Diagnostic Reasoning Foundations: Theoretical and Scientific Background With Suggested Competencies for Nurse Practitioner Education

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.