Measuring diagnostic competency and the analysis of factors influencing competency using written case studies.

PURPOSES To measure nurses' diagnostic competencies by using written case studies and to analyze factors influencing these competencies. METHODS A descriptive study was conducted using survey methods and a mailed questionnaire with a convenience sample of 376 nurses. Two written case studies were used to measure the diagnostic competencies of the subjects. Possible factors influencing nurses' judgments in making nursing diagnoses that were measured were clinical experience, decision-making responsibility, knowledge of nursing diagnosis, and attitude toward the use of nursing diagnosis. FINDINGS Subjects who demonstrated all three competencies were 35% (n = 131) for case study 1, and 53% (n = 200) for case study 2. Subjects who demonstrated diagnostic competency in defining diagnostic labels had the longest length of clinical experience. Subjects who were primary nurses with the usual responsibility of identifying nursing diagnoses showed the highest percentage of competency rates for defining characteristics, related factors, and risk factors. CONCLUSIONS Many of these Japanese nurses did not perform at satisfactory levels of diagnostic competency with these two written case studies. Factors that influenced diagnostic competency were length of clinical experience, decision-making responsibility, and frequency of studying nursing diagnosis.