Lauren A Petersen, Stephanie Delkoski, Sarah McCarthy
{"title":"Diagnostic Reasoning for APRN Learners: Overview of Teaching Strategies.","authors":"Lauren A Petersen, Stephanie Delkoski, Sarah McCarthy","doi":"10.4037/aacnacc2025341","DOIUrl":"10.4037/aacnacc2025341","url":null,"abstract":"<p><p>Diagnostic error is a critical issue in health care. To reduce diagnostic error and enhance practice safety of new graduates, advanced practice registered nurse (APRN) learners need intentional preparation in diagnostic reasoning. It is imperative that APRN programs integrate diagnostic reasoning into all program curricula. This article provides an overview of teaching strategies aimed at promoting skill development in diagnostic reasoning, specifically related to knowledge development, differential diagnosis, and reflective practices. The article reviews foundational information related to dual-process thinking and teaching strategies for APRN primary and acute care curricula. Knowledge development is supported by illness scripting and problem representation activities. Skills in differential diagnosis and diagnosis prioritization are supported by the use of grids and lists. Cognitive debiasing and reflective practice are supported through self-explanation and structured reflection. Implementation of tailored teaching strategies can effectively prepare learners for clinical practice as diagnosticians.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"131-142"},"PeriodicalIF":2.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sheila Smith, Mary Mescher Benbenek, Sarah Meyer, Jenna Herman, Elizabeth Weinfurter
{"title":"Diagnostic Reasoning as a Component of Clinical Reasoning in Nurse Practitioner Education: Extension of a Scoping Review.","authors":"Sheila Smith, Mary Mescher Benbenek, Sarah Meyer, Jenna Herman, Elizabeth Weinfurter","doi":"10.4037/aacnacc2025518","DOIUrl":"10.4037/aacnacc2025518","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic reasoning (DR) is a critical skill for nurse practitioners (NPs). This article provides an update of a 2022 scoping review of DR content in NP education, highlighting advances in curriculum integration.</p><p><strong>Objective: </strong>To assess the degree that scholarly literature about clinical reasoning in NP education includes DR; identify how DR is defined in NP education; and describe the teaching methodologies used to support DR-related knowledge, skills, and/or attitudes.</p><p><strong>Methods: </strong>We examined and categorized the literature from the past 2.5 years, assessing the scope, current status, and impact of DR-related content in NP education programs.</p><p><strong>Results: </strong>Literature reviews emphasized meta-cognitive strategies and competency assessment. Case reports described innovative teaching interventions and objective measures of student competency. Primary research articles explored a variety of DR topics, including survey research, diagnostic accuracy, structured reflection, and tool validation studies. New contributions included model and tool development articles for teaching and evaluating DR.</p><p><strong>Conclusions: </strong>Substantial progress was seen in the integration of DR components, theory, evidence-based teaching, and evaluation approaches in NP education, demonstrating increased awareness of the importance of DR competencies for NP students. Extending these advances to faculty, preceptor, and NP research development will provide important foundations for NP education and scholarship.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"158-173"},"PeriodicalIF":2.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sheila Smith, Mary Mescher Benbenek, Lauren A Petersen
{"title":"Diagnostic Reasoning Foundations: Theoretical and Scientific Background With Suggested Competencies for Nurse Practitioner Education.","authors":"Sheila Smith, Mary Mescher Benbenek, Lauren A Petersen","doi":"10.4037/aacnacc2025354","DOIUrl":"10.4037/aacnacc2025354","url":null,"abstract":"<p><p>This article provides a comprehensive narrative review and explanation of the theory, science, and component processes of diagnostic reasoning, based on over 30 years of diagnostic reasoning literature. Building on this background information and the authors' nurse practitioner education and practice expertise, foundational diagnostic reasoning concepts and processes are applied to nurse practitioner education and practice. Foci are suggested for nurse practitioner education competencies in the diagnostic reasoning components of illness scripts and script activation, interaction and encounter management, hypothesis-directed patient evaluation, problem representation and differential diagnosis, value-based testing, identifying and communicating the working diagnosis, developing the management plan, and metacognition and documentation. The desired goals include highest quality practice, diagnostic safety, and improved health outcomes.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"109-122"},"PeriodicalIF":2.