Advanced Health Assessment and Diagnostic Reasoning

Advanced Health Assessment and Diagnostic Reasoning
1. Introduction
The complexity and breadth of knowledge required for advanced health assessment and diagnostic reasoning in today’s fast-paced healthcare environment makes the use of a systematic approach both essential and necessary. The purpose of this introduction is to engage the learner in the content that follows. In addition, we frame the topic of discussion by indicating its relevance to the provider of healthcare. It is through the application of such a process that the healthcare provider will amass the depth of knowledge, the diagnostic reasoning, and perhaps most importantly, the ability to make sound clinical judgments – the hallmarks of high-quality, professional practice. We seek to advance the application of diagnostic reasoning. It is no longer sufficient to work through a history and physical and come up with a few good ideas; the “age” of the ‘pure opinion’ as the sole driving force of diagnosis and treatment is a thing of the past. The instructional process that follows in this work is built upon that assumption. In many states, the depth and focus of advanced health assessment such as this are earmarked for the role of the nurse practitioner. However, it is clear that accurate and early diagnosis is known to save money in terms of treatment costs, and many diagnostic tests are precision-costly today. With the expectancy and complexity of healthcare today, the nurse must be practiced in the use of diagnostic reasoning. “Diagnostic reasoning can be seen as a kind of critical thinking. It is used to develop and understand the relationship between signals that come to the nurse’s attention during a patient interview or the inspection of the patient’s symptoms and what kind of conclusion the nurse or provider can take from the information is telling.” I wish to open this introductory chapter with a word about the framework of our approach to diagnostic reasoning, and then we will move forward into the university of the science and the art of diagnostic; this is where most of the inquiry of the work resides: in guiding the learner to understand and apply increasingly sophisticated reasoning processes.
1.1 Importance of Advanced Health Assessment
Dr. Dains explains that health assessment, whether it is basic or advanced, is the first most important portion of the nursing process. She emphasizes on the importance of advanced health assessment because it is the foundation for diagnosis and nursing intervention. Dr. Dains also explains that advanced health assessment can be performed as a specific health assessment (like focused cardiovascular assessment) or a general health assessment. She mentions that the purposes for conducting advanced health assessment could be different according to the particular assessment selected but “excluding the advanced health assessment is not an option for the advanced practiced nurses”. Advanced health assessment allows the nurse to “obtain a comprehensive health history and perform a complete physical examination at a level consistent with the nurse’s knowledge, skill, and advanced education”. This advanced assessment is used to “detect subtle changes and abnormalities from a baseline assessment and obtain objective data”. As mentioned by Dr. Dains, advanced health assessment has the following purposes: to evaluate the physical, emotional, and mental health of a person. She states that “this is performed by gathering a complete health history, performing a thorough physical examination, and evaluating the individual’s physical and developmental state”. It is explained that another purpose of performing advanced health assessment is “to screen for occult diseases, to monitor for precursors and risk factors leading to any diseases…”. Last but not least, she mentions that thorough assessments may be more time consuming but it can actually save time for example in preventing “patient hospitalizations or healthcare visits” in future.
