Beebe Sarah L, McNelis Angela M, El-Banna Majeda, Dreifuerst Kristina Thomas
Bayhealth Medical Center, Dover, DE.
Vanderbilt University School of Nursing, Nashville, TN.
J Am Assoc Nurse Pract. 2024 Dec 1;36(12):711-718. doi: 10.1097/JXX.0000000000001018.
Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research.
To present a model of the factors of diagnostic reasoning in Advanced Practice Registered Nurses (APRNs), based on a review of the literature supporting the Metacognitive Diagnostic Reasoning (MDR) Model © .
A review of the literature through systematic database search, historical articles, texts, and documents was conducted from inception through August 2023 ( N = 41).
The MDR model depicts the following concepts: (1) metacognition is viewed as the driving force of diagnostic reasoning; (2) dual cognitive processing and knowledge representations are used; (3) once a diagnosis, treatment plan, and evaluation are complete, APRNs use metacognition for the next patient encounter, using repetition for improvement of the process.
The model combines key concepts of diagnostic reasoning, providing a framework for researchers to develop and test, and faculty to teach and evaluate this complex process in learners.
The MDR model provides research opportunities to validate its usefulness and effectiveness and a framework to guide educational research, contributing to the body of evidence-based practice in nursing. In addition, it may foster ongoing education and training that could lead to more accurate diagnoses and treatment plans, ultimately improving patient care by reducing diagnostic errors.
诊断推理是一个复杂的认知过程，需要基于知识和经验进行直观的启发式处理，以及深思熟虑和反思性思考。关于改善诊断推理干预措施的证据并不一致，部分原因是使用了不同的术语和模型来指导研究。
基于对支持元认知诊断推理（MDR）模型©的文献综述，提出高级实践注册护士（APRN）诊断推理因素模型。
通过系统的数据库搜索、历史文章、文本和文件，对从开始到2023年8月的文献进行综述（N = 41）。
MDR模型描述了以下概念：（1）元认知被视为诊断推理的驱动力；（2）使用双重认知处理和知识表征；（3）一旦诊断、治疗计划和评估完成，APRN在下次接诊患者时使用元认知，通过重复来改进过程。
该模型结合了诊断推理的关键概念，为研究人员开发和测试以及教师在学习者中教授和评估这一复杂过程提供了一个框架。
MDR模型提供了验证其有用性和有效性的研究机会，以及指导教育研究的框架，有助于护理领域的循证实践。此外，它可能促进持续教育和培训，从而带来更准确的诊断和治疗计划，最终通过减少诊断错误来改善患者护理。
