Roles and Ways of Knowing

Advanced Roles & Ways of Knowing
An Advanced Practice Nurse (APN) is described as a registered nurse with a graduate level education in nursing from an accredited college or university. Over the years, the APN has become a vital part of the healthcare team providing affordable, advanced care both in and out of the hospital setting. An APN has extended his/her nursing skills by not only past and present experiences but also by research. It is crucial for an APN to be grounded in research and theory and to allow that knowledge to guide his/her clinical practice. The APN gains insight from different ways of learning, ways of becoming scholarly, theories, and models that will directly affect the outcomes of his/her practice. Role of Scholarship

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Scholarship is defined as learning but on a higher level. For the discipline of nursing, there are four aspects of scholarship written by Boyer (1990). These scholarships, the scholarship of knowing, teaching, practice, and service, are used in APN’s practice on a daily basis. Applying or integrating these four areas of scholarship have become an essential part of being an APN. The first of the scholarships is the scholarship of discovery (Peterson & Stevens, 2013). The APN uses the scholarship of discovery by conducting research and applying that research to take better care of patients. Next is the scholarship of teaching (Peterson & Stevens, 2013). This scholarship may be carried out by having a professional mentor that he/she can learn from in his/her practice. Scholarship of integration is the third scholarship introduced by Boyer (Peterson & Stevens, 2013).

An example of this type of scholarship is when nursing convenes with other disciplines and collaborates on patient care. The final scholarship is the scholarship of application and it is used in the actual practice of nursing (Peterson & Stevens, 2013). The APN can consider the development of knowledge and evidence based practice as it applies to his/her practice during the application of this scholarship. As these examples show, all of these scholarships are used in the day to day activities of an APN. These scholarships have not only helped expand their knowledge but has elevated that knowledge to a more scholarly level. Role of Adult-Gerontological Acute Care Nurse Practitioner

There are several specialties for an APN to pursue like adult-gerontological primary or acute care, pediatric primary or acute care, or women. One of these specialties is an Adult-Gerontological Acute Care Nurse Practitioner (AG ACNP) that must get certified to be involved with direct patient care. The AG ACNP’s role includes taking care of adults, from young to old, in a collaborative effort with other providers of the health care team including hospitalist and intensivist. The AG ACNP provides comprehensive care to adults in a variety of settings both in and out of the hospital. The certified AG ACNP does meet the criteria of the consensus statement and falls under one of the four roles of an Advanced Practice Registered Nurse (Kleinpell, Hudspeth, Scordo, & Magdic, 2011).

AG ACNP have the opportunity to become certified by the American Nurses Credentialing Center (ANCC) a subsidiary of the American Nurses Association (ANA) and the American Association of Critical-Care Nurses (AACN). The criteria to sit for either of these certifications are as follows: must be a licensed RN, must have a graduate degree from an accredited school and an AG ACNP Program, and must have completed at least 500 clinical hours focused on acutely ill adult-gerontological patients (American Nurses Credentialing Center, 2013; American Association of Critical-Care Nurses, 2013). After becoming credentialed, the AG ACNP is not limited to working in a hospital; they are only limited to working with adults over the age of nineteen in critical/acute care settings. The Synergy Model

The AG ACNP is involved with direct patient care and a way to assist in this care is by using models/frameworks in their practice. One model that was created by the AACN and is available to AG ACNP to assist in complex cases in acute/critical care areas is the Synergy Model. The purpose of this model is to make a connection between nursing practice and patient outcomes (American Association of Critical-Care Nurses, 2013). In this model, the needs of patients and their families drives the direction of care and treatment that the nurse gives.

The nurse’s competencies are measured in eight different categories and given a score from one to five (Hamric, Spross, & Hanson, 2009). Next, the patient’s characteristics are measured on a scale from one to five in seven different categories (Hamric, et al., 2009). The outcome of these two sets of questions will assist the AG ACNP to understand complex cases better and in return have improved outcomes (Hamric, et al., 2009). The Synergy Model is not the only model out there for an AG ACNP to use in his/her practice, however it is centered on complex cases found in an acute/critical care setting which will improve patient outcomes. Ways of Knowing

Another way for the AG ACNP to learn is by the four fundamental pieces to the types of knowing identified by Barbara Carper in 1978. They are empirical, ethical, esthetic, and personal. Empirical knowing is based on factual knowledge that is able to be verified (Chinn & Kramer, 2008). Empirical knowing is displayed when a nurse uses accepted clinical practices to take care of a patient and the AG ACNP takes this same knowing to bassist in diagnosing a patient using evidence based practice research. The second type is ethical knowing, and it is brought about by personal self-awareness of one’s attitude and moral values (Chinn & Kramer, 2008). A nurse is using ethical knowledge by being a patient advocate and standing up for what is right for the patient. An AG ACNP displays the application of ethical knowledge by putting personal bias aside to be able to treat a patient. Next is esthetic knowing thought of as the art of nursing (Chinn & Kramer, 2008).

