Evaluate the future vision and goals of your chosen MSN role and relate to emerging healthcare trends and needs.

Evaluate the future vision and goals of your chosen MSN role and relate to emerging healthcare trends and needs.

Advanced Practice Role And Change Theory Essay

Leading through Change


Nurses work together in rapidly changing environments and must adapt to keep up with these changes. Understanding the chosen nursing advanced practice role, change theory, and leadership skills fosters cooperative relationships and advances healthcare for all as nurses leading in the healthcare environment.Advanced Practice Role And Change Theory Essay



Analyze your chosen MSN role. Reflect on the future of nursing and healthcare and how your chosen MSN role, change management, and leadership strategies will address the needs of the future healthcare system.

Evaluate the future vision and goals of your chosen MSN role and relate to emerging healthcare trends and needs.
Investigate change management strategies you and other nursing advanced practice colleagues should understand to promote appropriate change management and response to the rapidly evolving healthcare system. Appraise leadership qualities necessary for your chosen advanced nursing practice role. Determine qualities you currently possess and those qualities you will need to develop for your chosen role.
Develop a plan to expand your leadership toolbox. What will you do to develop your leadership skills for future needs and challenges?Advanced Practice Role And Change Theory Essay
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The idea of Advanced Nursing Practice (ANP) is reported to have commenced in the USA in the early parts of the 20th century (Mantzoukas, 2006) and its development has been well recorded in the literature (Ketefian, Redman, Hanucharurnkul, Masterson & Neves, 2001; Furlong & Smith, 2005). But lack of clear definitions for the concept, its scope of practice and standards has resulted in a great diversity in practice (Woods, 1999; Pearson & Peels, 2002; Daly and Carnwell, 2003). Furlong and Smith (2005) identifies that several attempts have been made to conceptualise advanced nursing practice. This has resulted in some consensus on the core concepts that underpin ANP such as clinical autonomy, professional and clinical leadership, research capabilities, application of theory and research to practice and graduate level education requirement (Ketefian et al., 2001; Furlong & Smith, 2005; Mantzoukas, 2006). Knowledge level, skill level and population of response model developed by Calkin (1984) and ‘from novice to expert’ model by Benner (1984) are some of the models that were developed but none of these analysed contextual influences on advanced nursing practice.

Manley (1997) developed a conceptual framework that describes four integrated sub roles (expert practitioner, educator, researcher and consultant); necessary skills and processes as well as contextual prerequisites for the advanced nurse practitioner to achieve outcomes strove for. This framework was developed from a model by Hamric (1989) and shares similarities in the four sub roles, some skills and processes. However, the framework by Manley (1997) establishes a relationship between the ANP role, its context and its outcomes, giving it an advantage over the models of Calkin, Benner and Hamric. It is worth stating, at this point, that the term ANP is not for a single role but for different advanced nursing roles such as nurse practitioners, certified nurse midwives, nurse anaesthetists and clinical nurse specialists (Ketefian et al., 2001)Advanced Practice Role And Change Theory Essay

I have worked for one year as a general nurse (Nursing Officer rank) after completing my four-year nursing training in Ghana. My responsibilities include ensuring adequate nutrition and elimination, administering medication and reporting on patient’s response, allocating task based on skill of staff, supervising staff and students in the ward, and participating in ward rounds (GHS, 2005). Henry (2007) states that Ghanaian nurses have automatic promotion after every five years of service until they reach the rank of Principal Nursing Officer. It seems that this is changing. My experience is that, recently, higher education certificate as well as evidence of continuous professional and personal development is a requirement for certain roles in the nursing profession. Moreover, research, leadership and application of theory to practice are some of the advanced nursing skills that are not well developed in my current role. I have, therefore, enrolled in the MSc. Advanced Nursing course to develop these skills to advance my nursing practice.Advanced Practice Role And Change Theory Essay

