Concept & Philosophy For APN Highest level-Quality Clinical Ca.docx

Concept & Philosophy For APN: Highest level-Quality Clinical
Care
Presented by
Liu Cuan
1
Introduction
Currently undertaking the FNP program;
I also work as a registered nurse;
Vast experience in pediatrician
In this presentation I articulate:
A nursing concept based on providing best quality care
possible;
Concept grounded in Nurse Practitioner Care Model &;
Environmental Nursing Theory
Personal Philosophy; convergence of idealist-realist view

Currently, I am working as as a registered nurse and have had
vast experience in nursing, particularly working with children.
Advanced nursing practice requires utilization of advanced
skills to handle complex clinical tasks. At the center of it all, I
believe that this is achieved by utilizing a nursing concept
targeting provision of the best quality of care possible that
compels or mandates nurses to maximize the use of their
advanced skills.
In this case, in articulating the high-quality nursing concept, I
utilize the the nurse practitioner care model, which is designed
to enhance the provision of high-quality care through a system
that recognizes and enhances the contribution of the nurse
practitioner into the healthcare system
I also utilize environmental theory, which advocates for quality
of environment when caring for patients. Quality environment
can be facilitated through implementation of nurse practitioner
care model (Bahouth, Blum & Simone, 2012).
I also articulate for a personal nursing philosophy that I believe
should be aligned to provision of high quality care.
2
Reason for selecting Nurse Practitioner Care – NPC Model
The NPC Model aims facilitate provision of high quality
clinical care
Aligned to my nursing concept.
The model ensure utmost efficiency in the delivery system.
Cost-effectiveness in the delivery system (Bahouth, Blum
&Simone, 2012).
Clarify the role of nurse practitioners (FNP) in interdisciplinary
healthcare system.

The nurse practitioner care model is designed to enhance the
provision of high-quality care through a system that recognizes
and enhances the contribution of the nurse practitioner into the
healthcare system (Bahouth, Blum & Simone, 2012). Hence, it
is aligned to my nursing concept of the providing highest level
of quality care possible.
The general idea behind the model is that the NP deserves to
work in an environment that can allow them to optimize their
potential in the pursuit of professional objectives.
The advantage of this model lies in applying it in the provision
of long-term holistic care that promotes the healing of a variety
of diseases and different types of patients. Hoslitc care is a
mark of high quality care, as it allows consideration of all
factors affecting a patient health.
Pertinent to the provision of high quality care is the role of the
nurse as the main leverage within the system.
Studies have established that many NPs are hindered from
actualizing their potential because of the structural flaws within
the healthcare sector. The nurse practitioner model is designed
to provide the necessary support on which nurses can rely to
optimize their potential in the sector.
3
Characteristics of the Model
Nurse practitioner care model utilized advanced clinical
judgment.
The model lays emphasis on expert clinical practice (Stewart
&DeNisco, 2013).
The model is distinguished by the element of systems thinking.
Focus is on the provision of evidence-based care at advanced

nurse practice level.
The nurse practitioner care model enhances the capacity of the
NP to provide quality healthcare services in a manner that
accords with standard practice. The utilization of advanced
clinical judgment is considered as a strategy of providing the
best quality care with focus on achieving maximum patient
satisfaction (Stewart & DeNisco, 2013). Another outstanding
advantage of the nurse practitioner care model is the focus on
expert clinical practice as a mark of quality and excellence in
the provision of care. Under this model, NPs are trained in the
art of systems thinking, which is crucial for the enhancement of
quality care within a supportive healthcare environment. The
model lays emphasis on evidence-based practice as an important
factor in the provision of quality care. The relevance of this
model lies in the fact that a well-coordinated environment
allows the NP to deliver quality healthcare in accordance with
the requirements of professionalism at all levels of the system.
4
Characteristics Continued
Consultations take place at intra and inter-professional levels
(Stewart &DeNisco, 2013).
On-going research-based practice for continued improvement of
standards.
Paying attention to the specific needs of a given population.
Provision of leadership basing on clinical, professional and
systems standards.

