Medical advancement and practices have changed healthcare over the years. As the healthcare system changes so does the role of a nurse. As the elderly population in the United States grows the demand for primary care also increases but the use of Nurse Practitioners is estimated to reduce the shortage of primary care services (Schiff, 2012).This paper will provide an overview of the benefit of a framework for praxis for an Adult Primary Care Nurse Practitioner (APCNP) and examine how the framework helps in the development of nursing knowledge. The writer will give an overview of the role of an APCNP and how this role can help enrich the overall healthcare system. The paper will explore ideological, theoretical, and ethical components that guides and contribute to the growth of an APCNP framework for praxis. The paper will finally examine a case study of the use of the framework for praxis in a clinical setting.
Overview of Praxis
Praxis is defined in numerous ways for different disciplines, for the nursing profession it is defined as the combination of practice and theory (Kilpatrick, 2008). Many healthcare practitioners see knowledge acquired through clinical practice (praxis) as subjective and not real knowledge because theory is always linked with scholarly achievement, as such it is difficult in present day nursing practice to recognize the importance of praxis (Penney & Warelow, 1999) According to Chinn and Kramer (2011) praxis may arise out of a single person or a group. Praxis arising at an individual level is based a person identifying and pondering on an issue that controls one’s capabilities and understandings, then taking the responsibility in changing the issue for themselves and others affected (Chinn & Kramer, 2011). A significant intent of praxis is the incorporating of theory and practice that helps in the acknowledgment and valuing different types of knowledge (Kilpatrick, 2008).
Chinn and Kramer (2011) states “nursing praxis values and labels those clinical experiences by bringing together the worlds of nursing practice and theory through the use of reflection and action” (p. 83). It is believed nursing praxis helps in knowledge development. “With each turn of reflection and action at least four ideals are used as a benchmark for determining the worth of emancipatory knowledge, these are sustainability, social justice empowerment and demystification” (Chinn & Kramer, 2011, p. 84).
Nursing praxis is important to an APCNP’s practice; it creates opportunity for change by influencing personal nursing theory and the development of nursing knowledge through self-reflection. Self-reflection helps challenge the APCNPs personal and professional standards. Praxis may also help advance the role of the APCNP by reducing the disparities between clinical practice and concepts (Chinn & Kramer, 2011). Incorporating theoretical, ethical and philosophical beliefs of the APCNP will help provide a framework for praxis.
Overview of the role of an Adult Primary Care Nurse Practitioner (APCNP)
An Adult Primary Care Nurse Practitioner (APCNP) is a primary care provider and is at the forefront of providing healthcare to the public. Certain standards must be attained before one can become an APCNP; these include graduate education with a concentration in an APCNP program and certification through examination. Duties of an APCNP include patient education, performing physical assessments, diagnosing and prescribing medications (Hamric, Hanson, Tracy, & O’Grady, 2014). APCNP may practice in private clinics, acute care facilities, long-term care facilities or public health departments (Fitzpatrick & Emerson, 2011). As the elderly population in the United States grows the demand for primary care also increases, as such the use of an APCNP is estimated to reduce the shortage of primary care services (Schiff, 2012).The expanded use of APCNPs increases the ability to increase access to health care, especially in the commonly underserved areas (Schiff, 2012).
Liberation theory by Paulo Freire, a Brazilian educator establishes a technique of teaching literacy for underprivileged adults based on dialogue (Sanford, 2000). The Liberation theory is chosen as the philosophical basis for practice because it’s centered on patient education and building trust between the nurse and patient through dialogue .The use of liberation theory and the theory of self-efficacy by Bandura will help the APCNP in the promotion of health education. According to Cody (2011), health is described as an attitude that reflects accepting responsibility for self in developing
purpose in life (p. 377). Health is currently viewed much more than the absence of disease. According to Bandura (1989), the theory of self- efficacy is based on self-confidence and is a good indicator for motivation to make behavioral changes.
Self-efficacy theory is based on the mastery of skills, modeling of skills especially by others and social persuasion of others to help create the belief that the patient is capable of mastering skills. Health literacy in the overall healthcare system is vital; it improves patient satisfaction, decrease patient concerns, increase compliance to care, creates patient autonomy and increases overall quality of life. Utilizing theories provide the APCNP with the opportunity to effectively educate; to enable the patient to understand their current health conditions in order to be able to make suitable healthcare decisions. As an APCNP it is necessary to explore ways to effectively educate patients because patient education is a vital part of continuum of health (DeMarco, Nystrom, & Salvatore, 2011).
Theory development is the fundamental step for expansion of nursing knowledge. The theory of goal attainment by Imogene King addresses the phenomena, patient education. The theory was first presented in the 1960s by Imogene King (King, 1997). The basics of Kings Theory encourage nurse patient communication; the nurse helps the patient set goals and work together with the patient to attain the goals (King, 1997). The theory focuses on patient education, through interpersonal relationship with nurses and patients; allowing the patient to acquire knowledge or develop skills to help achieve goals. The theory encourages dialogue between the patient and nurse and this process opens the possibilities for participants to present problems, to seriously reflect and to identify solutions not previously realized. Essential attributes of the theory that influences patient education includes the necessity to make all health information accessible to the patient. Due to the importance of disease prevention patient education is vital; as such the APCNP should determine the best possible theory to help achieve desired outcomes through patient education.