Esthetics knowing focuses on what is happening at the present time with a patient and shows empathy for the current situation. The AG ACNP understands situations can change quickly in a critical situation and must be able to apply esthetic knowing to address the individual patient’s needs. The final type of knowing is personal knowing and it is represented by personal knowledge learned through personal experiences (Chinn & Kramer, 2008). An example of gaining knowledge through personal knowing is taking the opportunity to get to know his/her patient and build a personal rapport with the patient. It is necessary to understand the four patterns of knowing to help one to become a more well-rounded and knowledgeable APN. Paradigms

A paradigm is a pattern or model that provides a guideline and uses theories, laws, and/or personal experiences to assist nurses in solving complex cases and managing research which in turn will reflect in APN’s practice by having better outcomes. There are two paradigms that have opposed views on how to solve these problems and conduct research to come up with a solution, but both paradigms are useful in AG ACNP’s practice. These paradigms include the empiricism and interpretative paradigms. The empiricism paradigm is a good model for an AG ACNP to incorporate into practice because it takes quantifiable data that can be verified to help diagnose a patient in an acute/critical care setting. This paradigm proves to have an ontological belief that there is only one answer or outcome to a situation by using quantitative measurement and only empirical learning (Monti & Tingen, 1999).

The interpretative paradigm embodies learning from the mind, body, and spirit, and takes a holistic approach to nursing that uses esthetic, ethical, and personal knowledge of learning to come up with an outcome (Monti & Tingen, 1999). Truly, to treat patients in a critical/acute care setting the use of both paradigms is beneficial to not only treat the patient but also be conscious of the patients’ mind, body, and spirit as whole. By using both empirical and interpretative paradigms in practice, an AG ACNP must consider evidence based practice, policy and procedures, the patients’ relationships, and financial situations to help with patient outcomes. Conclusion

There are various theories, frameworks, and paradigms that contribute to improving the patients’ environment, the patients’ care, and that help guide the APN’s practice. The AG ACNP will acquire more knowledge and better understanding of the best ways to take care of patients by using these resources. These will help guide the AG ACNP’s practice toward a holistic approach of treatment. They will remind the AG ACNP to take into consideration the patients’ circumstances, relationships, and financial abilities when managing the patients’ care. The four Roles of scholarship enforce a more scholarly approach to applying research into practice.

The Synergy model also drives the nursing practice to have better patient outcomes by taking each patient individually into consideration. The four types of knowing expresses the power gained from knowledge learned in different ways. It takes more than one theory, model, or paradigm to be able to care for patients in an acute/critical care practice. Not only is it important to learn by quantitative, empirical knowledge, it is just as important to obtain knowledge through other means such as qualitative, inductive reasoning. In conclusion, for the APN to become more knowledgeable and scholarly one must obtain this knowledge from many sources.

American Association of Critical-Care Nurses (2013). ACNPC-AG – Certification for Adult-Gerontology Acute Care Nurse Practitioners. Retrieved from American Association of Critical-Care Nurses (2013). The AACN Synergy Model for patient care. Retrieved from American Nurses Credentialing Center (2013). Acute Care Nurse Practitioner credential awarded: ACNP-BC. Retrieved from Carper, B. (1978). Fundamental patterns of knowing in nursing. In W. K. Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed., pp. 23-33).

Burlington, MA: Jones & Bartlett Learning. Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in nursing (8th ed.). St. Louis, MO: Mosby Elsevier. Hamric, A. B., Spross, J. A., & Hanson, C. M. (2009). Advanced practice nursing: An integrative approach (4th ed.). St. Louis, MO: Saunders Elsevier. Kleinpell, R. M., Hudspeth, R., Scordo, K. A., & Magdic, K. (2011). Defining NP scope of practice and associated regulations: Focus on acute care. Journal of the American Academy of Nurse Practitioners, 11-18. Monti, E. J., & Tingen, M. S. (1999). Multiple paradigms of nursing science. Advances in Nursing Science, 21 (4), 64-80. Peterson, K., & Stevens, J. (2013, April 19, 2013). Integrating the scholarship of practice into the nurse academician portfolio. Journal of Nursing Education and Practice, 3, 84-92.

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