“Advanced nursing practice is the deliberative diagnosis and treatment of a full range of human responses to actual or potential health problems. ” (Calkin, 1984). Advanced nurse practitioners attempt to maximize the use of knowledge and skills and improve the delivery of nursing and health care services. The field of advanced nursing practice differs from basic practice as the former requires clinical specialization at the master’s level. At this level, nurses become expert practitioners whose work includes direct and indirect patient care.
Direct patient care involves caring for patients and their families; this is the focus of my section on nurse clinicians. Indirect patient care includes work as an educator, researcher, and a consultant. One aspect of all these nursing roles that has fascinated me is the collaboration that occurs with other medical professions. Collaboration occurs at all levels of nursing practice and not just expert practitioners. By practising collaboratively with medical staff, other nurses, and members of an interdisciplinary team, patient outcomes can be greatly improved. Nurse as Clinician
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As clinicians, nurses have an “in-depth knowledge of a clinical population, advanced recognitional abilities, and increased use of past whole situations of situation specific referents for understanding the clinical situation” (Benner, 1984). Advance nurse practitioners focus on client and situations which enhance positive outcomes for the client. Thus, the practitioner’s actions are purposeful, directed towards excellence and pragmatic (Sutton & Smith, 1995). Nurse clinicians practice with distinct characteristics while aiming for an effective management of the health problems of patients.
Clinicians become competent in managing the complex health issues of patients and thus are in a front-line position to improve patient quality of care (Chuk, 1997). Nurse clinicians possess expert nursing skills which results in an acceleration of the nursing process. This allows them to focus on the root of the problem without wasting time on fruitless assessment (Chuk, 1997). As a result of their education and experiences, clinicians intervene more for meeting patient’s needs than do basic practitioners. Nurse as Educator Nurses take on educator roles both in educating the public on their health nd as educators in clinical practice and academic settings. As a public educator, nurses teach and counsel patients and families to enhance health and well-being. Patient and family health education is an important step in preventing disease. In order to be able to properly educate their clients on health promotion and well-being, nurses must first fully understand “health”. Nurses do not view health as “the absence of illness” but “define health as the extent to which an individual or group is able to realize aspirations, to satisfy needs and to change or cope with the environment in which they live. ” (CARNA, 2005, p. ). Nurses hold a holistic view of the person and health and address health within the context of a person’s wholeness, including biological, emotional, psychological, social, cultural, and spiritual dimensions. Incorporating these ideas, nurses use the determinants of health as a way of dealing with and achieving health for an individual. Nurses recognize the broad determinants of health as income & social status, education, culture, physical environments, gender, health services, social support networks, employment & working conditions, health services, personal health practices, and biology & genetic endowment.
A nurse educator in a clinical setting recognizes that continuing competence through life-long learning is essential to professional nursing. A clinical educator promotes and facilitates an atmosphere of life-long learning through the development and implementation of a variety of learning opportunities such as continuing education opportunities in the work environment and orientation programs (CARNA, 2005). In an academic setting, advanced nurses are involved in classroom teaching for undergraduate and postgraduate nursing students.
Through teaching, students benefit from learning hot theories and advanced nursing practices are blended in delivering direct patient care (Chuk, 1997). As an educator in an academic setting, the nurse “ensures the development and implementation of a broad-based educational preparation for students that includes a breadth of knowledge and skills from nursing and related disciplines to meet the complex health needs of clients in constantly evolving practice environments. ” (CARNA, 2005, p. ). Nurse as Researcher Advanced nurse practitioners participate in nursing research in an effort to “support and guide nursing practice as well as improve nursing care, client outcomes, and the health care system” (CARNA, 2005, p. 6). Anderson & Hicks (1986), describe three levels of nursing research. At the first and most basic level, practitioners should be able to explain, evaluate, and communicate the nursing research related to their clinical specialty to staff nurse.
Practitioners should keep up to date with relevant research literature, and undertake appropriate training in research method to enable judgement of the validity and reliability of findings and their relevance to nursing care. The second level involves practitioners being able to test and apply the research findings of others to patient care. At the highest level, practitioners should conduct research and not simply analyze and apply other research (Chuk, 1997). As nurse researchers engage in ongoing research, they can better explore the concepts of evidence, evidence dissemination, and utilization in nursing practice (CARNA, 2005).
Patients will benefit from any level of research practitioners engage in. Nurse as Consultant Another way of improving patient care is the involvement of nurses in consulting. Nurses can be consultants for patients or staff nurses. Due to the expertise of advance practice nurses, staff nurses would seek advice from them in cases of complex patient care (Chuk, 1997). Through the consultation process, a number of patient care problems can be identified and solved. To identify and solve these problems, the nursing process is used (Anderson & Hicks, 1986).
The nursing process is a problem-solving mode of action which guides “nurses to develop a style of thinking that leads to sound clinical judgments. ” (Vye-Rogers, 2007). As a problem-solving model, the nursing process consists of five stages: assessment, diagnostic, planning, implementing, and evaluation. The nursing process involves decision making in every stage and allows for the nurse consultant to be highly creative when using the nursing process. Overall, the goal of nurse consultants is to help define problems, identify appropriate resources, and support nurses in problem solving. References Anderson, G. & Hicks, S. 1986). The clinical nurse specialist role, overview and future prospects. Australian Nurses Journal, 15(8), 36-38, 53. Bridges, J. M. (1990). Literature review on the images of the nurse and nursing in the media. Journal of Advanced Nursing, 15(7), 850-854. Calkin, J. D. (1984). A model for advanced nursing practice. The Journal of Nursing Administration, 14(1), 1037-1043. Chuk, P. K. (1997). Clinical nurse specialists and quality patient care. Journal of Advanced Nursing, 26(3), 501-506. Cohen, A. (1991). Two portraits of caring: a comparison of the artists, Leininger and Watson. Journal of Advanced Nursing 16(8), 899-909.
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