Paper
Friday, July 23, 2004
Principles of Evidence-Based Practice Applied to Diagnostic Reasoning
Cibele Andrucioli de Mattos Pimenta, RN, PhD and Dina de Almeida Lopes Monteiro Cruz, RN, PhD. School of Nursing, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
Nurses apply knowledge, perceptual, and cognitive skills to analyze patient data and interpret patients' responses that can be improved by nursing interventions. The outcomes of quality-based nursing care depend on the appropriateness of nursing interventions, which are based on the accuracy of nurses' interpretations of patient data. The purpose of this paper is to apply Sackett et al's (2001) evidenced-based model (EBM) to diagnostic reasoning using a written case study. According to Sackett et al. (2001), the principles of evidence based practice (EBP) are used in diagnostic reasoning by identifying the: (a) validity of a diagnostic test; (b) ability of a test to discriminate those who do or do not have a specific response; (c) ability of a test to estimate the magnitude of a response when it is present; and (d) the appropriateness of a diagnostic test within the context of a diagnostic task. Applying the principles of evidenced-based practice (EBP) to diagnostic reasoning requires the availability of research findings in an integrative and cumulative fashion. Simulations of clinical cases are useful tools to apply the principles of EBP to nurses' interpretations of patient data. They serve as exemplars of how available research findings can be applied, and illustrate the gaps in nursing knowledge that jeopardize application of the principles of EBP in diagnosis and screening. The identification of these gaps is important to guide the development of nursing knowledge. The authors developed a framework for use of the EBM to demonstrate teaching EBP in relation to diagnostic reasoning. A written clinical case study of a critical care situation will be presented and research findings on decreased cardiac output will be incorporated as evidences for the diagnostic task.
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