groups (U=238.5, z=-.04, p=.97).
Nurse practitioners’ diagnostic reasoning reflected an analytic-intuitive
style whereas registrars reflected an analytic style, however, this
difference was not statistically significant, t(44)=1.91, p=.06. Diagnostic
reasoning style was not related to diagnostic reasoning abilities in either
the nurse practitioner (rs=-.14, n=30, p=.46) or registrar (rs=.03, n=16,
p=.90) groups. There was no difference in how nurse practitioners and
registrars employ maxims to guide their diagnostic reasoning, t(44)=-.89,
p=.38. Maxims used to guide diagnostic reasoning were not related to
diagnostic reasoning abilities in either the nurse practitioner (r=-.17,
n=30, p=.37) or registrar (rs=-.08, n=16, p=.77) groups.
Conclusion: Nurse practitioners’ diagnostic reasoning, although
incorporating more System I processes than registrars, does not differ
from that of registrars. This supports the nurse practitioner role as a
sustainable solution firstly, to effectively meet the health needs of the New
Zealand population and secondly, to address workforce shortages.
Description
Keywords
Nurse practitioners, Diagnostic reasoning, Diagnosis, Registrars