[prairienp]

Originally Posted by Browndog

I will try again. I agree wholeheartedly with shisalion. If think that if I should hear one more theory, write one more paper, or be presented with one more nursing diagnosis such as "hopelessness secondary to distance from relatives", I shall uncerimoniously barf.

I agree with the wholistic nature of nursing, but when I am sick, I want a provider with a thorough understanding of pathophysiology, pharmacology and biochemistry, not just an understanding of nursing theorists.

Absolutely teach me to be a caring, wholistic caring practitioner who treats the whole person.....but for goodness sake teach me to treat the disease process as well.

What about a model that incorporates the medicine of PA school with the wholistic teachings of NP school?

browndog

I want a NP who understands and applies the theory directing their practice. Application goes beyond "understanding", theory should provide the direction to why you are doing something. Using social cognitive theory or Pender’s Health promotion model has provided insight in how I can be more effective in my practice. These are well researched models that have been proven to be effective. On the other hand, I have not ever used a nursing diagnosis in my NP education or practice. I don’t practice medicine or for that matter nursing, I prefer to say I practice or provide health care.

[jjjoy]

I notice that neither theory you mention are nursing theories. The two you do mention more relate to behavior change as opposed to medical interventions. Of course, a good practitioner will teach and encourage their patients and be aware of theories of behavior change. Is there generally anything unique to "nursing practice" when functioning as an NP?

The OP was wondering about the differences in pursuing an NP education versus a MD education and if one has the choice between them, why would one choose one over another. A common refrain is that since NPs come from a "nursing model" they are more "holistic." Do you have any thoughts on that?

[prairienp]

Originally Posted by jjjoy

I notice that neither theory you mention are nursing theories. The two you do mention more relate to behavior change as opposed to medical interventions. Of course, a good practitioner will teach and encourage their patients and be aware of theories of behavior change. Is there generally anything unique to "nursing practice" when functioning as an NP?

The OP was wondering about the differences in pursuing an NP education versus a MD education and if one has the choice between them, why would one choose one over another. A common refrain is that since NPs come from a "nursing model" they are more "holistic." Do you have any thoughts on that?

Nola Pender is a nurse, I have always considered her Health Promotion Model as nursing. I think you are making an assumption that a good practitioner will teach and encourage and be aware of behavior theories. My experiencehas been most are not aware or at least unable to describe the model they use in practice , they just do “it”. Is your experience different? I believe NPs are taught to use these models in the delivery of health care, I don’t see the same models being used to teach MDs.

[jjjoy]

I guess I've tended to see the major application of such a health promotion model in nursing practice to be applied more by public health nurses or school health nurses maybe even case managers as opposed to nurse practitioners. I've also seen the Pender model used in health psychology research. I've had more exposure to public health, where practitioners come from a variety of backgrounds, including both nursing and medicine.

I guess I just also naturally assume that most people automatically consider a person's background, emotional disposition, current socioeconomic factors, etc when addressing a patient because my mother, a teacher, approaches everyone that way no matter the situation. The idea that if it isn't explicitly emphasized over and over again (as opposed to maybe a short seminar on patient sensitivity in med school) it won't be considered in practice is something I guess I need to get my head around.

My experience was that in practice (floor nursing), I wanted to be less focused on the "symptoms" but with time and personnel constraints, I'd barely manage to take care of all the nursing tasks much less take on anything beyond an immediate physical need. I also felt that school didn't prepare me to handle all of those tasks so here I had all of this encouragement and instruction on "whole person nursing" but not enough training in practical application skills (such as quick assessments and prioritization) to survive on a hospital floor as a new grad. So I'm coming from the angle of questioning how NP school can train up their graduates to be both medically well-grounded and well-versed in whole patient care in the relatively short time frame that their schooling encompasses, especially for those nurses who fast-track through accererated programs BSN to NP without previous clinical experience.