The nurse practitioner care model encourages consultations at
all levels of the profession in order to broaden the knowledge
base of the practitioner. Consultations usually take place at the
intra and inter-professional levels in a manner that harnesses
diverse knowledge, insights, and skills towards the attainment
of a particular professional task (Stewart & DeNisco, 2013).
In recognition of the dynamic nature of the modern healthcare
environment, this model fosters the system of on-going
research-based practice in all cases.
Knowledge acquisition on some of the dynamic challenges of
the new system is a factor that is crucial for the overall
enhancement of the quality of care.
Moreover the model proposes the need to pay attention to the
specific needs of particular populations. The nature of care that
is provided within provisions of the model is organized in a
manner that gives the NP greater control over the healthcare
processes. The element of professionalism is paramount within
the whole scheme.
5
Characteristics Continued
Collaboration among the members of the multidisciplinary
healthcare team.
Insistence on standard procedures in order to enhance efficiency
(National Institutes of Health, 2015).
Coordination of the care systems to attain higher levels of
efficiency.
Proper utilization of resources to promote efficiency in the
processes.

Under this model, the NP has the duty to establish productive
channels of communication with the physicians and other
healthcare teams in order to engage well with the system at all
levels.
The element of collaboration is an important factor in the
attainment of the interdisciplinary efficiency. Surveys have
shown that healthcare environments that provide elaborate
avenues for the nurses to engage meaningfully with the other
healthcare providers rank highly in terms of overall service
provision (National Institutes of Health, 2015).
An additional way of shoring up the efficiency of processes
entails the insistence on standard procedures as a way of
reducing the operational challenges that often undermine the
objectives of the process.
The NP should be able to contribute fully and at different levels
towards the attainment high quality care at the individual level.
Apart from emphasizing on the need for coordination across the
departments, the system is generally designed in a manner that
promotes the proper utilization of resources.
6
Nightingale’s Environmental Theory
Theory developed by Florence Nightingale (Masters, 2017).
Argues that the quality of the environment crucial for healing.
Argues that the environment could be utilized to enhance
healing.
Warns that unfavorable environments can undermine healing.
According Nightingale’s environmental theory, the element of

nursing is largely dependent on the quality of the environment
(Masters, 2017). Nightingale developed the theory upon the
realization that patients who were nursed in high quality
environments had greater chances of responding well to
treatment compared to those who were nursed in unfavorable
environments.
According to this theory, it is upon the nurse to organize the
environment in a manner that promotes the healing process.
Nightingale’s environmental theory is based on the proposition
that the environment could be utilized in a manner that
promotes healing.
One of the outstanding facts that the theory puts across is that
the process of healing depends on both internal and external
factors.
The external factors that influence the healing process usually
operate at the level of the environment. The theory is usually
applied in a broad sense to imply any other environmental
factors that are directly or indirectly connected to the healing
process.
7
Theory Continued
Nurses and other healthcare workers must demonstrate
competence in sanitation.
The nursing environment should have enough light and water
(Masters, 2017).
The nurse should be keen on environmental factors that
undermine quality care.
Maintaining hygiene should be both personal and shared.
The Nightingale environmental theory emphasizes on the idea of

sanitation as an enabling factor in the provision of quality care.
The theory provides that nurses and other healthcare teams
should focus on ways of enhancing the cleanliness of the
nursing environment as a matter of quality care (Masters, 2017).
Without proper sanitation, the patients within the particular
nursing environment become susceptible to infections and
communicable diseases (Buttaro, Trybulski, Polgar-Bailey &
Sandberg-Cook, 2012). Sufficient supply of light and water are
considered as some of the important measures that are crucial
for providing an ideal nursing environment. This theory is
currently applied to issues that go beyond sanitation to other
factors that combine to enhance the quality of care. The nurse
has the responsibility of ensuring that every detail of the
environment is organized in a manner the promotes healing and
enhances comfort. The quality of the environment is regarded as
one of the factors that determine the level of patient
satisfaction.
8
Theory Application and Selection
Selected because;
It facilitate delivery of quality care;
Focus on external & internal environment;
Applicable in;
Improving nursing environment. This help;
Counter medical errors, as well as, infections;
Enhance recuperation of patient;
Improve patient satisfaction
Nurses are required to put in place measures that ensure that the
nursing environment is quiet and non-threatening. Noisy