It appears that the four advanced nursing roles described by Ketefian et al. (2001) are present in Ghana, although the term ANP is not used. East and Arudo (2009) identifies that due to shortage of health personnel, nurses in sub-Saharan Africa perform certain roles and tasks that would be classified, in other countries, as advanced practice. Ghanaian nurses in these roles have some degree of clinical autonomy, especially in the district hospitals, but not necessarily a graduate level education. Instead, a post-basic diploma is required for some of them (nurse anaesthetist and clinical nurse specialist roles). Until recently, post-basic diploma was the qualification for medical assistants (similar to nurse practitioner role). Thus, ANP roles in Ghana developed as a result of shortage of health personnel and the health needs of the population. However, the roles are different from those in the UK and USA in areas such as research, professional and clinical leadership, academic qualification, and clinical autonomy.Advanced Practice Role And Change Theory Essay

Therefore, with the ANP conceptual framework of Manley (1997) as the focus, I hope to achieve the following objectives in advancing my practice:

Develop a teaching package to slow progression of chronic kidney disease (CKD) among patients with diabetes

Advance myself as a nurse educator and the other sub roles identified by Manley (1997)

Develop leadership and effective change management skills

Contribute to the professional development of my colleagues.Advanced Practice Role And Change Theory Essay

The Project: Introduction and Rationale for Selection
In advancing my nursing practice, my focus for this project is to develop a teaching package to slow progression of chronic kidney disease among patients with diabetes. Other patients at risk of developing kidney failure, including those with hypertension would also benefit from this project. The package would, also, be used among patients with stages 1 – 4 chronic kidney disease.Advanced Practice Role And Change Theory Essay

In the final year of my nursing training, I had to submit a ‘care study’ to the Nursing and Midwifery Council of Ghana. The patient I worked with had been diagnosed with type II diabetes. The care study required that I participate in the active management of the patient and present a report on that, as well as a literature review on the condition. I reflect on the entire process now and I realise that complications of diabetes were just mentioned to the patient, with no adequate information on how they can be prevented.Advanced Practice Role And Change Theory Essay

This project is, therefore, anticipated to create awareness of chronic kidney disease as a major complication among patients with diabetes in Ghana and how to delay its progression, if not avoid it. My primary focus would be to develop a strategy that would reach out to all patients, including those with low literacy skills. This would advance the nursing care and health education given to such patients, thereby, delaying the need for dialysis (Thomas et al., 2008).Advanced Practice Role And Change Theory Essay


Literature Review
WHO (2002:11) defines chronic conditions as “health problems that require ongoing management over a period of years or decades” and has labelled them as the biggest challenge faced by the health sector in the 21st century. While the economic cost of managing chronic diseases is high, Suhrcke, Fahey & McKee (2008) identify some strong economic arguments that may be made in support of the need for societies to invest in their (chronic diseases) management. They identify some primary benefits such as improved health (in terms of patient’s quantity and quality of life in years), long-term cost savings from complications avoided and workplace productivity experienced by patients and their employers. Nevertheless, preventing their occurrence is central in the general management of chronic conditions (Nolte & McKee, 2008) and this is a responsibility for all, including governments, private sectors, healthcare systems and individuals (Novotny, 2008).Advanced Practice Role And Change Theory Essay

Chronic Kidney Disease (CKD) is becoming a global pandemic (Mahon, 2006; Chen, Scott, Mattern, Mohini & Nissenson, 2006; Clements & Ashurst, 2006). The disease causes gradual decline in kidney function (Silvestri, 2002). It has been categorised into 5 stages according to the glomerular filtration rates (Johnson & Usherwood, 2005) and the progression through these stages is influenced by several processes, mostly lifestyle-related (Riegersperger & Sunder-Plassmann, 2007). Management of stage 5 (end stage) is either by dialysis or kidney transplant (Johnson & Usherwood, 2005, Chen et al., 2006). Patients with CKD stages 4 and 5 experience other complications such as anaemia and metabolic acidosis that must, also, be managed efficiently (Silvestri, 2002; Murphy, Jenkins, McCann Sedgewick, 2008). This, in addition to dialysis, accounts for the reported higher costs of managing CKD (Gonzalez-Perez, Vale, Stearns, Wordsworth, 2005; Kaitelidou, Ziroyanis, Maniadakis, Liaropoulos, 2005).Advanced Practice Role And Change Theory Essay

