Dr. Nurse

This is a paper I wrote a couple of years ago on the history and implications of the DNP.

Dr. Nurse:

Development and Implications of the Clinical Nursing Doctorate

In 2004, the American Association of Colleges of Nursing (AACN) endorsed the Doctorate of Nursing Practice (DNP) degree for entry into advanced practice nursing with full implementation by the year 2015 (Montoya & Kimball, 2007). The decision prompted debate among nurses, physicians, allied health professionals, and consumers concerning the need and usefulness of this clinical doctorate (Chase & Pruitt, 2006). Issues in question include scope of practice, role in healthcare education, economic implications, and impact on the healthcare system. The DNP is a natural progression of the nursing profession allows nurses to attain professional parity, improve patient care based on evidenced based practice and specialization, and influence policy for the enhancement of systems and organizations.

The first clinical doctorate for nurses was developed by Case Western University in 1979 in response to a desire for an advanced clinically focused degree (Royeen & Lavin, 2007). Prior to this time, nurses seeking a higher level of education were limited to research-focused doctor of philosophy (PhD) programs or educational doctorate (EdD). Following Case Western’s example, other universities across the United Sates began to form their own clinical doctorate program, but the degrees varied widely in both curriculum and title. One of the goals of the AACN is to transition the present clinical doctorate programs to the DNP, which allows for a clearly defined curriculum requirements and basis for scope of practice (AACN, 2006).

Another goal of the DNP is to answer the growing trend in other healthcare disciplines that offer or require a clinical doctorate for entry to practice. Established professional doctorates include medical (MD), veterinary (DVM), and dental (DDS). In the past decade, audiologists, nutritionists, occupational therapists, and physical therapists have adopted the clinical doctorate. Laboratory science, nuclear medicine, and physician assistant programs are in development (Royeen & Lavin, 2007). The DNP credential provides professional parity that allows for improved interprofessional communication and collaboration among doctors, psychologists, pharmacists, and other doctoral prepared healthcare professionals.

Several of the AACN goals concern improvement of patient care both through the individual practitioner and system delivery (AACN, 2006). Professionals and consumers are not satisfied to accept tradition as a rational for performing duties. Evidenced based practice, health promotion, development of health care policy for patient advocacy, and transforming healthcare delivery systems through patient care technology and systems are areas in which the DNP serves to improve patient health and outcomes. Clinical expertise in assessment, categorization of disease, and treatment strategy is gained through clinical practice (Burman, Stepans, & Jansa, 2002). This knowledge and experience can be used to evaluate and improve on existing organizational structures and system thinking.

The DNP fills a number of needs that have appeared as a result of a changing healthcare system and population shifts. Longer life spans require healthcare providers to manage multiple and complex illnesses with cultural competence, interdisciplinary collaboration, and advanced knowledge of informatics (Royeen & Lavin, 2007). The DNP graduate in private or collaborative practice as a nurse practitioner is a cost-effective solution to the current shortage in primary care left by physicians moving toward highly specialized and acute clinical areas offering higher levels of reimbursement (Montoya & Kimball, 2007). Consumer knowledge and access to information demands well-educated clinicians current with pharmaceuticals, testing, and medical procedures. In their investigation of clinical decision making with nurse practitioners, Burman, Stephans, Jansa, and Steiner (2002), reveled a tendency to rely on intuition more than scientific method and evidenced based practice in assessment, diagnosis, and treatment of clients. The additional exposure to evidenced based practice that the DNP offers to advanced practice prepares nurses for client inquiry and rational for decision-making. Increased sophistication of technology and expansion of knowledge creates a divide between knowledge and practice that may be rectified by DNP graduates in the role of clinical nurse educators (Montoya & Kimball, 2007). Demands for change in the operation of the healthcare system require policy changes in individual units and hospitals as well as on state and national political levels. DNP graduates with a focus in administration are positioned to influence change due to their direct daily interactions within these systems and knowledge of theories central to and outside of nursing practice.

