Scoping review: Diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education

• Published in: Journal of advanced nursing Vol. 78; no. 12; pp. 3869 - 3896
• Main Authors: Smith, Sheila K., Benbenek, Mary M., Bakker, Caitlin J., Bockwoldt, Denise
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-12-2022; John Wiley and Sons Inc
• Subjects: advanced practice nursing; Clinical decision making; Clinical Reasoning; Clinical training; Competence; Curricula; Curriculum; diagnosis; diagnostic reasoning; Diagnostic tests; Educational programs; Educational research; Humans; Innovations; literature review; Medical diagnosis; nurse practitioner; nurse practitioner education; Nurse practitioners; Nurse Practitioners - education; nursing; nursing curriculum; Nursing education; Patient-centered care; Primary care; Primary Health Care; Problem Solving; Review; Reviews; scoping review; Teaching; Tests; United States > US; clinical reasoning; advanced practice nursing; diagnosis; diagnostic reasoning; nurse practitioner; nursing; literature review; nurse practitioner education; nursing curriculum; scoping review
• ISSN: 0309-2402; 1365-2648; 1365-2648
• DOI: 10.1111/jan.15414

Aims
Diagnostic Reasoning (DR) is an essential competency requiring mastery for safe, independent Nurse Practitioner (NP) practice, but little is known about DR content included in NP education programs. The aims of this study were to identify whether and how the concept of DR is addressed in NP education.
Design
We conducted a scoping review on DR‐related content and teaching innovations in U.S. primary care NP education programs, with implications for NP education programs worldwide. Concepts and principles with global applicability include: conducting focused and hypothesis‐directed histories and exams, generating the problem statement, formulating the differential diagnosis, appropriate and relevant diagnostic testing, determining the working diagnosis and developing evidence‐based, patient‐centred management plans.
Data sources
N = 1115 articles retrieved from Medline, Embase, PsycINFO, and CINAHL for the period 2005–2021. Forty‐one scholarly articles met inclusion/exclusion criteria.
Review methods
Data were extracted, synthesized and grouped by theoretical frameworks, content included, educational interventions and assessment measures.
Results
Most articles provided descriptions of approaches for teaching NP clinical or diagnostic reasoning. Ten papers directly referenced the current science and theory of DR.
Conclusion
The US NP education literature addressing DR is limited and demonstrates a lack of shared conceptualizations of DR. Whilst numerous components of DR are identifiable in the literature, a robust teaching/learning scholarship for DR has not yet been established in the US NP education literature.
Impact
Whilst primary care NP education programs are beginning to incorporate DR education into their curricula, little research has been conducted to demonstrate the effectiveness of educational outcomes. Increased integration of DR content into NP education is needed, including increased educational research on teaching DR competencies.
Patient or public contribution
No patient or public contribution was included in this review, as the public is generally not familiar with DR or its teaching approaches.