The duty of nurse practitioners has proved to have more progressive aspects than that of registered nurses. They provide both primary and specialized healthcare to patients, their families, and the community in very extensive settings. The most primary areas of practice are in pharmacology, pathophysiology and physical assessment. For such reason, Nursing Practitioners must possess greater functional standards such as competent level of patient care which is based on professional practice, clinical inquiry or reasoning and practice (Naylor & Kurtzman, 2010). Therefore, for the Nursing Practitioners to accomplish such duty, then ethical decision models and cultural competencies must be adhered to. Besides, some health organisations have resorted to increasing the roles of nurses in patient care. The outcome has been that professional Nursing Practitioners can deliver high quality and safe patient care. However, the barriers imposed on Nursing Practitioners hinder them from practising to the extent of their training and education. Therefore, several policy makers in the health industry are advocating for the need to award Nursing Practitioners with an additional comprehensive understanding of Physical assessment, pharmacology and pathophysiology.
Contrary to Registered Nurses, NPs have the ability to both diagnose and treat the sick. However, such functions can be carried out under the instructions and in the presence of a physician. Sometimes, NPs may perform such functions in the absence of doctors thus, acting as physician-extenders. It should be noted that when they take up such responsible, they are only limited to providing basic care to patients who have a common sickness. Eventually, advanced physicians are then free to attend to patients with urgent and chronic conditions within the clinical setting. Due to their extended roles, there is a raging debate if there is the need to increase the knowledge base of Nurse Practitioners on physical assessment, pathophysiology and pharmacology. However, it is imperative to equip with NPs with both ethical decision-making models and cultural competencies a better clinical practice since they have more advanced roles than the Registered Nurses (Kenealy, Docherty, Sheridan & Gao, 2010).
The need for Comprehensive Understanding
Nurse practitioners do employ their skills during the assessment of pathophysiology, pharmacology, and physical aspect of patients. However, in the course of their practice, there is a situation that requires their extreme intervention. However, such interventions come with duties that are beyond the skills of pharmacology, physical assessment and pathophysiology. Hence, when such demand arises, it means that the PNs have to take up the roles of physicians (Kenealy, Docherty, Sheridan & Gao, 2010). Besides, there is often an expectation that they have to perform such clinical services as accurate as the absent educated physicians. Therefore, more often, nurses do encounter roles that are beyond their training. It should be noted that though an RN has a role that cuts across the nursing practice which mostly is to ensure patients comfort, there skills limit them to work under the supervision of PNs. Therefore, PNs can handle patients in areas of pharmacology, pathophysiology, and physical assessment better than RNs but less competently than the physicians. It is because the PNs do not possess enough experience regarding patients health and recovery. Hence the need to endow them with advanced assessment skills (Kenealy, Docherty, Sheridan & Gao, 2010).
Applying applicable knowledge, in particular patient situations
Nursing Practitioners should have the capacity to apply specific assessment skills and knowledge to their patients in any clinical cases. For example, NPs require Comprehensive Understanding in pathophysiology, pharmacology, and physical assessment skills. Such knowledge is fundamental for making distinct judgments about a particular patient from another. Hence, understanding such clinical aspects is critical especially in cases where patients are not able to follow a clear and transitional recovery paths. Therefore, by developing a comprehensive understanding, NPs can prepare for such situations as diagnostic and intervention skills (Ferguson & Pawlak, 2011).
Ability to anticipate risks, crises and vulnerabilities
Unlike RNs who only provide basic patient care, the more advanced role of PNs has elevated them to a situation where they keep facing the challenges of making an accurate judgment about patients health conditions in the absence of physicians. Besides, such conditions require the PN to apply clinical forethought which may be limited in the areas of pathophysiology, pharmacology, and physical assessment. Therefore, unlike RNs, PNs require advanced knowledge and skills regarding diagnostic evaluations and the use of necessary clinical equipment. Hence, in the absence of a physician, a PN with adequate knowledge about a particular patient, can easily make a critical diagnostic assessment and proceed to assemble or deploy the necessary clinical equipment required for treating the patient. Besides, the PN shall be able to save a life in the absence of a physician or a late-coming physician (Starr & Wallace, 2009).