Proponents of adoption of the DNP as an entry to advanced practice nursing site professional parity and interdisciplinary collaboration, improved competence, and broader base of knowledge, and skills as advantages (Royeen & Lavin, 2007). It is in the interest of the nursing profession to provide advanced clinical preparation in light of the increasing number of healthcare practice doctorates adopting this strategy. It prepares the advanced practice nurse for leadership in the field through experience, brings expert clinicians to education, and provides an alternative to research and educational based doctorates for those that wish to continue in direct care. The hallmark of the DNP is specialization within the larger domain of nursing practice, making the transition from a general practice RN to a specialized DNP a natural progression (AACN, 2006).

Opponents observe this degree does not expand the practice role and increases the current shortage in nursing education due to lack of faculty trained in clinical doctorate teaching (Chase & Pruitt, 2006). Many regard the DNP as a self-serving educational inflation that is expensive without equitable compensation (Royeen & Lavin, 2007). Additionally, the use of the initials DNP imply that the graduate is a nurse practitioner and a title inclusive of education and leadership roles should be adopted. The American Medical Association (AMA) has voiced concern over clinical doctorates in relation to patient confusion, safety and trust. The AMA suggests the DNP is misleading for patients and specifically objects use of the terms doctor and resident in the clinical setting for healthcare professionals not related to medicine or osteopathy (AMA, 2006).

Many similar objections were brought forth and overcome during the conceptualization of the pharmacy doctorate (PharmD) prior to the adoption of the degree as an entry to practice (Montoya & Kimball, 2007). The current MSN programs require more hours than other masters degrees and the DNP adds a significant amount of didactic and clinical education to the pre-established masters programs. The title granted should match the work accomplished. Recognition of doctoral level work does serve the individual but more importantly makes the public aware of the preparation and dedication required to earn their trust as healthcare professionals. Confusion over initials will wane with consumer education, establishment of one degree name for all nursing clinical doctorates, and identification tags required in most healthcare facilities. The term doctor is not the sole possession of those who practice a particular profession but rather is for the social and professional use of those who attain a certain level of education be it research, education, or practice focused.

There remains a concern within the nursing profession over the use of DNP graduates as a substitute for PhDs in nursing education. The DNP is intended for direct practice in the field and is not designed to prepare a faculty member for an academic career in a research extensive or intensive institution (Royeen & Lavin, 2007). Universities with less of a research focus may find themselves relying on both the DNP and PhD prepared nurses to fill the educational shortage. The DNP graduate may be employed in clinical instruction, institutions with a focus on associate or practical nursing degrees, and practitioner focused DNP programs while PhD gradates would continue to serve in the classroom on a BSN and educational or administrative focused DNP. Delineation of teaching duties will likely be resolved on an institutional level with ongoing debate over which degree produces the superior educator.

The research article used in the discussion of nurse practitioner practice was a qualitative design using a constant comparative analysis method (Burman, Stephans, Jansa, & Steiner, 2002). According to the levels of evidence recommendations presented in the Nursing 601 lecture, this is a level four design. Evidence was obtained through clinician interview to investigate clinical decision-making and resulted in a grade B recommendation.

          Change in established institutions does not come without conflict both from within and outside of the system in transition, and the adoption of the DNP is no exception. The nursing profession must progress to remain relevant in an evolving healthcare system. The DNP allows advanced practice nurses to develop expertise in clinical practice, education, and administration, which will provide professional parity and patient confidence not only in title, but also in competence.

References

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved August 23, 2008, from http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf

American Medical Association (AMA). (2006). Resolution 211 (A-06): Need to expose and counter nurse doctoral programs (NDP) misrepresentation. Retrieved September 2, 2008, from http://www.pacnp.org/files/resolution__211_-_nursing_doctorate.pdf

Burman, M. E., Stepans, M. B., Jansa, N., Steiner, S. (2002). How do NPs make clinical decisions? [Electronic version]. Nurse Practitioner, 27(5), 57-64.

Chase, S. K., & Pruitt, R. H. (2006). The practice doctorate: Innovation or disruption? [Electronic version]. Journal of Nursing Education, 45(5), 155-162.

Montoya, I. D., & Kimball, O. M. (2007). Marketing Clinical Doctorate Programs [Electronic version]. Journal of Allied Health, 36(2), 107-112.

Royeen, C., & Lavin, M. A. (2007). A contextual and logical analysis of the clinical doctorate for health practitioners: Dilemma, delusion, or de facto? [Electronic version]. Journal of Allied Health, 36(2), 101-106.