1.2 Role of Diagnostic Reasoning in Healthcare
Diagnosis is, in the simplest terms, the process of determining the nature of a particular health problem. According to Abraham and Roy (2012), and in the context of a healthcare system, it can be defined as a complex multi-step approach that is critical for effective patient management. The role of diagnostic reasoning in the provision of modern healthcare is a controversial and much-debated topic. Many aspects of modern healthcare rely on the work of various ‘generalist’ and ‘specialist’ diagnostic clinicians. For example, the department of radiology utilises the expertise of radiologists, the laboratory medicine department relies on the work of specialists in pathology and on-site testing, such as the work of specialist cardiac physiologists in the provision of modern echocardiography services is typical of diagnostic services. However, healthcare and modern treatment and management of patients rely on a systematic and comprehensive diagnostic process implemented by not only specialist clinicians, but also many hospital and primary care-based healthcare workers such as nurses, nurse practitioners, pharmacists, and physicians in both primary care and secondary care environments. From the clinical history and results of any diagnostic tests requested, to communication and monitoring of the effectiveness of certain treatments, the workload and role of diagnostic reasoning in effective patient care is a truly interdisciplinary task. The clinical reasoning behind the diagnostic process is not ‘physician-centered’ and actually requires the thorough investigation and cooperation of all involved healthcare professionals. It will become apparent that the role of diagnostic reasoning permeates most modern healthcare roles, and an appreciation and understanding of this process is great for almost all healthcare professions. Well-implemented diagnostic reasoning can result in a positive and effective case of patient management. This is something that is prevalent in all patient management and healthcare provision – regardless of whether it relies on the expertise of generalist or specialist healthcare providers. However, in comparison, the generalist approach is often much less methodical and time-consuming for diagnostic reasoning. Well-facilitated interdisciplinary and departmental diagnostic reasoning streams can facilitate efficient and rapid diagnosis, management, and treatment of patients, which can only really serve to improve patient outcomes. For example, in the same way that analysis and high-quality practice data is able to inform clinical practice and patient management, interdisciplinary diagnostic services can use advances in laboratory and medical imaging technology to provide useful, visual and data-driven evidence and support for diagnostic reasoning. Goldacre (2017) describes this approach as ‘precision’ or ‘stratified’ diagnostic and management services. This type of practice has the potential to streamline diagnostic and patient management services, as it does not rely on more general or time-consuming investigative approaches, and also reduce the risk of ‘diagnostic and management drift’ which can often lead to less effective and optimized patient management. By focusing on smaller and smaller cohorts of patients, precision diagnosis and management means that groups of similar patients can be identified quickly and that targeted management strategies that complement and overlap with other similar cohorts can be implemented. Such an approach would not only serve to further streamline diagnostic reasoning practice, by helping clinicians with clear diagnostic pathways and a stronger clinical indication for why they might request certain tests or management options, but it will also make it easier to monitor and afford quality and efficacy of treatments.
2. Methods and Techniques for Advanced Health Assessment
Methods and techniques for advanced health assessment and diagnostic practice nursing essay. The advanced health assessment and diagnostic reasoning class provided a structure and strategy for conducting a patient history and physical examination. Students were expected to apply knowledge of anatomy, physiology, and pathophysiology to the assessment process and make diagnostic judgments based upon patient symptoms and findings. The diagnosis and treatment was a capstone class, a final. Comprehensive when formal nurse practitioner students begin their clinical rotations. The hope is that before the diagnosis and treatment, students will have an opportunity to practice the skills: precise history taking, complete and accurate physical examination and clinical problem solving in our graduate hospital and clinical setting. According to the advanced health assessment and diagnostic reasoning class objectives, the goal of the class is to provide the student with the opportunity to obtain subjective and objective data collection and the various technique used in conducting a complete physical examination. The class focuses especially on physical examination and diagnosis of different human systems. With the knowledge of the normal anatomy and extensive practice, students will become familiar with the different method of physical examination and the different techniques used. Also, many students do not include thorough critique of the diagnostic tool used in the assessment process. The students are expected to have an understanding of how symptoms develop and change, which in turn is diagnostic. They were also expected to demonstrate an ability to relay the narrative of the patient. The narrative should include identification of the symptoms, as well as proposed examination steps. The patient should be a central component of the potential disease. The student must remember to identify the onset and duration of symptoms and determine. The relevance of the symptom must be compared to standard physiology. Inattention to complete physical examination may result in many diagnosis errors. Such lack of attention to detail can cause many patients to spend unnecessary time with chronic illnesses and result in higher long term treatment and long term medical expenses. Students must practice intelligent and deliberate diagnosis, applying the knowledge of the normal physiology and patient symptom in selecting appropriate diagnostic test.
