DNP 825 Topic 3 Discussion Question One
DNP 825 Topic 3 Discussion Question One
Provide examples of measures that APNs can collaborate with direct care nurses in implementing evidence-based changes to improve health literacy in practice.
The purpose of this paper is to describe evidenced-based interventions as implemented by Advanced Practice Nurses (APN) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the six core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are
the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision-making.1 This article chronicles a typical patient’s journey through a post hospital discharge nursing research study involving APNs as “intervention nurses” and discusses the various aspects of the APN core competencies throughout the process.
Keywords: Advanced Practice Nurse, Transplant, Intervention research
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Changes in the health care system have resulted in shifting a significant portion of care to the home environment where cancer patients and their care partners are responsible for care previously given by nurses in the acute care setting. The complexity of this shift is especially evident in the population of hematopoietic cell transplantation (HCT) patients who have life-threatening disease and treatment, and are acutely ill for weeks to months after hospital discharge. It is to this population that the advanced practice nurse can bring considerable knowledge and skill.
With the growth in Advanced Practice Roles such as the Clinical Nurse Specialist and Nurse Practitioner titles there is more recognition and interest in the potential benefits that APNs may bring to the care of patients. Numerous studies have shown the value of using advanced practice nurses in the clinical setting yielding significant contributions and examples of outcome measures for APNs.2 Cunningham (2004) listed many studies of diverse populations submitting undeniable recent evidence that APNs are effective in improving the outcomes such as patient satisfaction, readmissions, cost, health status, and complications.3 Mundinger and colleagues have done two studies with clear evidence that nurse practitioners have equal or better clinical outcomes in the primary care setting as compared to physicians.4, 5
Tujhuis and colleagues conducted a randomized controlled trial of a clinical nurse specialist intervention and found that clinical outcomes were comparable to inpatient and day teams.6 Burns, et al (2003) used four advanced practice nurses to manage, enhance protocol adherence and monitor a process of implementation for an institutional program to improve clinical and financial outcomes of mechanically ventilated patients.7 Gawlinski and colleagues (2001) discussed the role of the APN in affecting cardiovascular outcomes in a study comparing two groups of patients: one on a nurse-implemented diuretic protocol therapy and the other group on a nonprotocol diuretic therapy arm. The group with the nurse intervention had increased diuresis, a reduction in the time to reach hemodynamic goals and pulmonary artery catheter use, a decrease in electrolyte imbalances, and a reduction in the inpatients length of stay.8 Naylor and colleagues showed that comprehensive discharge planning by clinical nurse specialists improves outcomes after hospital discharge and cost savings.9
In a follow-up study and publication, Brooten and colleagues discussed the testing of a quality cost model of advanced practice nursing transitional care and found that in several studies APNs consistently improved patient outcomes and reduced health care costs across various patient populations.9–11 The purpose of this article is to present an example of a typical patient participating in a nursing research intervention study as further evidence of the value of the role of the APN in the care of complex cancer patients.