Identify a theory or model which can be used as a framework for a future evidence-based project.
Review literature regarding issues or concerns within your selected area of advanced practice nursing. Select a theory or model which is relevant to Emergency Department Nurse Practitioner. Offer a meaningful context for evidence-based practice surrounding the issue or concern which you identified.
Address Theoretical Framework to Support Evidence-based Practice Assignment
Identify and describe a theory or model, and explain its relevance to the Emergency Department
Describe an issue or concern regarding the Emergency Department of advanced practice and explain its impact on health care outcomes.
Explain how the theory or model can be used as a framework to guide evidence-based practice to address the issue or concern, and discuss the unique insight or perspective offered through the application of this theory or model.
Full Answer Section
- Proficient: Has 3-5 years of experience. The nurse perceives situations as wholes rather than in terms of isolated parts. They have a more holistic understanding and can anticipate typical events, allowing for more flexible and less effortful performance.
- Expert: Has an extensive background of experience. The expert nurse has an intuitive grasp of the situation and immediately knows what needs to be done without conscious deliberation. Their performance is fluid, flexible, and highly proficient.
Benner emphasizes that progression through these stages is not merely about time or education, but about experiential learning, critical thinking, and clinical judgment. Each stage builds upon the previous one, with a shift from relying on abstract principles to gaining a deep, intuitive understanding of clinical situations through experience.
Relevance to the Emergency Department Nurse Practitioner (ED NP):
Benner's theory is highly relevant to the ED NP role for several reasons:
- Skill Acquisition in a High-Acuity Environment: The ED is a fast-paced, high-stakes environment where rapid assessment, critical thinking, and swift decision-making are paramount. Benner's theory directly addresses how nurses develop these essential skills through experience.
- NP Role Development: The transition from a Registered Nurse (RN) to an ED NP, and then from a newly graduated NP to an experienced one, involves significant skill acquisition and role maturation that perfectly aligns with Benner's stages. A new ED NP might feel like a "novice" or "advanced beginner" in the NP role, even if they were an "expert" ED RN.
- Mentorship and Preceptorship: The theory provides a framework for understanding the learning needs of NPs at different stages of their development, informing mentorship and preceptorship programs.
- Interprofessional Collaboration: It helps explain the different perspectives and approaches to patient care among healthcare professionals with varying levels of experience (e.g., a novice NP interacting with an expert ED physician or an expert ED RN).
- Quality of Care: The level of a nurse's expertise directly correlates with the quality and safety of patient care delivered, a crucial aspect in the ED.
2. Issue/Concern in Emergency Department Advanced Practice: Diagnostic Error in Complex Presentations
A significant issue or concern for Emergency Department Nurse Practitioners, profoundly impacting healthcare outcomes, is
diagnostic error in patients presenting with complex, atypical, or subtle symptoms of high-acuity conditions (e.g., sepsis, myocardial infarction in women, atypical presentations of stroke, less obvious pediatric emergencies).
Impact on Healthcare Outcomes:
Diagnostic errors in the ED can lead to severe consequences:
- Delayed or Missed Diagnosis: Crucial time is lost in initiating appropriate treatment, leading to disease progression, increased morbidity, and higher mortality rates. For example, a delayed diagnosis of sepsis can rapidly lead to multi-organ failure and death.
- Adverse Events: Incorrect diagnoses can result in the administration of inappropriate treatments, leading to adverse drug reactions, unnecessary procedures, or complications.
- Increased Length of Stay and Hospitalizations: Patients with missed or delayed diagnoses often return to the ED or require prolonged hospital stays, increasing healthcare costs and resource utilization.
- Patient Dissatisfaction and Loss of Trust: Patients and families experience anxiety, frustration, and a loss of trust in the healthcare system when a diagnostic error occurs.
- Nurse Practitioner Burnout and Legal Ramifications: ED NPs grappling with diagnostic uncertainty and the pressure to make rapid decisions are at higher risk for burnout. Diagnostic errors can also lead to professional liability and litigation.
The ED's inherent characteristics – high volume, rapid pace, incomplete patient information, and the diverse acuity of presentations – make it particularly prone to diagnostic errors, especially when dealing with non-classic symptomology.
3. How Benner's Theory Guides Evidence-Based Practice (EBP) for this Issue
Benner's "From Novice to Expert" theory can serve as a robust framework to guide an evidence-based practice project aimed at reducing diagnostic errors in complex presentations by ED NPs.