[reflect]

Hi all,

I'm doing more research about the NP and PA professions and have read a lot about both. The only thing I'm not sure of is the type of training each one receives, either the "nursing model for NPs" or "medical model for PAs."

Can you guys tell me more about the "nursing model" approach of training as opposed to the "medical model."

thanks.

[CraigB-RN]

Good luck. Ive been trying to get someone to answer that question for me and i'm more than halfway through NP school. I've posted this question a couple of times and in most cases it get's ignored.

[goodknight]

I'm only in the ASN program, but my understanding is that the "nursing model" is more wholistic. You focus on the whole person, their lifestyle, emotions, ect., not just the disease. And the "medical model" is more centered on the treatment of the illness by itself.

[Traveler]

This question has been discussed lots in a previous thread. And no, I don't think it has been ignored at all but when some people have a particular conviction in their mindset nothing can be said that will make any difference. In my experience as an RN for ten years and a student pursuing a MSN/NP- I agree with goodknight. From my education and from my experiences as both a hcp and a patient, the nursing model of care tends to be more holistic as opposed to a more keyed in focus. Yes this is what we are told in nursing school but it is also what I have seen in the field. Of course there are MD's, PA's who do follow a holistic approach similar to the nursing model of care, but generally speaking this is not the case in my experience. If a patient has a pressure ulcer the NP will focus not only on the actual wound (and nurses have more experience with chronic wounds and treatments), but also on nutrition and lifestyle teaching. If a patient presents with chronic pain, the NP is more likely to ask questions and assess sleep, family relationships, how the pain has impacted their life, what they do on a daily basis in addition to looking for pathology, disease, etc. Again, there are PA's and MD's who do this but through my experience this is not the norm. This is why NP's are very well suited for general family practice. I have seen more NP's with good bedside manners than I have MD's.
Ann

[SusanJean]

Originally Posted by Traveler

This question has been discussed lots in a previous thread. And no, I don't think it has been ignored at all but when some people have a particular conviction in their mindset nothing can be said that will make any difference. In my experience as an RN for ten years and a student pursuing a MSN/NP- I agree with goodknight. From my education and from my experiences as both a hcp and a patient, the nursing model of care tends to be more holistic as opposed to a more keyed in focus. Yes this is what we are told in nursing school but it is also what I have seen in the field. Of course there are MD's, PA's who do follow a holistic approach similar to the nursing model of care, but generally speaking this is not the case in my experience. If a patient has a pressure ulcer the NP will focus not only on the actual wound (and nurses have more experience with chronic wounds and treatments), but also on nutrition and lifestyle teaching. If a patient presents with chronic pain, the NP is more likely to ask questions and assess sleep, family relationships, how the pain has impacted their life, what they do on a daily basis in addition to looking for pathology, disease, etc. Again, there are PA's and MD's who do this but through my experience this is not the norm. This is why NP's are very well suited for general family practice. I have seen more NP's with good bedside manners than I have MD's.
Ann

This is absolutely correct. The nursing model incorporates the medical model (by way of "empirical knowledge") into the nursing model. But it also looks, in treating the patient, at the patients' environment, family, etc., etc.
Having attended PA school, I found it lacking in how I wanted to deal with patients. With a background in social work AND medicine, I found that nursing encourages me to treat the whole person. I was fighting an uphill battle in PA school and am now thriving in nursing school.
Yes, I could have practiced as a "holistic PA" but for my own piece of mind, I would prefer the rounded education that the nursing model provides.

BTW, this all was greek to me before I landed in a nursing theory class -- so I completely dismissed these debates before enrolling in PA school .

[reflect]

Originally Posted by SusanJean

This is absolutely correct. The nursing model incorporates the medical model (by way of "empirical knowledge") into the nursing model. But it also looks, in treating the patient, at the patients' environment, family, etc., etc.
Having attended PA school, I found it lacking in how I wanted to deal with patients. With a background in social work AND medicine, I found that nursing encourages me to treat the whole person. I was fighting an uphill battle in PA school and am now thriving in nursing school.
Yes, I could have practiced as a "holistic PA" but for my own piece of mind, I would prefer the rounded education that the nursing model provides.

