Chapter 12: Mediated Roles Flashcards
CORE COMPETENCIES OF THE APRN
Expert guidance and coaching of patients, families, and other care providers
Consultation
Research skills, including utilization, evaluation, and conduct
Clinical and professional leadership, which includes competence as a change agent
Collaboration
Ethical decision-making skills
THEME OF RELATIONSHIPS DERIVING FROM COMPETENCIES
Expert guidance and coaching reflects mentoring, with expectations of others to either take the lead or share the pathway of care
Consultation with direct involvement of another provider, with the need to confirm findings
Research skills support the professional obligation to improve practice, often involving other practitioners
Clinical and professional leadership are powerful when approached in an interdisciplinary manner
Collaboration means to “work together, especially in a joint intellectual effort”
The inclusion of the team in ethical decision making is key to the holistic care of patients
COLLABORATION
Quality patient care is achieved by including the contributions of all care providers
The “key to success” for any initiative that extends beyond an individual’s scope of activity
True collaborative practice has no hierarchy
The contribution of each participant is based on the knowledge or expertise brought to the situation
MODELS OF COLLABORATION
Parallel model
Sequential model
Shared model
Collaborative model
Each distinguished by:
How is the expertise of each member of the team used to the fullest? Who is responsible for decision making and patient care?
CONSULTATION, CO-MANAGEMENT, AND REFERRAL
Consultation: expanding the APRN’s ability to work with and through others, while maintaining autonomy over the situation
Co-management: working together to manage a complex case; shared responsibility
Referral: relinquishing care temporarily or permanently
INTERDISCIPLINARY TEAMING
Members of the health-care team integrate their discipline’s work and create plans of care together, centering on the patient’s needs
Involves a strong emphasis on relationship-centered care
Interdisciplinary teams are the epitome of working with and through others, while recognizing the importance of an individual’s clinical expertise
MULTIDISCIPLINARY
Multidisciplinary Approach to Patient Care: noninteractive and nonintersecting activity
Interdisciplinary Approach to Patient Care
healthcare providers integrate their work focusing on their patients’ needs
SOME QUESTIONS A TEAM MEMBER MAY ASK
Are my own goals consistent with team goals?
Do I advocate solutions that will benefit all team members?
Do I cooperate with other members’ activities?
Do I feel individual responsibility for the joint outcomes of the group members?
Do I view my contributions as belonging to the group, to be used or not as the group decides?
PROFESSIONAL NURSING CONNECTIONS
Basic nursing lays the foundation for the APRN
This overlap and sharing of skills creates a bond between RNs and APRNs
Resistance from other nurses has been common
Professional connections between the RN and APRN can be fortified rather than diluted by professional conflict
EXEMPLARS
Answer each of the following questions.
How would you describe your role?
How would you describe your working relationship with physicians, other nurses, and other members of the health-care team?
What does “referral” mean to you?
What does “consultation” mean to you?
How open are members of other disciplines in taking direct referrals or consultation from you?
What degree of authority do you experience in these situations and in your role?
Do you observe that you bring about change and a higher order of knowledge to practice?
Can you discuss a situation that may exemplify your role, especially regarding your work through other people?
NARRATIVES ON THE ADVANCED PRACTICE ROLES
The acute-care nurse practitioner
The clinical nurse specialist
The nurse-midwife
The primary care nurse practitioner
The nurse-anesthetist
