NPs and the Integral Knowledge Base

NPs and the Integral Knowledge Base
NPs and the Integral Knowledge Base

NPs and the Integral Knowledge Base

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For this paper, the writer will use the template as a guide in completing the paper. APA 6th edition is Key to this paper that’s why it is critical to follow the sample paper when completing this paper. The writer must also address all the key requirements mentioned in the questions and give very responses.

Write a 6 page paper (excluding title and reference pages) evaluating the necessity of a more comprehensive understanding of pathophysiology, pharmacology, and physical assessment skills for the role NP in contrast to the role of the RN.
Analyze and integrate the impact of cultural competence and ethical decision making models on clinical reasoning, health policy and practice in regard to this more comprehensive understanding in the role of the NP.


• ANA – Code of Ethics for Nurses

• NCCAM, National Institutes of Health

• The Role of Ethnicity in Variability in Response to Drugs: Focus on Clinical Pharmacology Studies (2008)

• U.S. Department of Health and Human Services – National Advisory Council on Nurse Education and Practice

• U.S. Department of Health and Human Services – The Data Bank: National Practitioner Healthcare Integrity and Protection (n.d.)

• U.S. Department of Health and Human Services – Office of Minority Health

• MayoClinic Proceedings – Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice

• – National Prevention, Health Promotion and Public Health Council – The National Prevention Strategy: America’s Plan for Better Health and Wellness

• U.S. DHHS, Office of Disease Prevention and Health Promotion, Healthy People

• Dossey, B. (2008). Theory of Integral Nursing. Advances in Nursing Science. 31 (1),pp. E52–E73 Wolters Kluwer Health.


NPs and the Integral Knowledge Base


Nursing is a vital profession in the healthcare field. There are different level of nurses based on experience, training and educational qualifications. This can be registered nurse or nurse practitioners. The scope of practice and authority of these nurses differ from one state to another. Cultural competence is an important aspect of nursing profession given that practice in a culturally diverse setting is inevitable in nursing profession. This paper will look into the difference in the roles of registered nurses and nurse practitioners assess the justification nurse practitioners to have advanced knowledge of pathophysiology, pharmacology and physical assessment. It will also examine the importance of cultural competency in nursing care.

Registered nurse and Nurse Practitioner

A registered nurse is a healthcare practitioner whose main job is educating and treating patients as they assist doctors. In many instances, they also help patients to put up care plan. Some of their responsibilities include administration of medication and therapy, maintaining IV lines for fluids as well as monitoring and recording patient’s condition for doctor’s assessment. The level of education is basically a bachelor’s degree in nursing or a collage diploma. They must work under a physician and are not authorized to prescribe medication and diagnose diseases.

A nurse practitioner often abbreviated as NP is a graduate nurse who has specialized in advanced practice nursing. They are licensed to offer a wide range of care services which include performing physical exam and taking patients history. Unlike registered nurses, nurse practitioners are allowed to order laboratory tests, diagnose, treat and manage diseases. They can also perform certain procedures like lumber puncture and bone marrow biopsy, coordinate referrals, write prescriptions and give hand outs concerning healthy lifestyles and disease prevention. They do work in diverse settings such as neonatology, primary care, women’s health, oncology, school health, pediatrics, nephrology, cardiology, family practice and emergency care among others. Some nurse practitioners are able to work in clinics under no supervision of a doctor while others work together with doctors in a team of public health care professionals. They have two levels of regulation and the scope of practice as well as their authority is highly influenced by the state laws. First they are licensed under the state law, and then obtain certification through national organizations that have consistent professional practice and standards in all states. The laws that govern NP licensing are different in different states, many states nowadays require that NP obtain national certification and a masters degree, other states require that a NP to work with a medical doctor while others have no recognition for nurse practitioners (Iglehart, 2013).

Nurse practitioners are to a greater extent well prepared to give primary care. They have undergone training in managing health problems of many kinds as well as in health promotion. Due to the current challenge that exist in patient care; the role of nurse practitioner can only increase than to reduce. Nurse practitioners are able to work independently in acute care settings and in primary care, their effort can help modulate the cost of healthcare through patient’s education and provision of frontline primary care (An Expanding Role for Nurse Practitioners. (n.d.). In the present day, nurse practitioners are commonly used by Americans in a lot of healthcare needs and they are fully recorgnised by many providers and most healthcare consumers as a vital component of latest healthcare system. For at least fifty years nurse practitioners have given a lot of services in both chronic, acute and community settings, hence they are very important in the healthcare system. It is also expected that NPs are likely to become even more essential as American obtain broader services due to the healthcare reforms (Nurse Practitioners: Shaping the Future of Health Care (n.d.).

Educational pathway

The IOM report acknowledges the fact that nursing has had definitional issues throughout its history, especially in regards to the educational pathways. There are three pathways which are required for initial licensing. First is an associate degrees offered by nursing schools and community collages which takes a period of between two to three years for completion. Secondly is a diploma that is offered by hospitals and take three years. Lastly is a four year degree in nursing usually offered by schools of nursing as well as in universities. The curriculum contains preparatory courses, focus on sciences, public health, nursing research and clinical training. A nurse with a bachelors degree need an additional between 500 to 700 clinical hours that is supervised and a masters degree to qualify as a nurse practitioner (Garcia, 2011).