The Motherload

This was the first week where all of the classes had readings and a post, test, or quiz due. Yaoza! Here is a rundown of the assignments so those reading can get an idea of what 14-credit-hours in a DNP program wants from your brain:

Epidemiology:

Chapters five, six, and eighteen - about 70 pages

Additional readings (ACS and CDC reports - another 30 pages)

About 30 homework questions

Blackboard discussion

Quiz (4-hour time limit)

Biological Treatments of Psychiatric Disorders

Stahl chapters one through four - 122 pages

Pliska chapter seven - 20 pages

Discussion board posts on chapter reading

BioStatistics

2 chapters - 60 pages

Webcasts (a little over an hour)

Submit a test question that covers descriptive statistics

Complete review questions

Test 1

Interviewing and Counseling

Chapter three - 20 pages

Descriptive Log

Philosophy of Science

Read "A Briefer History of Time"

Chapter 1

Essay quiz submission

And this week was my first, and hopefully only, official goof. In his mercy. my bioethics teacher let me turn in my question a day late because I neglected to see Friday, not Sunday was the due date. I was not the only culprit and he sent our an email that sufficiently chastised me to the point where I already have the assignment for next week completed. The great news is, I got 100 on my test - doing the review questions does pay off . . .

. . . unlike in epidemiology where I bombed the quiz and lowered my grade to a B. Lovely. Next week is the midterm and there is supposed to be 10 points extra credit. I imagine the credit will be as impossible to get as her normal test questions. I would not mind doing so badly if I could understand the rational for asking some of the questions (seriously, 20% of it came from the book and a bunch had unnecessary word-play that had nothing to do with understanding the material . . . and having taken MSN board exams, those questions do test you understanding, not your test-taking ability!) and get an explanation of the answers. Alas, it is sink or swim. If I ever needed validation I am not cut out for public health, it was this week.

And yes, I am behind on the reading. This week has been nuts in many ways and I have come to the realization I have to budget in more study time and take less patients. Thankfully I have all Labor Day to labor away and catch up!

"The More Things Change, The More They Stay The Same"

10 points if you can name the movie and character (hint: call me snake!)

After completing the assigned reading on interpersonal communication and attending an excellent presentation on lateral violence today, I am in a revolution kind of mood.

Nurses have been burying their mistakes since the first report on deficits in nursing education came out in the 1800's. Not only was nothing changed, but they refused to publish the reports! Fast-forward to present and we see every excuse in the book to maintain the status quo in professional conduct and portrayal in pop-culture. So here are my top three contributors to enduring stagnation within the nursing profession.*

"Nurses eat their young"

Ahh, the mantra for new grads since Flo hung up her cape. I heard it multiple times in undergrad and unfortunately experienced in my first nursing job. While everyone acknowledges this is a detrimental and pointless hazing culture, little is done to curtail the nastiness because "that is just the way it is and you need to adapt to the aggressor rather than make the aggressor change their attitude." People are allowed to perpetuate workplace hostility because as a whole, nurses would rather gossip then confront. We are also quick to judge and slow to forgive and, if ever, forget. Nearly half of all new nurses in my area quit nursing in the first year because of "mean girls." Sometimes they switch units and sometimes they leave the field entirely. Catty, punitive, and passive-aggressive behavior contribute to the barriers we encounter to being regarded as a professional and not a skilled laborer.

Over-theoried, Under-practiced

I have heard it, seen it, and believe it: Diploma nurses were the best nurses. They knew how to be nurses when they got out of nursing school - none of this "I can't wait to graduate so I can get out and learn to be a nurse." From stories I have heard them tell, they had their own set of issues, but they were competent in delivery of care and pioneered the way to advanced practice education. Ah, advanced PRACTICE, implies there should be some basic practice, right? Practice is based on knowledge and I am seeing a dangerous dumbing-down of nursing programs with reductions in overall clinical hours. Hard laboratory sciences need to stay in the nursing curriculums and not be replaced with so-called health care versions like statistics-lite or mini-microbiology or chemistry-concepts. Spending more time in the classroom talking about care, but not really in the trenches performing it does not breed confidence or competence. Great, you can pass the NCLEX, but now that you are a licensed public servant, all you have is a pocket full of skills and a hope that you will have a competent preceptor and supportive work environment.

