Adult Nurse Practitioner Recent Trend

Adult Nurse Practitioner

Recent trend in medical care have brought the adult nurse practitioner into a position of not only support but primary care of psychiatric as well as other patients. The role of the adult nurse practitioner in the specialty of psychiatric care generates significant opportunity and can produce significant conflicts as traditional general practitioner roles are transcended, requiring additional training and specialized understanding of this new avenue of specialization. This work will address the literature surrounding this relatively new role, some of the trends that have created it and specifically the autonomous role that nurse practitioners are sometimes required to play, with the inclusion of legislation and authority to do so. Balancing the role of the nurse-patient relationship with new authority of autonomy is an essential aspect of the transition in modern medicine to nurse practitioner autonomy and primary care of patients. Nurses must understand the science and the core of patient nurturing to bridge the distance between the care provider and the client, and logically they are in the best position to do so.

Specialized care in advanced practice nursing has been present for many years but it is more significant today as the medical care system more effectively acknowledges the benefit of APN in cost effective care, especially in specialized areas. The psychiatric nursing field is demonstrative of this trend and now it is left to nurse training programs to expand services to train APNs to meet this growing specialty need. Autonomy has been a near constant struggle in advanced practice nursing as legislation has had to catch up with the trend of primary care by Nurse Practitioners in specialty areas, such as psychiatric care. The role of an antonymous health care provider in psychiatric nurse practitioner specialties will be discussed, with the inclusion of prescription privileges as well as a discussion of the autonomous routes of care for individual clients demanding the ability of the provider to manage the care, in a nurturing manner, of the individual as much as possible and conscientiously make referrals when needed.

The issues and challenges inherent to the role of the autonomous primary care provider in a specialized field are clearly associated first with adequate and current training in specialty care. Issues such as prescription privileges are also significant, as specialized care in the psychiatric field requires significant knowledge associated with a very clinical setting, with constantly evolving drug therapy regimens as well as with maintenance medications for other aspects of care, not related to psychiatric care. The nurse practitioner must be fully aware of the options for pharmaceutical care as well as all the potentials for interaction and conflicts that could arise in cases where medication can seriously make the difference in quality of life, for prolonged illnesses, like so many psychiatric ailments are. The nurse practitioner and the training agents must be aware of the complicated nature of psychiatric medications, what they do and what the symptoms of interactions are as well as the symptoms of non-compliance, a frequent issue in psychiatric medicine. Additionally, the role of the advanced practice specialized nurse practitioner in psychiatric care is significant in the development of patient relationships that are more akin to the role of the nurse as nurturer, as the separation of the practitioner (by authority) is a constant struggle in psychiatric care, as mental illness is an exceedingly personal experience requiring significant emotional connectivity. The Nurse Practitioner role, even in autonomy must not become one of a surrogate physician or psychiatrist, but must remain true to the nurturing role of the nurse, as is needed most clearly in psychiatric care.

Krauss (2000) emphasized it is irrelevant to focus on whether biological reasons are the root of mental illness because many individuals are unable to benefit from biopharmacologic advances "because of ineffective or inconsistent relationships with health care providers... The practitioner-patient relationship is the medium through which biomedical research is translated. It is not hyperbole to say that biomedical discoveries are rendered meaningless unless they are transformed through a caring relationship into action" (p. 49). (Raingruber, 2003, p. 104)

In short the role of the autonomous nurse practitioner is a balance between offering patients the nurturing care that is inherent of the nursing profession, while still providing the client the benefit of skill and nominal authority to develop treatment plans as well as ensure therapeutic positive results in autonomous privilege.

Silverstein asks in Therapeutic Interpersonal Interactions: The Sacrificial Lamb? How it is possible for the nurse practitioner profession to maintain continuity of care in autonomy, while still providing traditional aspects of the nurturing role that the nurse fills. The author wonders, as the title suggests if the demand for autonomy will create a loss in the system of nurturing care. I chose this article because it is demonstrative of a concern that is inherent in the development of advanced practice nursing, through autonomy.

Raingruber's Nurture: The Fundamental Significance of Relationship as a Paradigm for Mental Health Nursing also demonstrates the need to remain balanced in the continuum of care as nurses move toward more autonomous functioning they must retain the ideals of the nurture function. Raingruber stresses that this pinnacle of change is one where opportunity can be lost or won by the nursing field and the public it treates as the lack of a nurturing relationship between care providers and mental health clients has been a significant historical barrier to treatment and that nurses with a foundational understanding of the role of nurturing relationships have a benefit of understanding that other primary care providers do not. Raingruber also stresses that this opportunity could be lost in the transition from nursing support roles to specialized autonomous primary care providers and must be seen and recognized as an opportunity and a benefit to clients and the larger community. I chose this article because it like Silverstein's reiterates that regardless of the level of authority that a nurse practitioner has he or she needs to be wise to the core values of nursing care, one of the most important being the establishment of nurturing relationships, rather than those that create barriers to patient care and compliance.