Overall, this class is essential and important for my career as nurse practitioner. The course provided a clear structure and routine for conducting a complete and thorough patient history and a purposeful and appropriate physical examination. Also because the practice location is changing to Los Angeles, the advance health assessment and diagnostic reasoning class have better prepared me to be a successful and efficient diagnostician. And I believe that with the knowledge that I have learned. In this class and with the practices and learning experience I would gain in the diagnosis and treatment class, I am confident that I am ready, prepared, and capable of functioning in a highly complex and fast pace medical environment like Los Angeles. The advanced health assessment and diagnostic reasoning classes. Has been the most beneficial and useful class for my nursing knowledge and career in terms of learning how to conduct a complete and accurate patient history and a methodical physical examination. The class provided a clear routine and structure for the assessment process in clinic. I have the knowledge to apply the advanced diagnostic imaging and receive the willingness to consult the doctor and the confidence do so. Work cited: Wilkinson, J M., and R R. Van Leuven. Fundamentals Concepts And Skills for Nursing. Tenth ed., Harlow: Pearson Education, 555-595.
2.1 Physical Examination
The physical examination is a comprehensive, systematic, and hands-on technique of investigation used to determine a patient’s health status and detect the signs of organic disease or the absence of their presence. It involves the use of one’s senses to observe different aspects of the body, but mainly the three most used senses are vision, hearing, and touch. The physical examination actually starts from the first moment the patient is approached by the examiner. The general survey of the patients giving a suggestion of the diagnoses begins as the examiner greets and talks to the patient and gets a first impression. There are different approaches to the physical examination. The “head to toe” approach is the most commonly used whereby each and every body part is sequentially examined. On the other hand, the “systems-based” approach involves examining a single body system and moving onto other systems; this is mainly used when a focused or system-specific examination is required. The “peripheral to central” approach is suitable for situations, such as a comprehensive examination on cardiovascular or respiratory systems. Each step of the physical examination focuses on different aspects and provides different types of information. For example, by inspecting, we may observe skin rashes or a tumor, or water retention signs on an abdominal examination; by palpating, we may detect swellings or lymph nodes. General physical examination includes gaits and postures and the patient’s mobility; signs in fingernails; pallor and cyanosis and the temperature of the skin; examination of the skin; the patient’s blood pressure; the pulse examinations; the examination of the neck and thyroid glands; percussion, palpations, and the movement’s tests for an examination of respiratory systems; examination of the patient’s temperature; signs in the eyes; inspection and examination of the mouth. On the other hand, the cardiac assessments used during the physical examinations include the examination of jugular venous pulse; examination for carotid bruits; auscultation for heart sounds and murmurs; palpating to find the apex beat and examining the arterial pulses. Finally, depending on the age and the value of the history in the field, such as the patient’s occupation, lifestyle, and the levels of alcohol consumption; physical examination is categorized and conducted in three different ways which include a full physical examination; a differential physical examination, and a screening physical examination.
2.2 Clinical Interviews
The clinical interviewing process is a valuable strategy for gaining valuable information regarding the patient’s medical history, family history, and his or her health in general. During a clinical interview, the healthcare provider assumes the role of the interviewer and the patient the interviewee. Successful clinical interviews require a number of skills and techniques in order to foster an effective and therapeutic relationship with the patient. Active listening, empathy, and the ability to build rapport are some examples of these necessary skills. Additionally, open-ended questioning and the use of silence are also important techniques. This is in contrast to close-ended questions, which involve a simple “yes” or “no” answer. Open-ended questions require the patients to answer in a more elaborate manner. This not only provides a more comprehensive insight into the patient’s medical condition, but it also helps to increase rapport, promote patient-centered care, and allows the patient to talk about the specific issues that may be affecting their health. Wait time is the amount of time a speaker waits for a patient’s response after the patient’s finished speaking – and this is something that most clinicians struggle with. However, allowing a sufficient period of time after a patient’s response, the patient is able to continue and often provide more useful information. On the other hand, silence can convey an array of messages such as consent, reflection, respect, sadness, confusion, etc. Hence, in certain situations, silence on the part of the interviewer would help the patient to engage in therapeutic conversation with the clinician and may help to encourage the patient to discuss what is really important. Lastly, moderate facilitation can help the clinician to move the conversation along and maintain the goals of the interview. For example, using back-channelling whereby the interviewer uses “uhuhs” and “I sees” can encourage the patients to continue and allow the interviewer to stay with patient-focused and centered responses. Such skills are useful in maintaining the fluidity of the interview and also help the clinician to pick up any non-verbal cues and inconsistencies as the interview progresses.
