Professional Autonomy as an Advanced Clinical Practitioner - Essay Example

Professional Autonomy as an Advanced Clinical Practitioner Introduction The role an advanced clinical practitioner plays in the society today is everpresent and ever felt as the needs and demands of the community grow and vary. Service and professionalism are principal values that must be upheld constantly. It thus becomes imperative to advance the knowledge and medical skills of the clinical practitioner to cater to the specific needs of the patient and different situations that will be confronted. It is thus the aim of this paper to show the importance of advancing the education of clinical practitioners. This paper shall also demonstrate how the health promotion will be further pursued and advanced through education of the patients by the competent and capable health care professionals. Health Promotion / Education in Clinical Setting The trend to be advocated today is to promote health through the proper education of the primary health care providers and the patients as well. To respond to the need of the patients, it is best to improve first the skills, competence and independence of the nurse practitioners caring for them. This is the professional autonomy of the advanced clinical practitioners that pertain to their capability to work and serve the patients without depending on the instructions or supervisions of the physician (Dueker et al., 2005). The degree of this professional autonomy may vary depending on what policies a given locality may have. There could be certain areas in the clinical setting where substantial regulations are imposed on the authority of the nurse practitioners. For example in United States, some states have granted nurse practitioners the authority to prescribe medications of certain controlled substances (Pearson, 1998). Such responsibilities and tasks show how dynamic and comprehensive a nurse practitioner must be. Evolution of the Culture of Nursing The culture of nursing has evolved through the years. Nursing people probably existed from the time that people started getting sick. However, traditionally, people think of nurses as the ones who help and follow the instructions of the doctor to implement the treatment of the patient. They also are the ones who do the actual caring and assistance to the patients. Such are very noble acts and they still hold true today. However, there is a more dynamic point to things now (Dueker et al. 2005). Today, the nurturing provided by advanced clinical practitioners goes beyond the usual or traditional notion of their roles in health care. Today, competent nurses are equipped with the right knowledge and skills that will be able to support and educate a patient, from the time of their referral until they are discharged from the hospital (Dueker et al. 2005). The International Council of Nurses or ICN (2002) has defined the role of nurses today as clinical practitioners as one who is duly registered and who has been able to obtain an expert level of knowledge base, capable of decision-making even on complex situations and medically competent for practice even for a prolonged period. The nursing staff of a hospital caring for the diabetic patients must employ the necessary accommodations to suit the needs and demands of a patient. Registered nurse practitioners should even go beyond the basic requirements to get licenses (Dueker et al., 2005). There is more focus now on the overall treatment that is not grounded solely on the primary care. Today, they must have the proper training to diagnose and treat acute illnesses like DKA, be able to operate technical devices, interpret laboratory test results and even provide counseling to patients (Dueker et al., 2005). Advanced clinical practitioners do engage in primary care of the patients like conducting services and actual caring for the patients. However, they also must be able to specialize in a field for practice and they also have to put primacy too on the education of the patients for the prevention of the disease (Dueker et al., 2005). This new and more holistic dimension among nurse practitioners could definitely encourage a positive effect among the patients. Context of the role of the nurse practitioner as a leader for changing health care policies A nurse practitioner today has a more holistic role in the development of and caring for the patients. This dynamic position of the nurse should be recognized as the considerable contribution of the nurse practitioners in health care today. To effectively fulfill this niche, the nurse now is expected to have competent skills. The Royal College of Nursing (2002) further enumerates the many aspects that are covered like proper case management of the condition of the patient; encouraging a nurse-patient relationship; teaching and coaching function; monitoring and maintaining the quality in health care provided; cultural expertise and specialized role in managing the health care systems. Given these different aspects covered, the nurse is allowed the opportunity to see more of the perspective of the patients. This fact now presents the additional or rather the real value of the role of the nurse. It is more than just getting additional tasks or authority in the work place. It is more than just having a more pronounced responsibility and accountability in the whole system of health care. Take for an instance the cases that will demonstrate that patients have given more feedbacks in the presence of the nurse practitioners (Dolan et al., 1997). Thus the added skills and competency of the nurse practitioner combined with this insight into the real concerns of the patients could very well result to an empowered individual who can estimate the needs of the patients with what present health care policies provide and vice versa. Giving the nurse practitioners the professional autonomy and credentials will provide more weight to their recommendations to policy-making bodies