NSG 517 Discussion The Systems and Integral Theory

Learning these skills are a necessity in being an effective APRN. This includes the importance of listening to the patient, building strengths, and creating a safe environment so the patient feels supported and able to open about struggles they are dealing with. Doing this will help create a bond with the patient and potentially increase your chances of treating the patient correctly and more effectively. I chose this topic because being able to coach someone and guide them into better habits is a big reason I went into this profession. I love to listen to people and attempt to help them through their own struggles and guide them to reach their own goals.

This ties in with Watsons Model of Caring, which is a theoretical framework based on loving kindness, it provides a feeling-based approach to coaching. This theory honors and respects the patients’ values, beliefs, lets them be autonomous and set their own goals. (Tracy & O’Grady, 2019). When they can set goals based on their own values and belief this will allow the APRN to better understand the patient and will increase the patients’ chances of achieving this goal. This also ties in with the NONPF competency “Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment”. Being able to listen to the patient and then evaluating on how you should provide care to this specific person is very important when trying to achieve individualized care.

The six characteristics include use of holist perspective, formations of therapeutic partnerships with patients, expert clinical performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches to health and illness management.

I believe that I do a very good job at holism, therapeutic partnership and use of diverse approaches. Being able to recognize the dementions of each patient, physiologically, socially, emotionally, cognitively, and spiritually is something I feel I am very strong at doing. I love to form a bond with a patient before even talking about the reason why they are seeking medical attention. I think it is very important to understand the patient and what their needs are before diving deeper into the medical issues. Understanding how they take in information and how they have been able to reach their health goals in the past or barriers to reaching their health goals. Communication is a strength of mine when caring for patients, it is essential to develop a therapeutic relationship, increase patient satisfaction, establish trust, and increase adherence to the treatment plan. (Tracy & O’Grady, 2019).

I think I can work on the use of evidence as a guide to practice. I need to practice searching for evidence-based articles about the ever-changing nursing practice. Learning the various search engines available to get information from will be very beneficial for me as an APRN. Reflective practice will also be a characteristic I will need to strengthen, and I believe this will happen with experience. This is a way to take experiences an APRN has and critically analyze and think to improve their practice. (Tracy & O’Grady, 2019).

The different theories, ways to interact with patients and characteristics of an APRN will help strengthen my bond with patients. These concepts have made me think about how to interact with different patients and how to really look at each patient individually and treat them in their own way. Doing that will help make the patient more successful with treatment and more satisfied with the care they are receiving. The coaching aspect of this reading really hit home for me and gave me great ideas about how to help a patient reach their health goals.

Tracy, M. F., OGrady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.

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Learning to search and apply evidence based practice in our nursing role is definitely a skill we are all working to gain. I first head of this term while completing my nursing degree and more during this graduate studies. I have gotten more comfortable with evidence based practice and I continue to hone in this skill. As yo have said, it takes practice in order to find these evidence base studies in the various online database. Use of evidence as a guide for practice is one one the six characteristics of advance direct care. This includes learning to search the databases for studies related to our interest, reading the various reports. It also entails seeking out evidence based clinical guidelines and collaborating with other colleagues to consider evidence based improvements in care. According to Tracy and O’Grady (2018), it is advisable to not only use clinical expertise, but also incorporate external evidence as APN. As future APN, it behooves us to keep abreast of new knowledge primarily in the form of primary research reports. Armed with this knowledge, we can finetune our APN practices specifically our clinical decision making. In our future practices, we may have to make paid subscriptions to paid databases if they are not provided to us, it may be a small price to pay but with massive benefits in our clinical practices. Our patients are exposed to the internet and have access to more information than in previous eras, thus keeping informed on evidence based practices and using this a guide to practice definitely serves to give positive outcomes. I would say it is a very constructive use of the internet for APN.

Reference

Tracy, M. F., O’Grady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s Advanced Practice Nursing: An integrative approach. Elsevier.