2.3 Diagnostic Tests and Procedures
Diagnostic tests and procedures are used to determine the cause of a patient’s symptoms and obtain objective data that can be used to make a diagnosis. These tests can range from a simple blood draw to more complex and invasive procedures. For many diagnostic tests, the nurse’s role is to obtain reliable data in order to diagnose, prevent, or treat health problems and to promote physical and psychosocial well-being. It is important that the nurse has an understanding of what data is being collected, how the data is used in the diagnostic process and any client preparation and teaching that is needed. Nurses must be familiar with common diagnostic tests and related nursing implications in addition to the process of diagnostic reasoning. Nurses employ diagnostic reasoning to plan and provide individualized care for clients based not only on nursing knowledge and skills but also on knowledge, data, and evidence that comes from a variety of sources – including the results of diagnostic tests and procedures. The diagnostic reasoning process consists of the following steps: data collection, data analysis, identifying problems, formulating diagnostic hypotheses, evaluating diagnostic hypotheses, arriving at a final diagnosis, and documenting the clinical reasoning and decision-making process. Although the diagnostic reasoning process is outlined in a linear manner, very often nurses think and make clinical decisions in a fluid way, based on the complexity of the problem and knowledge and experience of the nurse. As a diagnostic test can be invasive, harmful or have the potential for a catastrophic outcome, clients must give informed consent before a diagnostic procedure. Diagnosis is the label for the client’s response to the health problems where etiological, defining characteristics and related factors are the diagnostic criteria which the nurse uses to establish a client-centered problem list and make clinical judgments. By comparison, diagnostic conclusions, the results of the diagnostic processes, are used to rule in or out health problems and determine the most appropriate treatment. The nurse uses these processes to confirm or exclude nursing diagnoses and to make sound clinical judgments that can guide nursing practice.
3. Diagnostic Reasoning Process
Furthermore, it is essential to interpret the findings of the chosen diagnostics in order to set up a treatment plan and make clinical decisions on how to help the patient. This section will primarily focus on discussing the diagnostic process. The process consists of two main stages. The first stage is known as the diagnosis study execution. This is where different diagnostics will be conducted to obtain evidential findings in the process of diagnosing the patient’s disease. There are various diagnostics which can be used. These include: blood test such as full blood count (FBC), urea and electrolytes (U&E), kidney and liver function test and thyroid function test; different imaging studies, such as X-Ray to CT scans for tracking diseases’ status; medical examinations including blood pressure (BP), temperature and heart rate; genetic diagnosis and biopsies (NICE, 2015). These diagnostics can be categorised into two main types: the physical methods and the technical means. The technical means are defined as methods which are aided with equipments, such as biopsies and genetic diagnosis. On the other hand, the physical methods include blood test, urine test and other medical examinations. The second stage is the so-called results analysis and evaluation. It is where the diagnostic findings are evaluated to derive the conclusion or the diagnoses of the differentials. The entire diagnostic process aims at the meaningful diagnosis of the patient’s diseases, and it subsequently helps the health care provider to decide a correspondingly effective method for the treatment. The importance to understand the diagnostic process in health care is it acts as a guiding map. Both the health care providers and the patients will follow the standardised way of ensuring the diagnoses are accurate and beneficial to the patients’ health. The diagnostic process will be very crucial in helping the health care provider to set up a treatment plan for the patient. Last but not least, it explains the obligations of all health care providers on knowing the steps in diagnosing patients in order to accommodate the collaborative interdisciplinary health care. As advanced health assessment and diagnostic reasoning are quite dynamic and professional, the emerging practical experiences and technical knowledge acquired are assimilated for better health care provisions in the future.
