1. Advance Practice Roles Theorists

2. Dear JoAnn, I read with interest your JAANP article on The discovery of unique NP theory in the literature. I have been in family practice since 1976 and am about to complete my DNP at USF. Both my EBP class and advanced practice roles class have caused me to read extensively and I appreciated the insight from your article. I am trying to tie in transformation learning/humanistic theory with EBP. Somehow seeing how NPs and MDs tend to take the dehumanized, synthesized evidence, interpret the guidelines and then apply them to practice with patients. I wonder what nursing theories this evokes? I graduated in 1972, predating the nursing theorists publication and was a product of an AA program for RNs. Returning to school 7 years ago and finding myself in a unique position of seeing nursing theory and the medical model as integrated in my practice without formal intro was interesting except, until now, I have had little faculty input that were practicing NPs. How, as an intended teacher in upcoming years, do I foster a model of NP practice is what I am trying to wrap my tired brain around. Any ideas, theorists you have come across would be huge. I am writing about Paterson and Zderad and Madeleine Leininger in the hopes of keeping the human side of practice in play for my students. Your NP theories to describe "nurse practitionering" was classic and exciting. Truly a part of why I am in a clinical doctorate. Sincerely, Helene

3. Dear Helene: I too am a product of the 70's, although from a diploma program. I've been a practicing NP in primary care and an educator since 1985. Throughout the years I have had difficulty incorporating nursing theory into practice but finally reconciled a few years ago with the completion of my doctoral dissertation. I earned a PhD and was well into the program before the DNP took shape. I used Pender's Health Promotion Theory as a framework for a study of antibiotic adherence in an otherwise healthy college student population. It certainly took quite a defense, but as I see it, persons who are striving for an enhanced level of wellness are promoting their health. There is a distinction here between health promotion and disease prevention. I believe I practice using the former concept. Perhaps this may help you as you reach the end of your studies....if you would care to discuss further, please contact me. Gooc Luck! Jo Ann

4. Pender's Health Promotion Theory

5. Blend of Nursing and Medicine “Theories are the lenses through which inquiry is conducted.” Theory determines what is meaningful as the result of inquiry or evidence. (Fawcett et al., 2001) NP theories include components of nursing, medicine, social science and biology

6. George Engel introduced the major theory in medicine, the BPS Model. The model accounted for biological, psychological, and sociological interconnected spectrums, each as systems of the body. In fact, the model accompanied a dramatic shift in focus from disease to health, recognizing that psychosocial factors (e.g. beliefs, relationships, stress) greatly impact recovery, the progression of, and recuperation from illness and disease.

8. What about NP theorists? Can the PSB Model be adapted to NP practice? What constitutes a Theorist/Theory? How do NPs remain current and forge theories to reflect practice?

9. Engel eloquently states: "To provide a basis for understanding the determinants of disease and arriving at a rational treatments and patterns of health care, a medical model must also take into account the patient, the social context in which he lives and the complementary system devised by society to deal with the disruptive effects of illness, that is, the physician role and the health care system. This requires a biopsychosocial model."

10. Biomedical Model Reason for visit: Patient complains of chest pain. Presentation: The focus is on physical causes of disease. The clinician will ask few questions on recent diet, pain history, and familial incidence, however, empirical signs and symptoms of myocardial infarction are considered paramount. Diagnosis: The clinician will order objective lab tests and monitor vital signs (i.e. temperature, pulse, and blood pressure) that would form the sole basis of any finding. Therapy: The clinician will prescribe a medicinal plan for the patient based on biological etiology and pathogenesis.

11. Biopsychosocial Model Reason for visit: Patient complains of chest pain. Presentation: The aim to ascertain psychosocial and physical processes that may cause the chief complain, chest pain. The clinician may ask for a history of recent life stressors and behaviors. Diagnosis: Based on a combination of psychological factors and standard lab tests, the clinician will form a diagnosis. Therapy: The clinician discusses the available interventions with special attention to behaviors and lifestyles that could influence her pain and adherence to the treatment plan. The patient is involved in formulating and implementing the plan, and maintains a supportive relationship with the clinician.

12. Client/Patient EBP Clinical Collabora tion Bio- Psycho- Social Model Plan for health

13. Helene: I understand your thought processes, but you need to have confidence that this model could work for you and perhaps other NPs in practice when you present your material. If it makes sense to you, then this is what you will defend. Check the 2nd to last slide....I believe you have the acronym for the model transposed. Good Luck and let me know how well your presentation was received. Perhaps you are on to "something". Jo Ann

14. References Fawcett, J., Watson, J., Neuman, B. Hinton Walker, P.,& Fitzpatrick, J.J.(2001). On nursing theories and evidence. Journal of Nursing Scholarship, 33(2), 115-119 Lakhan, S. (2006) The Biopsychosocial Model of Health and Illness. Connections Project. Connections Module. Retrieved March 2 2009 from: http://cnx.org/content/m13589/1.2 Nicoteri,J., Andrews, C. (2003) The Discovery of Unique Practitioner Theory in the Literature: Seeking Evidence Using an Integrative Review Approach. Journal of the American Academy of Nurse Practitioners.15(11).494-500.