NR 510 Theory and APN Role Discussion Part Two

As a future CNP, Karen will establish relationships with patients and colleagues. She is a primary care provider who will deal with patients of all ages. Karen will be trained to individually assess health problems and risk factors and to develop treatment plans. She may decide to collaborate with other health providers and colleagues to identify patients’ health problems and implement the appropriate interventions. Karen’s overall goal is to improve the health of the individual and family. To foster a strong relationship between herself, her patients, and other healthcare providers on her patients’ healthcare teams, Karen must master the art of interpersonal communication. This is the process that allows people to exchange information and feelings through verbal and non-verbal messages (Lee & Doran, 2017). Interpersonal communication is face-to-face communication that determines how well patients and CNPs understand each other and work together to reach health goals (Lee & Doran, 2017).

Psychiatric nursing pioneer, Hildegard Peplau’s Theory of Interpersonal Relations model points out four sequential phases, the primary areas of communication essential to the nurse/patient relationship: orientation, identification, exploitation, and resolution (Nursingtheory.org, 2016). These frameworks help nurses understand their behavior in relation to listening to patients describe their health problems and working with other health providers. Peplau describes nursing as a “therapeutic, healing art” that becomes an interpersonal process because of the interaction between the NP, patient, and other healthcare providers (Arora, 2015). Interpersonal communication guides the way NPs create treatment plans and set health goals for patients and their families. Positive, open, and respectful interpersonal communication help the nurse and patient work together to become mature, knowledgeable partners in the care process (Arora, 2015). In my experience, patients often feel nervous and anxious around medical personnel. Many patients become defensive, passive-aggressive, shy, or uncomfortable all because they do not want to be perceived as uneducated about their health or the diagnosis/treatment information being relayed. Patients feel nurses and doctors talk at them instead of with them. I have heard patients complain that nurses are rude just because the patient did not understand what the nurse said about a diagnosis or treatment. Karen can use Peplau’s theory to engage in better ways to communicate with patients and help them feel valued. Undergraduate nursing school taught me best practices in creating a solid patient-nurse relationship. In Peplau’s model, this begins with the orientation stage. First, I should introduce myself to the patient then state my credentials and the role I will play. I should ask the patient his or her preferred name. I want to relieve the patient’s anxiety, so I ask the patient if there are any recent health changes he or she would like to discuss with me. I want to normalize the situation, so I may even ask about family life, hobbies, talk about the news, etc. There are so many ways for me to help the patient feel comfortable talking to me. The point is to let the patient know through verbal and non-verbal communication that I am here to help.

References

Arora, S. (2015). Integration of nursing theories in practice. International Journal of Nursing Science Practice and Research, 1(1), 8-12. Retrieved from https://www.researchgate.net/publication/283319003_Integration_of_Nursing_Theories_in_Practice

Lee, C. T., & Doran, D. M. (2017). The role of interpersonal relations in healthcare team communication and patient safety: A proposed model of interpersonal process in teamwork. Canadian Journal of Nursing Research, 49(2), 75-93. Retrieved from https://doi.org/10.1177/0844562117699349

Nursingtheory.org. (2016). Hildegard Peplau Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/peplau-theory-of-interpersonal-relations.php

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I truly believe the concept of care or caregiving is central to the role of the FNP. I agree with your point that nursing theories provide a foundation for nurses to refer to in regard to improving patient outcomes and carrying out treatment plans. Care and compassion go hand-in-hand. Nurses are obligated and have a duty of care to apply these elements when serving patient populations, but nurses should also remember to apply the concepts of care and compassion to themselves. I sometimes feel nurses are expected to be perfect, which is unrealistic. Brandford and Reed (2016) state nurses suffer from depression more than other professionals due to job stress. There is a shortage of nurses because they do not feel valued or respected. When nurses continue to work through their depression caused by a lack of compassion and empathy from patients, colleagues, and other medical professionals, nurses make mistakes due to trouble concentrating (Brandford & Reed, 2016). Nurses then begin to show less compassion to patients and colleagues. It is also important for nurses to receive emotional and professional support.