Presently, more than 23,000 adults in the UK undergo dialysis treatment as a result of kidney failure and this number is expected to increase yearly (World Kidney Day, 2009). Korle-Bu Teaching Hospital (Ghana) recorded 558 cases of CKD between January 2006 and July 2008 in the country (All Africa, 2009) and this may represent less than 30% of the total disease burden as the hospital serves a few regions in the country.Advanced Practice Role And Change Theory Essay

Several studies have identified diabetes mellitus and hypertension as the major causes of CKD (Clements & Ashurst, 2006; Rosenberg, Kalda, Kasiulevičius & Lember, 2008; Marchant, 2008; Stropp, 2008; Thomas, Bryar, Mankanjuola, 2008; Ulrich, 2009). Amoah, Owusu and Adjei (2002) report of little, but outdated, statistics on the prevalence of diabetes in Ghana. Another report is on the assumption that diabetes is uncommon in Ghana (ibid.). However, it appears that my clinical experience at KATH alone suggests otherwise to the latter. Amoah et al. (2002), again, report that data on diabetes in Ghana is unreliable and this is confirmed by incongruent data observed in the literature. For example, Abubakari and Bhopal (2008) report that prevalence of diabetes in Ghanaian adults (25years and above) was 6.3% in 1998 while the Ministry of Health, Ghana (2001 cited by Aikins, 2004) estimates diabetes in 4% of Ghanaians between 15 to 70 years. Notwithstanding, Aikins (2004) reports of increase in the prevalence rates of chronic illnesses in the country, and diabetes is no exception.Advanced Practice Role And Change Theory Essay

Primary care management delays nephropathy and other complications of diabetes (Thomas et al., 2008). They add that there could be a lot of potential savings if the need for dialysis can be delayed, even if for a short period for a few patients. Since prevention reduces healthcare costs (Booth, Gordon, Carlson & Hamilton, 2000), Ghana, not being a rich country (CIA, 2008) stands to benefit from such an approach. Chen et al. (2006), also, identify that delaying the progression of CKD improves clinical outcomes and moderates costs. Strategies to delay progression include good glycaemic control, blood pressure control, smoking cessation and other lifestyle modification (Nicholls, 2005; Clements & Ashurst, 2006; Rosenberg et al., 2008). Patients’ knowledge on these factors may lead to a change in behaviour which, in turn, would yield positive outcomes in the management of their conditions.Advanced Practice Role And Change Theory Essay

Health education is one of such strategies to achieve positive outcomes and prevent complications, especially if the method used is appropriate for the age group as well as their cultural background (Funnell et al., 2008). It is often used interchangeably with ‘health promotion’ in the nursing literature and criticisms have been made on that (Whitehead……). The argument has been that health promotion has shifted from preventing specific diseases or detecting risk groups towards health and well being of whole populations (Naidoo & Will, 2000). Hitherto, health education remains central to health promotion (Whitehead, 2), and, because of the dominance of the medical model, health promotion is mostly equated to prevention of disease, through primary, secondary or tertiary prevention in clinical settings (Naidoo & Wills, 2000).Advanced Practice Role And Change Theory Essay

Secondary and tertiary prevention interventions prevent complications such as chronic nephropathy development in patients with diabetes and health education is one of such interventions (Rosenberg et al., 2008; Naidoo & Wills, 2008). Diabetes is, predominantly, self-managed (Collins et al., 1994; Funnell & Anderson, 2002), making education very necessary as it empowers the patients to take charge of their health behaviour and other factors that influence their health status (Piper, 2009). Whitehead (1) adds that health education focuses on lifestyle-related and behavioural change processes, making it an integral part of comprehensive diabetes care (type II education).Advanced Practice Role And Change Theory Essay

