Why is Nursing Going into Advanced Practice?

By 1980, the American Nurses Association has (ANA) has declared that “specialization in nursing is now clearly established and that specialization is a mark of the advancement of the nursing profession”. Advanced nursing practice has reached increasing levels of acceptance and demand, interprofessional conflicts increased, with medicine perceiving Clinical Nurse Managers (CNMs) as a competitive threat. According to Hamric (1989), the role of the Clinical Nurse Specialists (CNS) “originated for the purpose of improving the quality of nursing care provided to patients” the historical development of psychiatric CNSs is the oldest and one of the most highly developed CNS specialties. This growth in the psychiatric nursing body of knowledge provided the support for psychiatric nurses to begin exploring new leadership roles in the care of mental health clients in both inpatient and outpatient settings. The impressive development of the psychiatric CNS role helped initiate the growth of other CNS specialty areas.

As the number of Nurse Practitioners (NPs) is increasing in response to the increasing demand, and the NP role has attracted considerable attention from professional groups and policy makers. The Obama Administration’s records on supporting the nursing workforce has stated the following  “…With implementation of the law, we have new opportunities to move to a health care system that focuses on increased access to primary care, improved care coordination and an emphasis on prevention and wellness—efforts nurses have focused on from the beginning. This is what the future of health care looks like, and it makes the work and expertise of America’s nurses more important than ever.”

Advanced nursing practice includes specialization but goes beyond it. The skills we learn in a Masters Program function synergistically to produce a whole that is greater than the sum of its parts. For the many reasons I chose to enroll in the Masters, is because I want to possess advanced health assessment, diagnostic, and clinical management skills that include pharmacological management. I want to feel more autonomous in my direct clinical practice. I have always been dedicated to coaching of patients, families and other health care providers, so, a masters in nursing will legitimize my professional attitude and practice. Another reason that is crucial for me is research, evidenced based practice is the golden frame for us; nurses, so research skills including, utilization, evaluation, and conduct are well taught and developed in the Masters program.

The common rule is that a Masters degree is inevitable for advanced practices nurses (APNs). The role of an APN, whether in primary care or acute care, makes a bigger difference because it challenges the status quo. The role is so expanded that includes, and is not limited to collaboration, leadership, management, and ethical decision-making. 

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The Patient-Therapist Relationship: Secret of the Care

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“…Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”  

 – Francis Peabody, MD

 Therapists (e.g. advanced practice psychiatric nurse, psychiatrist, and psychologist) should initially make sure that they know a patient’s name and that the patient knows the therapist’s name.  They should introduce themselves to other people who have come with the patient and should find out whether the patient wants another person present during the initial interview.

 Qualities of the caregiver:

  • Imperturbability: the ability to maintain extreme calm and steadiness
  • Presence of mind: self-control in emergency
  • Clear judgment: the ability to make an informed opinion that is free of ambiguity
  • Ability to endure frustration: the capacity to remain firm and deal with insecurity
  • Infinite patience: unlimited ability to hear pain
  • Charity towards others: to be generous especially to the needy and suffering
  • The search for absolute truth: investigate facts and pursue reality
  • Composure: calmness of mind and bearing
  • Bravery: the capacity to face or endure events with courage
  • Charity towards others: to be generous especially to the needy and suffering
  • The search for absolute truth: investigate facts and pursue reality
  • Composure: calmness of mind and bearing
  • Bravery: the capacity to face or endure events with courage

Confidentiality:

As much as physicians must legally and ethically respect patients’ confidentiality, it may be wholly or partially broken in patients’ situations. If a patient makes clear that he or she intends to harm someone, the therapist has a responsibility to notify the victim.

Countertransference:

Emotions breed countermotions. For example, if the care giver is hostile, the patient becomes hostile; the care giver then becomes even angrier than before and the relationship deteriorates rapidly. Rising above such emotions involves being able to step back from the intense countertransferential reactions and explore why the patient is reacting in a self-defeating way. If the therapist can understand that the patient’s antagonism is in some ways defensive or self-protective and most likely reflects transferential fears of disrespect, abuse, and disappointment, the doctor may be less angry and more empathetic.

Empathy:

Empathy is a way of increasing rapport. An empathetic therapist may anticipate what is felt before it is spoken and can often help patients articulate what they are feeling. Patients sometimes say “How can you understand me if you haven’t gone through what I’m going through?” Clinical psychiatry, however, is predicated on the belief that it is not necessary to have other people’s literal experiences to understand them. The shared experience of being human is often sufficient.

While much early work on this subject was generated from a psychodynamic perspective, researchers from other orientations have since investigated this area. It has been found to predict treatment adherence (compliance) and concordance and outcome across a range of client/patient diagnoses and treatment settings. Research on the statistical power of the therapeutic relationship now reflects more than 1,000 findings.