Paper
Friday, July 23, 2004
Determining Accuracy of the Diagnosis Anxiety in Basic and Advanced Nursing Practice: An Exemplar
Barbara Krainovich-Miller, EdD, APRN, BC, Division of Nursing, Steinhardt School of Education, Division of Nursing, Steinhardt School of Education, New York University, New York, NY, USA
The purpose of this paper is to demonstrate the use of Sackett et al.'s (2001) five steps of an evidenced-based model (EBM) to achieve diagnostic accuracy using the exemplar diagnosis of Anxiety. The first step is to convert the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question. The question for this presentation will be: “What is the accuracy of the data used to derive the diagnosis of anxiety by professional registered nurses at the basic level and the diagnosis of Generalized Anxiety Disorder (GAD) by advanced practice registered nurses. The second step is for the clinician to find the best evidence with which to answer the question. The use of multiple electronic data-bases will be discussed as the appropriate method for securing data-based articles on diagnosing anxiety. The third step, critically appraising the derived evidence on anxiety “for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice)” (p. 4) will be demonstrated. Along with the best available evidence for accurately deriving the diagnosis of Anxiety, the gaps in research (data-based) literature will be discussed. Multiple examples of the fourth step, integrating the findings of the critical appraisal on diagnosing anxiety with nurses’ clinical expertise at the basic and advanced practice levels with paradigm examples of “patient’s unique biology, values and circumstances” (p. 4) will be presented. The use of decision trees for enhancing diagnostic reasoning for differential diagnoses for the nursing diagnosis anxiety (e.g., Fear) and GAD (e.g., (Anxiety Disorder due to a general medical condition) will be explored as a critical method for completing step four. Finally, step five, evaluating the nurse clinician’s “effectiveness and efficiency in executing the previous four steps” (p. 4) will be examined in deriving the exemplar diagnosis of Anxiety.
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