Paper
Friday, July 23, 2004
This presentation is part of : Evidence-Based Nursing and Diagnostic Accuracy
State of the Science: Accuracy of Nurses' Interpretations of Patient Data
Margaret Lunney, RN, PhD, Department of Nursing, Department of Nursing, College of Staten Island, CUNY, Staten Island, NY, USA
In the last four decades, studies of nurses' interpretations of clinical situations, both simulations and actual cases, have shown that nurses' interpretations of patient data, and thus accuracy, vary widely from low to high (Lunney, 2001). Despite research evidence of the risk of low accuracy, there is little to no discussion in the nursing literature of strategies to avoid this risk. Risks of low accuracy diagnoses detract from the quality of care and are inconsistent with the goal of achieving evidence-based nursing. The purpose of this paper is to define accuracy of nurses' interpretations of patient data, describe the state of the science, and explain the importance of using an evidence-based model to address the accuracy of nurses interpretations of patient data.

Accuracy is the degree to which interpretative statements or diagnoses match the cues or patient data in a clinical situation. Since 1966, whether accuracy was measured as a dichotomous or a continuous variable, every study supported the hypothesis that there is a risk of low accuracy. This is not surprising since there are numerous complex and diverse factors in three categories that impact on accuracy: the nature of the diagnostic task, the situational context, and the diagnostician. To date, evidence suggests that accuracy is associated with knowledge of nursing concepts, use of teaching aids, reduced data accumulation, and a variety of thinking strategies.

The goal of EBP should prompt nurses to seriously address diagnostic reasoning processes. As in other disciplines, nurses' interpretations of clinical cases are the foundation for selection of appropriate interventions to achieve positive health outcomes. Use of an evidenced-based model in the diagnostic realm can help nurses to establish the strong foundation that is needed for evidenced-based nursing.

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