Hales et al. Preparing for Prescriptive Privileges: A Standard for the Psychiatric-Mental Health Preceptorship details the inherent role of the nurse practitioner as the source of prescription services and calls for careful attention to this autonomous role provision and all the necessary training it requires. The work clearly demonstrates that autonomous care is a thought provoking trend that must be carefully prepared for, even in the wake of rapid changes in autonomy, as legislation has begun to catch up with roles. I chose this work as it supports the standard of role training in a transition to autonomous care.

Each of these works relates to the specific need of the nurse practitioner to remember and apply core nursing philosophies with regard to highly skilled care in autonomy and nurturing relationships. For the most part, in the past primary physicians are taught the science of medicine, and those who are most effective in their various roles learn the necessity and skill of nurturing patients during real life experiences with them. The benefit that nurses at every level have is that nurture is a core developed aspect of training and care that has significant importance. Each of these articles stresses the importance of merging the science of medicine training with the nurture role to effectively become specialized advance practice nurse practitioners in autonomy, the role that was chosen for this work. The need to blend these two congruent aspect of nursing care is most evident in the specialty of psychiatric care, as the content and context of psychiatric care demands both science and nurture to elicit positive results in patient care and compliance.

Raingruber best illustrates the point of the content and context of psychiatric specialty care when summarizing the findings of the work. The findings of the work, express the opportunity that Nurse Practitioners, specifically have due to the nature of psychiatric illness and the core standards of nurture in the profession.

Psychological, social, cultural, environmental, biological, and experience-based problems are the root of mental illness. Mental health nursing must have a comprehensive paradigm that honors the relational nature of the nurse-patient relationship, the critical influence of environment, the importance of biological factors, and the way that narrative understanding and history shape behavior. (Raingruber, 2003, p. 104)

The nurse practitioner specialist in psychiatric care has the benefit of exceeding expectations through a base understanding of the importance of the nurturing relationship with the patient.

Silverstein on the other hand in the findings of the work, stresses the need to make sure that core values of nurturing are not lost in a bid to create a role of autonomous specialty nurse practitioner in psychiatric care, especially considering the scientific biological basis of much of the modern care in this field. The work finds the need to constantly reiterate core values of nurturing as the field transitions to autonomous care, on a scientific model. To make the point Silverstein reiterates the history of psychiatric specialty nursing, a traditional role for specialty care in nursing.

To deliver specialized care to those in mental institutions, mental nurses were required to possess specific qualities and demonstrate unique abilities, such as sympathy, intelligence, and trustworthiness (Church, 1982). Other essential attributes included knowing how to calm the nerves of an anxious or suicidal patient by using empathy and tact. Mental nurses' abilities set them apart from other nurses, but were difficult to define and understand, for they were ethereal in nature and not easily describable. (Silverstein, 2006, p. 33)

These understandings, described by Silverstein as "ethereal" have become a basic core set of values for the nurse in training and practice and must not be lost, regardless of the transition to autonomous scientific-based care.

Hales et al. has the most comprehensive description of the modern trend to create specialized autonomous care, focusing on scientific training and assimilation of autonomous specialty nurse practitioners in mental health care.

Major shifts in today's healthcare system have resulted in a clear demonstration that advanced practice nurses (APNs) are able to provide cost-effective, high-quality care to patients and their families (Cooper, 2001; Gabay & Wolfe, 1997; Mundinger et al., 1999; Pinkerton & Bush, 2000). Although much of the focus has been on nurse practitioners (NPs) in the primary care setting, APNs in specialty areas are receiving growing attention. Specifically, psychiatric-mental health APNs (both clinical nurse specialists and psychiatric nurse practitioners) have become significantly more visible in providing care to the mentally ill population (Baradell & Bordeaux, 2001; Puskar & Bernado, 2002; Society, 1997). and, just as primary care NPs have altered and positively affected the primary care environment (Pearson, 2002; Simpson et al., 2001), psychiatric-mental health APNs have become key players in building a mental healthcare environment and infrastructure that increases patients' access to quality care, while reducing overall costs. (Hales, Karshmer, Williams, Mann & Robbins, 2004, p. 93)