[christvs]

Originally Posted by Browndog

I will try again. I agree wholeheartedly with shisalion. If think that if I should hear one more theory, write one more paper, or be presented with one more nursing diagnosis such as "hopelessness secondary to distance from relatives", I shall uncerimoniously barf.

I agree with the wholistic nature of nursing, but when I am sick, I want a provider with a thorough understanding of pathophysiology, pharmacology and biochemistry, not just an understanding of nursing theorists.

Absolutely teach me to be a caring, wholistic caring practitioner who treats the whole person.....but for goodness sake teach me to treat the disease process as well.

What about a model that incorporates the medicine of PA school with the wholistic teachings of NP school?

browndog

Browndog-I totally agree with you! I am sick of hearing about nursing theories and nursing diagnoses as well. I am a very caring nurse who always listens to what my patients and their family members are saying, I assess their needs fully, I know how important communication is, I try to view the patient holistically, I am a big fan of health promotion, but I too cannot stand to hear about one more nursing theory in my graduate NP program. I feel the nursing theories are very common sense, and that I already knew the info in nursing theories, and so I don't see why I have to spend a full year studying the names of the theories when what I really need is more time learning how to prescribe meds and treatments, how to do differential diagnoses, etc...I wish Master's level NP programs did not put so much emphasis on nursing theory and nursing research. A little of it is fine, but an entire year of it, when there are only 2 years in this MSN program? That's too much in my opinion. I feel I know how to critically evaluate nursing and medical research and it didn't take me very long to figure out how to do it. I know how to be an RN but now I need to know how to perform medical skills such as diagnosing, treating, etc..and I wish they taught us these skills starting on day one of our program. That to me would make more sense.

[core0]

Originally Posted by jjjoy

I guess I've tended to see the major application of such a health promotion model in nursing practice to be applied more by public health nurses or school health nurses maybe even case managers as opposed to nurse practitioners. I've also seen the Pender model used in health psychology research. I've had more exposure to public health, where practitioners come from a variety of backgrounds, including both nursing and medicine.

I guess I just also naturally assume that most people automatically consider a person's background, emotional disposition, current socioeconomic factors, etc when addressing a patient because my mother, a teacher, approaches everyone that way no matter the situation. The idea that if it isn't explicitly emphasized over and over again (as opposed to maybe a short seminar on patient sensitivity in med school) it won't be considered in practice is something I guess I need to get my head around.

My experience was that in practice (floor nursing), I wanted to be less focused on the "symptoms" but with time and personnel constraints, I'd barely manage to take care of all the nursing tasks much less take on anything beyond an immediate physical need. I also felt that school didn't prepare me to handle all of those tasks so here I had all of this encouragement and instruction on "whole person nursing" but not enough training in practical application skills (such as quick assessments and prioritization) to survive on a hospital floor as a new grad. So I'm coming from the angle of questioning how NP school can train up their graduates to be both medically well-grounded and well-versed in whole patient care in the relatively short time frame that their schooling encompasses, especially for those nurses who fast-track through accererated programs BSN to NP without previous clinical experience.

This is the real problem with medicine these days. It doesn't matter where you practice (NP/MD/PA). The payors do not pay for health promotion, they pay for symptoms. If you spend extra time working on health promotion you won't make money.

David Carpenter, PA-C

[prairienp]

Originally Posted by core0

This is the real problem with medicine these days. It doesn't matter where you practice (NP/MD/PA). The payors do not pay for health promotion, they pay for symptoms. If you spend extra time working on health promotion you won't make money.

David Carpenter, PA-C

Great point, and the exact reason I do practice health promotion. I am not in this for the $$$$. Is this the main difference between being a Doctor and a NP in the U.S.? I would say that any healthcare system besides the U.S. will pay for health promotion, a rationale explanation why we rank so low in so many categories while spending so many $$$$.
Wasn’t the original premise of HMOs health promotion, an ounce of prevention equal to pound of cure.