My interest to become the Women’s Health Nurse Practitioner was motivated by the clinical experience as a registered nurse. I interacted with patients from varied parts of the world during my tenure in the nursing practice. The most compelling part is that most of the patients in hospitals are women. The number of units/wards offering healthcare services to women overwhelms those units dealing with men’s physical condition in the health care sector. The areas  I have worked in, delivering care to women, include the antenatal ward, labor and delivery room, postpartum, obstetrics and gynecology wards (Nurse practitioners in women’s health, 2012.) The total duration of my work in these units amounts to four years. In addition to these areas, I then moved on to work in the dialysis unit for another four years. Despite giving healthcare services to both men and women in the dialysis unit, my interest in offering services to women exacerbated. Finally, I got an opportunity to offer services in my area of interest, when I joined the field of public health nursing. I got ample chances to interact with women seeking annual visits and family planning services.

The role of Women’s Health Nurse Practitioner (WHNP) involves a wide range of health measures targeting to improve female health. The services involve both curative and preventive measures, covering women in the reproductive bracket (Nurse practitioners in women’s health, 2012). These services are offered in all levels of healthcare centers; right from community health centers to referral levels, as well as home based care sectors. WHNP plays a vital role in society except for the hospital setups. The core roles of this occupation include health checkup services (Pap smear, pelvic examination, breast examination and urinalysis), counseling services (menopause, infertility, sexual assaults and depression), inpatient care for admitted women patients, pregnancy related services (antennal care, management of labor, delivery, postnatal care, and family planning) and maintaining multiple health care records related to women’s health. In some cases, the WHNP plays the role of referring a client to higher management (Perks, 2010).

WHNP Scope of Practice

WHNP scope of practice defines a range of practices that can be competently performed in the healthcare system as per levels of education as well as federal, state and professional bodies’ regulations. The scope of practice can be broadly classified into professional and individual. On the one hand, professional scope of practice will vary from the sections that WHNP is working in. Their wide range of knowledge and skill permits to work in different hospital units/wards with miscellaneous duties. On the other hand, individual scope of practice is governed by personal principles, values and expectations. According to Hamric et al., 2009, expertise in the line of duty is a crucial determinant of individual scope of practice. 

The academic qualifications for a WHNP in Mississippi are governed by Mississippi Board of Nursing (MBN). The board regulates the qualification for advanced nursing practice after its gaining from the required state examination. WHNP may vary in qualification from graduate, master’s and doctorate levels. The certifying examination body for WHNP is the National Certificate Corporation. The scope of practice for a WHNP is an extrapolation from the scope of registered nurse practitioner focusing on the women’s health.  The compass of practice majors on the primary health care requirements among women. One of the bodies that delineate the practices of nurses is the International Council of Nurses (ICN) (America Nurses Association, 2012). ICN describes that in cases such as advanced level of nursing practices alike WHNP, the educational qualification should encompass integration of education, practice and management. The scope of practice according to MBN and ICN encompasses the services that promote and maintain wellness, oncology services, dealing with substance abuse among women, assault and violence directed to women, gynecological problems, obstetric measures and urogenital complications management. WHNPs are also accredited to obtain access to specialties in the areas of interest. These areas include the oncology, Obstetrics & Gynecology, and urinary tract infections among others (AmericaNurses Association, 2012). In such cases, their scope of practice will be more specific to their line of practice (Hamric et al., 2009). Consequently, it is worth mentioning that the scope may vary depending on the level of qualification in women’s health care. On top of all this, the WHNP is expected to be autonomous in practice, portraying profound decision making, health assessment and improved case management skills. The scope of practice for WHNP is also broadly defined by the Nurse Practice Act.

