The role of the family health practitioner:an advanced nursing practice framework - Essay Example

? The Role of the Family Health Practitioner: An Advanced Nursing Practice Framework Indiana This paper explores on the development of a personal advanced nursing practice framework and its application to the recognized roles of the family health practitioner using clinical studies. Academic requirements, knowledge, skills and experience by these registered nurses were listed and fully described. The American Nurses Association includes nurse practitioners, certified nurse-midwives, clinical nurse specialist, and certified registered nurse anesthetists as classes of advanced practice nurses. In addition, the significance of the role of advanced practice nurses was discussed. Imogene King’s Goal Attainment Theory was utilized to reexamine the theoretical frameworks to the advanced practice responsibilities. Family health theory and its integration to primary health care were also described. Lastly, the importance of the role of the family health practitioner as a first point of contact as well as the strengths and weaknesses of the formulated framework with regards to its application to patients in various health states were analyzed. Keywords: advanced nursing practice, family health practitioner, goal attainment theory The Role of the Family Health Practitioner: An Advanced Nursing Practice Framework The different roles of advanced practice nurses are gaining worldwide recognition considering the importance of these health practitioners to the ever shifting health care system. For one, advanced practice nurses provide immeasurable quality care to patients without giving any prejudice to race, sex or economic standing of the patients. They are also proven to serve as cost-effective members of health care centers or hospitals. Advanced practice nurse is defined by the American Nurses Association (2011, p. 1) as “an umbrella term for registered nurses who have met advanced educational and clinical practice requirements – including nurse practitioners, certified nurse-midwives, clinical nurse specialist, and certified registered nurse anesthetists.” Aside from the health industry, advanced practice nurses perform other tasks outside of its origin and occupy positions in the academe as educators, corporate as consultants or researchers and government as policy experts. The nursing theories applied by advanced practice nurses to their day to day activities in real life as a basis for guidance are essential in achieving the correct disposition in the workplace. According to Jansen and Zwygart-Stauffacher (2010), Nursing research uncovers scientific evidence for best practice, and research utilization skills enable advanced practice nurses to bring fresh ideas and proven interventions to health care consumers. Complex, evolving reimbursement mechanism requires that advanced practice nurses education also encompass content in financial management and health policy issues (p. 2-3). Truly, while APNs are expected to deliver advanced nursing attention to their affiliated institution, these professionals tend to work through the limitations of the organization such as conducting home visits to outgoing patients, among others. The basic personal advanced practice nursing framework is consisted of the identification of the evolution of advanced nursing practice, definition and characteristics, educational preparation, roles, regulation, competencies, impact of advanced nursing practice and support for advanced nursing practice. This framework is valuable in creating academic courses, laying out the concepts for clinical studies, influencing government position proclamations and construing advanced nursing practice for health care workers, policy makers, employers and the public (American Nurses Association, 2011). Moreover, adapting a nursing theory is a vital component of advanced practice nursing education since it determines the perspective of the nurse in assessing patient conditions and needs. The theory used for the personal practice framework is the Goal Attainment Theory by Imogene King, where the nurse who closely works with the patient formulates goals exclusively for the latter according to his or her needs, given that the two of them are in mutual understanding of the situation. This theory empowers the patient to participate in his own health care and is satisfactorily updated with his health conditions. Nurses following this theory are expected to possess social knowledge and skills developed through constant patient interaction. King defines the Goal Attainment Theory as a nurse having a “personal touch” with the patient, which evolves from communication and mutually agreed goals. With the help of the advanced practice nurse, these goals will eventually help the patient restore his health and maintain it to optimum level (Williams, 2001). The paradigms of the Goal Attainment Theory are based on the essence of the conceptual framework which is constant interaction. The environment, composed of internal and external, is regarded as the background for the interactions being undertaken in this theory. Internal environment converts energy so the individual can amend to the external environment, while the external environment entails formal and informal groups where the nurse is also a part of. Nursing is defined as a practice of unceasing and dynamic human interaction between the nurse and the patient by utilizing verbal and nonverbal