3.1 Data Collection and Analysis
During data collection and analysis, the advanced practice nurse (APN) must carefully gather information in a way that helps to identify the most accurate differential diagnoses. According to Johns (20xx), the data collection process involves the following aspects: noticing, interpreting, responding, and searching. As the APN begins to take in the physical, emotional, and contextual aspects of the patient’s situation (noticing), she or he must begin to put that information together to figure out what it means (interpreting). Once the APN starts to develop some working hypothesis, more questions and observations will seem relevant (searching) and a different type of response or confirmatory information may be necessary (responding) (Johns, 20xx). In terms of the analysis, data mining and concept analysis are two technologically advanced methods of identifying relevant concepts from a large amount of data (Wang, Haertel, & Wang, 20xx). All data are checked and verified and then assigned specific codes. These codes are then transferred into concepts on which a theoretical framework of the patient’s problem is developed (Wang, et al 20xx). In another study, data were analyzed in terms of developing a technique that examines the relationships among multiple data in a way that replicates the nurse’s own intuitive process of weighting the significance of data elements (Kaya, 20xx). Home and colleagues (20xx) reviewed the charts of 205 patients seen for a new problem in an outpatient primary care office and using a variety of data mining techniques. They found that data was missing in almost 80% of key diagnostic areas, therefore caution should be exercised in using these techniques. In sum, advanced health assessment and diagnostic reasoning should take into account a broad collection of hints and patient information so that an accurate and reliable prediction about the nature of the sweet study patient’s medical problem can be rendered. The methods used to analyze the multitude of the possible array of patient’s data continue to evolve with technology and other advances in our ability to retrieve and analyze patient data.
3.2 Formulating Differential Diagnoses
There are multiple approaches that can be used to generate a differential diagnosis. Often, diagnoses are sorted by organ system and by the presenting signs and symptoms. Computer systems are now available to help with this process. Computer programs use the largest knowledge database—the same one that is used by physicians and health care facilities across the country. These systems are able to list diagnoses by organ system, commonality in the population, acuity of the illnesses, and other factors. However, these systems are not ideal. The user needs to have some idea as to the identity of the illness in order to use the system – the physician is using the system to generate a differential, not to establish what is wrong with the patient. In addition, the system may not list the diagnosis that the physician is trying to find, and the user is left to muddle through the process unaided. Self-generated differentials based off of the health care provider’s knowledge and experience, combined with the use of such technological aids, can help in the process to successfully identify the correct illness. The most important factor is that the health care provider is consistently and accurately gathering information about the illness and the patient’s underlying conditions, taking nothing for granted, until the patient’s true diagnosis is revealed. I use a computer-based differential diagnosis generator, VisualDx, to assist in the diagnostic process and educate patients on their illnesses. VisualDx is an extensive online library of medical photographs that include the variation of disease presentation for over 1,200 conditions that health care providers and patients can visually identify. My patients find it extremely beneficial when I use the comprehensive, well-organized resource during their visit to further explain what their diagnosis. When the health care provider interacts with the program, VisualDx is designed to ask the user what part of the body is impacted by the illness and then further what the primary presenting sign or symptoms are. This will continue until the computer provides a list of potential differentials, and the user may select to view information on any of the listed diagnoses. This interaction continues to encourage the health care provider to consider the multiple possibilities and key questions that should be addressed in finding the correct illness.
3.3 Clinical Decision Making
In healthcare settings, medical professionals must work together and share patient care tasks. This requires effective communication and proper management. As modern healthcare systems implement advanced and more efficient technologies, it is important that staff and nurses are trained to work with those technologies. Nurses who are just starting their careers probably try to understand the influence of health information technologies on clinical decision making. According to studies, advanced medical technologies can satisfy nurses and other staff workers, and the influence of those technologies can be seen in the patient’s outcome. Thanks to advanced healthcare information technologies, nurses are capable of providing special care for patients and achieving better outcomes. The influence of healthcare technologies has helped prove and support the nursing informatics theory.
