Internal Medicine Family Practice Nurse Clinicians Medical Students

Adapting the Approach: Nurse Clinicians

The case-based approach to educating nurses provides a rich format for analyzing complex problems as well as a structured approach for exploring interventions and patient care outcomes. Indeed the traditional "nursing process" (APIE - Assessment, Planning, Intervention, and Evaluation) is best learned in the context of real life clinical scenarios. The pediatric cases developed for this Bright Futures project should prove very useful to nurses across educational levels (undergraduate, graduate, and continuing education), roles (staff nurse or advanced practice nurse), settings (e.g., clinic/private practice, school, or home health care), and specialty areas (i.e., pediatric, family, psychiatric/mental health, and community). These cases can also be used to foster discussions about interdisciplinary collaboration and case management.

Using a case-based curriculum with nurse clinicians may take many forms. Two groups of learners who will especially benefit from this Bright Futures project are 1) pediatric staff nurses, and 2) pediatric nurse practitioner students.

Although most nurses develop expertise in areas of specialization, such as pediatrics, the staff nurse role is that of a generalist. The Bright Futures cases span developmental ages and stages (infancy through adolescence), address both acute and chronic care needs, and adopt a holistic or biopsychosocial perspective. Thus, this case-based curriculum is ideal for use as an ongoing series for staff development seminars. Prior to each seminar, the nurses would be given information about the "case of the month," along with assigned readings. Seminar discussions would give nurses the opportunity to acquire specific information as well as to examine personal attitudes, to explore barriers versus enhancers to care, and to identify further training needs.

The role of the pediatric nurse practitioner (PNP) is that of a specialist who is licensed to practice in the expanded role. PNP's provide primary health care and manage common health problems or illnesses. Students must complete a rigorous graduate program to acquire the knowledge and skills for advanced practice. Clinical practice management courses for PNP students typically span two or more consecutive semesters and so the Bright Futures cases could be integrated into the classes scheduled for the year. For instance, in preparation for a class on pediatric gastrointestinal (GI) problems, the students would be given the case information on Recurrent Abdominal Pain (RAP), along with the assigned readings. While that seminar discussion would focus on the pertinent health history, physical exam, and laboratory diagnostics specific to RAP, the students would also be learning about related GI conditions and how to work with children experiencing chronic pain. The case-based format gets students much more actively involved in the learning process by fostering critical thinking and problem solving. All of the Bright Futures cases pertain to the standard PNP curriculum, and many of the cases are applicable to other NP specialties (i.e., family nurse practitioners and psychiatric clinical nurse specialists). Ultimately, this case-based curriculum lends itself to involving clinical preceptors in the discussions and thereby narrowing the gap between academia and practice.

In summary, the Bright Futures case-based curriculum is an excellent modality for teaching nurses and nurse practitioners.

Pam Burke, Ph.D., R.N., C.S.-F.N.P., P.N.P.