of the clinics, hospitals and even the community (Dolan et al., 1997). DKA Patient Consultation at Ward Level Diabetic ketoacidosis or DKA is considered as 'a state of severe uncontrolled diabetes,' consequently, this calls for constant medication using insulin and fluids (Hamdy, 2006). DKA is a more acute form of diabetes that can threaten the life of the patients. It is generally found more on people with type 1 diabetes. The disease takes place because of the absence or deficiency of insulin supply in the body. This is further coupled by the increased production of hormones that aggravate the condition like growth hormones, cortisol and glucagons (Hamdy, 2006). DKA today is responsible for the majority of the cases of diabetes-related admissions to hospitals. It comprises more than 50% of the reported cases on children (Hamdy, 2006). Thus, it becomes imperative to aim for the progress in the field. When an instance came that a DKA patient at the ward level seeks for consultation, the most basic information must be at hand to properly apprise the patient and answer any questions. At best, the discussion must be comprehensive enough to cover any preventive measures available in the case of the DKA. Furthermore, if there are any seminars or special consultations conducted for such comprehensive discussion, this must be made known. The patient must be informed of all the avenues available to address the disease and prevent its complication. Educational programs are being introduced today in clinics and hospitals so that patients can easily learn how to take care of their situation and so that they can easily administer self-care (Hamdy, 2006). Patient (Repeated Hospital Admission for DKA) Many patients of the diabetic ketoacidosis disease are subjected to repeated hospital admissions due to the complications and poor management of the disease. The emphasis in encouraging this policy culture among hospitals and clinical practitioners is emphasized even more by the clamour and demand of this reality. There are previous studies that revealed that there are existing hospitals with staff without the right and adequate knowledge to address the problem of diabetes (Wamae & Da Costa, 1999; Holdich, 2000). There is even a study that suggests that the education and skills of the hospital staff have a constructive correlation with the length of stay of diabetic patients in the hospital (Feddersen & Lockowood, 1994). Thus these dilemmas confronted by the patient must be responded to. The role at the policy level is to implement effective regulations to properly assess the capabilities and competency of the hospital staff serving the patients (Dueker et al. 2005). At this point, one will definitely appreciate more the role that a clinical practitioner will play. There are things that can be done at the level of nurses like me who can do the change right away. This is to be conscientious enough to seriously administer the proper case management and treatment to the patient. Educate the patients on the complications of the disease and explain clearly in terms that can be understood by them the different consequences a particular action may have, being cautious on the bad and encouraging the good. Plans to Develop for the Patient Early and proper planning for the education and support of the DKA patients in any stage or condition will be helpful in ensuring that the nurse practitioners succeed in giving the necessary treatment or consultation advice. In light of the facts presented above, I will present here some plans that are good to be developed for the patients and may very well be administered by clinical practitioners catering to diabetic patients. Of course, delivering effective primary care is still a principal consideration. Upon the time that the patient is admitted to the hospital, he or she must get the most immediate needs called for by the situation. Then, a review upon the records and history of the patient should be conducted to provide a basis for long-term care plans. This should include the preventive measures. Ambulatory care for the patient must also be considered. Even at the time the patient is not anymore maintained in the clinical facility, there should be still a system that will provide supervision and care. This is best established by maintaining a contact and relationship with the patient and the family. The role of educating the family or immediate community of the patient will also matter here. With regard to tertiary care, this requires highly specialized health care and consultation. Thus if there are patients under primary care that require this kind of attention already, they must be immediately referred. The technical facilities and specialized skills of the people in tertiary care must be utilized as much as possible especially for patients in the acute phase. There are also pertinent systems and procedures that must be designed and implemented to accommodate and properly assess the patient who has been admitted at an acute stage already. There must be a practice or training within the clinical practitioners in a given facility or unit to efficiently deliver the system and provide needed care to the patient. Expertise is very crucial at this point. This expertise or specialization must be maximized to manage the case of the patient in the acute phase. This is to minimize the risks of the complication, avoid fragmented care by different staff members and reduce the costs as much as possible. Barriers There may however be obstacles and barriers in the implementation of the plan to the case of a patient. In the implementation of the primary care, there might be no any new barrier, considering that this is the traditional role of the nurse. In the level of the perception of the people, this may be an obstacle. There are still people who may be not yet fully trust this professional autonomy of the nurses as there are not much studies conducted yet to establish serve as a strong foundation