Reference

Brandford, A. A. (2016). Depression in registered nurses: A state of the science. Workplace Health and Safety, 64(10), 488-511. Retrieved from https://doi.org/10.1177/2165079916653415

Great choice of theory. In my experience as a nurse, effective communication is the most important thing to patient care and collaboration with all the staff involved in a patients care. A simple greet of the day and calling them by their last name in the first introduction usually establishes a rapport. After a rapport is established, we can begin to ask patients what they prefer to be called. I always take advantage of the first introduction to establish a rapport. If patients feel uncomfortable, asking them how they are feeling is a very simple way to give them the opportunity to open up to you. If they remain uncomfortable, I let them know to call me if there is anything they need. And when they call for something, I ensure I accomplish it. Doing this almost always reduces anxiety and creates a strong rapport between me and my patient and family members. Theory in communications will help us improve holistic care. Far too often, I have patients coming into the hospital with inadequate information after leaving a doctor’s office, which boggles my mind. This is also common in the hospital setting, where doctors leave the patients room and they don’t have a clue what the doctor said to them in regards to medications and treatment plans. This just tells me that, holistic care is not being taught because acute care continues to dominate health care. I hope that one day, holistic care dominate health care and health care education.

I think that Karen hasn’t opened her mind to what nursing theories can do and have done for us as nurses. There are so many that have brought us to be the nurses that we are today. I honestly didn’t think they were that important, until taking the theories course a few months ago. I had taken multiple theory classes before this. I just never had thought deep enough about their importance.

I like to describe Katharine Kolcaba’s comfort theory when discussing nursing theories. I especially like this theory because it describes holistic care to patients. The patient can be an individual, a family, a community, or institutions who are in need of healthcare (Lima, Guedes, Silva, Freitas, & Fialho, 2017). This will be especially true for CNS, as we will be treating not only a certain patient. Education always involves more than that patient. Family is generally involved. Community prevention is also extremely important such as childhood obesity or mental health education. The numbers of those suffering from these two particular diagnosis are on the rise, and education to the community may be helpful in the prevention of them.

Kolcaba also describes the different types of comfort that can be utilized. The human needs are addressed as relief, ease, and transcendence (Merkel, 2007). Most patients that present will have some form of pain. One way of providing comfort is to decrease the amount of pain that the patient is experiencing. Pain can be acute or chronic, in which cases the pain may not be completely relieved, but if the patient can get back to doing their everyday life activities, then they have been treated appropriately. Different types of pain relief could be non medicinal, such as a warm blanket or a hand to hold. Sometimes these patients need something simple like that, but it means more to them than we think. As a CNS, providing comfort to patients is the key to a successful diagnosis.

Lima, J., Guedes, M., Silva, L., Freitas, M., Fialho, A. (2017). Usefulness of the comfort theory in the clinical nursing care of new mothers: critical analysis. Scientific Electronic Library Online, 37(4). doi:

http://dx.doi.org/10.1590/1983-1447.2016.04.65022 (Links to an external site.)

Merkel, S. (2007). Comfort theory: A framework for pain management nursing practice. Retrieved from www.aspmn.org (Links to an external site.)

I believe that different medical professionals use different types of approaches. I honestly believe that anybody with nursing backgrounds use a more holistic approach. Few physicians that I have worked with seem to use a holistic approach. Through different research and courses, I have found that holistic care dates back to Florence Nightingale times, which isn’t generally taught to those that don’t take nursing courses. I think it is important for all providers to remember that physical care isn’t all that patients need. Emotional, spiritual, and mental health is also very important when treating and diagnosing patients. The patient may be physically being treated, but unless they are mentally prepared for the treatment course, such as cancer, then the patient isn’t getting the total continuum of cares that they need.

Technically, as providers, we also need to be using holistic care to care for ourselves. There have been instances in the ER when I leave after a day of work, that my legs ache, and I break down into tears because I am emotionally drained. We need to be sure to use holistic cares for ourselves, not only the patients.

I too am an advocate of holistic nursing. In my class NR510, I am writing a paper on FNP holistic cancer treatment plans. I think that patients as well as nurses and other medical professionals should integrate holistic healing into their patient care. I have come across many nurses who feel that holistic treatments are not valid treatment options because they are not “certified.” However, I believe this mindset is due to a lack of knowledge. Holistic treatment plans are not meant to replace traditional medical treatment plans or modern medicine, they are meant to heal the body on a whole level (Hines, Wardell, & Engebretson, 2014). This includes addressing the spiritual, emotional, physical, and mental health of the patient (Hines et al., 2014). The American Holistic Nurses Association is a great place for nurses to gather information on what holistic healing entails. Nursing bachelor and master’s degree programs are even beginning to offer course related to holistic healing. The Journal of Holistic Nursing is also another great resource for nurses to refer to if they have questions about what holistic nursing entails.

