Family Nurse Practitioners Role - Research Paper Example

Analysis of Family Nurse Practitioners’ Role Introduction As I was reading through the characteristics or competencies of the different advance nursing practices, I have decided to pursue a career in family nursing. According to the World Health Organization, (WHO) 1998 report, family nurse practitioners handle a broad range of medical services in many different settings like the patient’s home, clinics, community-based nurse-managed health centers, long-term care facilities, hospitals, hospice centers, and nursing homes, basically anywhere a primary care physician might practice. The focus of care is on the family unit specializing in family nursing and in the context of the community. They provide primary health care services across the client’s life spanning from newborns, to infants, to children, to adolescents, to adults, to the elderly and including but not limited to pregnant and postpartum women (WHO, 1998, p. 106; “Family nurse practitioner programs”, 2008; NONPF, 2002, p. 21; “Family nurse practitioner”, 2008; “MSN,” 2003). Family nurse practitioners help individuals cope with illnesses and chronic disabilities. They assist families concerning health issues by promptly detecting health problems in the family so that they can be treated at an early stage. They can also give advice on lifestyle and behavioral actions that can pose a risk on the patient’s health or the balance in the family unit (WHO, 1998, p. 106; “Family nurse practitioner programs”, 2008; NONPF, 2002, p. 21; “Family nurse practitioner”, 2008; “MSN,” 2003). Numerous studies have been presented to the WHO in regards to family-centered care and showed that this approach was effective in giving the patient optimal health (Häggman-Laitila, 2005, p. 199; Siebes, et. al, 2006, p. 503; LeGrow & Rossen, 2005). Family Nurse Practitioner Competencies The National Organization of Nurse Practitioner Faculties (NONPF) mentions four roles of the family nurse practitioner that helped me decide to pursue this position for my advanced career in nursing. These are: (1) provider of direct health care services in promoting health, protecting health, preventing disease and managing disease; (2) collaborating with the patient for a more effective approach to patient care; (3) teaching or coaching role; and (4) making sure that the family receive the appropriate clinical services for their health problems (p.21). Delivering Direct Health Care Services According to Chalfin (1994), approximately fifty-eight million Americans do not have any insurance coverage (p. 275). Aside from the people not being able to afford health care, only one fourth of medical school graduates go into the practice of primary care specialties such as family medicine, pediatrics, general internal medicine and obstetrics-gynecology, hence the need for more primary care providers. In order to provide these services, nurses have stepped-up to the plate and the American Association of Colleges of Nursing (AACN) created advanced nursing programs (Sherwood, et. al., 1997). Family nurse practitioners are expected to be able to assess all aspects of the patient’s health. This may include health promotion, health protection, disease prevention and treatment. Although the family nurse practitioner’s task is not to diagnose a patient’s illnesses and give a cure, it is his or her competency to critically identify health problems in order for the patient to take action regarding his own health. Part of the family nurse practitioner’s job description is to provide counseling for the patient and his or her family in dealing with chronic diseases (NONPF, 2002, p. 21). It is imperative that these nurses are familiar with the pathologic process of the disease to determine if the activities of the patient and the patient’s family are detrimental to the patient’s health. For instance, in an interview conducted by Tapp (2000) in the Family Nursing Unit in Canada, amongst nurses in this facility and the families that avail of their services, to explore the therapeutic conversations between nurses and families, revealed that there are parts of the conversation that showed the importance of counseling in coping with a hereditary chronic illness. The patient and his wife were trying to deal with an ischemic heart attack after a kidney transplant secondary to polycystic kidney disease. Concerns were raised about the changes in diet and exercise and anticipating loss or grief and fear of death. He was worried that discussing his illness with his family would cause more distress in the family. On the contrary, this was not the case because the kidney disease is hereditary and one of his children already has it. In talking about the disease, the son actually wanted to know more about it especially the warning signs to watch out for when the kidneys start to “shut down” in order for him to address this problem before it is too late (p.74-78). This is the aspect I was interested in most, to be able to work with families in the healing process and health prevention or preventing further morbidity. Other roles of the family nurse practitioner entail screening activities to detect a disease early; provide advice on health promotion and avoiding risky behaviors such as smoking while pregnant; implement the doctor’s therapeutic plan in order for the patient to return to a stable state; and to optimize the patient’s health (WHO, 1998). Family Centered Care WHO (2000) recognized that family-centered care is important when working in health care environments. Numerous studies revealed that the