communications. Common goals are set through this mode of interaction based on mutual opinion and current treatment situation. Health is recognized as the dynamic holistic and functional state of a human being, where any disruption to this condition is considered as illness. Lastly, the recipient of care or the client is referred as the active being that needs information on his health, care in times of illness and care to avoid illness (Williams, 2001). One of the recognized roles of advanced nursing practice is the family health practitioner, a career developed by the insurmountable service that nurses extend to remote populations in order to provide health care to isolated areas. These registered nurses offer direct care to patients and are equipped with additional educational preparation combined with experience and have the ability to establish the competencies to diagnose interpret diagnostic test, perform particular medical procedures and prescribe medicines by themselves. The demand for these professionals is increased as the health care system is reformed in the 1990s and people started to acknowledge the need to access primary health care. In addition, family health practitioners were trained to analyze and synthesize knowledge gathered from school; understand, interpret and apply nursing theories and researches; and develop the advanced nursing profession in a holistic manner. Specialties of these graduates of master’s and post-master’s programs include family health, adult care, acute care, pediatrics, women’s health, psychiatry, neonatology and gerontology (National Organization of Nurse Practitioner Faculties, 2004). On a clinical study conducted by Horrocks, Anderson and Salisbury (2002), the ability of the family nurse practitioner in providing primary care as first point of contact as comparable to that of doctors in the United Kingdom was measured. The researches directed a systematic review of randomized controlled trials and observational studies paralleling the primary care given by nurse practitioners and doctors for patients with identical health problems and observed patient satisfaction, health status, process of care and costs. Results showed that patients felt more satisfied by the care provided by the family nurse practitioners because the former engaged in longer consultations and probed about the patient condition than did the doctors. In terms of health status, prescriptions, referrals and return consultations, there are no significant difference between the recommendations of the nurse practitioners and doctors. Over all, the quality of care delivered was higher with the nurse practitioner consultations. The paradigms of the Goal Attainment Theory stay true with the clinical study observations above. The components of the author’s personal practice framework interrelate with the paradigms of the featured theory. The health of one family member influences the entire family system since they all exist within the same personal system, specifically the society. The perception of family to another member or the patient is similar, driven by their interaction with the nurse practitioner, the environment and how the patient deals with the current health and nursing care given to him. In addition, the notion of family nurse practitioner offering front line care in hospitals and health care institutions as an effective and economical management of patients helped the author to imbibe other concepts to better understand the personal practice framework carries the principle of the Goal Attainment Theory. Example of these constructs is the personal system or the individual, the interpersonal and the society. Personal system involves the perception, development and self-growth of a person; interpersonal system includes communication, interaction and transaction between individuals; while society embraces any group where the person is involved like family, peers, religious groups and work, among others. The said concepts embody the open system that the Goal Attainment Theory discusses, a mutual goal-setting process to achieve necessary care and wellness through mutual cooperation. Together with the support from the family, the patient and the nurse practitioner bring different set of values, attitudes and ideas to exchange (Williams, 2001). Furthermore, the personal practice framework influences the author’s role as a family nurse practitioner. The competencies of the nurse practitioner, provided the necessary trainings, experience and educational attainment to achieve such status, will offer an advantageous care and treatment option when combined with an open communication with the patient. The potential capacity of family nurse practitioners to substitute for doctors in the management of patients with acute illness exposes the great deal that these health care professionals contribute to health care institutions. Based on the studies of the National Organization of Nurse Practitioner Faculties (2004), the ability of nurse practitioners has developed to include tertiary health care to their scope of treatment levels. From the first roles of these health professionals of assessing children health status, family health practitioners are now increasing their roles by merging into specific competencies such as acute care and psychiatric mental health, and by completing certifications for obstetric, gynecologic and neonatal specialties (Scherer, Bruce and Runkawatt, 2007). As for the relationship between the practice