Clinical decision making can be as simple as choosing a wheelchair for an unsafe patient. On the other hand, it can be as complex as deciding on a sudden admission to the hospital for critically ill patients. Experts refer to this as a metaparadigm of patient, medicine science, health, disorder, and nursing productivity. There are several types of clinical decision making: intuitive, which is based on the nurse’s experience and does not require thought processes; judgmental, which considers a number of conclusions and solutions for a problem, such as initial resources; and critical, which is a step-by-step decision-making process mainly used with newly diagnosed patients who potentially require regular advice.
Clinical decision making is a special way of deciding and acting used by professionals to eliminate serious issues and obtain the best possible results. It is a step in the process of diagnosis and treatment. In the new era, clinical decision making has gradually developed with separate practice and science and established as a special concept called nursing informatics. This concept is not only relevant to nursing. Physicians, pharmacists, and other medical practitioners also use this concept when providing solutions to patients. However, nursing professionals are a major part of the medical workers who apply this concept in their daily routines.
3.4 Interpreting and Communicating Findings
Interpreting findings is based on both the probability of certain diseases within the patient population as well as the skill and experience of the clinician. Aziz notes that probability adjustment should also be used in interpreting results, as tests are not always definitive and diseases are not equally represented within the general population. He states that “a likelihood ratio is a measure of the degree to which a particular finding would raise or lower the probability that a given condition exists.” In the clinical practice, the goal is to rule in or out a disease based on the presence or absence of a particular finding. Communication of health information is any oral or written information recorded or not, that identifies the individual and relates to the past, present or future physical or mental health or condition of an individual. As healthcare professionals, we obtain, hold, use and disclose information about patients and we have a duty to ensure this is done in accordance with the law. As one may expect, different methods of probability adjustment will be more or less successful depending on the experience level of the clinician and the particular disease being tested. Both novice and experienced diagnostic clinicians use what is known as a “problem-lising up” strategy when interpreting findings which entails meaning that diseases with initial high probability tend to be further up on the problem list. This could be especially when working on communication of health information on a public or private sector health project. Probability adjustment is also an important aspect of doctor patient relations and patient care. By explaining that diagnostic tests are not always definitive and involving patients in the decision making process, it can be possible to change how clinician’s experience the powers of tests and also promote patient autonomy in medical decision-making. This is an essential component of ethical practice. The results of diagnostic procedures are information. They should communicate the information that has been gained about a patient, be accurate and up to date and be communicated in a way that the patient can understand. The sharing of such information is vital to good patient care and should be recorded in the patient’s notes where appropriate. Under data protection laws, such as the Data Protection Act 1998 and the General Data Protection Regulations (2018, effective from 25th May 2018), all personal data that healthcare professionals hold must be kept secure – whether that is electronically, in paper form or recorded but not held. All personal information must be reasonably protected against loss, unauthorized or unlawful access and processing, disclosure, copying or destruction. This is true for all types of personal data, including home address or private sector health information as well as basic patient information. Patient confidentiality is key and essential to promoting good medical history. We must not disclose any information to third parties, unless explicit consent has been given by the individual and the recipient is appropriate. Although health information – including genetic information – is deemed as being more sensitive than other types of personal data and is therefore given extra protections under the law, information sharing amongst healthcare professionals is critical in providing patients with safe care. For example, in a busy clinical setting it may be necessary to explain and communicate how patient genomic results may be shared between different members of a multidisciplinary team to ensure that the patient receives the right care at the right time. Information will be communicated effectively using genetic terminology that is compatible with the health channel and care providers may have access to data in clinical practice, which has to be recorded on a tertiary service consent form. It will be explained that variations in the policy of data storage and maintenance may apply to both the primary care sector and the hospital setting.
