Evidence Based Nursing (EBN) & Diagnostic Accuracy Rona F. Levin, PhD, RN (New York, USA) Margaret Lunney, PhD, RN (New York, USA) Barbara Krainovich Miller, EdD, RN (New York, USA) Diná Monteiro da Cruz, PhD, RN (Sao Paulo, Brazil) Cibele de Mattos Pimenta, PhD, RN (Sao Paulo, Brazil)
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Evidence Based Nursing (EBN) & Diagnostic Accuracy
Evidence Based Nursing (EBN) & Diagnostic Accuracy. Rona F. Levin, PhD, RN (New York, USA) Margaret Lunney, PhD, RN (New York, USA) Barbara Krainovich Miller, EdD, RN (New York, USA) Diná Monteiro da Cruz, PhD, RN (Sao Paulo, Brazil) Cibele de Mattos Pimenta, PhD, RN (Sao Paulo, Brazil). - PowerPoint PPT Presentation
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Evidence Based Nursing (EBN)& Diagnostic Accuracy
Rona F. Levin, PhD, RN (New York, USA)Margaret Lunney, PhD, RN (New York, USA)
Barbara Krainovich Miller, EdD, RN (New York, USA)Diná Monteiro da Cruz, PhD, RN (Sao Paulo, Brazil)
Cibele de Mattos Pimenta, PhD, RN (Sao Paulo, Brazil)
Objectives
• Explain accuracy of diagnosis as the foundation of EBN-M. Lunney
• Describe an evidenced-based model (PCD) for use by nurses-R. Levin
• Apply the PCD format to diagnose anxiety-B. K. Miller
• Apply the PCD format to teach EBN- D. M. da Cruz & C.M. Pimenta
Foundation of Evidence-Based PX: Accurate Interpretation of Data
• Interpretations determine actions
• Additional data to be collected• Subsequent interpretations• Possible outcomes to consider• Choices of interventions
Foundation of Evidence-Based PX: Accurate Interpretation of Data
• High potential for inaccuracies• Human beings are complex and diverse• We do not “know” other people
Foundation of Evidence-Based PX: Accurate Interpretation of Data
• What is diagnostic accuracy?Accuracy is a rater’s judgment of the degree to which a diagnostic statement matches the cues in a patient situation (Lunney, 1990).
Challenge of Achieving Accuracy:
Puzzle: What is the Diagnosis?
Research Findings
• Studies: 1966 to present
• Conclusions: Interpretations vary widely
• Influencing factors:• Diagnostic Tasks
• Situational contexts
• Nurse Diagnosticians
Diagnostic Tasks
• Factors studied:• Task complexity
• Amount of data
• Relevance of data
Situational Contexts
• Factors studied:• Time constraints
• Role in healthcare system
• Factors still to be studied:• Policies
• Procedures
• Philosophy and theories
Nurse Diagnosticians
• Factors studied:• Education
• Use of teaching aids
• Nursing experience
• Cognitive strategies
• Cognitive abilities
• Personality
Summary of Research Findings: Positive Influences on Accuracy
• Education related to nursing diagnoses
• Knowledge of diagnostic process and concepts
• Teaching aids for diagnostic reasoning
• Variety of thinking processes
• Experience specific to diagnostic task
• Lesser amounts and complexity of data
Conclusions from Knowledge Development
• Problem: Diagnostic Accuracy varies from high to low.
• Solution: Use an evidence-based practice approach to facilitate the formulation of accurate diagnoses.
Evidence-Based Practice
Best Evidence
Clinician’s Experience
PatientPreference
Solving the PuzzleIs it this? Or This? Or This?
Evidence-Based Practice to Solve the Puzzle
• Evidence from Literature• Which diagnosis are indicated by the cues?
• What differentiates similar diagnoses?
• Which of the possible diagnoses is the best match?
• Clinician perspective
• Patient perspective
EBM Model
• Asking answerable questions
• Finding the best evidence
• Appraising validity of evidence
• Integrating evidence with clinician expertise and patient preferences
• In adult critical care patients (population) who exhibit angry outbursts, complaints about treatments that interfere with sleep/rest, and irritable behavior (cue cluster) what are the possible nursing diagnoses to consider (differential diagnosis)?
Asking Answerable Diagnostic Questions in Nursing
• Possible diagnoses to consider• sleep pattern disturbance
• ineffective coping
• hopelessness
• powerlessness
• fear and/or anxiety
• cognitive impairment
• other?
Asking Answerable Diagnostic Questions in Nursing
• Based on evidence, what is the strength of the cues in relation to the possible diagnoses?
• Based on evidence, which of the possible diagnoses represents the best match with the cues?
• Does the patient validate the clinician’s interpretation?
Finding the Evidence
• Knowledge of possible diagnoses
• Research evidence associated with specific diagnoses
• Knowledge of useful data bases
• Access to data bases and sources
Appraising the Evidence
• Assess validity of the research-based evidence• Type of study
• survey of nurses?
• Observation of patients?
• Sample size and selection
• Applicability to your practice
Integrating Evidence
• With clinician’s expertise• knowledge of diagnoses and diagnostic task
• specialty focus
• frequency of caring for patients’ with specific responses (cue clusters)
• knowledge of related interventions
Integrating Evidence
• Patient’s Perspective• Uniqueness of individual
• Context of human response
• Values and preferences
• Validation of nurse’s interpretation
Evaluating Effectiveness
• Am I looking for the research evidence about human responses?
• Am I considering the highly relevant diagnoses associated with observed cue clusters?
• Am I considering the individual patient and the specific context when applying research-based evidence?