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Growth in Nurse Practitioner Fellowship Programs: Implications for Scope of Practice.","authors":"John D Gonzalez, Kristin H Gigli","doi":"10.4037/aacnacc2025678","DOIUrl":"10.4037/aacnacc2025678","url":null,"abstract":"<p><p>Postgraduate fellowship programs for nurse practitioners have proliferated since 2007. These programs facilitate the transition to practice for new nurse practitioners as well as those who are experienced and choose to move to a new specialty. Outcome data demonstrate the effectiveness of these programs in promoting the development of novice nurse practitioners. Fellowship programs offer education outside the framework of the Consensus Model for regulation of the licensure, accreditation, certification, and education of advanced practice registered nurses and have limited implications for nurse practitioners' scope of practice. Greater understanding of the limits of fellowship programs is needed to ensure that nurse practitioners work within their scope of practice.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 1","pages":"14-19"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Critical Care Nursing Response to the Maui Wildfire Disaster: Narrative Review and Case Study.","authors":"Christin Quarry, Margaret Slota","doi":"10.4037/aacnacc2024456","DOIUrl":"10.4037/aacnacc2024456","url":null,"abstract":"<p><p>Climate change has increased the frequency and severity of natural disasters, including the 2023 wildfires in Maui, Hawai'i. The no-notice disaster affected hospital operations at the sole acute care hospital that serves the community, requiring immediate interventions and reallocation of resources. The purpose of this article is to explore the role that critical care nurses play in responding to wildfires. Literature related to the nursing role in managing wildfire injuries and the events on Maui are explored and a case study presented. Results are organized into themes: environmental limitations, disaster response and code triage activation, no-notice preparation for critical care nurses, preparation to increase patient capacity and maintain patient safety standards, hospital staffing and staff affected by the disaster, management of patient care and hospital system operations, and disaster medical tent. Preparation for no-notice events requires critical care nurse involvement to effectively facilitate care for patients affected by disasters.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"35 4","pages":"334-342"},"PeriodicalIF":2.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia G Lobos, Emerson B Nairon, Maria Denbow, DaiWai M Olson, Jennifer E Wilson
{"title":"Critical Care Clinicians' Knowledge of Post-Intensive Care Syndrome.","authors":"Patricia G Lobos, Emerson B Nairon, Maria Denbow, DaiWai M Olson, Jennifer E Wilson","doi":"10.4037/aacnacc2024672","DOIUrl":"10.4037/aacnacc2024672","url":null,"abstract":"<p><strong>Background: </strong>The term post-intensive care syndrome refers to a group of symptoms that commonly occur after intensive care unit discharge, leading to worsening physical or mental health. The incidence of this syndrome is increasing. Critical care clinicians can play a pivotal role in improving patient outcomes through knowledge of post-intensive care syndrome risk factors and symptoms.</p><p><strong>Objective: </strong>To explore critical care clinicians' current knowledge of post-intensive care syndrome as a basis for developing critical care educational interventions.</p><p><strong>Methods: </strong>This quantitative, cross-sectional, observational pilot study was conducted to survey critical care physicians, nurses, nurse practitioners, and physician assistants at a university hospital on their knowledge of post-intensive care syndrome symptoms and risk factors and their confidence in their ability to recognize the condition.</p><p><strong>Results: </strong>A total of 51 clinicians completed the survey. The overall levels of knowledge and confidence regarding post-intensive care syndrome risk factors and symptoms were low, with no significant differences found by clinician role.</p><p><strong>Conclusions: </strong>These findings support the need for interprofessional education on post-intensive care syndrome risk factors and early identification of symptoms in the critical care setting.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"35 4","pages":"300-306"},"PeriodicalIF":2.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stopping Delirium Using the Awake-and-Walking Intensive Care Unit Approach: True Mastery of Critical Thinking and the ABCDEF Bundle.","authors":"Kali Dayton, Mark Hudson, Heidi Lindroth","doi":"10.4037/aacnacc2023159","DOIUrl":"10.4037/aacnacc2023159","url":null,"abstract":"","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 4","pages":"359-366"},"PeriodicalIF":2.2,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11019856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}