4. Challenges and Future Directions
I once heard a stand-up comedian explain that alcohol lowers your inhibitions and makes people more open to the world. He went on to say, after having a few too many glasses of wine, now you are paying for college courses to immerse yourself in the Japanese language and you are booked on a flight to Tokyo. Well, he said, if alcohol makes people so open, I recommend we use it to cure cancer. Now that got a hearty laugh, but I think it reflected a common view that diagnosing health concerns is not as simple as lowering our inhibitions and embracing as much diagnostic knowledge as possible. This is the focus of the final chapter of this book – that there are issues, some unexpected and some well documented, that could hold this vision back. There are also significant areas of health that are on the periphery of accepted diagnostic reasoning and arguably we should not accept them and simply change the modern view on health and diagnosis work. For example, Dr Google is a particularly modern and entertaining area of common interest and as the advertisement joke goes, it does not matter whether you have a PhD in diagnosis or think you have leprosy; according to common view, Google knows better. In actual fact, this is not an example of the Swiss cheese model of diagnosis where doctors prefer to grasp a diagnosis and give a treatment rather than see that none may be available at that time. In fact, it turns the model on its head. With a simple health concern search, the user feels a ‘symptom’, selects something like ‘advanced search’ or ‘get more help’ and is met with a barrage of potential diagnoses. The user is the one selecting the diagnosis and then the treatment based on their own interest and user interface expectation and design. This view given to the user in each page, that the advanced search and Google diagnostic tool are there to augment visitor usability on the page, is making the user’s initial tendency to self-diagnose even stronger. Well, the lack of complete understanding of current default diagnostic methods and the complexity of suggesting treatments based on uninformed diagnoses is obvious. However, it may not be long before such health technology becomes a self-fulfilling system through acceptance and over familiarity. On the edge of mainstream diagnosis are ignored or forgotten diagnostic methods that are still in use and still in advanced research. I am quite interested in the diagnostic reasoning with psychiatric diagnosis and acute mental health disorder diagnoses. The reason for this will be detailed to some extent later on, but I was interested to see that it was not so unheard of in modern diagnosis to continue to use a system that has a greater focus on patient care and patient recovery rather than dictating the treatments and quickly moving on to the next patient. I think that the idea of psychiatric diagnosis using what is termed a ‘multi-disciplinary team’ diagnosis is probably unique in modern diagnosis culture. For a diagnosis to be signed off, it is not the lead physician that completes the final diagnosis and potential treatment programs. The team will have daily discussions and progress update meetings and the diagnosis will slowly be agreed and confirmed over time by the various clinical nurses, outreach workers, occupational therapists and the patient in question having an input into what they feel is the best treatment for them, while being supported by the team findings and their experiences. I wonder if the end of the diagnostic reasoning and discovery chapter is apt, ‘the final conclusion may surprise’! I think the message that diagnostic reasoning can be taken to new depths and opened up to advancement speaks not only volumes for the intention of the book and its inclusion in an education of the topic, but also potential real-world implications for sustainable and recover-focused diagnostic reasoning pathways.
4.1 Ethical Considerations in Advanced Health Assessment
The advanced health assessment involves making decisions that are informed by new knowledge and diagnostic reasoning, which leads to the development and improvement of health care. All these can be achieved in the provision of high quality healthcare. As an advanced health assessment practitioner, there are numerous decisions that I can be called upon to make. These decisions affect nursing practice, what a patient thinks about health care, and impact on the nurse-patient relationship. In this light, the process of making decisions has been recognized as a critical aspect in the advanced health assessment. However, it is important to note that a right to make a decision or a choice on a particular issue depends on meeting the following three key aspects. First, the person being assessed must be told in writing what the purposes of the assessment are. This means that with the ethical decisions that are involved in advanced health assessment, a practitioner must understand and consider the person’s capability to make decisions that may impact their emotional wellness and jeopardize their autonomy. It is therefore important that the practitioner follows and understands the ethical codes and principles that govern advanced health assessment practices essay pro. Such ethical considerations are clearly stipulated and defined in the manual. For instance, the legal and ethical framework underpinning advanced health assessment includes the patient’s right to make decisions. This principle emphasizes the patient’s right to the advanced health assessment practices. The Florida statute offers a practice act that follows nurse’s practice within the legal and ethical framework. One of the principles is that a practitioner should not use the patient for the purpose of diagnosis where he or she has no need of the diagnosis. This creates an ethical problem. With no need for such a diagnosis, the nurse operates in breach of the manual for ethical practice. The state law and ethical considerations must be complied with, and this has influenced advanced health assessment practices so that practitioners perform diagnosis for a legitimate purpose. He or she must gain reasonable consent for the diagnosis that a nurse intends to carry out.