for the premises of the advocacy. Some may also regard this holistic approach as a mere term to a mere substitution that will take place in the hospital while the doctor is away, even if such is not the case. There might also be some people, patients and their families who may find it difficult to comprehend or accept that a nurse who shall take on some responsibilities that were traditionally in the exclusive province of the physician or doctor. Overcoming Barriers There are still claims that the cases and evidences establishing the role of the nurse practitioner are not yet substantial. However, this should not hinder clinics and facilities from implementing the guidelines that will only improve the system further. Also it would be advisable to adapt an organizational structure that will properly place the role of the nurse practitioner where it is really useful and responsible. This is to properly apprise the people of the new role assumed by nurses of today. Nurse practitioners should not be regarded as 'fillers' for the job while the physicians are out or too busy. Nurses have a niche of their own that they will be able to properly fulfil to serve the needs of health care and promotion. Using education again in this aspect can further help in shaping the mind of others who may still be apprehensive in the endeavour. Finally, the nurse practitioner, in their own ways must do everything to the best they can, with conviction and dedication, to inspire not only the patients but their families as well on the purpose and efficacy of the new roles. These things mentioned do not yet cover the bigger picture of things, particularly the effort that would spring from the government policy level in terms of health industry. There should also be a recognition coming from this part so that the community may understand properly and that proper guidelines will be set, ideally at all localities. Effective Health Care Strategies (Educating the Patient) There are certain skills and knowledge needed to properly effect the health care promotion and strategies. First, the nurse must be capable of carrying out physical examinations and psychological evaluations of the patient (Roberts-Davis & Read, 2001). This includes the willingness and dedication to go through numerous consultations and discerning the proper responses to the questions of a patient. As a consequence of these skills, it is also imperative that the data are interpreted properly and premises are given their right conclusions which shall include the detection of risks the patient is exposed to and the diagnosis of any symptoms complained of (Hicks & Henessy, 1998). Decision-making skills are also needed, especially for cases where time is the essence and the patient needs right treatment immediately (Offredy, 1998). Delivering the Health Care It was said that even back in the year 1927 diabetic patients are already enjoying education with regard to their illnesses when the Joslin Diabetes Center started implementing a home care service by nurses to assist in the management of the disease (Bloomgarden, 2000). There are also findings that all kind of interventions to the disease will already promote knowledge of the matter (Brown, 1999). However, these are not sufficient, especially in this time when the diabetes has been found to become more complicated and in the more complicated lifestyle of the people today. Education calls for more than just giving a statement. Education should focus more on motivating and empowering individuals, both the patients and their immediate family members. It is imperative that the nurse practitioner display the utmost dedication and concern to the needs of the patient. Treatment of the patient is the primary concern, but the nurse must go beyond looking at the responsibility as mere delivery of services. To properly tackle the problem, there must be more focus on the patient as an individual or a friend receiving care rather than as a patient receiving medications. This could definitely improve the expectations of the patient to the health care (Anderson et al. 1995). The patient must get the necessary and crucial information regarding the disease. For example, diabetes is a disease that shall continue to progress through time. Thus the patient must be properly apprised that he or she is not to be blamed if conditions like the hyperglycemia should get aggravated (Bloomgarden, 2000). The nurse practitioner must then properly explain the different aspects of the disease, things to do and not to do, the proper dieting and the ideal lifestyle. There should be at least a discussion of the different changes in the behaviour that can be implemented in the particular case of the patient (Bloomgarden, 2000). During this stage, the nurse practitioner must be very alert in assessing the attitudinal-belief of the patient, including too the psychological state (Bloomgarden, 2000). Studies show that the community and the cultural background of a patient can affect the way a patient will evaluate the knowledge thereby affecting too the implementation self-care (Ahern et al., 1993). This makes it imperative for the nurse to be effective in assessing every case and situation. The right assessments can indicate properly the areas that the practitioner must be cautious with in the discussion as well predict and prevent the obstacles that may be encountered because of certain beliefs or attitudes. This can also be a basis to know how to properly apprise the family supporting the patient. Empowering the patient is also a substantial step to give the treatment its holistic approach. It is said that at least 95% of the diabetes treatment is handled by the patient (Bloomgarden, 2000). Thus, the patient must develop a sense of faith in the capability and efficacy of doing things on his or her own. The relationship must be a two-way one where the nurse and the patient interact and collaborate in the efforts. It is also recommended in this regard to