Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study

Pirret, Alison M., Neville, Stephen J. and La Grow, Steven J. (2015) Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study. International Journal of Nursing Studies, 52 3: 716-726. doi:10.1016/j.ijnurstu.2014.08.009

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Author Pirret, Alison M.
Neville, Stephen J.
La Grow, Steven J.
Title Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study
Journal name International Journal of Nursing Studies   Check publisher's open access policy
ISSN 0020-7489
1873-491X
Publication date 2015-03-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.ijnurstu.2014.08.009
Volume 52
Issue 3
Start page 716
End page 726
Total pages 11
Place of publication Bromley, United Kingdom
Publisher Elsevier
Language eng
Formatted abstract
Background Nurse practitioners perform a diagnostic role previously delivered by doctors. Multiple studies demonstrate nurse practitioners are as effective as doctors when managing chronic conditions and minor illnesses and injuries. No studies have focused on how nurse practitioners compare to doctors in their management of complex cases presenting for the first time.

Objective This study assessed how nurse practitioners’ diagnostic reasoning abilities when managing a complex case compared to those of doctors’?

Design A comparative research design.

Participants Purposeful sampling recruited 30 nurse practitioners and 16 doctors working in multiple specialties in New Zealand. All doctors were completing postgraduate specialist training programmes. Specialties included older adults, emergency care, primary health care/general practice, cardiology, respiratory and palliative care.

Methods A complex case scenario assessed by an expert panel and think aloud protocol was used to assess diagnostic reasoning abilities. The ability of 30 nurse practitioners to determine diagnoses, identify the problem, and propose actions was compared to that of 16 doctors. Correct responses were determined by an expert panel. Data gained from the case scenario using think aloud protocol were quantified for analysis.

Results 61.9% of doctors identified the correct diagnoses, 56.3% the problem and 34.4% the actions as determined by the expert panel. This compares to 54.7% of nurse practitioners identifying the correct diagnoses, 53.3% the problem and 35.8% the actions. Analysis revealed no difference between these groups (diagnoses 95% CI: −1.76 to −0.32, p = 0.17, problem χ2 = 0.00, p = 1.0, or actions 95% CI: −1.23 to 1.58, p = 0.80).

Conclusion Nurse practitioners’ diagnostic reasoning abilities compared favourably to those of doctors in terms of diagnoses made, problems identified and action plans proposed from a complex case scenario. In times of global economic restraints this adds further support to alternative models of care.

What is already known about the topic?
• Multiple studies demonstrate nurse practitioners achieve similar patient outcomes to doctors.
• Most studies comparing nurse practitioner patient outcomes to doctors compare their management of chronic conditions and minor illnesses and injuries
• Few studies compare nurse practitioner diagnostic reasoning abilities to those of doctors.
• Most studies comparing nurse practitioner diagnostic reasoning abilities compare them to house officers.

What the paper adds
• Nurse practitioners analysis of a single complex case compare favourably to that of registrars in terms of diagnoses made, problems identified and action plans proposed from a complex case scenario.
• The findings of the study suggest nurse practitioners’ diagnostic reasoning developed from education and experience enables them to diagnose and manage complex patients presenting for the first time.
Keyword Complex case
Diagnostic accuracy
Diagnostic reasoning
Nurse practitioners
Registrars
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 3 September 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
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Created: Sat, 20 Sep 2014, 00:21:59 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work