NUR 513 What is your personal worldview?

NUR 513 What is your personal worldview?

Worldview is defined as a collection of attitudes, values, stories, and expectations about the world around us, which inform our every thought and action. A worldview is how culture works out in individual practice. (Gray, 2011). I was raised by a Muslim father and a Catholic mother. I am close to both sides of my family so my upbringing was diverse. I also experienced discrimination while I was growing up, because of my religion and ethnic background so I know how it feels when you are not receiving the same care and attention as the majority.

I started nursing in the Philippines. In the middle of my nursing career, I worked in Saudi Arabia for 7 years and that also had a huge influence on my worldview. Then I immigrated to the US and have been here since. Nursing in the Philippines, where resources are very limited, and patients are mostly uninsured, was very challenging. In Saudi Arabia, we have abundant resources but the challenge there was being mindful of the culture. Saudi’s have very strict rules when it comes to male and female interactions. Male nurses are usually not allowed to take care of younger female patients and this can prove to be very challenging to staffing allocation. In the United States, our practice is well guided by regulations. We can also have some challenges with insurance eligibility and socio-economic resources. We also have a very diverse population of patients in the US.

All these experiences that I had in my career as a nurse have made me realize how important cultural competency is when providing care to our patients as well as working with colleagues from different cultural backgrounds. It may have caused some misunderstandings in the past but these experiences shaped the kind of nurse I am now and how I want to be when I practice as an APRN.

Cultural competency is an essential component to be infused into professional practice. The professional nurse practices in a multicultural environment and must possess the skills to provide culturally appropriate care. Assume every encounter is a cross-cultural encounter even if you appear to have the same cultural background. It is very important to ask questions, discuss relevant issues, and avoid making assumptions in all clinical encounters. Cultural awareness is being knowledgeable about one’s own thoughts, feelings, and sensations as well as the ability to reflect on how these can affect one’s interaction with others. (DeNisco, 2021). As an APRN, having cultural awareness and cultural competency is key to caring for a diverse patient population and working in a culturally diverse organization.

References:

Gray A. J. (2011). Worldviews. International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists, 8(3), 58–60.

DeNisco, S. (Ed). (2021). Advanced practice nursing: Essential knowledge for the profession (4th Ed.). Jones and Bartlett Learning

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In the acute inpatient, bedside nurses frequently admit, transfer, and discharge patients. The discharge instructions are not only a document in the medical record but a reminder for patients. Guide the patient to follow up with their primary provider, outpatient procedure, and follow up with specialists. Many times, we have patient acknowledge their incidental findings during hospitalization. But no control over their care after discharge; this is a pure discrepancy in our health care system. Our hospital has a customer service that will call patients the day after their release; it’s just customer service and doesn’t cover professional advice or track patient follow-up appointments.

According to Siegmund, incidental finding coordinator or care coordinator is a new role for advanced practice registered nurses (APRN). This care coordinator’s role was to manage a patient with incidental findings and required ongoing coordination of their care. The care coordinator ensures patients keep their appointments, provides patient-based care and coordinates with other healthcare team members. Their position can potentially reduce inefficiencies and improve patient outcomes, close the gap for lack of tracking of patients, collaborate with the specialist, refer patients to the right place for their incidental findings, and stop the discrepancies in our health care system. (Siegmund et al., 2020)

Siegmund, L., Hamilton, A., & Nespeca, T. (2020). Incidental findings coordinator: A new role for advanced practice registered nurses. OJIN: The Online Journal of Issues in Nursing, 25(2). https://doi.org/10.3912/ojin.vol25no02ppt5422

One resource that helped me understand advanced practice registered nurse roles is titled “Advanced nursing practice roles: closing the knowledge gap.” The authors begin the article by outlining the growing demand for improved patient outcomes. Ko et al. (2019) acknowledge that achieving improved outcomes require recognition of advanced practice roles. The outlined roles include certified RN anesthetists (CRNAs), certified nurse midwives (CNMs), clinical nurse specialists (CNSs), advanced practice RN (APRN), and clinical nurse leaders (CNL).

     The article goes ahead to outline that all these four key roles require master’s level and doctoral level degrees. The authors also indicate that advanced registered nurse roles significantly influence patient and healthcare outcomes. In the next ten years, the need for advanced practice nurses will rise by 31%, given the mandate to address the aging population and promote preventive care (Ko et al., 2019). They conducted an educational intervention to obtain knowledge on advanced practice roles in an 877-bed level 1 hospital. 

     The study results indicate that practice guidelines and toolkits are crucial in guiding advanced registered nurses in their roles. Good leadership is also important in ensuring the appropriate implementation of the four key roles. There is a gap in leadership knowledge of the roles of advanced practice nurses. However, they should understand that NPs, CNMs, and CRNA deliver high-quality care to patients in diverse settings (Ko et al., 2019). On the other hand, a CNS consults with other nurses on patient care, provides direct patient care, and works to enhance health practices at the macro and local levels. The CNL roles are mainly focused on the micro level with a key focus on safety and care quality. 

Reference

Ko, A., Burson, R., & Mianecki, T. (2019). Advanced nursing practice roles: closing the knowledge gap. Nursing management, 50(3), 26-36.

In regard to roles of the advanced registered nurse, a resource that I have found helpful is from New England Institute of Technology. The reason I like this resource is because it briefly explains roles of various master’s prepared nurses: nurse practitioner, nurse educator, nurse anesthetist, nurse midwife, nurse manager, clinical nurse specialist, research nurse, nurse consultant, forensic nurse consultant, nurse ethicist, and health informatics nurse. Some of the roles listed above are completely new to me, so this has been very helpful. Additionally, this resource also lists basic skills you will acquire from getting your master’s in nursing. Arguably, my favorite part of this resource is that it not only informs you of benefits of becoming a master’s prepared nurse, but it also lists some possible drawbacks of being a master’s prepared nurse (New England Institute of Technology, 2020). A negative thing I can say about this resource is that is does not go into great detail about each role, but it does give you a general understanding. I enjoy reading resources like this because it is interesting to see all of the roles that a nurse can pursue.

References

New England Institute of Technology. (2020, September 11). What can you do with a masters in nursing in 2022? https://www.neit.edu/blog/what-can-you-do-with-masters-in-nursing

I wanted to share this article regarding role of the Advanced Practice Registered Nurse (APRN), although the focus is more on public health. It is relevant to the current topic on health equity as one of the strategies discussed in this article is promoting more APRN to provide primary care in the communities since they are particularly skilled in collaboration, partnership development, communication, system transformation, engaging across sectors, and other competencies needed for effective systems change to address health equity. (Bekemeier et al., 2021). It also enumerated APRN skills and competencies in relation to the roles they perform.

The COVID-19 pandemic has highlighted the need for nurse leaders who “embrace the interconnection” between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. (Bekemeier et al., 2021)

The nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. APRNs bring into their practice nursing’s relationship-focused and holistic view of health, competencies like analytic assessment, policy development, program planning, communication, cultural humility, financial planning and management, and leadership. (Bekemeier et al., 2021)

References:

Bekemeier, B., Kuehnert, P., Zahner, S., Johnson, K., Kaneshiro, J., Swider, S. (2021) A critical gap: Advanced practice nurses focused on the public’s health, Nursing Outlook, 69 (5), 865-874, https://doi.org/10.1016/j.outlook.2021.03.023.