The above implies that when patients with diabetes receive health education, it enhances their ability to collaborate with the effective management of the disease and, consequently, avoid its complications. However, very little knowledge on CKD as well as misunderstandings of illness and treatment has been reported (Jain, 2008; Holström & Rosenqvist, 2005). Patients may not appreciate the role that lifestyle modification, in addition to pharmacological interventions, can play in effective management of diabetes. Since diabetes, usually, do not present any physical symptoms, patients tend to distance themselves from it and, as a result, ignore the education being provided because they do not feel ill (Holström & Rosenqvist, 2005). Complexity of self-management of diabetes may also be a major contributor to the reported misunderstandings (Szromba, 2009). The primary concern then becomes who should educate these patients and what strategies should be used to achieve positive outcomes?Advanced Practice Role And Change Theory Essay

Making time to educate patients and their families on everything that they need to know is seldom easy because of the busy schedules of nurses in the ward (Rankin & Stallings, 2001). Yet, Hamric (1989) and Manley (1997) have documented the integration of health education into the roles of advanced nurse practitioners and Rankin & Stallings (2001) have attested to this. Advanced nurse practitioners are able to draw on their knowledge and skills related to higher education as well as their expertise from practice to achieve positive outcomes in the clinical settings (Manley, 1997). Szromba (2009) suggests that alternative methods to the traditional lecture method of health education should be utilized to enhance self-care. Babcock and Miller (1994) suggest that discussion, demonstration, modelling, group activities and role playing are other teaching strategies that the health educator can employ. However, they add that consideration should be given to the strategy that best fits the objectives, content, the clients, the health educator and the reality of the learning situation. This underscores the importance of client needs assessment in health education.Advanced Practice Role And Change Theory Essay

Literacy skills of the clients should, also, be taken into consideration during health education. This project is to be implemented in Ghana and WHO (2009) estimates an adult illiteracy rate of about 35% of the total population. The use of written materials may be a difficulty in such settings, especially as the literates may not understand the jargons used in health very well. Therefore, the health educator should ensure that materials are simplified so readers do not have difficulties in understanding the content. Rankin & Stallings (2001) suggest that health educators should, therefore, focus information on the core of knowledge and skills that clients need to survive and cope with problems, teach the smallest amount possible, make points vivid, present information sequentially and allow patients to restate and demonstrate what has been learnt. They also suggest the strategic use of educational media such as flipcharts, photographs, drawings and videotapes to enhance understanding.Advanced Practice Role And Change Theory Essay

Aims and Anticipated Outcome
The primary focus of this project is to develop a teaching strategy to slow the progression of chronic kidney disease among patients with diabetes in Ghana. Consideration would be given to strategies that would reach out to and promote understanding among patients with low literacy skills. It is anticipated that when patients have enough information on their disease condition, they would collaborate with the healthcare team in the management of the condition.

I hope to enhance my knowledge on the management of chronic kidney disease and my role as a nurse educator. This experience would, also, be transferred to my colleagues in Ghana and lead to general improvement in the management of chronic kidney disease in the hospital.Advanced Practice Role And Change Theory Essay

This collaboration would, therefore, reduce complications of the disease and enhance patients’ quality of life. As has been identified by Thomas et al. (2008), when complications such as kidney failure and the need for dialysis is delayed for a short period among few patients, a lot of financial savings is made. Therefore, in addition to providing quality care for patients and enhancing their quality of life, this project would reduce the cost of managing complications of diabetes and chronic kidney disease in Ghana.Advanced Practice Role And Change Theory Essay