Difference in Scope of Practice

In an orthopedic unit, the WHNP has a significant role among the patients. The orthopedic nurse in this section is involved with giving care to both male and female patients in this unit. Their activities in regard to women include paying attention to bone deformities, fractures, bone infections, cerebral palsy among other complications affecting the musculoskeletal system (America Nurses Association, 2012). On the one hand, their daily activities include assessment, monitoring and evaluation of the patients, maintaining immediate patient records for consistency of care, collaborating with other health care practitioners. On the other hand, WHNP in orthopedic ward will focus on the causes of the orthopedic conditions in respect to women’s health. These causes may be related directly to female physiologic factors, endocrine system, or social factors. Using his or her knowledge, he or she offers the best possible intervention.  

Typical Day. A typical day’s activities depend on the unit where this association is working. The wide range of areas of practice where the WHNP can be located differentiates the duties. However, a common observation among the WHNPs is that they are involved in collaborative management with other health care practitioners in the care delivery among women. A day is spent offering services search as preconception care, prenatal and postpartum care, STDs management, menopausal and gynecological issues (Kending, 2000). For those who are specialists in WHNP, they also offer consultancy services.

Theoretical Background

Patient Exemplar

Mrs. W was a married woman in her early fifties. She was accompanied by her husband to a hospital with complains of swollen, tender and painful ankles. The problem has been exacerbating for the past three years despite taking analgesic from a nearby chemist. The husband complained that drugs from the chemist have not been helping his wife. He lamented that Mrs. W  had also lost weight by 3 kilogram for a period of three years. She also complained of feeling weak to carry heavy loads that she was carrying easily before, and sweating at night. The couple was immensely curious about the cause and prognosis of this case. Moreover, the client complained about back ache after rising from the investigation couch. She was ordered to undergo an X-ray diagnostic test to examine her ankle.

Trauma was elucidated after reviewing the X-ray results, and the patient was sent for pain management using anti-inflammatory agents in combination with steroids. However, after a month, the patient was brought back to hospital after suffering an incomplete left tibia fracture. The husband of the client explained the cause of the fracture caused by minor slip while climbing out of bed. She was admitted in the hospital for comprehensive management. While she was in the ward, the orthopedic nurse realized the slowed rate of healing and proposed the management to examine the patient. It was also noted during this time that the patient had mild urinary incontinence. She had never shared this information due to feeling of shame. At this time the patient was noticed by a WHNP who identified the complications linked to postmenopausal effects. This was confirmed by bone mineral density test. The patient was ordered to be examined by osteoporosis management.

The patient was prescribed hormonal therapy, calcium and vitamin D supplements and injectable Forteo under the supervision of fracture management. After three months, the patient was discharged home to continue hormonal therapy. She was requested to go on with clinic checkups for effective monitoring of her progress. The management proved worthwhile after a period of one month. She was able to walk comfortably, had no complains about night sweat or back pain, and she could carry a load without tiring abnormally. The role of the WHNP was well displayed, and the issue of collaboration in delivery of care was also a factor that appeared to boost the patient’s recovery rate despite a period of misdiagnosis and mismanagement.

Nightingale’s Concepts. Nursing practice comes from the founder, Florence Nightingale. Nightingale developed concepts that play a vital role in managing clients effectively. In her notes, Nightingale’s Notes on Nursing, 1860, there are a total of thirteen concepts, which implementation puts the patient at a better nature of position to act properly. She believed that nurses play an integral part in necessitating appropriate action of nature for the sake of improving, promoting, and maintaining health quality. Among the thirteen concepts, petty management and observation of the sick form the suit of the best description for the patient exemplar (Mrs. W). 

