Advanced Practice Nursing

Roles

Susan Kelly
King University
 Scenario

Mr. B. is a 60 year old Caucasian male recently diagnosed with type 2 diabetes mellitus 3 months ago. Medical history
includes, hyperlipidemia, obesity and hypertension.
Social history: Married, lives with his wife of 35 years, 2 children living outside of the home, reports good support system.
Works full time at a sedentary job running heavy equipment, no reports of exercise regimen, tobacco abuse, alcohol, or illicit
drug abuse.
Diet history:
 Breakfast: Meat biscuit with coffee; Lunch: A sandwich chicken or turkey with chips, water and coffee; Supper: Oven
prepared chicken occasionally pork or beef, salad or vegetables; Snack: Carrots or broccoli with ranch dip or pretzels and
cheese cubes; Drinks: Coffee with 2% milk and water will have little Debbie cakes occasionally.
In addition to Rx medication regimen, plan includes:
 Reinforcement of education on diabetes management
 Collaborate with other members of the healthcare team such as a consult with a diabetes specialist and a nutritionist.
 Providing education on community based resources
 APRN role and the competencies needed to
perform the role

Advanced practice registered nurses in this type of role “have clinical expertise and advanced knowledge in health and
wellness promotion and illness intervention models for specific patient populations”
(Fessler, Haynor, McEachen, & Yam, 2013, p. 279).
 To fulfill this role, the nurse could be Baccalaureate, Master’s, or Doctoral prepared
 APRNs possess specific competencies deeming them competent to fulfill this role:
 Holistic thinking
 Foster team work (factor needed to implement planned care)
 Possess the ability to educate and motivate patients as well as validate their understanding

(Fessler, Haynor, McEachen, & Yam, 2013)

 Importance of this role to the practice of
APRNs

Possessing the ability to conduct research related to practice in relation to the APRN role, disease management,
and clinical outcomes
 Manage complex health needs
 Example: High-risk and vulnerable population requiring high resource consumption
(Fessler, Haynor, McEachen, & Yam, 2013, p. 279)

 Fosters the continuum of care as well as omitting redundancy and waste

 Assess - Plan – Collaborate – Implement – Monitor – Evaluate
(Fessler, Haynor, McEachen, & Yam, 2013, p. 282)
How this role is covered in the APRN Scope of
Practice and Standards of Care

The graduate-level prepared nurse and the APRN:

 Provide leadership in the coordination of interprofessional health care for integrated delivery
of healthcare services
 Break down and organize information in order to recommend necessary system and
community support measures, including modifications of surroundings.
(American Nurses Association, 2010, p. 40)
If this role was eliminated from the APRN
scope of practice

The APRN could not function efficiently; patient care would be affected in a negative manner as the facilitation
of the plan of care would be altered.
This role as an APRNs focuses on:
 Patient advocacy
 Critical thinking
 Assessment/Reassessment
 Cost-benefit analysis and negotiation
 Organizational skills (time management, networking, and prioritization)
(Fessler, Haynor, McEachen, & Yam, 2013)

APRNs would decrease their value and benefit to the healthcare team
 The influence of nursing theory on this role

Jean Watson’s Philosophy and Science of Caring Theory

The integration of holistic care in order to:
 Promote health
 Prevent illness
 Care for the sick
 Restore health

Building patient relationships that are helpful and trusting.

 Involves communication and establishing a rapport:
 Remaining focused on the whole patient
 Attempting to understand the patient’s wishes, as well as the rationale behind the wishes

(Petiprin, 2016)
 How would this APRN role be different without
nursing theory?

Assumptions associated with Watson’s Model:

“A caring environment is one that offers the development of potential while allowing the patient to
choose the best action for him or herself at a given point in time” (Petiprin, 2016, para 7).
Caring is complimentary to curing
(Petiprin, 2016)

The role of the APRN Without Watson’s Theory would be:

Non-personalized
Cut and dry
Businesslike
How does this role advocate for the
patient?

Helps the patient to achieving autonomy and self-determination

(Fessler, Haynor, McEachen, & Yam, 2013, p. 281)
This is accomplished by:
 Stewardship
 Communication and planning
 Utilizing a family-centered approach
 Encouragement of independence and autonomy
What is this APRN role?
Case Manager
References

American Nurses Association (2010). Nursing scope and standards of practice (2 nd ed.). Marlboro,
MD: McArdle Printing.
Fessler, D., Haynor, P. M., McEachen, I., & Yam, M. (2013). Case management and advanced
practice nursing. In L. A. Joel (eds.) Advanced Practice Nursing: Essentials for Role
Development (3rd ed.) (pp. 275-289). Philadelphia, PA: F. A. Davis.
Petiprin, A. (2016). Jean Watson nursing theory. Retrieved from:
http://nursing-theory.org/theories-and-models/watson- philosophy-and-science-of-caring.php