The Professional and Organizational Context
Komfo Anokye Teaching Hospital (KATH) is the second largest teaching hospital in Ghana, training many doctors, nurses and other paramedics in the Ashanti Region of Ghana. It is an autonomous service delivery agent under the Ministry of Health of Ghana (MOH, 2009a). In addition to training many of the health personnel in the Ashanti Region at KATH, many people within and outside the Ashanti Region seek healthcare there. As a result, provision of quality healthcare has always been the focus. An organisation that recognises the need for change, weighs costs and benefits, and plans for the change when the benefits outweigh the costs is ready for a change (Dalton & Gottlieb, 2003). KATH is, therefore, ready for change because some of its employees are sent overseas or to other parts of the country, whenever there is the need for a new skill or knowledge to be gained, to bring about a positive change within the institution. This may be a factor that would facilitate my agenda to implement some changes within the institution upon my return to Ghana.Advanced Practice Role And Change Theory Essay

However, Ghana, as a country is underdeveloped (CIA, 2008). Therefore, financial support, many a time, becomes a difficulty. Another challenge may be the fewer nursing staff. The Ministry of Health (2009b) estimates that there was a nurse-to-population ratio of 1:2024 in Ashanti Region and 1:1451 for the entire country in year 2007 while the WHO estimates that there are 9 nurses/midwives per 10,000 of the Ghanaian population (WHO, 2009xxxxx).

Nevertheless, the desire to provide quality patient care and reduce healthcare costs, and dedication from the health personnel are factors that would supersede the anticipated obstacles to the implementation of this project.Advanced Practice Role And Change Theory Essay


Waukesha Memorial Hospital is a community-based not-for-profit hospital located near Downtown Waukesha, Wisconsin. The hospital was originally founded in 1914 and moved to its current location in 1930 after receiving sponsorship through the local Kiwanis Club. The hospital has now grown to over 300 inpatient beds and employs over 2,700 staff members. The hospital is part of a larger healthcare network known as ProHealth Care. ProHealth Care was created in 1998 when the Waukesha Hospital System and Oconomowoc Hospital joined forces. The organization is now comprised of 26 primary care clinics, home health care, inpatient and home hospice services, long-term care, senior residency communities, and a health and fitness center (Waukesha County, 2010).

ProHealth Care has created a worldview for an optimal healing community which encompasses their mission, vision, and value statement. The mission of the organization is to “promote and deliver extraordinary health care in the communities it serves”. The vision is to “continue to be the provider of choice in the markets they serve as an optimal healing community distinguished by high-quality, cost-effective care and excellent service in an environment of safety, respect, and compassion”. The organization values a response of excellence service, respect, and compassion. The mission, vision, and values influence four strategic keys to the organization’s plan for success: Value Proposition, Physician Development and Relations, Employee Excellence, and Partnership with Patients and the Community (ProHealth Care, 2010). The espoused theory of the organization is that the influences of the mission, vision, and values on the strategic planning will create an optimal healing community. The theory in action appears to be congruent with the espoused theory as Waukesha Memorial Hospital was named one of the top 100 hospitals in the 2009 Thomson Reuters Health System Benchmark Study. Winners of the award had better patient outcomes and fewer complications, fewer safety errors, and higher patient satisfaction rates than their peers (Thomson Reuters, 2010).Advanced Practice Role And Change Theory Essay

The leadership of Waukesha Memorial Hospital is organized into a professional bureaucratic design. A Mintzberg model of the organizational structure can be found on page 4. Within the microsystem of the hospital, there are many subsystems. Subsystems are grouped together in one of specialty areas: Medical Staff Excellence, Clinical Excellence, Operational Excellence, Patient Experience, or Environment. Each of these categories has a Chief Operating Executive who then reports to the President/CEO of the hospital. Skills of professionals are standardized throughout the entire system; however, each subsystem functions relatively independently of the other subsystems within their category. The strength of the support staff in each subsystem creates the core of operating professionals (as demonstrated in the Mintzberg diagram). The techno-structure is present around the outside of the operating core; however, it does not have a strong influence on the core leadership.Advanced Practice Role And Change Theory Essay