Increased demand for healthcare

According to Institute of Medicine report of 2010, it is expected that millions of patients will access health services as per the affordable care act by the federal government. Practicing nurse should therefore be well equipped and take the lead in giving that care. Because the roles they play and their ability to take charge of a clinic without the supervision of a doctor. This IOM report of 2010 also serves as the direction that guides nursing profession. The foundation by Robert Wood Johnson indicates that nurse need to have a more strong educational base in order to advance their case for more clinical authority. Nurse practitioners need proper understanding of pathophysiology, physical assessment as well as pharmacology. This will be of great help to them as they diagnose diseases and prescribe drugs especially with the current shortage of physicians to take part in primary care and treat the growing population of newly insured persons. In addition to the current population growth characterized with more aging patients, finding a practitioner has been challenge.

Research has revealed that only close to 25% of graduates from medical schools join careers in primary care as physicians. The state laws governing scope of practice have also placed limits in regard to the clinical boundaries for nurse practitioners; most of them provide primary care in a number of settings. American Medical Association has shown full support for the law on scope of practice indicating the need to promote patient safety and ensure APRNs always provide primary care under the supervision of a physician. Nursing advocates however, are greatly opposed to these restrictions especially in regards to the limit on drug prescription. This is consistent with the IOM report which recommends that nurses need to be given freedom to practice to the extent of their training and education (Iglehart, 2013).

American medical association indicates that some states including District of Colombia permit APRNS to diagnose and treat patients. They are also authorized to prescribe medication and refer patients even without supervision by a physician, some states require that physicians are involved when the nurses diagnose, prescribe and treat patients. Many nurse practitioners view lack of permission to prescribe drugs as the main impediment that bar them from efficient care delivery. The truth is that for a healthcare professional to safely prescribe and administer drug, it is important that one fully understand disease pathophysiology, drug pharmacology and possess physical assessment skills for proper clinical diagnosis. Despite the rapid growth of physicians than the  population in the U.S  for over 30m years ago, it has been estimated that the nation is likely to face a shortage of close to 62,100, physicians, 33100 Primary care providers and 29000 of other specialist. Nurse practitioners are scarce in a number of areas, an issue that has been influenced by that fact that there is an equal distribution of nurse practitioners and physicians who are mainly concentrated in sub urban and urban areas thus leaving rural areas remain with a few practitioners yet these are the places that most often need medical help (Tornyay, 2008).

Cultural competence in nursing

Cultural competency in care is a nursing practice that is keen to issues that relate to culture, gender, race and sexual orientation. In this process the nurse aims to achieve the capability to effectively provide service in an environment with diverse cultural background. A cultural competence model as proposed by Camphinha-Bacote encompasses cultural knowledge, cultural encounters, cultural skills and awareness. In cultural awareness, the nurse recognizes, and develops interest on beliefs, values, life practices as well as problem solving modalities of other cultures. Cultural awareness helps the nurse to recognize the disparity between their culture and that of their patient’s hence devising appropriate approach to patient diagnosis and care. Cultural knowledge on the other hand is the process of seeking and obtaining education concerning various world views on different cultures (Chaloner, 2003).

This knowledge can help nurses to familiarize with ethnically diverse groups, practices, belief, world views and the strategies for problem solving. This knowledge can be obtained by reading literature on different cultures and participation in continuing education courses about cultural competence as well as attending conferences on the same. Cultural skill also a crucial part of the model helps a nurse to perform a better cultural assessment. This may help a nurse to adequately assess patient’s cultural values. Cultural encounter is concerned with participation within cross-cultural interactions with people who have different cultural backgrounds. These cultural encounters become important when dealing with patients for it helps to avoid stereotyping (A model of care for cultural competence. (n.d.).


Currently, Nurse practitioners have shown the ability to effectively deliver high quality healthcare services at low cost. Base on their high level of training and skills, and their ability to take charge of a clinic without supervision by a physician, Nurse practitioners need to have deep understanding of pathophysiology, physical assessment as well as pharmacology in order to enable them deliver services in a safer manner. This knowledge will enhance their diagnosis, prescription and patient care competence. This is unlike registered nurses who have to work under a physician mainly in patient care and education; they don’t need to have a deep understand of pharmacology, physical assessment and pathophysiology. It is also important to point out the important of cultural competence for proper service delivery in healthcare.


Iglehart, J. (2013). Expanding the Role of Advanced Nurse Practitioners — Risks and Rewards. New England Journal of Medicine, 1935-1941.

Nurse Practitioners: Shaping the Future of Health Care. (n.d.). Retrieved November 24, 2014, from

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Tornyay, R. (2008). Making Room in the Clinic: Nurse Practitioners and the Evolution of Modern Health Care. Archives of Pediatrics and Adolescent Medicine, 1093-1093.

An Expanding Role for Nurse Practitioners. (n.d.). Retrieved November 24, 2014, from

A model of care for cultural competence. (n.d.). Retrieved November 24, 2014, from

Chaloner, C. (2003). Ethics, Power and Policy The Future of Nursing in the NHS Ethics, Power and Policy The Future of Nursing in the NHS. Nursing Standard, 29-29.

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Garcia, A. (2011). The Future of Nursing: An Introduction to the Institute of Medicine’s 2010 Report. NASN School Nurse, 116-120.

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