Petty management emphasizes on the appropriate management for a patient right from first contact to the time when the professional relation ends. According to Nightingale, it is not possible to deliver consistent care solely to a patient. She recognized the importance of sharing knowledge with other people who can assist in managing the patient. This involves educating the patient, relatives, friends, colleagues, and significance of other current and crucial nursing care for the patient (Nightingale, 1860). In a broader perspective, this concept is demonstrated by the fact that the health care team had undertaken courses aimed at collaborative management. The patient was empowered with her management regime since she portrays positive compliance despite the fact that little improvement was observed in the first three years. At times when she was being discharged, she was given medication to continue taking it at home, and was provided with health education. The husband, who was the caretaker, received information about the way of assisting his wife in order to improve her health condition. This indicates how much the management team aimed to avoid the petty management. In one’s way, the prolonged recovery can be explained by Nightingale’s petty management concept. There was a poor management of the patient, starting from the drug dispenser over the counter and bad examination in the hospital before the correct diagnosis (menopause associated complications) was made.

Observation of the sick is another concept that is illustrated in the above exemplar. According to Nightingale, close observation of the diseased in terms of progress in the continuum of health is considerably imperative (Nightingale, 1860). The term observation used by Nightingale has a broad meaning since it incorporates observation, evaluation, monitoring, and interviewing the patients and the management team to determine the prognosis. This is crucial since it enables the management team to revisit the management regime. The orthopedic nurse offers perfect evidence depicting this concept. She once requested the consultant physician to revisit the management regime when the case of Mrs. W showed no improvement in the ward. The husband had also observed his wife’s health progress before the time he decided to accompany her to the hospital as the medication from the clinic proved to be futile. 

Quality and Safety Education for Nurses Criteria. The objective of Quality and Safety Education for Nurses (QSEN) project is to assist nurses with guidelines that enhance highly qualified practitioners with the rightful qualification. Target areas for this project are the knowledge, skills and attitude. These three areas form the foundation of competency in the nursing profession. Individuals can form precise judgment in regard to patient’s diagnosis and management owing to adequate knowledge. Rightful and adequate skills enable nurses to offer nursing services effectively to patients. In addition to this, a positive attitude in the management and prognosis of the client is adamantly crucial among nurses. The three factors form a formidable trinity of competency in the nursing profession (Quality and safety education for Nurses, 2012). This trinity guides the improvement of care delivered to the patient exemplar as delineated under QSEN headlines below.

Patient-Centered Care. The best patient-centered care competency measure that is evidenced from the exemplar “analyzes social, historical, economical and political dimensions of patient care processes and along with the implications for patient-centered care” (Quality and safety education for Nurses, 2012). The complications were exacerbated by poor social and historical perspective of disease management processes. The fact that the client went to preferred over the counter medication is socially explained. The patient and her husband relied on over-the-counter drug, and it turned into a factor that made them choose this mode of treatment. The economic background of this family was quoted as an issue of concern for the delay in seeking medical consultation at the hospital. The client claimed to be working in a company where she was “too busy” to visit a hospital. The patient was effectively managed through proper analysis of these factors.

The historical dimensions of patient management regime had crucial impediments in the healing process of the client. The poor history of improvement and the consistence in complications triggered a concern for reevaluating the management. The patient was admitted despite the claims that she was in a busy company, and chances of getting a free day were disputed for better management.

Teamwork. Contemporary hospital setup demands the need for collaborative patient management approach. The increase in number of patients, the need for quality and fast health care delivery system, and advancement in health care specialties underpin necessity to promote teamwork.  Teamwork competency was depicted by the fact that the orthopedic Women’s Health Nurse Practitioner and the physician “appreciated the importance of inter-professional collaboration” (QSEN, 2012) in managing Mrs. W.  The three people and other health care management professionals such as radiographers participated effectively in managing and improving the care of the client. In addition to this, the orthopedic nurse seemed to understand the vitality of “soliciting input from other team members to improve individual, as well as team performance” (QSEN, 2012). This was demonstrated when she evidenced a problem, consulted about it and advocated for change of regime while the patient was in the ward. The input from the WHNP was a turning point in the improvement of patient’s prognosis. Incorporation of a wide range of health care professionals improves management due to the broadened limits of knowledge, skills and experience.