The Waukesha Memorial Hospital system is influenced by several regulatory agencies including JCAHO (Joint Commission on Accreditation of Healthcare Organizations), CMS (Centers for Medicare & Medicaid Services), and the Wisconsin DHS (State of Wisconsin Department of Health Services). Accreditation of the system is obtained through JCAHO after an on-site evaluation/survey of the system is completed. Surveys take place every 18-39 months. During the survey, the hospital is evaluated on compliance of specific standards determined by JCAHO for that accreditation year. These standards are determined to ensure that patients Advanced Practice Role And Change Theory Essay

receive care in a safe and secure environment. While accreditation is not required for a hospital to be in operation, there are many benefits to accreditation through JCAHO; mainly it is required by CMS to be eligible for Medicare reimbursement (The Joint Commission, (2010).

CMS influences the system by determining which services provided by the hospital are eligible for reimbursement through Medicare and Medicaid. CMS dictates core patient care measures by which the hospital is expected to perform. If these goals are not met and there is not supporting documentation stating why the goal wasn’t met, CMS may withhold reimbursement for portions of the hospital’s billing. CMS also sets standards of care that will no longer allow reimbursement for certain complications of a hospital stay, i.e. acquisition of a pressure ulcer or hospital-acquired infection. Therefore, all services rendered in these instances must be paid for by the hospital system. This has forced the hospital system to initiate preventative and aggressive measures to ensure a higher level quality of care to all patients.Advanced Practice Role And Change Theory Essay

The State DHS Division of Quality Assurance also influences the system by developing rules and standards for the improvement of quality of patient care. State licensure and federal certification are obtained through the DHS and required for operation of the acute care facility. Like JHACO, the DHS also performs on-site surveys to ensure patient safety and/or investigate any complaints against the facility (Wisconsin Department of Health Services, 2008). The system has also been affected by legislation at the local level. For several years, a competitor system attempted to move into ProHealth’s market area. Local municipalities passed legislation that temporarily kept the competitor out of the area, but eventually, the competitor was allowed to build an acute care hospital within several miles of a ProHealth acute care system.Advanced Practice Role And Change Theory Essay

Waukesha Memorial Hospital is also influenced by other specialty and/or professional organizations. Involvement with an outside organization is generally determined by each category/subsystem within the hospital system. For example, the category Clinical Excellence is influenced by the American Nurses Association and Wisconsin Nurses Association. Nurses within the hospital system may choose to become active members in these societies to join forces in order to influence healthcare related legislation and its effects on patients and nursing staff. Within the subsystems categorized for Clinical Excellence, the ICU is involved with the American Heart Association, the American Association of Critical-Care Nurses, etc, whereas the OR is involved with the Association of Perioperative Nurses. These nursing organizations help create higher standards of care within their specialty area, promote continuing education to nurses, and provide certification for nurses within their area of expertise. Nurses at Waukesha Memorial Hospital are encouraged to become certified in their area of work as the hospital seeks to apply for Magnet Status from the American Nurses Credentialing Center. Achieving Magnet Status testifies that the hospital demonstrates excellence in nursing care. One of the requirements for application for the certification is that a certain percentage of nurses within the organization pass a certification exam within their area of care (med/surg, critical care, etc).Advanced Practice Role And Change Theory Essay

The hospital system has also created partnerships with several community organizations such as the Kiwanis Club, the United Way and the Waukesha Memorial Foundation. These partnerships promote the overall well-being of the community as well as a respectable public image for the hospital. In a now more competitive market, Waukesha Memorial’s continued commitment to the community has helped maintain the public’s loyalty to the organization.Advanced Practice Role And Change Theory Essay

The community surrounding Waukesha Memorial provides a diverse payer-mix for services rendered, however, exact statistics could not be found. The hospital serves patients with private insurance, no insurance or governmental coverage (Medicare/Medicaid). No person is denied hospital care based on inability to pay. The hospital does budget a substantial amount of funds yearly to help cover costs to those who are uninsured and unable to pay, however, the cost is not able to be deferred for all patients within these circumstances. While this patient group may receive needed care, the cost can be unbearable, forcing these individuals to forego needed therapies. This negatively impacts the community, making it more ill, financially strained, and under duress. As part of the strategic initiatives set by the hospital for 2010, patient education and health promotion plans were initiated to help decrease preventable hospital admissions and continue movement toward an optimal healing community.Advanced Practice Role And Change Theory Essay

