Advanced Practice Nurses play an important role in leading health care change. This role is instrumental to the improvement of both patient safety and quality of outcomes. The American Association of the Colleges of Nursing [AACN, 2006], developed core competencies for all advanced practice nurses called the DNP Essentials (AACN, DNP Essentials, 2006). The DNP Essential Two (AACN, DNP Essential II, 2006) clearly states, “advanced practice includes an organizational and systems leadership component that emphasizes practice ongoing improvement of health outcomes and ensuring patient safety.”

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The DNP Essentials (AACN, DNP Essentials, 2006) are the core competencies for all advanced practice nurses. The core competencies are supported by an practitioners’ individual foundation consisting of beliefs and views in regards to philosophies, paradigms, concepts, and theories. It is important for advanced practice nurses to reflect, assess personal beliefs, customs, and ethics, as well as obtain an understanding of your personal strengths and weaknesses. This process of self-reflection and ongoing personal development will dictate which paradigms, concepts, theories, and knowledge from other disciplines that you incorporate into clinical practice (Denisco & Barker, 2013).

This assessment is ongoing and will facilitate the development of advanced practice nurses into leadership roles. Also, an ongoing self-assessment process, as well as leadership development will help facilitate the development of praxis (Carper, 1978). The advancement of the nursing profession will move beyond practice to engagement in social processes. This process will facilitate the closure of health care inequalities in our current healthcare system, according to Carper (1978). I believe this is the one of the highest achievements for an advanced practice nurse.

In my current role as a Psychiatric Mental Health Nurse Practitioner (PMHNP), I am responsible for the assessment, diagnosis, and management of medications for psychiatric/mental health patients for patient age 4 and older. I utilize evidence based practice (EBP) guidelines, but incorporate current standards of practice in psychiatry due to outdated research in the field of mental health (American Psychiatry Association, Clinical Practice Guidelines).

I constantly struggle with the outdated EBP guidelines and lack of research in psychiatry in regards to management

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of medications for patients. This is especially a problem with children and under-served populations such as prisoners. There are many reasons for a lack of current EBP guidelines in psychiatric mental health. They consist of inadequate funding, lack of understanding by politicians and the public, and ongoing ethical issues. Most of the research in psychiatry and mental health is emerging from international sources such as the International Initiative for Mental Health Leadership [IIMHL] (Beinecke, R.H., & Spencer, J., 2007). IIMHL is government-to-government organizations facilitate the sharing of beneficial mental health information, and the United States is part of this worldwide initiative (Beinecke & Spencer, 2007).

Knowing myself in terms of ethics, morals, spiritual beliefs are important since they are the basis of my philosophy of patient care. I am very careful in monitoring both verbal and non-verbal language in working with my patient population. Also, I facilitate the building of a profession relationship between provider and patient by the use of myself in the initial assessment of a patient. I utilize many techniques known for effective communication with patients such as listening, empathy, open-ended questions, reflection, and many other techniques where I can obtain accurate information, as well as facilitate a professional relationship with my patient.

Empirical knowledge is also important since it is the verifiable, factual description, and explanation that EBP guidelines are based (Chinn & Kramer, 2004). As I struggle with outdated EBP guidelines is psychiatry, a new and exciting development has emerged which is challenging the future of mental health care. I am utilizing genetic testing for treatment resistant patients. Genetic testing is a new phenomenon in mental health, but I am able to test for ten genes, which have been implicated in contributing to mental health disorders (Kendler, K. S., Aggen, S. H., Knudsen, G. P., Røysamb, E., Neale, M. C., & Reichborn-Kjennerud, T., 2011). “Patterns of knowing have traditionally included ethics, personal knowledge, aesthetics, and empirical knowledge”, according to Carper (1987). These four elements are contribute to the basis of what we know as nursing knowledge. These elements contribute to how a nurse makes sense of their clinical practice (Carper, 1987).
Emancipatory knowledge is the praxis (Chinn & Kramer, 2004).

The paradigm that influences my clinical practice is called the Simultaneity Paradigm. It is based on the person-environment interaction, and it is constantly changing due to the patients’ interaction with a constantly changing environment (Parse, 1987, p. 4). One example would be the relapse of a patient with a known history of alcoholism. It would be important to assess and understand the reason for the patients relapse.

The patient in this case relapsed due to his son being in the military with deployment to an unknown location. The patients lack of social support and coping skills are an ongoing issue with his care, and would continue to be addressed with his treatment. As I practice I realize a gap exists between nursing research, theory, and clinical practice, and they are all interdependent, according to Chinn and Kramer (2004).

Advanced practice nurses provide care in a specific and certain manner. The standard of care reflects your professional and personal values (Cody, 2011). One example in psychiatry would be contacting the patients’ therapist to discuss the treatment plan and progress of care for the patient. It would be easy for a provider to skip this part of the ongoing assessment process, but your professional beliefs would dictate your course of action. Consultation and working with a treatment team is an essential part of treatment for all patients. DNPs will continue play an important role in healthcare leadership by eliminating health care disparities and filling the gap in healthcare delivery.

An ongoing process of self-assessment and ongoing personal development will dictate which paradigm, concept, and theories that advanced practice nurses and knowledge are incorporate into a clinical practice. Evidence-based practice will continue to play a large role in delivery of care since it ensures the best possible outcomes for all patients (AACN, DNP Essentials, 2006). Zaccagnini and White (2011) state the DNP Essentials (AACN, DNP Essentials, 2006) as being the new model for the advanced practice nurse. Nursing paradigms, concepts, and theories must support and reflect this new model going forward. Healthcare is in a constant flux of change and by building teams and sharing knowledge, and making people feel connected will be critical to the future of quality and safe healthcare systems (Lazaridou & Fris, 2008).

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