Nursing diagnosis: educational workshops to promote skill and inter-rater reliability

Educational workshops focusing on developing skill in use of nursing diagnostic terminology in the workplace were provided over a 12 week period for a sample population of registered nurses (RNs) in an acute care facility. Inherent in the workshop format was the concept of inter-rater reliability, analysis and resolution of differences. Following participation in the workshops, pairs of RNs conducted assessments on selected stable patients in the agency and completed a nursing diagnosis data collection tool for each. Data were analyzed to determine inter-rater occurrence agreement and total agreement. Most diagnostic category disagreement was related to differences in observations or missed observations. Disagreement over etiologies and defining characteristics for agreed diagnostic categories was rare. In general there was a paucity of defining characteristics for most diagnostic categories generated. Future workshops must emphasize the necessity of a valid database prior to diagnostic formulation.