family-centered approach was effective in the treatment of illnesses especially for chronic diseases. Family centered care means that the family takes an active role in the health of the patient. It gave control to the client instead of the service provider and services focused on the whole family as a unit rather than limited to the patient. Concerns regarding the illness and how it will affect the whole family were addressed. The family members in turn are able to share their knowledge with the professionals about the attitude of the patient and the family’s belief and practices, giving the professionals a holistic approach in the patient’s treatment (Häggman-Laitila, 2005, p. 199; Siebes, et. al, 2006, p. 503; LeGrow & Rossen, 2005). In order to assess efficiently family members’ most critical concerns and/or challenges regarding a health issue, Dr. Lorraine Wright (1989) developed the “One Question Question” (OQQ). The question is usually formulated as follows: “If you could have just one question answered through our work together, what would that one question be?” (p. 16). According to Wright, this kind of questioning by the nurse draws the family to identify the most pressing issue in a brief therapeutic conversation and not just what is important to the health care professional. However, in order for the family nurse practitioner to be able to start a nursing intervention, a relationship must be formed between the nurse and the family. A U.S. study (Zerwekh, 1992), revealed that the foundation for public health nurses to work were locating the family, building trust, and building strength (p.19). Most families referred to family nurse practitioners are high-risk parenting families; building trust is the foundation of forming relationships because most of these families are inexperienced in trusting relationships (Baggaley & Kean, 1999, p. 394-395). In addition, the family should be defined as providing care for the whole family and not just one or two members, for instance, the postnatal period should involve not only the mother and the child, but also the father as well. A study revealed that fathers were not asked by public health nurses regarding their children (Williams & Robertson, 1999, p. 56). Hence a paradigm shift in including fathers and husbands were added in the care of family nurse practitioners. Once the family nurse practitioner gains access to the family and builds trust, it is the family nurse practitioner’s duty to maintain this relationship through regular follow-ups throughout the patient’s life because each stage in a family’s life poses different problems. For example, an infant diagnosed with asthma becomes a child who will enter school. Teaching-Coaching Function The purpose of family home visits is to develop family self-help (Baggaley & Kean, 1999, p. 395). Family nurse practitioners may be part of the team who does family visits or are direct supervisors of the nursing staff who visit families. Nevertheless, part of their role is to impart knowledge to the families regarding health issues such as sexuality, terminal illnesses and substance abuse, to name a few. Psycho-motor skills are also imparted to the patients, for instance, the proper way to breast-feed a newborn child. Such skills are taught through modeling, coaching and tutoring (Apps et. al., 2006). An important role of family nurse practitioners is to demonstrate to the other family members in delivering the therapeutic plan of the physician. For example, parents of an asthmatic child must be taught on how to use a nebulizer and how to prepare hypoallergenic meals (Jokinen, 2004, p. 124). Spouses or other caregivers of adults who have hypertension or diabetes should learn how to use a sphygmomanometer or a glucometer, respectively, to give the right amount of medication to these patients. Managing Multi-agency Health Care Delivery Settings In order for the family to receive optimal health care, the family health practitioner must be knowledgeable of the services provided in the community and create partnerships with both the family and the community. The family health practitioner must also be able to identify when a patient needs referral to a specialist. Once the family health practitioner identifies such, he is obligated to follow-through and follow-up if the patient is getting the special care that he needs; for instance, if the parents are able to bring their child to physical rehabilitation centers for treatment of scoliosis, etc (Anning, 2005, Murray, 2008, p. 474; Hicks et. al., 2008, p. 453). Nurse Practitioner vs. Other Advanced Practice Nurses Aside from the family nurse practitioner, there are three other advanced nursing practices namely: (1) nurse executive; (2) nurse anesthetists; and (3) nurse educator. A nurse executive works in the administrative or managerial level. His or her task includes developing procedures and policies that will improve the quality of care given to the patient but at in an efficient manner that will not be costly to the hospital or the health facility. Nurse executives are leaders that collaborate, coach, and mentor nurses in their team to deliver quality patient care. Working hand in hand with the medical director, a nurse executive also brings clinical knowledge, insights and expertise in the quality and safety of health care to the board in order to make good board decision-making (Griffey, 2009, pp 7-8; AONE, 2001a; Johnson & Johnson, 2002). Compared with the nurse practitioner, the nurse executive is not directly involved with the patients’ diagnoses or treatment, however, they can develop procedures