Practice-Specific Concepts for Clinical Nurse Specialists

Introduction to Practice-Specific Concepts

Nursing practice is a profession grounded in conceptual and theoretical models that guide patient safety and quality initiatives. The use of these models is an important element of nursing practice applied across its various disciplines. As a clinical nurse specialist, nursing conceptual and theoretical models play a crucial role in achieving the specific goals of identifying, recognizing, treating, and monitoring illnesses and diseases. The process of applying such models involves developing practice-specific concepts related to one's professional practice and creating a personal philosophy and practice guideline. These practice-specific concepts should incorporate the four basic metaparadigms of nursing theory and be supported by research and evidence.

Overview of Clinical Nurse Specialist Practice and the Four Metaparadigms

A clinical nurse specialist (CNS) is a nurse professional who provides a crucial link in detecting, identifying, treating, and monitoring illnesses and diseases. In essence, this professional is an expert in the diagnosis and treatment of diseases within a defined area of expertise. Clinical nurse specialists generally focus on various specialty areas, including patients and their families, administration, and nurse management. These professionals therefore play a crucial role in promoting and enhancing the health of individuals and communities. Together with other categories of advanced practice nurses, clinical nurse specialists have developed specialized and extended competencies to address the diverse health needs of patients, families, groups, and communities (Lyon & Davidson, 2004).

As a clinical nurse specialist, my practice-specific concepts involve defining and incorporating the four basic metaparadigms of nursing theory. The first metaparadigm is the person, or human beings, who are regarded as open energy fields with varied life experiences. In the nursing field, human beings are valued individuals who deserve to be treated with dignity, nurtured, and understood. Consequently, humans possess the ability to make informed choices and decisions about their health ("Metaparadigm Concepts," n.d.). The second metaparadigm is the environment—the landscape and geography of human social experience, and the context in which daily life is experienced differently with respect to time, space, and quality. The third metaparadigm is health, a dynamic process that refers to the synthesis of wellness. The fourth and final metaparadigm is nursing practice, through which nursing is understood as both an educational discipline and a practice profession—the art and science of holistic health care governed by the values of human autonomy, responsibility, and choice.

Practice-Specific Concepts and Application of the Metaparadigms

One of my practice-specific concepts as a clinical nurse specialist is culturally informed care for the individual and environment. In this concept, the person and the environment are the two metaparadigm concepts of nursing theory employed. As a clinical nurse specialist and as part of the broader category of advanced practice nurses, providing culturally informed care is critically important. The significance of this care is rooted in the reality that multicultural considerations are central to daily professional practice, given that care focuses on a particular patient population. While my professional practice entails specializing in various diseases such as diabetes, culturally appropriate care is an important consideration because nursing practice involves working in varying clinical environments.

Culturally informed care for the person and environment is crucial for a clinical nurse specialist because patients are increasingly conscious of social implications within health care practices. Unlike some other specialties in nursing, a clinical nurse specialist must be especially attuned to these social implications, since daily practices may be dominated by a specific social segment and characterized by a predominant ethnic group. Therefore, the person and environment metaparadigms are highly relevant to clinical nurse specialist practice. The CNS must have the ability to provide culturally appropriate guidance to patients in consideration of both the patient and his or her environment.

The second practice-specific concept is patient safety and quality initiatives throughout health care activities. This concept draws on three metaparadigm concepts: person, health, and nursing practice. With respect to the person and health, patient safety and quality initiatives are designed to ensure improved patient outcomes through the use of appropriate health practices and activities. Health care must be safe, which means the clinical nurse specialist must exercise careful judgment at all times. When designing health care practices, the CNS should ensure those practices are patient-centered—taking into account various factors related to the patient, including social context, culture, and specific health care needs (Roussel & Swansburg, 2009, p. 20).

The significance of nursing practice to this concept is linked to the fact that professional practice incorporates the translation of clinical evidence into nursing care. This translation is based on evidence-based nursing care standards and programs of care, which serve as the foundation for nursing practice and influence the design of nursing interventions. Patient safety and quality initiatives thus shape daily professional activities, because CNS practice is continually focused on achieving quality, cost-effective, patient-centered outcomes.

Philosophies and Theories from Nursing Literature

One philosophy from nursing literature that supports both practice-specific concepts is Florence Nightingale's description of the nature of nursing. Based on her observations and data analysis, illness and disease are two distinct phenomena: disease is caused by many factors, whereas illness can include disease-related etiologies. This description is consistent with both concepts, as it forms the foundation upon which clinical nurse specialist practice is grounded.

Second, both concepts are consistent with the philosophy that culture is one of the organizing concepts through which the nursing profession is defined. Based on this philosophy, nurses need to understand how cultural groups define health and illness, maintain wellness through life processes, and how cultural background affects care delivery ("Cultural Diversity in Nursing Practice," n.d.). Cultural diversity in nursing practice draws its conceptual foundation from the nursing profession as well as from cross-cultural health domains and disciplines in the social sciences, including sociology, anthropology, and psychology.

Third, the concepts are consistent with Watson's Theory of Human Caring, Martha Rogers's Science of Unitary Human Beings, and King's Theory of Goal Attainment. The consistency with Watson's theory derives from the emphasis on carative factors and clinical caritas processes. Watson's theory addresses the nursing practice dimensions incorporated in the concepts, particularly with respect to creating a suitable environment and using appropriate health practices. Martha Rogers's Science of Unitary Human Beings postulates that nursing is a learned profession encompassing both science and art (Masters, 2014, p. 55). The link between this theory and the two concepts is that human beings are vibrant energy fields integrated with environmental energy fields, forming a unified whole from the combination of person and environment. The consistency of both concepts with King's Theory of Goal Attainment relates to the shared focus on achieving improved patient outcomes through patient safety and quality initiatives.

Conclusion

Professional practice in nursing specialties such as clinical nurse specialist practice requires the development of practice-based concepts. These concepts govern the actions of the nurse practitioner with respect to directing and providing patient care. The concepts must, however, be grounded in relevant theories, philosophies, and frameworks from the nursing profession. As a clinical nurse specialist, my two practice-based concepts are (1) culturally informed care for the person and environment, and (2) patient safety and quality initiatives across health care activities and measures. Together, these concepts reflect a commitment to holistic, evidence-based, and culturally responsive nursing practice.

References

"Cultural Diversity in Nursing Practice." (n.d.). American Nurses Association.

Lyon, B. L., & Davidson, S. B. (2004). Statement on Clinical Nurse Specialist Practice and Education. National Association of Clinical Nurse Specialists.

Masters, K. (2014). Framework for professional nursing practice. In Role development in professional nursing practice (3rd ed., Chapter 2, pp. 47–87).

"Metaparadigm Concepts." (n.d.). Nursing. The College of New Jersey.

Roussel, L., & Swansburg, R. C. (2009). Concepts and theories guiding professional practice. In Management and leadership for nurse administrators (5th ed., Chapter 2, pp. 18–49).

Ryan, P. (2009, June). Integrated theory of health behavior change: Background and intervention development. Clinical Nurse Specialist, 23(3), 161–172.