According to Cody (2011), people should be afforded the opportunity to be treated with dignity by having their values respected without judgment by others (p. 168). An APCNP providing patient health education can be faced with ethical dilemmas (Pavilish, Brown-Saltzman, Hersh, Shirk, & Rounkle, 2011). Ethical knowledge is required in nursing to guide practice because care outcomes depend on the nurse’s ethical and moral perception (Chinn & Kramer, 2011). Ethics help by identifying principles and create basics that help maintain human rights, and ethical values (Hamric et al., 2011). The changing healthcare system and patient care delivery systems have increased the complexity of ethical issues (Hamric et al., 2011). According to the American Nurses Association (ANA) (2001), the code of ethics provides an outline nurses can use in making ethical decisions when performing their duties to the public, to members of the health team, and to the nursing profession.
Ethical principles include autonomy, beneficence (bring about positive good), fidelity (trustworthy), and veracity (honesty) (ANA, 2001). As ethical agents and patient advocates, we know patient education includes written materials, but it’s also known that most written material available is above reading levels of the overall public. It is vital as an APCNP to take into account your responsibility to the ethical element of autonomy or fidelity in relation to patient education. Patient education is sometimes directed toward supporting patients to make decisions about signing consents.
It is the responsibility of the health care professional who is educating the patient to confirm that the patient has enough understanding about the consequences of the diagnosis, test or procedure that they are consenting to. In order not to violate the principle of autonomy, veracity and beneficence, the primary ethical step for healthcare providers would be to learn more about the patient’s literacy level and then assess to get appropriate educational materials suitable for the patient. In order to provide the most comprehensive educational material to patients and not infringe on ethical principles, providers need to consider the importance of using appropriate written materials at patient’s readability level.
The combination of the APCNP’s ideology, theoretical and ethical framework helps provide a framework for praxis. This also gives nurses the opportunity to help impact changes to the health of the community by concentrating on the quality of life of the community. As an APCNP creating a practice that promotes health literacy, empowerment, acceptance and equality is important. This can be done through the use of patient centered care model that helps in promoting effective patient education. With the use of liberation theory and theory of goal attainment the healthcare provider will be able to better assess patient and provide health education tailored for each patient. Ethical theories have to be examined and integrated throughout the patient education process to ensure patient services provided meets specific needs.
Mr. Bick is a 50 year old with hypertension who comes to the clinic for a follow up appointment after a stroke. During his appointment the nurse establishes a relationship by having a dialogue with patient; inquiring about patients overall life, through the dialogue the patient is able to share personal struggles with medication compliance due to work schedule. The nurse is able to educate patient on how to effectively take all medications without interfering with the patient’s work schedule .The patient sets a goal to reduce BP, the nurse guides the patient with different methods on reaching his goal, including diet modification and increasing activity level.
The case study utilizes the liberation theory to educate by building trust between the nurse and patient through dialogue. In the case study, it is noted that the patient’s self-efficacy made the patient more receptive to the health education offered by the nurse. The patient learnt different options for medication adherence without interference in his work schedule. The theory of goal attainment was also utilized; the patient set a goal and the nurse helped by educating the patient on different options to achieve his goal.
APCNPs are considered as nurses who are equipped with the clinical and management skills necessary to meet the key roles in transforming healthcare. Nursing obligation to patient education is entwined into many theoretical frameworks. The intent of the framework for praxis is to place the practice of patient education in a position where significant relations can be made between experiences of everyday practice, clinical research and scholarly inquiry.
American Nurses Association (ANA), (2001), Code of ethics for nurses, American NursesAssociation, Washington, D.C. Retrieved from http://www.nursingworld.org /Main MenuCategories/EthicsStandards/CodeofEthicsfornurses /code-of-ethics.pdf Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy.
Developmental Psychology, 25, 729-735.
Chinn, P. L., & Kramer, M. K. (2011). Integrated theory and knowledge development. (8th ed.).
St Louis: Mosby Elsevier.
DeMarco, J., Nystrom, M., & Salvatore, K. (2011). The importance of patient education
throughout the continuum of health care. Journal of Consumer Health on the Internet,
15(1), 22-31. doi: 10.1080/15398285.2011.547069.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice
nursing: An integrative approach. St. Louis, MO: Elsevier.
Kilpatrick, K (2008), Praxis and the role development of acute care nurse practitioner. Nursing Inquiry; 15(2), 116-126. King, I. (1997). King’s theory of goal attainment in practice. Nursing Science Quarterly 10(4),
Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Rounkle, A. (2011). Nursing
priorities, actions, and regrets for ethical situations in clinical practice. Journal of
Nursing Scholarship, 43(4), 385-95. doi:10.1111/j.1547-5069.2011. Penney, W & Warelow J. (1999) Understanding the prattle of praxis. Nursing Inquiry 6, 259-268 Sanford, R. C. (2000). Caring through relation and dialogue: A nursing perspective for patient education. Advance Nursing Science; 22(3), 1-15 Schiff, M (2012). The role of nurse practitioners in meeting increasing demand for primary care: National Governors Association. Retrieved from