Part 2: Description and Analysis of a Professional Nursing Role within the Healthcare System
In the past year, Waukesha Memorial Hospital has considered adding an Acute Care Nurse Practitioner role in the management of patients in the Intensive Care Unit (ICU). Currently there is one advanced practice nurse (APN) role assigned to the ICU and this individual functions as the unit Nurse Educator. In contrast to the Nurse Educator, the addition of the Acute Care Nurse Practitioner (ACNP) role would place the APN at the bedside. The role of the ACNP within the ICU would focus on direct patient care. This would include but is not limited to daily patient care rounds, interdisciplinary patient rounds, family/patient conferences, ventilator management, and endotracheal tube and vascular catheter placements. The ACNP would also be responsible to ensure that evidenced-based practices are maintained within the unit’s standards of care.Advanced Practice Role And Change Theory Essay

The ACNP in the ICU at Waukesha Memorial would be required to maintain state licensure as a registered nurse, certification in critical care through the American Association of Critical Care Nurses, and certification as an ACNP-BC through the American Nurses Credentialing Center. The ACNP would function within the ICU subsystem of the Clinical Excellence Category of the Leadership Organizational Chart. Key organizational relationships would need to exist between the ACNP and the ICU manager and director, the WMH Intensivist physician group, and the Performance Improvement nursing committees within the ICU. Advanced Practice Role And Change Theory Essay Collaboration with staff nurses, nurse specialists, and interdisciplinary team members would be essential to ensure quality, efficient, and safe patient care. Nursing collaboration would include the Diabetes Nurse Practitioner, the Stroke Nurse Coordinator, the Infection Control Nurse, the Nurse Care Coordinator/Discharge Planner, and the unit Nurse Educator. Collaboration with the Diabetic NP is essential as many patients in the ICU suffer from hyperglycemia which can inhibit healing and promote infection. The Stroke Coordinator is vital to the ICU of a Primary Stroke Center (certified by JCAHO) and with collaboration brings best practice to the patient suffering from stroke. Partnership with the Infection Control Nurse will decrease rates of hospital-acquired infections which are more likely to occur in the ICU. Alliance with the Nursing Care Coordinator allows for improved patient/family satisfaction in the emotional and spiritual aspects of illness. Finally, teamwork with the ICU Nurse Educator ensures improved education of staff nurses and therefore improving care of the patient at the bedside.

Adding an ACNP role to the ICU collaborative team has the potential to greatly improve the ICU environment and patient outcomes. In an article published by Kleinpell, Ely, and Grabenkort in 2008, studies completed on the use of ACNPs in an ICU demonstrate that the ACNP improves collaboration and communication within the unit between medical, nursing, interdisciplinary, and support staff. Patient management by ACNPs within the ICU has shown to decrease overall length stay, days on mechanical ventilation, and total cost of care for the ICU patient. ACNPs are more likely to adhere to best practice guidelines and ensure their implementation at the bedside. The increased autonomy of the ACNP allows for a holistic, patient-centered care approach over a more curative care approach often provided by a physician or physician’s assistant. This approach has been shown to increase patient’s satisfaction with their hospital stay. These studies validate the strengths of the ACNP role within the ICU.Advanced Practice Role And Change Theory Essay

The weakness of the ACNP role within the ICU is the continued lack of understanding of the role by the healthcare team, by patients, and by the community. There continues to be confusion regarding what an ACNP is and what they can do and what an ACNP is not and what they cannot do. It is up to the Advanced Practice Nursing community to continue to educate their peers, patients, and communities about the benefit of their role in the collaborative health team.Advanced Practice Role And Change Theory Essay

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