and policies that nurse practitioners can follow to bring the best quality of care to primary care patients and the nurse practitioners in turn can suggest ways to improve any aspect he or she encounters as he or she works with the family. One of the oldest professions in the career of nursing is the nurse anesthetist. A nurse anesthetist’s duty is to deliver the anesthetic agent to the patient during surgical procedures and monitoring them during and after the surgery same as an anesthesiologist. However, unlike anesthesiologists, nurse anesthetists can not practice pain management. Nurse anesthetists can work in the hospital operating room, out-patient surgery center, or in the U.S. Army assignments (Evans, 1998; All Star, 2002; Quantumx, n.d.). Nurse anesthetists have personal patient encounters when they take the patient’s history before the surgery and after the surgery until the patient’s discharge from the hospital or health facility. However, compared with the nurse practitioners who are involved in primary care, the nurse anesthetist does not diagnose the patient but only delivers the most appropriate anesthetic and the follow-up of the patient us only until the patient is discharged from the hospital then he or she is not anymore involved with the patient’s care. Also the nurse anesthetist’s work is confined within the operating room unlike nurse practitioners who work in the community. A nurse educator works in the classroom and practice setting grooming nursing students to become licensed practicing nurses and licensed practicing nurses to advance their knowledge and skills for advanced degrees such as nurse practitioners, nurse anesthetists, nurse executives or nurse educators. Nurse educators are critical for strengthening the nursing workforce to work in an ever-changing health care environment. Nurse educators are also involved in research and the pursuit of practices that will improve the quality of health care (AONE, 2001b). Compared to nurse practitioners, nurse educators work more with their colleagues than patients. Their practice is more on theoretical side than in the practical side. However, nurse educators can also work part-time as practicing nurses in the hospital or community setting, giving them more exposure to patients and strengthening their clinical skills that may or may not give them the edge to becoming a more effective nurse educator. I have decided to become a family nurse practitioner because it allows me to work directly with patients and their families to which I think for now will give me the most satisfaction in fulfilling my dream of caring for other people. Opportunities for Nurse Practitioners With the event of physician shortages, nurse practitioners have emerged to provide primary care for children, adults, elderly and basically the whole family. They are accepted in all 50 states to take histories, do physical examinations, diagnose, request further screening methods and treat many common acute and chronic illnesses without the presence of primary care physicians. In some states, nurse practitioners are allowed to prescribe certain medications (Mayo Clinic, 2009). The reason for my pursuit of a career in advanced nursing practice is to get more involved in the health care system of diagnosing and treating the patient. According to the American Nurses Association, 60-80% of primary and preventive care can be performed by nurse practitioners (as cited in Mayo Clinic, 2009). Job listings are numerous in Oklahoma for family nurse practitioners and physician assistants since the government is aiming to reach the more families by making available health care in almost all communities. With the shortage of doctors, nurse practitioners are aimed to fill-up these positions. Also, the Oklahoma state allows nurse practitioners to prescribe medications (Mayo Clinic, 2009). Currently, I am working in a team as a registered nurse in the community setting where my job entails assisting advanced nurse practitioners are providing health care for many different families. I have been exposed to newborns, infants, children, adolescents, adults, parent, soon to be parents, and the elderly. I enjoyed working with patients of all ages and collaborating with families and the community at large. It is there that I found that working with families as a whole unit and working with their current resources provided good results in the patient’s outcome. On a more personal note, my grandmother was diagnosed with diabetes just the year before. Because I was a registered nurse, my mother asked me to accompany my grandmother to the doctor’s office so that I may ask questions regarding the health care of my grandmother. I understood well the medical explanation of our family physician. Moreover, I was able to discuss with my grandmother and the rest of my family, in a context in which they understood, the medical problems of my grandmother and the treatment she has to undergo and the consequences of the doctor’s therapeutic plan were not followed. Meals in our home changed to fit the doctor’s diet recommendation and activities were planned so that my grandmother would get the exercise she needed. The change was good because I was able to explain to my family that our health is also at risk since diabetes is hereditary. My family is fortunate that they have someone like me working in the health sector but not all families are as fortunate. This is the reason why I would like to work with families, to promote health, to protect health, to prevent disease and provide treatment through education, counseling, screening methods, and