I enjoyed reading your post for this week. Advanced practice registered nurses have different skills in coaching and guidance skills. These qualities are important in the provision of quality healthcare services to patients. To ensure effective interaction between patients and healthcare professionals, there is always the need for listening to patients, building strengths, and provision of a safer environment so that patients become supported towards their recovery processes (Tracy et al., 2019). Advanced practice registered nurses should have research skills and knowledge that can allow them to discharge quality healthcare processes in line with the cultural and religious practices. Listening to patients is necessary in understanding the conditions and feelings and the approaches that can be undertaken to enhance treatment processes. Advanced practice nurses have effective skills and experiences in discharging individualized care (Rose, 2016). They often provide holistic care through engagement in the therapeutic partnerships with the patients. Besides, advanced practice nurses have expertise in clinical performance, application of reflective practices, as well as the use of evidence-based practices. Through continuous communication and engagement with patients, advanced practice registered nurses have been able to save lives of many patients across the healthcare systems. Through their skills and experiences, advanced practice registered nurses have been able to recognize the dementions of each patient, physiologically, socially, emotionally, cognitively, and spiritually is something I feel I am very strong at doing.

References

Tracy, M. F., O’Grady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.

Rose, P. M. (2016). Individualized care in the radiation oncology setting from the patients’ and nurses’ perspectives. Cancer nursing, 39(5), 411-422. https://journals.lww.com/cancernursingonline/Abstract/2016/09000/Individualized_Care_in_the_Radiation_Oncology.10.aspx (Links to an external site.)

What is the significance of your chosen topic in the field of advanced practice nursing? Why did you choose this topic? How does it tie in with one of the theories your learned about this week? Which NONPF competency do you feel the topic you chose supports and briefly explain why.

One theme that I found particularly meaningful in this week’s readings is the importance of advance practice coaching and guidance in achieving improved patient outcomes. I believe this topic is extremely significant in the current and ongoing work of not just advanced practice nurses, but all healthcare providers. We have seen a large number of healthcare crises with modifiable risk factors on the rise, such as obesity, for one. I chose the topic of advanced practice coaching and guidance, because I believe that with experience and practice, these provider skills have the potential to help combat some of the health crises our nation is currently facing.

According to Tracy and O’Grady (2018), “coaching is a critical component of a holistic care approach for nurse practitioners” (p. 183). The idea of coaching and guidance in nursing is founded in a variety of theories, including Nightingale’s Environmental Theory, the Midrange Theory of Integrative Nurse Coaching, the Transtheoretical Model, and Self-Determination Theory, among others (Tracy & O’Grady, 2018). However, in our reading, I was most intrigued by the Transtheoretical Model, which describes the different stages of readiness for change. These stages are precontemplation, contemplation, preparation, action, and maintenance (Tracy & O’Grady, 2018). It is quite clear that the provider can develop a more appropriate plan for a patient if they first recognize which stage an individual is in. Once this information is determined, the provider can then work towards creating a more appropriate and individualized plan for coaching or guidance. This refutes the general one-size-fits-all approach to medicine that is commonly in practice, and commonly failing to combat current health crises. Coaching through this individualized lens is an example of providing patient-centered care and recognizing the patient as a partner in decision making, and therefore falls under the National Organization of Nurse Practitioner Faculties’ (NONPF) core competency of Independent Practice (Thomas et al., 2012). The NONPF Independent Practice Competency encompasses not only independent practice and accountability, but also the provision of patient-centered care that encompasses a relationship of mutual respect, collaboration, and trust. Additionally, this competency focuses on maintaining respect for patients’ preferences and right to decision making (Thomas et al., 2012). Coaching most certainly focuses on these aspects of this competency, as it relies on participation and willingness of the patient, who actively sets their own goals that the provider helps them to achieve (Tracy & O’Grady, 2018).

Do some self reflection and think about characteristics and attributes that you already possess that would support any of the 6 characteristics of direct APN care. Identify the characteristics and attributes that you would like to strengthen.

The six characteristics of direct advanced practice nursing care are: the use of holistic perspective, formation of therapeutic partnerships with patients, expert clinical performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches to health and illness. As a nurse, I certainly have some experience in all of these fields, but there are certainly some that stand out as more commonplace in my career. I would say that my strengths in these areas are the use of holistic perspective, therapeutic partnerships, and the use of diverse approaches to health and illness, whereas I could improve on expert clinical performance, reflective practice, and use of evidence in practice.