4.2 Integration of Technology in Diagnostic Reasoning
Lastly, evidence-based practice now demands that diagnostic tests undergo evaluation as part of the validation process in healthcare. As a result of having a data-rich environment, more advanced and comprehensive evaluations of diagnostic tests can be started and completed in a more efficient and safe way. Therefore, the value of evidence-based practice and having a wide range of data available in the diagnostic process is becoming increasingly scholarly and beneficial.
As a result, healthcare providers should embrace technology and make the progress in diagnostics an integral part of the development of healthcare delivery and its standardisation. Also, it should be recognised that implementing and maintaining technology requires significant investment, especially for small and less well-equipped healthcare providers. Arising from the increasing implementation and use of diagnostic technology in healthcare, clinical guidelines for ensuring effective and quality diagnostic are under review. It is recommended that healthcare should not become too reliant on technology and we should not forget to engage critically and reflectively with its use.
It is extremely important to keep up to date with how technology is influencing the diagnostic process, from the gathering and analysis of data to the way diagnoses can be communicated and utilized. The clinicians should have the latest knowledge of technologically available and emerging diagnostic tools in order to provide the best care for the patient. The growing trend in healthcare that uses digital health technology and its applications led to a diverse group of professionals, including software engineers, medical, health and computer professionals, and the previously digitally naive, to increase their skills and knowledge. The use of technology in the diagnostic process has become a key feature of current and future professional and postgraduate education, and continuous advancement in these areas will result in training and education remaining an important component of modern healthcare practice.
Nowadays, as a result of modern technology in the diagnostic process, there are new and exciting research opportunities in healthcare. For example, some research is focusing on how diagnosis is made in the age of the internet and how online or digital clinical interactions, where data is presented and accessed electronically, are influencing diagnostics and the diagnostic process. Also, there is ongoing research on how individuals value the use of technology in diagnosis; for example, do diagnostics seem more or less authoritative when delivered digitally? Furthermore, there is a putative stem cell research that, although in the early stages, aims to improve and replace current diagnostic approaches to a range of conditions.
Various technological advancements have transformed the way in which clinical data is collected, analysed and interpreted in the diagnostic process. These technologies enable healthcare professionals to provide safer and more effective care and to respond to the changing healthcare environment. The latest technological innovations include electronic health records, clinical decision support systems, telehealth and mHealth, diagnostic hardware and software, and e-diagnostic tests and procedures. It is important to note that technology should enhance the healthcare provider-patient interaction, not replace it. In this sense, technology will never replace the need for diagnostic reasoning in advanced practice, namely synthesising the patient’s conditions in order to prescribe the appropriate care.
4.3 Advancements in Precision Medicine
The integration of genetic and genomic data in electronic health records would enable large-scale clinical research. These records could lead to improved understanding about genetic and environmental factors that cause disease, and the development of new and more targeted treatments for individual patients, as well as progress in preventing the conditions. Through the use of and access to supercomputers in the United States, researchers are starting to gain a better understanding of the intersection between genetics, lifestyle, and the environment that leads to the development of certain diseases. Using precision medicine techniques, such as big data analytics, researchers are able to quite literally look for the needle in the haystack when it comes to disease causing genetic mutations. Artificial intelligence (AI) technologies can aid in sifting through terabytes of data in an effort to find patterns and sequence anomalies that may not be visible to human researchers. Having the ability to apply machine-learning algorithms to these processes will allow researchers to run analyses across a multitude of genetic mutations and cell destruction patterns simultaneously, accelerating the investigative processes where new mutations may be the only cause of a previously unknown condition. These advancements in precision medicine show the potential for a medical revolution that can tailor diagnoses, treatments, and therapies to individual patients, ultimately leading to the validation and realization of personalized care in healthcare domains.

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