Nurses are Diagnosticians

With use of the term “nursing diagnosis”, it became apparent that nurses are diagnosticians. Before that time, the clinical judgment used in clinical practice to decide the focus of nursing care was invisible or not named. Today, in health care agencies where nurses do not use nursing diagnoses, or use them without a concern for accuracy, the invisibility of the nurse’s role as a diagnostician may still exist. With the start of this formal classification of nursing diagnoses, however,  it was broadly accepted that nurses are diagnosticians who use diagnostic reasoning in collaboration with patients to identify the best diagnoses to guide nursing interventions to achieve positive patient outcomes.

The diagnostic process in nursing differs from the diagnostic process in medicine in that, in situations when it is possible  to do so, the person or persons who are the focus of nursing care should be intimately involved as partners with nurses in the assessment and diagnostic process. This is because the focus of nursing care is the person’s achievement of well-being and self-actualization. People’s experiences and responses to health problem and life processes have specific meanings to them and these meaning s are identified with the help of nurses. It is also assumed that nurses do not make people healthy with their diagnoses and interventions; people make themselves healthy with their own behaviors. Thus, to achieve changes in behaviors that affect health, people and nurses together identify the most accurate diagnoses that have the potential to guide nursing care for achievement of positive health outcomes. Nursing interventions for diagnoses of human responses offer additional ways, besides treating medical problems, that the health of people can be promoted, protected and restored.

The focus of nursing is the “health” of “human beings” two of the most complex scientific concerns: more complex, for example, than chemistry and astronomy.  Health-related phenomena, such as sleep, comfort, or nutrition, are complex because they involve human experiences. We can never know for sure what other human beings are experiencing; yet the goal of nursing is to identify people’s experiences  or responses in order to support them. With human responses, there is also a tremendous overlap of cues to diagnoses and many contextual factors such as culture that can change the perspective of “what is the diagnosis?” Many studies have verified that interpretations of clinical cases have the potential to be less accurate than indicated by the data (Lunney, 2008)

With nursing diagnoses as the foundation of nursing care, nurses need to develop diagnostic competencies in order to become good diagnosticians. Diagnosticians are people who interpret data within their fields of expertise in order to provide needed services, e.g., an automobile mechanic must be able to diagnose why the car will not start in order to be able to fix it. A key element of data interpretations is that they are subject to error. A good diagnostician must be mindful that there are always risks to the accuracy of data interpretations. Becoming a nurse diagnostician, therefore, requires development of professional and personal skills and characteristics.

Two propositions are the basis for development of diagnostic competencies:

1.       Diagnosis in nursing requires competencies in intellectual, interpersonal, and technical domains.

2.       Diagnosis in nursing requires development of the personal strengths of tolerance for ambiguity and use of reflective practice.