The advanced practice nurses with DNPs throwing "I am a doctor" around does nothing to gain allies and just kicks up the dander of the AMA. Their argument that we do not have a residency or solid science grounding is pretty laughable when you look reports demonstrating increased patient satisfaction, decreased prescriptions for controlled-substance prescription, and equivocal outcomes. But when we start lowering academic expectations, decrease hands-on hours, and allow advanced practice nursing students to avoid clinical practice as an RN, we start supporting the contentions of the opposition.

If We Are So Trusted, How Come No One Knows What We Really Do?

Every year, nurses are consistently the #1 or #2 most trusted profession in the US, but the perception is still that we function as the arm of an MD or are little angles of mercy. Great nurses are often asked "why didn't you go to medical school?" as if being an ARNP is something less than an MD. I have seen it on numerous medical shows where the "sharp nurse" decides to go to medical school while the very notion of nurse practitioner school is not even addressed. I will not get into the various stereotypes or complete lack of nursing role in some of these shows, but we have all seen them and cringed.

The public does not understand that the focus of medicine is to treat diseases after it happens while the focus of nursing it to prevent disease by promoting healthy behaviors. In parent terms, we are the ones that say "I will give you until the count of 3" and the MDs are the ones who enact the discipline. We are not served by having collaborative or affiliation agreements with MDs instead of seasoned NPs who actually practice the same form of health care. Psychiatrists do not oversee psychologists or social workers, orthopedists do not oversee physical therapists or chiropractors, and pulmonologists do not supervise respiratory therapists, yet nursing is forced to perpetuate the handmaiden role.

And that's my Rant!

* Subject to change without notice

First "Real" Quiz

Technically, this was the second quiz, but the first one was a "do you understand the syllabus" gimmie, so I do not count it. Thankfully the points counted since my performance on this exam leave much room for improvement.

I managed to over-read a few questions and under-read the directions. After discussing these exact traps with my BSN students yesterday, I feel served, schooled, and paid back!

I sent the professor an e-mail to get some clarification on a couple of questions so I do not fall behind the curve, and a few hours later there appeared an announcement on Blackboard saying emails would be answered publicly after everyone had completed the quiz. I hope this means I am not the only one/one of the few with questions or I am going to feel like a real dunce.

Now that I have a feel for the question style, I hope to ace the rest of these for the duration . . . or at least get the 10 points of extra credit at mid-term.

****Update****

After analysis of the questions, a boon was granted on a couple of questions that had double negatives and caused over half the class to pick the correct-wrong answer. I was one of those and I got back a point - happy day!

Discussion Board Mishap

As a hippy roasted-nut vendor at an art show told me once, "the problem with people today is they rely on 2-D communication." She then want on to talk about extra-terrestrials, but that is besides the point. We may have come a long way in the speed of communication both through technology and decreasing formality, but we are a long way from the eloquent and specific speech used in great letter writers like John and Abigail Adams or Henry James or Horace Walpole.

This is my pedantic way of saying my humor does not translate well in print! I put up several thoughts about mortality including, as a punch-line, "what SHOULD we die from?"and was essentially cautioned about the dangers of ignorance and dropping the ball on health promoting and disease prevention practices. I suppose my delivery made me sound flippant about death and disease.

Ooops.

Things I Love About Memphis

I posted a list of links on the right of places I loved on my first real trip to Memphis.

Rachel's Salon and Spa: An Aveada salon. I spied it out of the corner of my eye as I was getting off the trolly stop on Main. I had a fabulous reflexology session on Thursday and amazing facial on Friday. It is not fru-fru at all and the staff is awesome. My therapist was Tawnie (I think) and she was excellent! The receptionist remembered me, was extremely friendly, and pointed me in the direction of my first authentic Tennessee BBQ. I will be a repeat customer!

Rendezvous BBQ: You know when you have to walk down a back ally and you can smell it a block before you get there, the cooking must be something! I grabbed some takeout of brisket and ribs that there was no way I could polish off. I also got a tip from the bartender about reveling my Kentucky ties - the Caliperi effect is alive and well!