healthcare environments can greatly compromise the quality of
care, particularly when the patient’s condition is sensitive and
unstable.
It is in line with this condition that many healthcare centers are
located far from heavy traffic. Drivers are also instructed to
avoid hooting when they approach the vicinity of the healthcare
facility.
Among the work of the nurse is to ensure that no pollutants are
found within the healthcare environment. The Nightingale
theory considers the environment as an important factor of
quality.
The organization of a healthcare environment also contributes
significantly towards the promotion of the quality of care. The
nurse should ensure that all the internal processes within the
healthcare institution are managed in a manner that reduces any
chance of infection or medical errors. Many organizations
usually put in place guidelines of enhancing the quality of the
environment in order to improve the general quality of care
(Masters, 2017).
9
Nursing Philosophy
I am an idealist-realist; What is imaginable can be conceive in
reality;
I envision APRN as a knowledge-based practice;
Capable on providing highest-level of quality care.
APRNs play an important role in the promotion of public health
(Kutzleb, 2015).
Nursing requires commitment and the genuine desire to improve
life’s quality.

My opinion of an Advanced Practice Nurse (APRN) is that of a
highly trained professional who is willing to deploy the full
extent of his professionalism to the improvement of health to
the highest level. This is often conceived as idealism, because
many factors impeding APRN delivery of quality care are
present. Nonetheless, I believe that as long as we can envision
highest quality of care possible, we can come up with strategies
to achieve it. This is where idealism and realism meet.
The main focus of APRN should be on the use of knowledge
and information for the continued improvement of healthcare in
a manner that inclines to the needs of the patients. The
provision of preventive care remains one of the strongest areas
of an Advanced Practice Nurse.
As the modern societies continue to grapple with the challenges
of advanced practice nurse, it has become necessary for
societies to think of healthcare practice as an area that requires
professional commitment and the capacity to engage closely
with the various indicators of healthcare performance.
In many ways, the quality of healthcare is highly dependent on
the manner in which the healthcare providers engage themselves
in the practices that accord with the demands of the populations.
The promotion of public health remains a critical area in the
field of nursing because it requires accurate prediction of the
needs of the clients and high level commitment to the
requirements of professionalism (Roger et al, 2012).
10
Model, Theory, and Philosophy
Nurse Practitioner Care Model

Nightingale Environmental Theory
Nursing Philosophy
In order for the nurse practitioner care model to work
effectively, it must link to an effective theory and a guiding
philosophy on healthcare practice. The combination of the three
elements promotes the utilization of various clinical judgments
in the promotion of healthcare within the community. The
Nightingale environmental theory is appropriate for the
operationalization of the model because it provides crucial
insights on the need to unite various environmental factors
towards the enhancement of clinical practice. The theory lays
emphasis on the need to maintain a clean environment as a
factor of high quality healthcare. The quality of healthcare is
determined by a range of factors that include the levels of
efficiency of the delivery systems. The nurse practitioner care
model is designed to harmonize the different parts and
processes of healthcare practice with the view of enhancing the
overall impact in the field of healthcare practice. Achieving the
advantage of efficiency depends on the capacity of the
healthcare practitioner to link the various characteristics of the
model to the theory and appropriate philosophy.
11
Conclusion
Within the nursing concept of highest-level quality care:
The nurse practitioner care model is designed to optimize the
NP’s potential.
Environmental theory targets provision of quality care;
Nursing philosophy target quality care;
Theory implemented in context of model, and vice versa

The model and theory can help articulate/implement my
philosophy in practice.
Emphasis on quality of care need to be based on EBP.
Enhancing efficiency is a primary factor.
Ultimately, the nurse practitioner care model is designed to
enhance the potential and performance of the nurse practitioner.
The model is based on the acknowledgment of the need for
efficiency and high quality of care within the healthcare
environment.
The model, philosophy and theory can be framework through
which can be used to implement each other. This is because they
all align to delivery of quality can and the concept of nursing
selected.
12
References
Bahouth, M.N., Blum, K., &Simone, S. (2012). Transitioning
into hospital based practice: A guide for nurse practitioners and
administrators. New York, NY: Springer Publishing Company.
Buttaro, T.M., Trybulski, J., Polgar-Bailey, P., & Sandberg-
Cook, J. (2012).Primary care - e-book: a collaborative practice.
Amsterdam: Elsevier Health Sciences.
Kutzleb, J., Rigolosi, R., Fruhschien, A...et al.(2015). Nurse
practitioner care model: meeting the health care challenges with
a collaborative team. Nursing Economics, 33(66), 297-304.
Masters, K. (2017). Role development in professional nursing
practice. Burlington, MA: Jones & Bartlett Learning.
National Institutes of Health.(2015). Nurse practitioners at the
NIH.Retrieved from http://www.cc.nih.gov/c
Roger, V.L., Go, A.S., Loyd-Jones, D.M., Benjamin, E.J.,