Foreseeing the unlikely events
Since an NP has an advanced role to play in the clinical setting, it is important that they have a comprehensive understanding of pathophysiology, pharmacology, and physical assessment skills so as to have a clear forecast on unexpected patient outcomes. Hence, they should be able to accomplish this through past experimental learning. With such comprehensive knowledge, the PNs can easily predict and counter certain situations by applying the necessary actions as a physician would have done. On the contrary, such knowledge can be achieved if the PNs have a daily routine with varying response patterns. They can then be able to possess expectations about certain situations with much flexibility. Unlike RNs whose functions are not entailing, PNs must possess comprehensive pathophysiology, pharmacology, and physical assessment skills. However, such comprehensive understanding can only develop by integrating the roles of PNs into ethical decision-making models and cultural competence (Naylor & Kurtzman, 2010).
Impact of ethical decision-making models and Cultural competence
Other than comprehensive understanding, Nurse Practitioners must adopt health policy, clinical reasoning and practice to perform their role more adequately. They also have the duty to integrate and utilise ethical clinical culture and comprehensive understanding. Hence, they have to adhere to health care standards (Elwyn, Frosch, Thomson, Joseph-Williams, Lloyd, Kinnersley & Edwards, 2012).
Clinical reasoning by Nurse Practitioners
Registered Nurses do work under the supervision of physicians. They bare little decision regarding a patients health situation as compared to NPs. However, NPs decisions must be based on the ethical clinical practice and cultural competencies. Moreover, PNs as caregivers tend to encounter clinical reasoning involving patients, families and communities. Therefore, they can acquire more comprehensive understanding through new clinical evidence. It also implies that PNs operate within social relationships. Thus, they have to maintain cultural and sound decisions when involving in health care situations. Besides, the reasoning behind the final determination about a patients health and treatment must not compromise competencies of medical practice and its ethics. Moreover, clinical reasoning is an applicability of technical and scientific knowledge which is based on a comprehensive understanding towards a clinical decision-making process. Since PNs are faced with various clinical situations by banking on comprehensive understanding when making clinical decisions, they can consider patients preferences, concerns, sensitivity and vulnerabilities to particular clinical interventions (Hamric, Hanson, Tracy & O'Grady, 2013).
On the other hand, because PNs operate in cultural settings of patients, communities and families, they must make clinical decisions that are ethical and possess cultural competencies while applying a comprehensive understanding of their role. Hence, the PNs must integrate ethical decision making and cultural competency during pharmacology, pathophysiology and physical assessments.
Health policy, comprehensive understanding and practice
Nurse Practitioners are more qualified than the Registered Nurse. However, they are less skilled as physicians. However, PNs have the ability to integrate more advanced health care services to a variety of patients. Unfortunately, due to their limited education, the health regulations have clipped them off certain roles. On the contrary, in the absence of physicians, PNs are required to make critical decisions regarding patients. Besides, in such situations, PNs need to act by health policies combined with ethical decision making and cultural competency despite acting outside their designations. On the other hand, in a dire situation, health policy should not deter NPs from dispensing clinical duties (Starr & Wallace, 2009).
Nurse Practitioners perform more advanced roles in the clinical setting than the Registered Nurses. Most of the time in the absence of physicians, they can diagnose and treat patients. Therefore, NPs should acquire a comprehensive understanding of clinical practice. Through in-depth understanding, the PNs can exercise critical clinical reasoning and observe the ethical standards and cultural competencies during the decision-making processes. Therefore, full understanding must integrate clinical reasoning and health policy.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013).Advanced practice nursing: An integrative approach. Elsevier Health Sciences.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., ... & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), 1361-1367.
Ferguson, L. A., & Pawlak, R. (2011). Health literacy: the road to improved health outcomes. The Journal for Nurse Practitioners, 7(2), 123-129.
Kenealy, T., Docherty, B., Sheridan, N., & Gao, R. (2010). seeing patients first: creating an opportunity for practice nurse care?. Journal of Primary Health Care, 2(2), 136-141.
Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health affairs, 29(5), 893-899.
Starr, S., & Wallace, D.C. (2009). Self-reported cultural competence of public health nurses in a southeastern U.S. public health department. Public Health Nursing, 26(1), 48-57.
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