Advanced Practice Nursing: A Case Study

Establishing effective communication with the patient is a critical factor in promoting patient quality care. Good communication is fundamental when providing safe and effective care at the beside in order to increase the quality of patient care. One of the many communicative barriers that exists between patients and the healthcare team are language barriers. Language barriers are considered an initial problem of translation or code-switching. Individuals who speak different languages require a certain code breaker in order to facilitate effective communication (Gregg & Saha, 2007). Furthermore, language barriers may hinder the quality of patient care and interfere with optimal clinical outcomes. According to Happ et al., 2011, nurses have the unique responsibility to engage in communication with patients and have control over the timing and method of communication. Evidenced based interventions such as communication boards are needed to improve nurses’ communication skills in order to achieve effective communication.

Can you imagine the how the healthcare industry would be without language, what seems to be impossible to imagine is the everyday reality of some patients because of their native language. Language is a major contribution to the health disparities that some populations face, because it makes it difficult for some patients to communicate their problems as well as understand the care they provided. Language contributes to the health disparities that some populations face because it creates a barrier between the patient and the care provider, making it difficult for a patient to receive proper care. Language barriers create a communication gap between a patient and a provider, forcing the patient to feel misunderstood and unable to trust his/her provider to properly care for them. I come from a family that speaks more than one language, so I have seen the impact language barriers can have on someone who doesn’t speak fluent English.

According to the 2011 U.S. Census, twenty-one percent of the population speaks other language at home besides English. Hence, one of the biggest challenges in Healthcare is the language barrier between the providers, Health care administrators and patients that speak foreign languages. This poses a challenge for medical entities,

To have quality of care within the health care system, effective communication is needed. Barriers arise when effective communication is not meet, patients with limited English proficiency are at risk for misdiagnosis, poor treatment decisions, trust between provider and patient is not there, and patients to not adhere to treatment plans and follow up if they do not understand what they need to do (Regenstein, Mead, Muessig, & Huang, 2009).

Non-English speaking citizens and immigrants are receiving improper medical care because of the miscommunication. The people who cannot speak English well are misunderstood, when they go to free clinics or hospital emergency rooms and attempt to explain their symptoms and illness or cannot understand the doctors or medical profession that are trying to help them. ” Interpreters are omitting questions about drug allergies. Patients are not telling nurses the correct symptoms. A mother misunderstood by putting oral antibiotic into the ears of the child instead of the mouth. The Puerto Rican word for mumps is not the same in Central America, so a child was mistreated. A doctor mistakenly told a parent to put a steroid crème on entire child instead of just the face” (Yolanda Prtida, 2005). Language barriers in the medical field are dangerous and some times even fatal. There is definitely a need for more translators in hospitals and doctors office. Clear communication is essential for safe quality healthcare. Poor communication can lead to disastrous outcomes, especially for patients with limited or no English ability.

There have been concerns regarding the identification and credentialing of advanced practiced registered nurses (APRNs). A APRN is a registered nurse who has successfully completed an accredited graduate-level education program, in which the individual is well prepared and successfully passed the nationwide certification examination (APRN Consensus Model, 2008). However, there are still debating issues of who would fall under the APRN category. The National Council of State Boards of Nursing (NCSBN) has identified four APRNs who are deem fit to be called ARPNs; however, only two will be named. They would be certified registered nurse anesthetists (CRNAs) and certified nurse practitioners (CNPs). Whereas, the nurse informatics and the nurse administrations are not considered to be APRNs; although, they are still license registered nurses but they do not provide direct patient care and are not required to take the national certification examination (ARPN Consensus Model, 2008).

Advanced Practice nursing (APN) is considered the usage of a broader scope of constructive, logical and research-based expertise related to the health and well-being of patients, within a varying disciplines (DeNisco & Barker, 2013). What is the future position of APNs in the progression of our healthcare system? What role will this writer assume, educator, practitioner, population health coach, or all three? The use of theory, primarily Sister Callista Roy’s Adaptation Model, and EBP give this writer a firm foundation to develop and modify her own practice framework.