Quality Improvement. The major cause of underachievement in managing the exemplar was misdiagnosis and poor investigations. “Using findings from root cause analysis to design and implement system improvements” (QSEN, 2012) would have been a prime area for improving the patient’s outcome. If the hospital had analyzed the root cause of Mrs. W complaints, followed by an analysis to implement the best regime, the client would have recovered earlier. The hospital needed to adopt root cause analysis strategy in diagnosing patient’s real condition(s). Furthermore, “explaining common causes of variation in the outcome of care, in the practice specialty” (QSEN, 2012) would have guided the health care practitioner’s right to choose between the over-the-counter drug dispenser and the management team in the hospital to arrive at a better management regime. Alternative treatment strategy would have been instituted after the patient responded poorly to the analgesic and steroids. Monitoring for possible causes of detrimental progress in managing a client proved to be an insightful point of correcting an error before the ensuing complications. Another competency measure that could have improved management outcome consists in “appropriate participation in analyzing errors and designing, implementing and evaluating system improvements” (QSEN, 2012). This can form the basis for improving the diagnostic procedures to avoid future cases of misdiagnosis.

Evidence-Based Support Changes. Evidence-based care involves implementation of best proven intervention, while putting into consideration patient’s values and preferences. It is different from the theoretical knowledge application since this has been evaluated practically and validated to give positive results (Smith, 2012). The practice incorporates expertise acquired from both clinical practice and experience in this sphere.

Intervention initiated by the WHNP to Mrs. W is a result of evidence-based practice and excellence in experience with women’s health cases. The drugs used to treat the patient were majorly painkillers, which were not coping with the main cause of the problem. This was symptoms relieving management. Unfortunately, managing pain facilitated adverse complications of the disease since the bone density and mass continued to reduce. This explains the reason why the patient suffered bone fracture from a minor accident. A competency that was maintained in managing the client was “acknowledging own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practice”. The orthopedic nurse welcomed the intervention of the WHNP which latter proved to be fruitful in managing the exemplar. 

Impact of Information System and Technology. Collaborating cannot be effective without embracing information system. Technology is a factor that has a positive impact on the management of patients in hospitals. This factor was witnessed in management of exemplar. The management team had to “value the use of information and communication technologies in patient care” (QSEN, 2012). This competency was achieved through incorporation of current technologies such as radiology in evaluating the patient’s conditions. Information concerning the patient’s history of management was well maintained in computers. This facilitated easy retrieval of the information and comparison of the previous management to detect errors, points of improvement, and ease communication. Entering data in the computer demonstrates how the health care team achieved the competency on “searching, retrieving, and managing data in making decision, using information and knowledge management system” (QSEN, 2012). In addition, the management team demonstrated the informatics competency on “promoting access to patient care information for all professions who provide care to patients” (QSEN, 2012). All the immediate participants in managing Mrs. W got easy access to necessary information regarding her condition. The information was secured in the computers, which had secret codes to log in; thus, maintaining the privacy and confidentiality of the patients.

Summary

In conclusion, choosing WHNP was motivated by my profound experience in the health care sector as a registered nurse and the need to participate in delivery of care to the largest group of female patients in the hospitals. The roles of WHNP were extrapolated by the registered nurse practitioner’s actions as a result of the growing need to endow the nurses with special skills regarding women’s health. The wide range of feminine health problems makes a well-educated and equipped nurse achieve better competency. This is achieved with the help of undertaking a master’s degree in women’s health. The scope of practice for WHNP depends on the location of practicing, unit in the hospital, and personal principles and values.

Mrs. W, who was suffering from post-menopausal complications, was used as an exemplar for better understanding of theoretical background. Nightingale’s concepts of petty management and observation of the patient were correlated with the exemplar. Petty management contributed to misdiagnosis, which was latter corrected after close observation of the admitted patient. The vitality of QSEN criteria for the graduate was revealed in the exemplar’s case. Emphasis was laid on the identified QSEN competencies with the aim of promoting health care outcomes.   

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