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Advance Practice Nursing
As a Nurse Practitioner I will:
- assess your signs and symptoms
using
- advanced clinical skills
- assessment tools
- diagnostic tests (such as lab tests)
- diagnose
- discuss my findings with you and propose a treatment plan
To meet your treatment goals:
- I might prescribe medications and recommend other types of therapies
- I might provide health advice, counselling or psychotherapy
- I sometimes consult other providers and refer to other health disciplines
- you and I will reassess and modify the treatment plan as needed
Definitions of Key Terms
Assess
The nursing assessment is the first step of the process which we will follow to help you get back on an even keel.
This step involves the gathering of information about your physiological, psychological sociological and spiritual well-being.
Diagnose
It means to identify a disease by its signs and symptoms. While some people really don’t like labels, others find it very comforting to have a name for what’s going on with them. As a nurse practitioner, I find that having a diagnosis helps me come up with a good treatment plan and provides us with language to communicate.
Sometimes it takes a while to get to the right diagnosis. Sometimes a person has many diagnoses at the same time. We don’t always wait to start treating symptoms until it is completely sorted out. We get started on the treatment using a “working diagnosis” and we keep assessing and re-evaluating until we get it sorted out.
Discuss
I mentioned that a diagnosis offers us “language to communicate”. That’s where the “discuss” comes in. When a diagnosis is made, it important to take the time to explain that diagnosis, what it is, what it is not, and what can be done about it.
Treatment Plan
A treatment plan is an assortment of intervention strategies which are proposed with the goal of either treating or managing a particular condition. I say treat or manage because some conditions can be cured (fully resolved) while others cannot, in which case the aim of treatment is to lessen its negative impact on the well being of the person, while improving the person’s ability to function despite the condition.
Prescribe medication
Yes, a Nurse Practitioner can write prescriptions for medications.
Therapies
The term “Therapies” here refers to interventions which are intended to remedy a health problem.
Health Advice vs Counselling vs Therapy
Here is how I differentiate between these three terms:
Health advice here means that I provide suggestions, based on 25+ years of experience and reading recent research, on how to deal with specific health problems.
Counselling is a form of talk therapy which involves a therapeutic process. It is usually short term and intended to assist my patient in gaining insight into his/her difficult situation, and in helping him/her acquire the knowledge, skills, and confidence to address the problem.
Psychotherapy is also a from of talk therapy, but a more involved and lengthy process than counselling. It involves the use of psychological therapeutic methods to help a person change unhelpful behaviours and overcome problems using desired coping strategies. This process usually leads to improved well being and mental health and more satisfying interactions with others.
Consult
Asking for a consult means that I would be reaching out to a provider more knowledgeable in a particular area of expertise and present your case (my assessment along with your test results) to this provider, so that he/she could offer an opinion about what would be most helpful for you.
Refer
As with the consultation, a referral involves sending information to a more experienced / specialized provider, but what we are requesting is a bigger involvement on their part. Depending on the situation, the other provider would:
a) see you in their clinic, assess, provide recommendations, and send you back to me in order for us to resume working together on the problem, equipped with their opinion and treatment recommendations;
b) see you in their clinic, assess, provide recommendation, initiate treatment and send you back to me, for us to continue treatment. He/she might expect us to follow up on an as needed basis or at certain intervals;
c) see you in their clinic, assess, provide recommendation, initiate treatment and take over looking after you while the issue we consulted on is being treated.
Reassess
Reassessing is an important step in the nursing process. We look at how things are going and appraise whether or not we have:
a) gathered the right information;
b) made the right diagnosis;
c) chosen the right treatment approach;
as well as:
d) whether you are making progress in the ways that we are expecting;
This step allows us to not waste time doing unhelpful things and to make appropriate changes when required.
Modify
If we find that something is lacking in any of the previous steps then we can go back and fill in what is missing and make the appropriate adjustments.
Even Keel Health 