framework and the nursing process, the practical application of the theoretical concepts may be harder to accomplish for huge government hospitals or medical centers brought about by patient population and staff count. The limitation in providing more time with the patient to satisfactorily set the goals for his care and treatment may affect the quality of the interaction between the nurse practitioner and the patient. However, for small health clinics where nurse staff is almost in proportionate with the number of patients, patient empowerment and interaction can be done following the practice framework model. The diagnosis and prescription of pharmaceuticals will be conducted solely by the family nurse practitioner, and will collaborate with the patient and his family members to conceptualize the treatment options during the course of illness (National Organization of Nurse Practitioner Faculties, 2004). The adaptability of the practice framework to clients within the family unit depends on the age and health state of the patient. The family nurse practitioner discusses the diagnosis and set treatment goals with the parents or guardians of ill children and minors. On the other hand, adult patients have the option to conduct the goal setting in front of family members with consideration to the health state of the client. Families have the tendency to be appeased by the sufficient care and attention that the family nurse practitioner provides to the patient. The open communication that the health professional extends makes the members of the family feel enabled during uncertain times brought by illness. With the knowledge, experience, transparency and attention that family nurse practitioners deliver to clients, a harmonious relationship between them arises which leads to client satisfaction (Williams, 2001). Consequently, there are disadvantages in performing the job duties in health care centers for the nurse practitioner. In a research article by Wilson, Pearson and Hassey (2002), the barriers in developing the nurse practitioner role in primary care in the United Kingdom were deliberated, listing job and financial security, training and scope of responsibility of nurses, and structural and organizational barriers as main obstructions. Others see nurse practitioners as threats to the doctor’s role, and consultations with them might produce larger consequences due to misdiagnosis. Doctors without experience working with nurse practitioners were noted to feel loss of status and self-esteem. Another point of concern is that most of the doctors interviewed in the study believe that patients prefer to see them and are resistant to deal with nurse practitioners, particularly when patients perceive their condition as serious. These beliefs can be straightened out by proper patient education and the acceptance of doctors to the new system. Creating a framework for advanced nursing practice shapes the perception and working ethics of a future nurse professional in conducting his or her role as a family nurse practitioner after leaving the academe. Applying suitable nursing theory and theoretical frameworks to the advanced practice role could not only make the nurse practitioner set his or her expectations to the real world of the profession, but to understand the underlying details to the concepts of nursing and the holistic approach to them as well. The functions of the family nurse practitioner greatly benefit the patient and his family, and studies have been conducted to describe the satisfaction that patients derive from this relationship. Family nurse practitioners are also advantageous to resolve the current limitations in health care centers such as shortage of doctors, escalating cost of health care not only within third world countries but with improved countries as well, and time constraints. Still, doubts and discrimination are evident in fully accepting the role of nurse practitioners as caused by job security, issues in nursing capabilities and constraints in the system. These issues can be resolved by proper patient and colleague educational events on the academic and practical accomplishments, and potential value of family nurse practitioners. References American Nurses Association. (2011). Advanced practical nursing: A new age in health care. Backgrounder. Retrieved from http://nursingworld.org/FunctionalMenuCategories/ MediaResources/MediaBackgrounders/APRN-A-New-Age-in-Health-Care.pdf Horrocks, S., Anderson, E. & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324: 819 Jansen, M. and Zwygart-Stauffacher, M. (2010). Advanced practice nursing: Core concepts for professional role (4th ed.). New York, NY: Springer Publishing Company, LLC. National Organization of Nurse Practitioner Faculties (NONPF). (2004). Acute care nurse practitioner competencies. Retrieved from www.nonpf.com/ACNPComps?nal20041.pdf Scherer, Y. K., Bruce, S. A., & Runkawatt, V. (2007). A comparison of clinical simulation and case study presentation on nurse practitioner students’ knowledge and con?dence in managing a cardiac event. International Journal of Nursing Education, 4 (1), 1–14. Williams, L. (2001). Imogene King's interacting systems theory: Application in emergency and rural Nursing. Online Journal of Rural and Health Care, 2 (1), 25 - 30. Wilson, A., Pearson, D. & Hassey, A. (2002). Barriers to developing the nurse practitioner role in primary care: The GP perspective. Family Practice, 19 (6), 641-646. doi: 10.1093/fampra/19.6.641 Read More