Nurse Practitioners

HISTORICALLY

Nurse practitioners are now common, and practice in a number of specialties (Le-Mon, 2000) from accident and emergency (Shea & Selfridge-Thomas, 1997) to dementia care (Rolfe & Phillips, 1995). In a postal survey of 17 closed-response questions by Miles et al. (2002) to identify and describe nurse-led clinics in genito-urinary medicine services across England, of the 209 Departments across England 190 responded (a 91% response rate). The author showed that some nurses had taken on 'nurse practitioner' roles including eliciting the sexual history, performing the examination, making a diagnosis, and supplying selected treatments.

Le-Mon (2000) proposed that development of the nurse practitioner role had been hampered by its lack of structure and that role definition was important for it to be accepted in the healthcare community. Sidani and Irvine

(1999), who suggest that there is variability in role conceptualisation and that role responsibilities are unclear, supported this view. The title of 'nurse practitioner' had not been protected (Le-Mon, 2000), and the former UKCC didn't see the nurse practitioner role as an advanced practice role because of its medicalisation (Casey, 1996). The UKCC (1993) believed it to be ambiguous, as all nurses 'practise': hence all nurses are nurse practitioners.

DEFINING WHAT A NURSE PRACTITIONER IS

Often criticised by non-nurse practitioners as being 'mini doctors' and not nurses (Woods, 1998), the nurse practitioners' key strength comes from the utilisation and augmentation of both sets of skills in clinical practice. They assess both the bio-medical and psycho-social (nursing) facets involved in caring for their client group, rather than adopting a cure-only perspective (Mundinger, 1995). In a sense, then, they combine the best of both worlds (Ventura, 1998) and are described as 'hybrids' that 'blend' (Mick & Ackerman, 2000), and 'integrate' both expanded nursing functions and medicine into their clinical practice (Sidani & Irvine, 1999). This is better described by Le-Mon

(2000), who suggests that doctors assess health, using a natural science perspective in relation to standardised norms where health is the absence of disease, and nurses utilise a holistic approach in which only individuals can describe their own health. It is because of this approach that the nurse practitioner's emphasis is on preventive health care and health promotion (Ventura, 1998), although, they must retain a nursing core with its focus on 'care', rather than adopting the medical model with its focus on 'cure' (Wright, 1997).

The Royal College of Nursing (2005) stated that nurse practitioners make professionally autonomous decisions, for which they have sole responsibility, and receive patients/clients with undifferentiated and undiagnosed problems. An assessment of their healthcare needs is made on the basis of highly developed nursing knowledge and skills. This includes special skills not usually exercised by nurses, such as physical examination. They screen patients for disease risk factors and early signs of illness. In conjunction with the patient they develop a nursing care plan for health with an emphasis on preventive measures, and provide counselling and health education. Nurse practitioners also have the authority to admit and discharge from their own caseloads and to refer to other healthcare providers as appropriate.

The American Academy of Nurse Practitioners Scope of Practice position statement states that nurse practitioners are advanced practice nurses who provide primary health care and specialised health services to individuals, families, groups and communities (AANP, 1993). Mundinger (1995) suggests that in primary care doctors and nurse practitioners share common bases of knowledge, and that while doctors obviously have a greater depth of knowledge around disease detection, nurses also bring different additional skills. These include a holistic health assessment, which incorporates environmental and family factors, health promotion/education, disease prevention, counselling and the knowledge needed to craft a care regimen using community and family resources.

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