nursing model vs. medical model

CraigB-RN, MSN, RN · Mar 9, 2005

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 · Mar 9, 2005

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 · Mar 10, 2005

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 · Mar 10, 2005

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 :uhoh3: :uhoh3: :) .

reflect · Mar 10, 2005

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 :uhoh3: :) .

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 · Mar 10, 2005

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, MSN, RN · Mar 10, 2005

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 · Mar 11, 2005

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 · Mar 11, 2005

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"?

Ever-learning RN · Nov 11, 2007

Your question popped up when I was doing research on nursing theories in relation to Prisoner Nurses at Auschwitz for my current grad class. I haven't read the entire discussion thread but I think I might have some thoughts for you to ponder. The medical model is theoretically based on a Positivist view point. The theory supports decisions and care based on empirical data that has been born out by research (please don't remind me that 50% of common medical practice is not born out by research, I am aware :-)). Clearly this means that patient related decisions must be factual, data collected and compared against current knowledge and prescription for care be evidence based.

In contrast, nursing has evolved over decades from this positivistic theory base through postmodernism (metatheory that supports the attention to recipricol relationships between individuals and their environments) and on to neomodernism, which supports integrating historic values and traditions of nursing (our enduring themes of patient centered care, culture/ethnicity, cleanliness - yes Florence, etc.) while allowing us to explore and propose alternative ways and methods for nursing science to grow and flourish. If you are interested in further exploration, two good references are Fitzpatrick and Whalls Conceptual Models of Nursing Practice or Reed, et al Perspectives on Nursing Theory.

If you can't guess by now, this semester's course is graduate nursing theory, taught by Dr. Ann Whall, one of the preeminent guru's of theory. (She wrote the book!) She has challenged us to understand that without theory, we really don't know why we do the things we do (so well) and are ships without rudders. I will grant you that 30 years ago when I started in nursing I thought theory was just ivory tower babble. Now, after so many years of watching our profession grow in fits and starts, I see that this is our foundation. So...look back (or forward) into the theoretical underpinnings of nursing theory and you'll see why nurses are invaluable, unique, and must maintain that theoretical basis for practice.

DaisyRN, ACNP · Nov 14, 2007

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.

hi there,

just wanted to comment on your question regarding np's "practicing what they were taught..." i am about to graduate from an np program, so i have put in a lot of clinical time with both mds and nps. what i have learned is that mds can also be "holistic" - but nps are more often associated with being holistic than mds. and i will be very honest with you... when i hear the word "holistic" i think... touchy/feely/alternative therapies types of things. but... i know that those things are only other parts of "holistic care."

to me, after more experience, being a holistic provider means not only making sure your icu patient is hemodynamically stable, but also that the family is contacted, that the patient is comfortable, and basically... that you are just looking at the whole picture (hence: "holistic" ). there is time for this in each patient encounter, because it should not be thought of as a separate task. it just comes out in your assessment/conversation with the patient/family. you can learn a great deal about your patients' expectations/cultural beliefs/family dynamics by simply listening to them during your initial interaction and assessment. for example, when you're feeling on their abdomen or feeling pulses or assessing for edema... you can talk to them. you'd be surprised how much you can learn about your patients in such a short amount of time.