BTW, this all was greek to me before I landed in a nursing theory class -- so I completely dismissed these debates before enrolling in PA school .

thanks for the insight; I think I see the difference now. It seems like the NPs have the same type of training as the DOs, who focuses more on the whole self rather than just the ailment.

Honestly, I still have not seen a difference between the two professions (NP and PA) in practice. I've been treated by a couple of NPs and did not noticed them do this "holistic" type of dealing with diseases. They seemed the same as the MDs and PAs I've seen.

Next question: are there any NPs that really practice what they were taught in NP school (holistic healing)? I'm sure you guys are out there, but I'm wondering if you are put in a situation where you find you don't have a lot of time to spend with each patient, so you don't have time to do this "holistic" type of investigation with each patient.

[HealthyRN]

I agree with the above. I am a junior BSN student and I can tell you what they are teaching us in school regarding the nursing model vs. medical model. From my understanding, the medical model focuses on the diagnosis and treatment of disease. The nursing model focuses on the treatment of the human response to disease and also incorporates the prevention of disease, which is not an aspect that the medical model emphasizes. However, I believe that a good health care provider, regardless if it is a NP, PA, or MD, must combine the the models to a certain extent. To be an effective provider, one must certainly learn to look at the whole person, rather than just focusing on the disease aspect. From my experience as a patient, it does seem that NPs are able to do this better, at least in my opinion. I would love to hear what NPs have to say on this!

[CraigB-RN]

I just started reading a book by Susan K Chase, called Clinical Judgment and Communication in NUrse Practitioner Practice. In the first chapter she talkes about, not models, but domains. When we move from being a staff nurse to a nurse practitioner, we add componants of the new domain, Medicine, to our domain. The diagnostic skills, knowledge. We incorperate this into our practice.

After 2 years of trying to get someone to explain to me the difference, this is the first time I"ve ever seen it in writing in a way that I can understand. THe book tosses out a lot of theary but it was very helpfull for me.

[zenman]

Originally Posted by reflect

thanks for the insight; I think I see the difference now. It seems like the NPs have the same type of training as the DOs, who focuses more on the whole self rather than just the ailment.

Honestly, I still have not seen a difference between the two professions (NP and PA) in practice. I've been treated by a couple of NPs and did not noticed them do this "holistic" type of dealing with diseases. They seemed the same as the MDs and PAs I've seen.

Next question: are there any NPs that really practice what they were taught in NP school (holistic healing)? I'm sure you guys are out there, but I'm wondering if you are put in a situation where you find you don't have a lot of time to spend with each patient, so you don't have time to do this "holistic" type of investigation with each patient.

I think you hit on it here. Your practice is basically dictated to you by the work setting and payors, meaning big insurance. So, when you retire and just need to do a little work on the side for cash payments, your practice will probably be more holistic.

[SusanJean]

Originally Posted by reflect

thanks for the insight; I think I see the difference now. It seems like the NPs have the same type of training as the DOs, who focuses more on the whole self rather than just the ailment.

Honestly, I still have not seen a difference between the two professions (NP and PA) in practice. I've been treated by a couple of NPs and did not noticed them do this "holistic" type of dealing with diseases. They seemed the same as the MDs and PAs I've seen.

Next question: are there any NPs that really practice what they were taught in NP school (holistic healing)? I'm sure you guys are out there, but I'm wondering if you are put in a situation where you find you don't have a lot of time to spend with each patient, so you don't have time to do this "holistic" type of investigation with each patient.

The traditional DO training focuses on whole self. Current training is more and more medical model. DId you know that DO's as a group prescribe more drugs than MD's??
There was another poster that mentioned that it is driven by the insurance companies. I have to agree.
But I also think that is the path of least resistance for most practictioners - an easy cop-out for not getting involved w/ their pts.

What do you consider "holistic"?