Throughout the development of theory in the discipline of nursing there are concepts of knowledge that are fundamental. Four of these patterns of knowing were first explored by Carper (1978) which included: empirical knowing, ethical knowing, personal knowing, and aesthetic knowing. Later, an additional facet was added by Chinn and Kramer (2008) which introduced emancipitory knowing. While all of these forms of knowledge are critical for holistic nursing care, this paper will place an emphasis on personal knowledge and how it contributes to the development of knowledge within nursing and the roles of advanced care practitioners.

Effective communication with patients is critical to the safety and quality care. From the last two decades ,number of researches has been conducted on the impact of language barrier on health and healthcare. It is observed that language barriers are the main cause of medical errors, complication and adverse event. But due to data limitations ,limited researches on impacts of language barrier has been conducted in Canadian setting. However, the researches conducted on other countries on the impact of language barrier on quality of care is applicable in the Canadian context. Some researches shows that there are several barrier which affect quality of care and patient safety. Now, researches has begun to know the complexity of language, culture, race, health literacy that may affect patient care. Current approaches are moved towards the knowledge of risk of language barrier rather than implementation of effective, evidence informed strategies.

The purpose of effective communication in healthcare is to provide first-class medical care, minimal to no medical errors and have precision; and without it there is room for medical errors, poor patient care and an ineffective team that produces undesired outcome. In the professional and patient relationship, the lack of good communication causes the patient to be apprehensive in asking questions, to worry about being bothersome because they feel other patients are sicker, and there is an assumption that the patient does not have any concerns. There are barriers to communication that include only one between the sender and receiver of the message understands the message, cultural differences, and lack of education. In sending the message it is essential that the message is received with clarity, it is concise and complete. If the patient has a language barrier, it can be masked by the patient not responding to information and it is detected as a result of poor or no compliance. In literacy concerns, all information should be presented on a 5th grade level to aid in the comprehension of the information. The care of the patient should be patient/family centered which helps in detecting any language, cultural or literacy barriers (Schyve, 2007). For example, a 46 year old single male patient that is functionally literate is admitted with a diagnosis of acute angina. During the

The Advance Practice Nurse has a long and interesting history. Advanced practice nursing has gone from women being trained by physicians to administer chloroform to, in some states, having their very own practice. The term of advanced practice did not begin until the 1980s, prior to that the advanced practice nurse was described as having an extended or expanded role. While the advanced practice nurse had finally gained a name for their role there are currently several definitions to define this ever changing field. There is currently no standardized definition of the Advanced Practice Nurse (APN). Three definitions of advanced practice will be described and reviewed within this text.

As the young and rapidly-aging population continues to increase, the demands of primary, acute and chronic disease management will also increase. As a result, more health care professionals who provide primary care will be needed to meet these demands. Thus, the emergence of Advanced Practice Registered Nurse (APRN) evolve. APRN is a nurse who has completed a graduate degree and has acquired advanced knowledge and skills. APRNs are grounded with theory, concepts and principles that enable them to assess, diagnose, treat and manage their patients. APRNs can work in conjunction with other health care professionals or independently. APRNs improve access to health care by providing care in the rural and underserved areas. APRNs also reduce the cost to health care (Joel, 2013).

I see many challenges in regards to providing care to patients that do not speak English especially in the healthcare realm. From the very beginning we need to know what is wrong, what happened, how long it has been going for, what medical history they have, allergies, and medication taken. How can we treat what we do not know is wrong? In order to probably do some root cause analysis you need to drill down and see what is going on, which cannot be done if you cannot communicate. Also, you do not know what I making things better. These non-English speaking individuals will have unmet needs because of my inability to

The role of Advanced Practice Nursing (APN) has changed dramatically in recent years. Currently, the Unite States (U.S.) health care is focusing on delivering a cost -effective health care to all patients. In the last decades, there were many efforts to control health care over spending in the U.S. One of such efforts is to focus on applying proven principles of evidence-based practice and cost-effectiveness to find the least expensive way to produce a specific clinical service of acceptable quality (Bauer, 2010). The vast changes in health care system, such as cost, need for high productivity, limitation on reimbursement, and the inadequacy on access have made APNs to think in a way where they most fit to provide independent care for

Effective communication is important in providing safe health care. Miscommunication can lead to many errors, which can inadvertently affect compliance, accurate diagnosis, and health promotion. There are a variety of translation services offered in the United States; however,