Investigation of the accuracy of nursing diagnostic reasoning by students in simulated clinical cases

INTRODUCTION: this research sought to investigate the accurate exercise of diagnostic reasoning followed by clinical decision-making, based on the double processing theory. GENERAL OBJECTIVE: to evaluate the accuracy of the nursing students' diagnostic reasoning when applying an educational technology based on double processing. SPECIFIC OBJECTIVES: to verify the accuracy of nursing students in correctly concluding the absence or presence of the diagnosis of "Ineffective Airway Clearance" in simulated clinical cases; to verify the level of diagnostic accuracy of nursing students for the clinical judgment of the "Ineffective Airway Clearance" in clinical cases simulated by the application of the Nursing Diagnostic Accuracy Scale; correlate the nursing student's identification of the relevance, specificity and coherence of clues, according to the conceptualization of the Nursing Diagnosis Accuracy Scale, with the clinical indicators inserted in the simulated cases. METHOD: controlled and randomized clinical trial, single-center, random and blind type. The experiment was carried out with 34 nursing students who worked on the nursing diagnosis "Ineffective Airway Clearance" in the simulated clinical cases. Two clinical cases were elaborated: Clinical Case 1 (experimental group), according to a clinical diagnostic validation study, in which accuracy measures were inserted, based on the double processing model; o Clinical case 2 (control group), which was elaborated by a construction-free procedure. To verify the level of diagnostic accuracy of nursing students, the Nursing Diagnostic Accuracy Scale was used. RESULTS: it was observed that 100% of students, in both cases, missed the inference of the name of the Nursing Diagnosis "Ineffective Airway Clearance". Students in Clinical Case 1 were more accurate when compared to those in Clinical Case 2. Students in Clinical Case 2 had a null category (35.3%), whereas in Clinical Case 1 this category did not exist. The moderate category was identified in 72.7% of the students allocated in Clinical Case 2 and in 29.4% of those in Clinical Case 1. In addition, 70.6% of students in Clinical Case 1 had a high accuracy, compared with 27.3% who experienced Clinical Case 2. Those who experienced Case 1 inferred an average of four signs and symptoms, while those who entered Case 2 inferred an average of 0.9 signs and symptoms. It was possible to observe that, as the number of referred signs and symptoms increased, so did the diagnostic accuracy and vice versa. CONCLUSION: the simulated clinical cases using diagnostic clinical validation studies based on the double- processing theory facilitate the detection of clues, such as signs and symptoms, which are essential to provide highly accurate diagnostic reasoning for nursing students, when compared to inserted students in simulated clinical cases based on pattern recognition.