Felicia Suzanne's: The fact these folks carry Pierre Ferrand Cognac, Citadelle Gin, and Matildacordials already puts these guys at an advantage. I ate a small dinner at the bar with a delicious blueberry-pear side car, organic chicken crepes, and a french toast dessert with ice cream, walnuts, and other delights. Yum.

McEwens: How can anyone resist a plate of heirloom tomatoes and mozzarella followed by flank steak and potatoes? A great combo of small plates, although the bar was rather limited. I look forward to the next try - their seafood menu looks awesome.

Orientation Week: Day Five

Another lovely 7am Interview and Concealing class - I am so happy we ran out of time for the planned exercises because I slept less than 3 hours that night. The big assignment coming up is recording a conversation using empathy and additive empathy. I really want to do this with a non-patient stranger rather than with someone I know.

The next class is another one that should have been optional. I knew I should not have walked in the door when I saw the powerpoint involved dressing for success, but like a chump, I rush to the front of the room thinking, surely this is not the full presentation. It was. Despite the fact everyone had to speak and dress well to make it through the interview, I guess they felt we all needed a brush up. Here are some highlights from the "rules" we went over:

- Wear a suit with a jacket that buttons

- No jewels after five

- Bread plate on the left, drink on the right

- Wear nail polish

- Do not eat until everyone sits at the table

- Shake with your right

- Get your hair done

- Wear your name tag on the right

- Wear make-up

I am not kidding.

The presenter was jovial, and we actually have the introvert personality in common. The most illuminating tidbit was the guidance on 15 second sound-bites if interviewed and having a collection of them that are clear, concise, and well practiced in the mirror. There! One lesson learned! One thing I love about attending a school in the real south, is that no one grumbled. They just smiled and left class.

And so orientation ends and I am off to home!

Orientation Week: Day Four

The morning started with a speech from our Distinguished Visiting Professor, Diana J Mason from Hunter College. We used her book during our Health Policy class in the MSN program at Bellarmine, so it was great to hear the author's voice. The bulk of the presentation concerned the role of the nurse in reforming health care. I feel I have been beaten over the head with health care reform enough. While it is true nurses play an important role in the restructuring of our healthcare system, this reform bill discourages nurse entrepreneurship through increasing regulation and taxation on small businesses (even those that are not healthcare-based!).

Here is a mix of things that ran through my head during the presentation (this is not inclusive, I wrote several pages of thoughts on this):

Primary Care Physicians assume they have the skills to be primary care providers – they specialize in diagnosis and treatment of disease, but not health promotion and disease prevention as part of care coordination. They also assume they have the qualifications to supervise DNPs! WE ARE NOT THE SAME PROFESSION!

Contrary to the contention that DNP's are not qualified to stand side by side with primary care MDs because we do not have a residency, we do have to proper education and clinical training that matches our scope of practice. Rather than front loading our programs with didactic work and coming out of medical school with little true patient time and responsbility, nurses have an integrated residency model that combines didatic and clinical work starteing the sophmore year at the BSN level. In fact, for many years one could graduate with their MD and do NO residency as long as they stuck to primary care and not a specialization. And guess what - those folks are grandfathered in to the states who finally decided to make residency a requirement for medical practice. It is worth reiterating ADVANCE PRATICE NURSES ARE NOT PRETENDING TO BE DOCTORS NOR ARE WE PHYSICIAN EXTENDERS! We are not "nurses with a little extra training" and we can do more than put a bandage on a wound and prescribe a Z-pack. We are our own profession with our own role in primary care that works with, not against physicians.

Why don't advanced practice practitioners train together in some type of integrated clinical experience? Good communication and collaboration can only benefit the patient and the various professions.

Another student gave a speech that I have said many times. MDs did not have a problem when Dentists, Podiatrists, Psychologists, Physical Therapists, Naturopaths, and Chiropractors encroached on the "Doctor" title that MDs commandeered as their own (despite the fact all of these are practice, not research doctorates). Why pick on the DNP?

“Communication is how we change things” I used to think just because you change the name of something doesn’t mean you change the perception. Changing nursing home to health home, patient to client (and probably coming soon, customer), noncompliant to noncoalescent does not change the facts that the home is under-funded and depressing, the person is seeking healthcare, and the person is not doing what you prescribed. On the other hand, I also believe “language is how we view the world” and that view can be altered if we change what we call it, though I do not believe the actual fact can. I hope.