carrying out treatment plans. References All Star Directories, Inc. (2002). Become a certified registered nurse anesthetist (CRNA). Retrieved May 18, 2010 from http://www.allnursingschools.com/faqs/crna. Anning, A. (2005). Investigating the impact of working in multi-agency service delivery settings in the UK on early years practitioners’ beliefs and practices. Journal of Early Childhood Research, 3 (1), 19-50. AONE (American Organization of Nurse Executives). (2001a). Nurse executive. Nurses for a Healthier Tomorrow Career Info. Washington, DC. Retrieved on May 18, 2010 from http://www.nursesource.org/executive.html AONE (American Organization of Nurse Executives). (2001b). Nurse educator. Nurses for a Healthier Tomorrow Career Info. Washington, DC. Retrieved on May 18, 2010 from http://www.nursesource.org/nurse_educator.html Apps, J, Reynolds, J, Ashby, V and Husain, F., (2006). Family support in Children’s Centres summary: Research and policy for the real world. Family and Parenting Institute, High Gate Road, London. Baggaley S., and Kean, S. (1999). Health visitors as family nurses: A discussion of research, policy and practice in the United Kingdom. Journal of Family Nursing, 5 (4) 388-403. Retrieved May 14, 2010 from http://jfn.sagepub.com/cgi/content/abstract/5/4/388. Chalfin, D. B., & Fein, A. M. (1994). Critical care medicine in managed competition and a managed care environment. New Horizons, 2(3), 275- 282. Evans, T. (1998). What is a nurse anesthetist?. Retrieved May 18, 2010 from http://www.anesthesia-nursing.com/wina2.html Family nurse practitioner. (2008). The Frontier School of Midwifery & Family Nursing. Retrieved on May 14, 2010 from http://www.midwives.org/family_nurse_practitioner.asp. Family nurse practitioner programs. (2008). Degree prospects, LLC. Retrieved on May 14, 2010, from http://www.bestnursingdegree.com/programs/family-nurse-practitioner/. Griffey, H. (2009). The nurse executives’ handbook: Leading the business if caring from ward to board. Burdett Trust for Nursing Booklet. Retrieved May 18, 2010 from http://www.burdettnursingtrust.org.uk/public/documents/The_Nurse_Executive's_Handbook.pdf Häggman-Laitila, A 2005, ‘Families’ experiences of support provided by resource-oriented family professionals in Finland’, Journal of Family Nursing, vol. 11, no. 3, pp. 195-224 Hicks, D., Larson, C., Nelson, C., Olds, D. and Johnston, E. (2008). The influence of collaboration on program outcomes: The Colorado nurse family partnership. Evaluation Review. 32 (5), 453-477. Retrieved May 14, 2010 from http://erx.sagepub.com/cgi/content/abstract/32/5/453 Johnson & Johnson Services, Inc. (2002). Nursing executive and nursing CEO. Retrieved on May 18, 2010 from http://www.discovernursing.com/jnj-specialtyID_253-dsc-specialty_detail.aspx. Jokinen, P. (2004). Family life-path theory: A tool for nurses working in partnership with families. Journal of Child Health Care. 8 (2), 124-133. Retrieved May 14, 2010 from http://chc.sagepub.com/cgi/content/abstract/8/2/124 LeGrow, K. and Rossen, E. (2005). Development of professional practice based on a family systems nursing framework: Families’ experiences. Journal of Family Nursing. 11 (1), 38-58. Retrieved May 14, 2010 from http://jfn.sagepub.com/cgi/content/abstract/11/1/38. Mayo Clinic. (2009). Nurse practitioner career overview. Mayo Foundation for Medical Education and Research. Retrieved May 17, 2010 from http://www.mayo.edu/mshs/np-career.html. MSN. (2003). Family nurse practitioner. Prarie View A & M University. Viewed on May 14, 2010, from http://www.pvamu.edu/pages/1013.asp. NONPF (The National Organization of Nurse Practitioner Faculties). (2002). Nurse practitioner primary care competencies in specialty areas: Adult, family, gerentological, pediatric, and women’s health [HRSA 00-0532 [P]]. Rockville. Quantumx. (n.d.). Becoming a nurse anesthetist. Retrieved May 18, 2010 from http://www.nursingguide.ph/article_item-390/Becoming_a_Nurse_Anesthetist.html Sherwood, G., Brown, M., Fay, V., Wardell, D. (1997). Defining nurse practitioner scope of practice: Expanding primary care services. The Internet Journal of Advanced Nursing Practice. 1 (2). Retrieved May 15, 2010 from http://www.ispub.com/journal/the_internet_journal_of_advanced_nursing_practice/volume_1_number_2_6.html Siebes, R., Ketelaar, N., Wijnroks, L., van Schie, P., Nijhuis, B., Vermeer, A. et. al. (2006). Family-centered services in the Netherlands: Validating a self-report measure for paediatric service providers. Clinical Rehabilitation. 20 (6), 502-512. Retrieved May 8, 2010 from http://cre.sagepub.com/cgi/content/abstract/20/6/502 Tapp, D. (2000). The ethics of relational stance in family nursing: Resisting the view of “nurse as expert”. Journal of Family Nursing. 6 (1), 69-91. Retrieved May 14, 2010 from http://jfn.sagepub.com/cgi/content/abstract/6/1/69 Williams, R., & Robertson, S. (1999). Fathers and health visitors “it’s a secret agent thing.” Community Practitioner, 72(3), 56-58. World Health Organization. (1998). Health for all policy framework for the European region for the 21st century [EUR/RC48/R5]. Denmark: Author. World Health Organization (WHO) (2000). The Family Health Nurse. Context, Conceptual Framework and Curriculum. Copenhagen: Health Documentation Services, WHO Regional Office for Europe. Wright, L. (1989). When clients ask questions: Enriching the therapeutic conversation. The Family Therapy Networker, 13, 15-16. Zerwekh, J. V. (1992a). Laying the groundwork for family self-help: Locating families, building trust, and building strength. Image: Journal of Nursing Scholarship, 9, 15-21. Read More