Not too long ago, the public’s perception of a nurse was someone who cared for you when you were hospitalized, offered comfort at a time when you most needed it and carried out requests that doctors had made. Doctors were responsible for making clinical decisions, and a nurse was seen as a “handmaiden” who carried out the doctors' requests. Wards were run with military precision. Patients were washed, dressed and beds made (with perfect hospital corners!) by a set time each day. The nursing staff were in fear of the matron who made her rounds to ensure that all was done according to protocol and that you were perfectly turned out in your starched nursing uniform and cap.
How things have changed! Nurse training has evolved, and nurses are taking on extended roles including further study to become Nurse Practitioners or advanced courses in particular specialities. In the US today, according to the American Academy of Nurse Practitioners (AANP) there are 115,000 Nurse Practitioners, and the majority work in primary care.
The Nurse Practitioner's role today includes taking clinical histories, performing physical examinations, ordering tests and interpreting results to rule in or rule out diseases, liaising with members of the multidisciplinary team about the patient and what course of action or treatment should be taken in the patient’s clinical care. These responsibilities are in addition to the core values of nursing which have underpinned the profession for many years:
- To promote health, healing and well-being, prevent disease and illness, minimize distress, suffering and assist people in adapting to their disease, if death is inevitable then provide the best quality of life for the patient, assist patients with their health, social, spiritual and psychological needs.
- To act as an advocate and in partnership with the patient and their family and to work within a multidisciplinary team to ensure the patient receives the best quality of care and outcomes possible.
Nurses are at the frontline with patients and their families 24 hours a day, seven days a week. They are responsible for a specific group of patients and plan their care, detect changes in their conditions and then act on these changes to ensure the appropriate intervention is actioned.
You can walk into a ward or clinic today and see many health professionals taking blood work, prescribing and administering medication, carrying out physical examinations, presenting on ward rounds, breaking bad news to a patient or their family, carrying out procedures involving cannulation, central venous catheters, chest drains and administering emergency medication. These could equally be interventions being carried out by a Doctor or a Nurse.
Happy National Nurses week. Be proud and enjoy how your profession has evolved and continues to evolve. In any one working day remember you are an advocate, colleague, team member, life saver, clinical expert, counsellor, researcher, carer, leader and a friend.
~Mandy Tomlinson, RN, Isabel Quality Assurance Director
See how other nurses have used Isabel. View the Video now: Nurse Practioners Rely on Isabel
Guest blog by Columbia University Medical Center's Rita Marie John, DNP, EdD, CPNP -- Associate Professor of Clinical Nursing, PNP/NNP Program Director
Recognizing that diagnostic errors are a problem for all practitioners, we saw the opportunity to use Isabel Diagnostic Decision Support System (DDSS) to improve the diagnostic skills of Advanced Practice Nurse (APN) students in the Pediatric Nurse Practitioner (PNP) and Family Nurse Practitioner (FNP) programs at Columbia University School of Nursing. While the use of DDSS has been studied in health care providers, the use of decision support among APN students has not been studied.
Study: Nursing Diagnosis Skill at Columbia University: The goals of our study are to evaluate the confidence and diagnostic accuracy of PNP and FNP students over the course of their program, track diagnostic accuracy over the study period, and evaluate differences in diagnostic accuracy between FNP and PNP students in reviewing pediatric cases.
Isabel IDEAS Program at Columbia: This innovative project utilizes a separate program within Isabel called Isabel IDEAS. The IDEAS program uses online cases which are developed based upon actual cases without revealing protected health information. Cases represent three level of diagnostic difficulty: easy, medium, and hard. Experienced PNPs reviewed the cases and critiquee the actual denouement and differential diagnoses generated by Isabel to create a gold standard for diagnostic decision making for e
ach case. Prior to using the Isabel DDSS, students read the cases in IDEAS, document the history and physical exam, enter their differential diagnosis, diagnostic tests, and treatment plan and rate their level of confidence for each case. The student repeats the process of differential diagnosis, diagnostic test, and treatment plan following use of the Isabel DDSS. The denouement of the case is made available to the student after a specified period of time.
Student Diagnosis Results: Students completed a total of 20 cases over two semesters and were graded on their work so that they would take the case generation seriously. In each semester, there was only one student in the PNP program that did not complete all 20 cases. Informally, students have reported that reading the denouement helped them understand diagnostic reasoning. The harder cases posed a challenge to some of the students. In all of the cases, the right diagnosis was obtained by at least one of the students. Students had more difficulties with the two cases that were unusual and had never seen in clinical practice. Students felt that deciding on which differential to list was challenging at times. In some cases, there was no difference between the pre and post Isabel in differential, diagnostics, or plan. This will need to be explored further in a focus group.
We are still in the process of data evaluation and are excited to see what the results will show.
~ by guest writer: Rita John, DNP at Columbia University Medical Center
