Family nurse practitioner communication strategies with patients and healthcare providers

Family Nurse Practitioner: Promoting Change

Strategies to communicate and educate stakeholders

I am currently employed as family nurse practitioner and am doing my DNP at a clinic under the supervision of a medical doctor. Communicating with patients is an essential component of treatment and care. If patients cannot engage in effective self-care at home, the treatment dispensed by the clinic will be of little value. The nurse must communicate clearly and seriously the full weight of the patient's condition and need for treatment. For example, if a patient is pre-diabetic, the nurse must make the patient understand what this means: that weight loss, diet and exercise modifications may be able to prevent full-blown diabetes from occurring. The fact that diabetes is not a disease that can easily be managed with drug treatments, although many new drugs and forms of glucose monitoring are available, should also be conveyed to the patient: pre-diabetes is still a serious condition. The nurse must work with the patient's schedule, budget, and knowledge when suggesting a feasible meal plan and exercise routine. Communication is much more than merely saying information: it means responding to the patient's unique needs.

As well as communicating with patients, another important stakeholder is that of the other healthcare providers existing within the organization. The nurse must be in contact with all elements of the patient's treatment team. The nurse's primary role is that of the patient's advocate who balances the patient's social, psychological, environmental, as well as physiological needs. Rather than simply treating the patient as a constellation of symptoms, the good nurse views the patient in a holistic fashion. This perspective is a necessary counterweight to a purely empirical and medical model. For example, a nurse might be aware that a doctor has a different paradigmatic analysis of a patient that needs surgery, as the doctor may primarily focus on the technical aspects of the surgery. The nurse may be equally concerned with the patient's psychological state, pain management, and concerns about postoperative follow-up with the family. Neither the nurse's nor another healthcare paradigm is perfectly 'correct:' what is fruitful is acknowledging these differences and engaging in dialogue. Ideally, the organization will support the concept of what has been called a 'learning organization:' "built on five practices…systems thinking, personal mastery, mental models, team learning, and building shared vision" (Small & Small 2011). Holistic integration of perspectives and a commitment to shared values is vital.

Successful implementation of your proposed evidence-based change

Overcoming the challenge of change resistance is vital. "The demands of healthcare mean nurses work in constantly changing environments; they must continually adapt to different demands, new technologies, government policies and other innovations" (Bowers 2011). However, nurses are often resistant to change because they feel the change is being imposed upon them by tone-deaf management. The most common change model is that of the 'unfreeze,' 'move,' and 'refreeze' model. This underlines the fact that it is essential that nurse leaders convey the need for change to generate a sense of urgency for the change to be effective and also once the change is implemented, standard operating procedures are instituted to ensure that the change 'sticks.' "When managing change it is important to identify with people and reduce the possible resistances they will have in accepting new ways of practicing…leading change means helping people to embrace the challenges to the point where they positively accept and psychologically own new ways of practicing" (Bowers 2011). Even if a change is clearly necessary in the eyes of the leadership, this does not mean that all nurses will automatically agree this is the case.

What are potential challenges for knowledge integration?

"Knowledge integration is a key facet of knowledge application. We define knowledge integration as the synthesis of individuals' specialized knowledge into situation-specific systemic knowledge" (Alavi & Tiwana 2002: 1030). For example, a nurse practitioner learns about nursing in theory in the classroom, but eventually applies that knowledge in practice, gradually gleaning more and more information from real life experience to the point that the knowledge becomes intuitive rather than consciously forced to the forefront of the individual's mind. Effective knowledge integration also entails that knowledge be shared between practitioners to be spread throughout the organization. "Knowledge, especially tacit knowledge such as expertise and know-how, is held only in the individuals' minds. Tacit knowledge is manifested only through action. The value of individual and organizational knowledge resides primarily in its application, an activity that we view as the crux of knowledge management" (Alavi & Tiwana 2002: 1030). Even when nurses work in teams, knowledge may not necessarily be shared in a fully integrative fashion. Sharing knowledge across different departments, units, specialties, and between nurses and physicians can be additionally challenging due to turf wars or differences in the background or language of practitioners.

How might you address those challenges?

Creating multidisciplinary teams that work regularly together within the organization makes knowledge integration a consistent facet of working: although knowledge integration may be focused upon during times of change, it is not something that can be scheduled as part of change management phases but rather be a regular aspect of the organization's standard operating procedures. A common language of organizational values which supports diverse perspectives is needed along with effective procedures to facilitate working in teams and inter-organizational communication.