I have spent my entire career in the inpatient hospital realm in academic institutions with pretty acute and often unique patient populations. I have met so many individuals seeking care throughout my career, and although I was not particularly strong at getting to know my patients early on, I feel as though this is definitely one of my strengths now. I have learned to see patients as a whole, to learn everything from their family dynamic to their current and past stressors that have brought them to where they are today. I feel that this has been an invaluable aspect in being able to advocate for my patients and set up a specific, and at times, diverse approach to their recovery that will actually work for them. Through this empathy and understanding, I have also been able to create meaningful, therapeutic relationships where I know there is mutual respect and trust. I have seen firsthand how this approach truly does create better outcomes and makes both me, as the provider, and the patient feel good about the success achieved.

According to Tracy and O’Grady (2018), expert clinical performance includes both clinical thinking and skillful performance. Although I have certainly become more adept as a nurse through experience, I am by no means an expert. Tracy and O’Grady (2018) state that the three main categories of knowledge are scientific and theoretical knowledge, experiential knowledge, and interpersonal knowledge of the patient (p. 156). I think, of these three, I could certainly increase my scientific and theoretical knowledge the most. In the same vein, I could also improve on the use of evidence in practice. However, I do feel as though both my knowledge and use of evidence have increased tremendously since being enrolled in this program. Lastly, I could do more with reflective practice. Although I do often reflect on my day and the events that occurred, I do not always reflect on how the event affected me, the patient, or a coworker. Additionally, I do tend to focus on particularly stressful or dramatic events that happen at work when I don’t reflect appropriately. This can certainly lead to an influence on my decision making in future events, as highlighted by Tracy and O’Grady (2018).

How will what you have learned this week impact your personal and professional work?

This week’s readings have certainly impacted my thoughts and practice in nursing, but can also be applied to my personal life as well. One of the omnipresent themes in the readings was that of individualized plans of care based on patient input and experience. The integral theory focuses on the individual experience based on four distinct perspectives; subjective (emotions, self-identity), intersubjective (philosophical, ethical, religious), objective (empiricial, chemical, biological), and interobjective (political, educational, legal, environmental) (Esbjorne-Hargens, 2009). One can easily see how each of these realms develops a person into a very unique individual with corresponding unique needs in healthcare. Similarly, systems thinking theory encourages this perspective of individualism (Peterson, 2017). Systems thinking looks beyond the details of the current situation to determine how the situation came to be as the product of the multiple interacting parts of an integrated system. As stated by Peterson (2017), looking at the system as a whole subsequently assists in “choosing the right means for one’s desired ends’” (p.45). One can see easily how this can also be applied to an individual, rather than a system, in terms of direct patient care. By considering all of the elements of an individual, a more specific plan can be put into place with, hopefully, more successful results. I will continue to empathize with patients, learning their current challenges and successes, and work with them to create individualized plans of care that allow for their success. I will use the knowledge I have gained this week to strengthen this approach for sure both in my current and future practices.

References

Esbjorne-Hargens, S. (2009). An overview of Integral Theory: An all-inclusive framework for the 21st century. Integral Institute. Retrieved from Rivier University Canvas course page.

Peterson, S. (2017). Systems thinking, healthcare organizations, global health, and the advanced practice nurse leader. In M. E. Zaccagnini & K. Waud. The Doctor of Nursing Practice Essentials. Retrieved from Rivier University Canvas course page.

Thomas, A. C., Crabtree, M. K., Delaney, K. R., Dumas, M. A., Kleinpell, R. Logsdon, M. C. … Nativio, D. G. (2012). Nurse practitioner core competencies. The National Organization of Nurse Practitioner Faculties. Retrieved from Rivier University Canvas course page.

Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s Advanced Practice Nursing – E-Book (6th Edition). Elsevier Health Sciences (US). https://bookshelf.vitalsource.com/books/9780323447706 (Links to an external site.)

NSG 517 Discussion The Systems and Integral Theory