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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Schizophrenia Spectrum and Other Psychotic Disorders, DSM-5

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To make it easy on psych students.

A diagnosis of Schizophrenia is quite debilitating on the patient and his/her family, that’s why it is crucial to distinguish between Schizophrenic patient and other disorders on its spectrum.

Schizophrenia diagnosis is made when you have at least one of the following: delusions, hallucinations, or disorganised speech in addition to catatonic behavior or negative symptoms (e.g., diminished emotions expression). the latter symptoms must persist for at least 1 month, and continuous signs of the disturbance must persist for at least 6 months.
Brief Psychotic disorder is relatively easy to distinguish from Schizophrenia since the symptoms must be present for less than 1 month.
Delusional disorder on the other hand, can be diagnosed when the criteria mentioned above in schizophrenia are never met, and the functioning of the patient is not as impaired as in schizophrenia.
Schizoaffective disorder can be considered as schizophrenia coupled with severe mood disturbances, and the clinician can specify whether its bipolar type or depressive type.
Last but not least, the schizophreniform disorder is similar to schizophrenia but with lesser impairment in functioning. Research shows that patients with schizophreniform disorder are more receptive to treatment and report less remission rates compared to those with schizophrenia.

Always make sure that the psychotic disorder is not substance induced and is not due to another medical condition (e.g. brain tumor, multiple sclerosis)