After the conference, I realized I needed to get my butt in gear and join the APNA, especially since their conference is in Louisville this year and I have a clinical group on Friday that could benefit from viewing the poster sessions.

We had yet another training in the afternoon. I have been using Blackboard for nearly 10 years now, and while I am not perfect, I did not learn anything new. All of these sessions really seemed targeted at learning the basics of the software and I wish that had made these sessions voluntary. In the meantime, I did set up my NAMI walk page, so it was not a total waste of time! Check out the Stigma Stampers team by clicking HERE.

The day ended with a gathering of all of us in the psych track and going over the timeline of clinical and requirements for the next 2 years. am so excited that I will have an opportunity to work with some of my mentors and that I am not strictly limited to MD and ARNP preceptors. This program really fosters learning, not just jumping through many of the usual arbitrary nursing hoops and red tape "because that's the way it is done, dear."

***If anyone is interested in a copy of Dr. Mason's lecture notes, let me know and I can forward a copy***

Orientation Week: Day Three

Having a 7am class on the schedule felt like hazing, however it was Interview and Counseling so at least I enjoyed it. We discussed reflective practice and methods to look back on interactions and improve them. It is interesting how vividly I remember the times I screwed up, especially when I first started as a nurse. Assumptions about how the patient perceives you can lead to postures, humor, or subjects that the patient finds offensive resulting in unforeseen escalations.

Biostatistics was up next, and what an amazing relief. From the syllabus, it looked like this was a rehash of the social stats class I took last year which is both good and bad. Apparently the teacher before him was a beast, but this guy is hilarious. He wants to take the scary out of statistics, but primarily, "the most important thing is by the end of the course, you love me." I am going to adapt a lot of his material if I get to teach a class at Bellarmine this year. When I found out he used to be an actor, it made sense that his style seemed similar to the way I instruct.

Last class of the day was Philosophy of Science. I admit that I have serious math envy and had already read a good chunk of Hawking before class. I would have loved to have been a philosopher if there was anyway to pay the mortgage by sitting around and thinking all day! I started working on the first essay assignment discussing space-time and defining several terms; if I actually submit what I think I am going to submit, my instructor is going to think I am either a real thinker, an idiot, or a wack-job.

Orientation Week: Day Two

We had a lot of tech-style orientation this morning – reviewing Office 2007 products (guess it is time to purchase the update!) and getting our laptops connected to the UTHSC system. I had a lovely afternoon break and hit the hotel gym. Unfortunately, the afternoon shower does nothing to stop me from pouring sweat on trolley back to school. The Memphis humidity is sneaky – unlike Louisville where you immediately can’t breath and feel ten ponds heavier when you walk outside, here you actually think it is bearable for a few minutes.

Next up, Epidemiology. This will undoubtedly be my challenge class because I want to “yes, but” nearly everything.

Take pertussis. The number of cases has risen by the thousands in the past several years and they are now recommending booster shots for pre-teens. If it is true the immunity wanes over the course of a few years, it has been doing so for decades. The rise in cases is recent and more likely do to lack of initial vaccination, not lack of a booster. I keep thinking about a lecture I hears a few years ago by an epidemiologist who is studying the link between the rise of auto-immune disease and preventative care measures like vaccines and anti-bacterial everything. Her arguments were compelling and I am putting it on the list of topics to re-research during the program.

After listening to the lecture, I have every confidence that the end results of epidemiologic study will lead to the following recommendations:

Balanced nutritional packets tailored to the individual as the dole means of nourishment (think the Matrix: “everything the body needs”)

Procreation via Petri-dish based on genetic optimization (See Heinlein’s “Beyond this Horizon”)

Mandatory vaccination, 6-month-breastfeeding, and exercise programs (funny that a lot of folks who are passionate about breastfeeding are wary of childhood vaccines)

Strict lights-out and wake-up-call policy by time zone (“ealy to bed, early to rise, makes men healthy, happy, and wise)

Motion-detection automatic UV-light sanitation systems installed in every home

Uniforms and job assignments by aptitude

Or, as explained in Escape from LA:

Snake Plissken: Got a smoke?

