Medical Model vs Nursing Model

[AnnoyedByFreud]

I agree with the previous post, but I just wanted to say that sinus tach can decrease CO if the ventricles aren't filling... which I think is what RnMD007 was alluding to, though it's hard to tell, since nursing diagnoses are convoluted and overly wordy.

I really agree with the idea that no matter what type of health professional you become (MD, PA, NP, whatever), you can be as highly educated/trained as you want. I know a lot of med students who don't go to lecture and teach themselves, for example. You can buy the books and put in the time to learn it all. I am particularly interested in being really strong in endo and neuro, since those relate to my specialty, so I'm learning it. When you're in practice, it's your responsibility to keep up on the research and knowledge for the sake of your patients, regardless of what type of provider you are.

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[sarjasy]

I agree with the previous post, but I just wanted to say that sinus tach can decrease CO if the ventricles aren't filling...

Decreased ventricular filling typically does not occur until HR reaches 150 BPM or more, in which case it begins to fall outside the definition sinus tach and is more likely something like PSVT, afib w/RVR, etc. CO = HR x SV, therefore increased HR increases CO until you reach the point where ventricular filling begins to drop and CO drops along with it (all else being equal). However, because CO = HR x SV, even in light of decreased ventricular filling, increasing HR can still maintain or even increase CO. My point was that her nursing diagnosis claims that decreased stroke volume is "evidenced by" tachycardia. Tachycardia is not inherently "evidence" for decreased SV, as sinus tach is a "normal" physiological response to increased oxygen demand in which the body responds by increasing CO via increased rate.

 

[AnnoyedByFreud]

Decreased ventricular filling typically does not occur until HR reaches 150 BPM or more, in which case it begins to fall outside the definition sinus tach and is more likely something like PSVT, afib w/RVR, etc. CO = HR x SV, therefore increased HR increases CO until you reach the point where ventricular filling begins to drop and CO drops along with it (all else being equal). However, because CO = HR x SV, even in light of decreased ventricular filling, increasing HR can still maintain or even increase CO. My point was that her nursing diagnosis claims that decreased stroke volume is "evidenced by" tachycardia. Tachycardia is not inherently "evidence" for decreased SV, as sinus tach is a "normal" physiological response to increased oxygen demand in which the body responds by increasing CO via increased rate.

Yes I already know that - my point is that she was likely trying to get at the idea that tachycardia can lead to decreased ventricular filling = lower CO, but since nursing diagnoses are so cumbersome, it didn't make sense.

 

[Isha2018]

If a nurse wants to learn the absolute most about medicine, obtaining a MD/DO seems to me to be the logical step.

I have been a nurse for 8 years, and I look forward to entering medical school this next July.

I completely agree that NANDA diagnoses are a bunch of crap, especially when documenting! I remember filling out seemingly endless nursing care plans for my BSN, and I really believe the care plans were not very useful for actual clinical practice.

I love the holistic principles in the nursing model of care, but I am ready to expand my horizons. By becoming a PA or NP, I fear I would be bored or not challenged enough in the future. When I'm 45, I don't want to think: 'Hey, I have not tapped my potential fully and now I'm a mid-level practitioner instead of a physician.'

 

[Isha2018]

I agree with the previous post, but I just wanted to say that sinus tach can decrease CO if the ventricles aren't filling... which I think is what RnMD007 was alluding to, though it's hard to tell, since nursing diagnoses are convoluted and overly wordy.

I really agree with the idea that no matter what type of health professional you become (MD, PA, NP, whatever), you can be as highly educated/trained as you want. I know a lot of med students who don't go to lecture and teach themselves, for example. You can buy the books and put in the time to learn it all. I am particularly interested in being really strong in endo and neuro, since those relate to my specialty, so I'm learning it. When you're in practice, it's your responsibility to keep up on the research and knowledge for the sake of your patients, regardless of what type of provider you are.

I agree that an individual can become as highly trained/skilled as possible. However, a highly skilled LIP/mid-level provider cannot generally practice at the level of a licensed physician, nor receive the same high level of compensation and recognition.

 

[Isha2018]

Nursing is an art and science and based on countless feedback, I have mastered the art.

Wow! I've been a nurse for 8 years, and I haven't mastered the art yet! That's a bold statement to make.

However, I do pray before each shift that I do no harm to my pts.

 

[deleted6669]

Wow! I've been a nurse for 8 years, and I haven't mastered the art yet! That's a bold statement to make.

However, I do pray before each shift that I do no harm to my pts.

27 years here and same prayer every day....

 

[Dejavu]

Having been an RN, a CRNA, and now a physician, here is my take on the original question; Nursing vs Medical models.

In medical school and residency the focus is taking a pt with a given set of signs and symptoms by taking a history, doing an exam, generating a list of what this could possibly be (the differential diagnosis), deciding what tests and exams would help sort it out, ordering them, looking at the results and then narrowing the differential down to arrive at what the pt probably has wrong with them. Then you learn to order what treatments have been shown to work. This process is done over and over and over again in Med School and residency.

My nursing education was mostly starting when the diagnosis is already narrowed down and, with an understanding of disease processes, then learning how to carry out the treatments as ordered, with a little TLC thrown in. There was little or no education and practice on deciding what tests are needed and what treatments would be best. For example, what chemotherapy agents need to be used.

That seems to me to be the difference in focus between the Med model and the Nursing model. I am just speaking from my own individual background.