Pathophysiology,_Physical_Assessment,_and_Pharmacology_Advanced.pdf

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Nursing education is a curious field. We preach the need to deliver holistic patient care. However, we teach nursing care by dividing the elements of care categorically. We then expect the student, who is the least experienced member of the teaching/ learning team, to integrate the information provided. We require students to intuitively identify the salient points and apply the knowledge they gain from the written word to a patient in the clinical setting. This groundbreaking textbook, Pathophysiology, Physical Assessment, and Pharmacology: Advanced Integrative Clinical Concepts, facilitates knowledge in a way that enables student understanding for real world application. Integrating the concepts of physiology/ pathophysiology, physical assessment, and pharmacology eliminates the silo approach to nursing education and guides the student to explore how each element impacts the other. Drs. Best, Buttriss, and Hines collaborate to bring both clinical and academic experience to the forefront in Pathophysiology, Physical Assessment, and Pharmacology. Written with sound educational practices, this book will help students to reframe the way they provide patient care. Nursing faculty will appreciate the thoughtful integration of the “the 3Ps” in each chapter and exemplars that provide rich concepts for class design and implementation. Pathophysiology, Physical Assessment, and Pharmacology is the textbook that teaches like nursing students learn and practice.

Introduction

Masters-prepared nurses provide, supervise, coordinate, and evaluate care in increasingly complex care environments. In order to make decisions that promote quality

outcomes, nurses must have advanced knowledge from many different areas, but particularly in the content domains of physiology/pathophysiology, physical assessment,

and pharmacology. For advanced practice nurses in direct care roles (i.e., certified registered nurse anesthetist [CRNA], certified nurse-midwife [CNM], clinical nurse specialist

[CNS], or certified nurse practitioner [CNP]), it is especially critical (and mandated by

some accrediting bodies) that students are prepared by separate classes in each of

these content areas (American Association of Colleges of Nursing [AACN], 2011).

There are requirements for a clinical component for direct care roles, which can be

met in traditional settings or through simulation (e.g., educators, clinical nurse leader

[CNL]) (Halstead, 2007, 2018; National League for Nursing [NLN], 2012). In addition to the advanced knowledge, the nurse must integrate these concepts to function

safely across inpatient and community-based health-care settings. For graduate students in tracks that lead to indirect care roles (e.g., administration, informatics), these

concepts can be combined into one class (AACN, 2011; American Nurses Association

[ANA], 2015).

Recommendations for graduate education are based in part on the Carnegie Foundation report (2009), Educating Nurses: A Call for Radical Transformation, which emphasizes the importance of advancing knowledge for masters-prepared nurses in clinical

practice theory and experience for all direct care roles (Benner, Sutphen, Leonard, &

Day, 2009). A scientific foundation for practice is formed from the three major areas

(physiology/pathophysiology, physical assessment, and pharmacology) with opportunities to apply this knowledge in clinical settings, whether in traditional clinical or

simulated settings. In this chapter, we provide an overview of how each of these subjects supports advanced practice in nursing and how their integration promotes patient and system outcomes

Physiology/Pathophysiology

Nursing education includes physiology at the undergraduate level but often moves to a focus on pathophysiology for graduate students, with the expectation that students possess basic knowledge of physiology from nursing practice experience. It is also assumed that students and/or practicing nurses review physiology content as needed in order to better understand pathophysiology. Within a wide variety of health-care settings, nurses must be able to determine normal findings based on their understanding of physiology, and identify any deviations from normal findings, or pathophysiology. While nursing is based in science, there is also a human element that requires nurses to make judgments using both scientific knowledge of pathophysiology and understanding of best practices; therefore, as nurses progress in their educational preparation for advanced roles, an emphasis on scientific knowledge, along with clinical application of this information, is necessary (Rodgers, 2016).

Advanced Physical Assessment

While based on the sciences, nursing is described as both a science and an art; nowhere is this more evident than in the area of physical assessment. Learned as the first step in the nursing process, accurate assessment is crucial to all other components of care; students and practicing nurses cannot underestimate its importance. As the nurse develops knowledge in caring for patients, there are usually concomitant advances in clinical skills. Advanced assessment skills incorporate both physical assessment and clinical reasoning skills that support the nurse’s ability to correlate assessment findings with possible diagnoses and treatment plans (Goolsby & Grubbs, 2019). The nurse’s ability to assess a patient and their family is critical to making correct decisions regarding care. Expectations of masters-prepared nurses include expertise with advanced assessment skills; while there is a focus on the aspect of physical assessment, a holistic approach to assessment is the ultimate goal.

Pharmacology

Knowledge of medication and its safe use/administration is a priority in current health care. The landmark Institute of Medicine (IOM; now the National Academy of Medicine) report, To Err Is Human (1999), continues to guide clinical practice and motivate nurses to promote a safe clinical environment. Pharmacology has a vital role across the continuum of care; nurses must be able to manage its use in treating acute illness, managing chronic conditions, and preventing disease. It is the nurse’s role to maximize the therapeutic effects of the pharmacological regimen, while minimizing the potential side effects and risk of complications. Nurses’ advanced knowledge of pharmacology is key to their ability to practice in an advanced role and to be leaders in promoting quality care.