ADVANCING DIAGNOSTIC SAFETY THROUGH NURSING SURVEILLANCE COMMUNICATION AND CLINICAL REASONING
DOI:
https://doi.org/10.65327/hsn.v12i2.2489Keywords:
Diagnostic safety, Nursing surveillance, Diagnostic error, Clinical reasoning, Patient safety, Interprofessional communicationAbstract
Misdiagnosis, delayed diagnosis, and incorrect diagnosis are significant patient safety concerns that impact a variety of health care settings. Until now, diagnosis has been considered a task that can only be undertaken by a physician, however, there is emerging evidence of a multi-person team approach where nurses are involved in diagnosis through continuous monitoring, repeated assessment, clinical reasoning, communication, escalation and follow up. This review will explore how nurses can enhance the safety of diagnosis throughout the care journey. Special emphasis is placed on early identification of deterioration, the understanding of fluid shifts in clinical observations, the recognition of differences between anticipated and actual progress and the sharing of unresolved issues. The review also takes into account the impact of diagnostic processes such as communication with patients and families; abnormal investigations; and how patient outcomes following treatment affects the process of recognition. Cognitive vulnerabilities such as anchoring, confirmation bias, premature closure and cognitive overload are mentioned when considering nursing judgement. Organizational influences, including staffing, workload, Professional hierarchy, Psychological safety, Information continuity, and Electronic health systems are also explored as factors that influence nurses' contributions to the effective diagnosis. To enhance diagnostic safety, nurses need to be recognized as active members in the diagnostic team and receive education in clinical reasoning, simulation learning, structured escalation plans, and collaborative work with the other professions, and nurse-sensitive indicators of diagnostic safety needs to be implemented. Increased use of nursing skills in diagnostics may help to minimize preventable harm and enhance continuity, timeliness and accuracy of care.
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