Reference: Hines, M. E. (2014). Holistic nurses’ stories of healing of another. Journal of Holistic Nursing, 33(1), 27-45. Retrieved from https://doi.org/10.1177/0898010114536925

Without nursing theory there would be no roots and basis for nursing. From some of the early nursing theories and theorists further theories have developed which continue to shape the many roles of nurses and advanced practice nurses. Take Watson’s Caring theory for example, this has become one of the prime examples in how physicians training and execution of care differs from the nurse practitioner.

As different institutions and associations, such as the American Association of Pediatrics recognize advanced practice nurses as having their own model and theories, I believe there will also be more of an acceptance among providers and decrease in the barriers NP’s are facing. One of the primary differences in care from a physician and nurse practitioner is the holistic approach of the nurse practitioner. Primary differences between a nurse and an APN are the APN’s “advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health, preventing disease, and helping patients make changes in their lives” (Hagedorn & Quinn,2004). The way NP’s practice and how they are viewed is partially due to nursing theorists and helping nursing essentially find its own voice apart from the medical model nurse practitioners were initially following(Hagedorn & Quinn,2004).

Hagedorn,S.,Quinn, A,(2004). Theory-Based Nurse Practitioner Practice: Caring in Action. Topics in Advanced Practice Nursing eJournal.

Nurse practitioners spend up to two thirds of the time with their patients communicating (Mason,2010). Fortunately all of this communication is not purely diagnosis and treatment but talk of well being for the person as a whole. Part of Watson’s theory places an importance on co creating “meaning while generating a sense of well being, comfort and wholeness (Mason, 2010). This can be exemplified through a patient I recently took care of who was 17 years old, has now been admitted to the hospital for 1 month, will an illness of unknown etiology. Due to the lack of diagnose for a while there was an unknown end in sight. Every morning upon rounding her beside nurses and her nurse practitioners would remind the rest of the team comprised Med students, fellows, residents, and attendings the importance of the patients prom which is next week. This girl was a previously healthy, normal 17 year old and her current dream in life was to go to prom. She is doing much better and fortunately they have been able to transition her to oral antibiotics and check in on her outpatient and she will attend Prom next week. This hold true for primary care as well. Take an elderly persons overall well being and the importance of being able to play with their grandchildren. Everyone has things in their lives which are important to them and as nurse practitioners it is important for us to speak to our patients and discover these things and help them achieve a good balance in their lives.

Mason, W. (2010). The transformative potential of transdisciplinarity for nurse practitioner students and nurse educators: A theoretical analysis (Order No. 3428816). Available from ProQuest Central; ProQuest Dissertations & Theses Global. (759116403). Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/759116403?accountid=147674

Nurses ability to communicate and connect with their patients and colleagues and health care professionals helps build positive relationships and provide a higher level of care. According to a 2013 study published in the Journal of Patient Safety, over 400,000 patients die each year from medical errors that could have been prevented if there had been better communication (Gluyas, 2015). Communication takes cooperation (Gluyas, 2015). The goal is for nurses to strive for a better level of teamwork with colleagues and patients. Peplau’s Interpersonal Relations Theory and the Dyadic Interpersonal Communication Model are two of the primary theories used to help explain and guide interactions between nurses and patients, as well as nurses and other medical professionals. There are barriers to communication, such as staff conflict over treatment plans and patient loads. The best way to address this is to listen to each other. Listening is a skill that is taken for granted because we have the ability to hear. However, most people do not listen to each other when they speak. Waiting for the other person to say what he or she has to say then trying to get one’s point across is not listening. Listening requires concentration and giving the speaker your undivided attention (Gluyas, 2015). Listening is also an ongoing process that requires dialogue, such as the ability to ask compassionate questions (Gluyas, 2015).