let the patient handle his or her medical records. Today, the nurse must hearten the patient and encourage more involvement through educating the patient and making him or her have considerable degree of control in their situation rather than let them just wait until their medication arrives or until someone tells them what to do next. Education should be a basic aspect of any diabetes treatment. Primarily, this is an indispensable tool to make the patients capable of staying away from further complications of the disease (Siminerio, 2000). This is where the interaction between the nurse and the patient is of utmost importance to further encourage the diabetic patient in the treatment efforts. The awareness of the patient can increase their satisfaction to the nurse practitioner who attends to them and even to whole health system that could favorably encourage a more effective medical result in the long run (Street & Voigt, 1997). There are a number of problem solving approaches that the nurse may take. These may vary depending on what the case and the circumstances will call for. This requires the proper appraisal of various aspects like the role or the specialization of the practitioner in the context of the clinical facility, the case or status of the patient and the equipment and utilities available. There are cases where all clinical practitioners are given the task to receive the patients, whether requiring primary or acute phase admission. They should therefore utilize all the skills they have in addressing each and every case addressed to them (Street & Voigt, 1997). There may be instances also when the facility gives specific roles to the nurse practitioners. Thus, a nurse in the primary care who received a patient in acute phase must attend to immediate needs but must immediately call the attention of those who are tasked for that section. The situations will vary depending on the cases of the patient and the policy of the hospital or clinic. Thus, this highlights even more the importance of promoting education and ample training to nurse practitioners. Conclusion Clinical practitioners exercising professional autonomy must take the initiative to properly shape their field in the health industry into being more responsive and effective to the needs of the patients they cater to, especially those who go through complicated diseases like diabetes ketoacidosis. It is important to equip the clinical practitioners with the necessary knowledge and skills, so that in turn they can educate the patients and the family of the patients properly. This shall be health promotion at its very core where individuals are empowered with their access to training, information and education. References Ahern, J., Grove, N, Strand, T., et al. (1993). The impact of the Trial Coordinator in the Diabetes Control and Complications Trial (DCCT). Diabetes Education, 19, 509-512. Anderson, RM., Funnel, MM., Butler, PM., Arnold, MS., Fitzgeral, JT. & Feste, CC. (1995). Patient empowerment results of a randomized controlled trial. Diabetes Care, 18, 943-949. Bloomgarden, ZT (2000). Educating patients with diabetes CME. Medscape Today, Retrieved July 16, 2006, from http://www.medscape.com/viewarticle/413047 Brown, SA. (1999). Interventions to promote diabetes self-management: state of the science. Diabetes Education, 25(6), 52-61. Dolan, B., Dale, J., & Morley, V. (1997). Nurse practitioners: the role in A&E and primary care. Nursing Standard, 11(17), 33-38. Dueker, MJ., Spurr, SJ., Jacox, AK. & Kalist, DE. (2005). The practice boundaries of advanced practice nurses: An economic and legal analysis. Research Division of Federal Reserve Bank of St. Louis, Retrieved July 15, 2006, from http://research.stlouisfed.org/wp/2005/2005-071.pdf. Feddersen, E. & Lockowood, DH. (1994). An inpatient diabetes educator's impact on length of hospital stay. The Diabetes Educator, 20(2), 125-128. Hamdy, O. (2006). Diabetic ketoacidosis. E-medicine. Retrieved July 15, 2006, from http://www.emedicine.com/med/topic548.htm Hicks, C. & Hennessy, D. (1998). A triangulation approach to the identification of acute sector nurse's training for formal nurse practitioner status. Journal of Advanced Nursing, 27(1), 117-131. Holdich, P. (2000). Pilot study of a novel approach to education: the Diabyte flyer. Journal of Diabetes Nursing, 4(4), 116-120. International Council of Nurses. (2002). - International Council of Nurses. Retrieved July 13, 2006, from http://www.icn.ch/networks_ap.htm 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, 819-823. Jamieson, L & Williams, LM. (2002). Confusion prevails in defining 'advanced' nursing practice. Collegian 9(4), 29-33. Lawton, R. & Burton, A. (n.d.). Clinical guidelines: A means to too many ends. University of Leeds. Retrieved July 13, 2006, from http://clinmed.netprints.org/cgi/content/full/2000070008v1. Offredy, M. (1998). The application of decision making concepts by nurse practitioners in general practice. Journal of Advanced Nursing, 28(5), 988-1000. Pearson, LJ. (1998). Annual update of how each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner, 23(1), 14-66. Roberts-Davis, M. & Read, S. (2001). Clinical role clarification: using the Delphi method to establish similarities and differences between nurse practitioners and clinical nurse specialists. Journal of Clinical Nursing, 10(1), 33-43. Royal College of Nursing (2002). Nurse practitioners: an RCN guide to the nurse practitioner role, competencies and programme accreditation. London, RCN. Siminerio LM. (2000). Diabetes education: the foundation for quality diabetes care and outcomes. 17th International Diabetes Federation Congress; Mexico: Plenary Session. Street, RL & Voigt, B. (1997). Patient participation in decision-making and subsequent quality of life. Medical Decision Making, 17, 298-306. Wamae, D. & Da Costa, S. (1999). An educator project to improve ward nurses' knowledge of diabetes. Journal of Diabetes Nursing. 3(3), 75-78. Read More