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Nurse Practitioners Can Make a Difference Patient by Patient


As indicated by recent research studies, patients made more than 1 billion visits to nurse practitioners last year, according to Joyce Martha Knestrick, PhD, C-FNP, APRN, FAANP.

The research also indicates NPs are educated and well-trained to provide patients and families access to high-quality, cost-effective primary healthcare services. [caption id="attachment_54590" align="alignleft" width="300"]nurse pracitioners - Joyce Martha Knestrick, PhD, C-FNP, APRN, FAANP Joyce Martha Knestrick, APRN[/caption] Knestrick talked with us about best practices when caring for families in the community and the resulting positive outcomes. She is the president of the American Association of Nurse Practitioners. With 25 years of experience, she currently practices as a family nurse practitioner at Wheeling Health Right in Wheeling, W.Va.

What are best practices when caring for families in the community?

Nurse practitioners' model of care focuses on the patient, family and community. To put the patient as the center of care, there needs to be involvement of the patient and family, which sometimes involves members of the community. They all bring personal knowledge and information to the treatment plan equation. Involving the family can help patients find the right care for their needs, preferences and current circumstances. Recently, a patient was discharged from the hospital to home. The patient's daughter had her own health problems and although she lived nearby, she was not able to care for her mother. The patient lived alone in an isolated area and in an older home with multiple stairs. She came to her follow-up appointment to see her nurse practitioner, and although normally meticulous about her appearance, her hygiene was poor and she had lost weight.

The NP talked with the patient and the niece who brought her to the appointment and discovered the family had not been involved in the discharge plan. The patient was unable to climb the 12 steps to the bathroom where the shower was located.

A new plan was made with the patient, niece and daughter via telephone, and community services were used to help keep the patient at home and healthy. This example shows when patients and families are partners in planning and making decisions about their healthcare, outcomes are improved.

What positive outcomes can nurses expect to achieve when implementing best practices and including the whole family in the process?

By implementing best practices, nurse practitioners can expect to understand the role of the family, the family dynamics and the impact of the family (and their decision-making) on the patient's care.

Because I am from rural mid-Appalachia, it is important that I understand the cultural norms within the community and that I deliver culturally sensitive care to my patients. My research has focused on aspects of caring for the population and provides me and other providers insight into ways to work with patients.

An example is the practice of smoking. Many women in my study continue to smoke despite the education and media regarding the effects of smoking. The women revealed many reasons for smoking, including a sense of having control over something in their lives. When I work with patients on smoking cessation, I ask them what is important to them in relation to smoking and quitting smoking. If the number of cigarettes they smoke a day is all they have control over, taking that away may do more harm than good. Then I try to find other ways for the women to feel in control. In addition, my involvement in research on access to care in Appalachia was the impetus for my former practice partner and I to start a nurse practitioner-run clinic. This clinic provided the culturally sensitive, patient-centered care the residents of the community were seeking.

Access to care improved and patient outcomes improved. Since the practice was part of the community, families and the community were empowered to help make the clinic successful.

For instance, a child and his parents came in to see the NP because he was experiencing frequent asthma exacerbations. Because the NP cared for the family, she knew one of the parents regularly smoked cigarettes. The NP assessed the situation and discovered the parent was smoking inside the home, and the more problems the child had, the more anxiety the parent reported. Because of his increased anxiety, he smoked even more cigarettes. The NP worked with the parents and the child [to make] changes in the environment and centered the care around the child. The parent stopped smoking inside the home and the child experienced fewer exacerbations.

What educational tools do you use to improve family education in this process?

At the American Association of Nurse Practitioners, we have a CE Center with information regarding various diseases that includes treatment and patient and family education. Depending on the problem or illness, NPs can go to various sources and evidence for a particular issue. In addition, patients and families can go to to find an NP in their geographical area.

What words of wisdom can you share with nurse practitioners who are considering the specialty of family practice?

The family nurse practitioner's role in a community setting can be both challenging and rewarding. Patients come to primary care with complex issues, and the nurse practitioner has to be prepared to make difficult and complex diagnoses and treatment plans with the patient as the center of care.

Keeping the family in the plan of care whenever it's possible and knowing the resources available in the community are essential in a family primary care practice. Keeping abreast of the current evidence to work with patients and families is necessary to produce good patient outcomes.

Another crucial aspect to the process is educating the patient and the family about health promotion and prevention practices at home. I have been in practice for more than 25 years, and now I see my patients' children and grandchildren. I am most satisfied in my role when I know that I have improved my patients' quality of life and have had a positive impact on the family.

How can nurse practitioners in family practice get involved in improving family practice through community involvement, research and legislation?

The American Association of Nurse Practitioners offers information to members in the areas of practice, education, research, advocacy and leadership. Joining the association gives members in family practice opportunities for continuing education to keep current and provide best practices for their patients.

AANP also is involved in research and provides opportunities for member engagement. NPs can learn how to advocate for patients and the profession in our advocacy center, and our fellows give member access to experts in caring for families.

In addition, the association has specialty practice groups for NPs to discuss current practice trends and, of course, our conferences provide continuing education and networking opportunities. For more information visit Patients and families might also benefit by visiting the association's patient-focused site,  

Take these courses related to nurse practitioners:

Advanced Practice Nurse Pharmacology (25 contact hrs) This course will help advanced practice nurses meet the new ANCC 25-contact hour pharmacology requirement for re-certification beginning Jan. 1, 2014. Written and rigorously peer reviewed by pharmacists and advanced practice nurses, this course features a wide range of medical conditions and the medications associated with them. Chapter topics include hypertension, diuretics, GI, critical care, sexually transmitted diseases, asthma, oncology, non-opioid analgesics, diabetes, weight loss, mental health conditions such as anxiety, bipolar disorder, depression and much more. The chapters highlight clinical uses, dosing, interactions and adverse effects for the common medications used in your practice. APN tips are featured throughout the chapters to help you in your prescribing practices. A Complementary and Integrative Practices Potpourri (1 contact hr) Data from the 2012 National Health Interview Survey showed that about 34% of American adults and 12% of children use some form of complementary and alternative medicine. Because of consumers' heightened interest in complementary treatments and their widening use, anecdotal efficacy and growing supportive research evidence, nursing and medical schools across the country now offer courses in CAM interventions and practices. Nurses and other healthcare professionals can expect questions from their patients about these complementary therapies, so they need to be informed and comfortable enough to discuss these unique approaches. Obesity Management (12 contact hrs) Data from the National Institute of Diabetes and Digestive and Kidney Diseases indicates that more than two thirds of U.S. adults are overweight (33.1%) or obese (35.7%) with an additional 6% classified as extremely obese. Nearly one third (31.8 %) of youths ages 2 to 19 are overweight or obese. The American Medical Association voted in June 2013 to declare obesity a disease in hopes of improving treatment efforts for management of this growing public health problem. Multiple tools are available to assist healthcare providers in counseling patients toward healthier eating and exercise patterns, yet due to limited time they have not accessed and arranged them into tools that they can use to improve outcomes for their patients.