Malloy: The United States is a non-smoking nation! No smoking, no drugs, no alcohol, no women - unless you're married - no foul language, no red meat!

Snake Plissken: [sarcastic] Land of the free.

Our professor is enthusiastic about her field and passionate about the wellbeing of the population. I am defiantly a individual and small-group focused practitioner, so my brain is going to get a good stretch in this class.

Last up of the day was my meat and potatoes class (or 30/30/40 if anyone is designing my nutritional regimen supplement) – Biological Treatment for Psychiatric Disorders. This was the smallest class and the first time we were able to have more personal introductions. We are a diverse bunch with varied backgrounds within the psych specialty. Some are in the second year of the 3-year post BSN-DNP, some are like me who have an NP degree and are working on their Psych Mental Health Certification with the DNP, and others are post MSN or CNL/CNS. Interests range from incorporating psych into their current adult/child/acute/family practice to further specialization in psych as a clinician.

Our first lecture discussed trauma as an origin for many of the over or misdiagnosed mental illnesses in childhood and a review of CNS responses to stress. I have so many new exciting things to share with my students this fall after just one lecture!

I also had that woo-woo feeling of “I am exactly where I need to be and doing what I am supposed to do.” I had that feeling over 10 years ago while driving back from the mountains in Santa Fe after the first week of my graduate program in Chinese Medicine. I love it when I get "signs" that don’t bonk me in the head!

Orientation Week: Day One

I flew into Memphis and cabbed it over to school just in time to sit through your usual school orientation - welcome, student assistance, health services, code of conduct, equality and diversity, honor code, campus safety, academic support, student panel - most of it was useful but much of it geared to the on-campus student. We got a free lunch (TNSTAAFL) and I snuck out to check into my hotel.

Since I hate driving, I decided to rely on public transport and take the trolly everywhere. I had initially intended on walking since my hotel is only a mile away, however the terrain is not conducive to a walk in triple digit temperatures. That, and when I asked some of the staff about walking there, bot said "this is Memphis, you know." Point taken.

The afternoon session began our first class, Interviewing and Counseling. This is the stuff I came for! We start with a "what would you say to this patient" exercise and I think years of teaching nurse-client interaction has made me a reflection junkie. We partnered up and recorded ourselves interview the other person and practicing empathy skills. I did not cringe at the sound of my own voice on playback and overall I did pretty well while identifying some areas I need to improve on. The class ended with a fabulous partitioner-patient communication demo by our instructor.

After preaching all last semester to my Nurse-Client Interaction students that there is not a script for perfect communication, it was nice to get validation from an instructor outside of Bellarmine. While I have been over lot of this material before, this was more of an advanced version. For example, I always thought the technique of echoing was a little creepy:

Patient: I feel sad.

Practitioner: You feel sad?

Sounds like you are just talking to talk or to prove you are listening. The "advanced" version is rephrasing with inference and a boatload of new emotional descriptions:

Practitioner: What I am hearing you say is you are discouraged and unappreciated because you have been working to have your family eat dinner together but no one wants to participate. That makes you want to stop trying and makes you feel like a failure.

Somehow therapeutic, somehow spooky in a fortune-teller sort of way! It is great to see that for as much as I know (or think I know), I have a good foundation on witch to refine and grow as a communicator.

The most interesting tidbit of the day came from the "Feeling Word Vocabulary" handout that classifies emotions into 5 categories with 3 levels of intensity. These link up nicely with the 5-Element emotions in TCM:

Happy - Heart

Scared - Kidney

Confusion - Spleen

Sad - Lungs

Angry - Liver

I keep thinking about a concept I learned in bioethics - language shapes the way we view the world. By and large I believe this to be true. Total number of words versus common and colloquial word usage between different languages is fascinating, especially when you come across those "it really isn't translatable in English" hurdles. In looking at this list, which is by no means comprehensive, there are dozens of ways to describe "happy" in English and I wonder if there is any correlation between knowledge/use of emotional descriptors and emotional contentment (i.e.. if you can specifically describe your feelings, does it aid your ability to set goals, feel secure, or pull out of unwanted emotions as opposed to someone who is vaguely or generally happy, sad, or angry?).

Bottom line - I am excited about this program and the upcoming changes in myself as both a clinician and a person.