Reference: Gluyas, H. (2015). Effective communication and teamwork promotes patient safety. Nursing Standard, 29(49), 50-57. doi: 10.7748/ns.29.49.50.e10042

Effective facilitation through effective communication skills is crucial (Ronan, 2016). This was a theory that by creating more effective communication with the patients they would become more relaxed and open more. This study was done, and it was found that “creating a positive fun atmosphere so that members feel relaxed, optimistic, safe to explore options and supported in making and implementing plans helped the patients open up more to the provider (Ronan, 2016). As advanced practice nurses we need to provide an atmosphere for the patient so that they do feel comfortable sharing inf0ormation with us as providers. When a patient is comfortable and a repour has been established this opens the patient to give more information they may not have otherwise disclosed. This could lead for better treatment to meet the patient’s needs. This in turn can cause a better outcome for the patient. Without theory each patient would be treated the same for each and every condition. There would be no change and healthcare would not advance. With theory healthcare is able to progress. Someone notices how something works better than something else and so a theory or idea begins. Research is done and then once the research supports the idea then change can be implemented. Change can be difficult to accept at first, but seeing better outcomes makes it more acceptable over time.

Reference:

Ronan, C. (2016). Group Family Nurse Partnership: Effective communication to support learning, adaptation and change within an intensive Group Family Nurse Partnership parenting programme. International Journal of Birth & Parent Education, 3(4), 29-34.

Nursing theory is used to explain several different concepts of nursing practice within the nursing profession, which can continue to carry on when in the advanced nursing role as a nurse practitioner. Just as many nursing theories are continued to be used during bedside care as an RN, these same theories may still be utilized as a clinician when diagnosing and creating a plan of care for patients. Several examples come to mind, such as Maslow’s theory, Pender’s Health Promotion Model, Leininger’s theory, Benner’s Professional Advancement Model, and many, many more. Let’s take a closer look with a few of these examples.

Leininger’s theory of culture care diversity and universality, developed by Madeleine Leininger by combining her experience as a nurse and her background in anthropology, is known as the first nursing theory to introduce transcultural nursing and its impact on health practices. Leininger had recognized that culturally consistent care is essential for the health promotion of family units, individuals and communities (Schub & Caple, 2017). Leininger’s theory is defined as “Transcultural nursing: an area of study and practice focused on cultural care differences and similarities of the beliefs, values, and lifeways of people and the use of knowledge to provide culturally specific and/or culturally congruent nursing care to clients” (Schub & Caple, 2017). Leininger’s theory provides information regarding what is diverse within belief systems and practices, as well as identifying both similarities and differences which assist clinicians understand their patient’s health related decisions and practices (Schub & Caple, 2017).

Benner’s Professional Advancement Model, also known as the Novice to Expert model, was developed by Dr. Patricia Benner, which introduced a revolutionary nursing practice-based theory, which can be applied by supporting the values of the nursing practice, evaluation, education, leadership and professional development. Benner’s theory is founded on the observed growth of nursing skills from the beginning stage as a novice, continues as the nurse acquires new experiences and skills, through the final stage as expert. Each of Benner’s five levels builds upon one another, refining abstract principles of nursing, thus expanding knowledge and experience gained within the nursing profession (Mennella & Schub, 2018).

I feel one of the nursing theories that is used very closely by a nurse practitioner is Pender’s Health Promotion Model.

Nola Pender was the founder of the Health Promotion Model, and she described health as “not the absence of disease, but as an evolving life experience” which involves “actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others” (Schub, 2016). Health promotion is considered a holistic approach to patient care, with emphasis on improving quality of life and overall wellbeing, with or without the presence of illness, by increasing health promoting behaviors such as eating a healthy diet, participating in regular exercise, and getting enough rest. This patient care model assists nurses in understanding their patient’s behavior regarding their health promotion, and it is when these behaviors are understood that the most individualized support can be provided and maintained to better enhance a patient’s health and prevent disease or illness (Schub, 2016).

Due to the fact that nurse practitioners teach their patients to improve and promote their health status, the Health Promotion Model would be used quite often as part of their daily practice with their patient’s. Although these are just a few of the many theories that nurse practitioners would continue to utilize, I would hope that these examples would be enough to change Karen’s mind, and that she may begin to understand the relevance that theory still holds as a master’s prepared APN.

Mennella, H.A., & Schub, T.B. (2018). Benner’s Professional Advancement Model. CINAHL Nursing Guide.

Schub, E.B. & Caple, C.M. (2017). Leininger’s Theory of Culture Care Diversity and Universality: Integration into Practice. CINAHL Nursing Guide. Schub, E.B. (2016). Pender’s Health Promotion Model: Integration into

NR 510 Theory and APN Role Discussion Part Two