Advance Practice Roles

Theorists

Dear JoAnn,I read with interest your JAANP article on The discovery of unique NPtheory in the literature. I have been in family practice since 1976and am about to complete my DNP at USF. Both my EBP class and advancedpractice roles class have caused me to read extensively and Iappreciated the insight from your article. I am trying to tie intransformation learning/humanistic theory with EBP. Somehow seeing howNPs and MDs tend to take the dehumanized, synthesized evidence,interpret the guidelines and then apply them to practice withpatients. I wonder what nursing theories this evokes? I graduated in1972, predating the nursing theorists publication and was a product ofan AA program for RNs. Returning to school 7 years ago and findingmyself in a unique position of seeing nursing theory and the medicalmodel as integrated in my practice without formal intro wasinteresting except, until now, I have had little faculty input thatwere practicing NPs. How, as an intended teacher in upcoming years, doI foster a model of NP practice is what I am trying to wrap my tiredbrain around. Any ideas, theorists you have come across would be huge.I am writing about Paterson and  Zderad  and Madeleine Leininger inthe hopes of keeping the human side of practice in play for mystudents. Your NP theories to describe "nurse practitionering" wasclassic and exciting. Truly a part of why I am in a clinicaldoctorate.Sincerely, Helene

Dear Helene:I too am a product of the 70's, although from a diploma program. I'vebeen a practicing NP in primary care and an educator since 1985.Throughout the years I have had difficulty incorporating nursingtheory into practice but finally reconciled a few years ago with thecompletion of my doctoral dissertation. I earned a PhD and was wellinto the program before the DNP took shape. I used Pender's HealthPromotion Theory as a framework for a study of antibiotic adherence inan otherwise healthy college student population. It certainly tookquite a defense, but as I see it, persons who are striving for anenhanced level of wellness are promoting their health. There is adistinction here between health promotion and disease prevention. Ibelieve I practice using the former concept. Perhaps this may helpyou as you reach the end of your studies....if you would care todiscuss further, please contact me.Gooc Luck! Jo Ann

Pender's HealthPromotion Theory

Blend of Nursing and Medicine

• “Theories are the lenses through which inquiry is conducted.”

• Theory determines what is meaningful as the result of inquiry or evidence. (Fawcett et al., 2001)

• NP theories include components of nursing, medicine, social science and biology

George Engel introduced the major theory in medicine, the BPS Model. The model accounted for biological, psychological, and sociological interconnected spectrums, each as systems of the body.In fact, the model accompanied a dramatic shift in focus from disease to health, recognizing that psychosocial factors (e.g.beliefs, relationships, stress) greatly impact recovery, the progression of, and recuperation from illness and disease.

What about NP theorists?Can the PSB Model be adapted to NP practice?

What constitutes a Theorist/Theory?How do NPs remain current and forge theories to reflect practice?

Engel eloquently states:

"To provide a basis for understanding thedeterminants of disease and arriving at a rational treatments andpatterns of health care, a medical model must also take intoaccount the patient, the social context in which he lives and thecomplementary system devised by society to deal with the disruptiveeffects of illness, that is, the physician role and the health caresystem. This requires a biopsychosocial model."

Biomedical ModelReason for visit: Patient complains of chest pain.Presentation: The focus is on physical causes of disease. The clinician will ask few questions on recent diet, pain history, and familial incidence, however, empirical signs and symptoms of myocardial infarction are considered paramount.Diagnosis: The clinician will order objective lab tests and monitor vital signs (i.e. temperature, pulse, and blood pressure) that would form the sole basis of any finding.Therapy: The clinician will prescribe a medicinal plan for the patient based on biological etiology and pathogenesis.

Biopsychosocial ModelReason for visit: Patient complains of chestpain.Presentation: The aim to ascertain psychosocial and physicalprocesses that may cause the chief complain, chest pain. The clinician may ask for a history of recent life stressors and behaviors.Diagnosis: Based on a combination of psychological factors and standard lab tests, the clinician will form a diagnosis.Therapy: The clinician discusses the availableinterventions with special attention to behaviors and lifestyles that could influence her pain and adherence to the treatment plan.The patient is involved in formulating and implementing the plan, and maintains a supportive relationship with the clinician.

Client/Patient

EBP

Clinical Collaboration

Bio- Psycho- Social Model

Plan for health

Helene: 

I understand your thought processes, but you need to have confidence that this model could work for you and perhaps other NPs in practice when you present your material.  If it makes sense to you, then this is what you will defend.  Check the 2nd to last slide....I believe you have the acronym for the model transposed.  Good Luck and let me know how well your presentation was received.  Perhaps you are on to "something".  Jo Ann

References• Fawcett, J., Watson, J., Neuman, B. Hinton Walker, P.,& Fitzpatrick, J.J.(2001). On nursing

theories and evidence. Journal of Nursing Scholarship, 33(2), 115-119• Lakhan, S. (2006) The Biopsychosocial Model of Health and Illness. Connections Project.

Connections Module. Retrieved March 2 2009 from: http://cnx.org/content/m13589/1.2• Nicoteri,J., Andrews, C. (2003) The Discovery of Unique Practitioner Theory in the

Literature: Seeking Evidence Using an Integrative Review Approach. Journal of the American Academy of Nurse Practitioners.15(11).494-500.