Berry, J.D., Borden, W.B., … Turner, M.B. (2012). Heart
disease and stroke statistics 2012 update: A report from the
American Heart Association. Circulation, 125(1), e2-e220
Stewart, J.G., & DeNisco, S.N. (2013).Role development for the
nurse practitioner. New York, NY: Jones & Bartlett Publishers.
13
Source Organization Worksheet
Course: COLL100
Instructor: Dr. Gibson
Project Name: <Career in Food Service Presentation>
Project topic: <Food service director/ Restaurant manager job
qualifications, wages and benefits.>
For each article or source you investigate and decide to keep,
log the following information for easy reference.
Article Title: Opportunities in Restaurant Careers
Article Author: Chmelynski, Carol
Database or Web URL:
http://search.ebscohost.com.ezproxy2.apus.edu/login.aspx?direc
t=true&db=nlebk&AN=114829&site=ehost-
live&scope=site">Opportunities in Restaurant Careers
Date Retrieved (when did you find the article?): July 16, 2017
Source’s Publication Date: 2004
Publishing Information: McGraw-Hill Professional
Source Summary: This article starts with an overview of the
food service industry. It goes into detail on several positions
from the ground up. It looks at management positions and their

educational requirements. There are also several key resources
for those interested in lower or higher level careers in the food
service industry.
*****
Article Title: YUM! Careers in food. Career World, 33, 18-21
Article Author: Daily, Laura
Database or Web URL: https://search-proquest-
com.ezproxy2.apus.edu/docview/209773000?accountid=8289
Date Retrieved: July 16, 2017
Publishing Information: Scholastic Inc. Stamford
Source Summary: Food service/ Restaurant managers must have
knowledge of several key subjects in order to perform
efficiently. Some of these subjects such as Mathematics,
Biology and Chemistry helps to make managers flexible and
adaptable to any setting. The source talks about key
personalities in the food service industries, those that enjoy
working with food throughout their careers.
*****
Article Title: More than food and drink: Careers in restaurants.
Article Author: Liming Drew
Database or Web URL: https://search-proquest-
com.ezproxy1.apus.edu/docview/218507202?accountid=8289
Publishing Information: Superintendent of Documents
Source Summary: Article looks at the various positions within
the food service industry; it shows how they work hand in hand.
Everything from wages to job outlook is discussed. The job of a
manager/ director requires the deep understanding of human
behaviors and personalities.
*****
Article Title: Food Service Managers, on the Internet
Article Author: Bureau of Labor Statistics

https://www.bls.gov/ooh/management/food-service-
managers.htm
Source’s Publication Date:
Publishing Information: U.S. Department of Labor,
Occupational Outlook Handbook, 2016-17 Edition
Source Summary: This source looks at the expectant growth in
the food service industry in terms of jobs. It explains the job
duties of food service managers, resources for employment, how
to become a food service manager and many other interesting
facts about the career.
*****
Article Title: Food Service Director Salary
Article Author: Payscale
http://www.payscale.com/research/US/Job=Food_Service_Direc
tor/Salary
Publishing Information: Payscale Inc.
Source Summary: This source reviews the average and median
salaries of Food Service Directors; it goes into detail by looking
at geographical areas, skills, experience and specific employers.
*****
Article Title:
Article Author:
Date Retrieved:
Publishing Information:
Source Summary:
*****

Article Title:
Article Author:
Date Retrieved:
Source Summary:
*****
Article Title:
Article Author:
Date Retrieved:
Source Summary:
*****
Article Title:
Article Author:
Date Retrieved:
Source Summary:
*****
Drew Liming
Drew Liming is an
economist in the
Office of Occupa-
tional Statistics

and Employment
Projections, BLS.
He is available at
(202) 691-5262 or
[email protected]
gov.
I
n restaurants, the food’s the thing. But the drinks, presentation,
service, and ambience are important, too. And it’s up to
restaurant workers to provide diners with a square meal that’s
well rounded.
The hard work of the kitchen, bar, and dining-room staff
gets food and drink from menu to mouth. Some of the more
visible workers may include waiters and waitresses (also known
as servers), busboys, hosts and hostesses, bartenders, and
sommeliers. Less visible restaurant staff includes chefs, cooks,
managers, dishwashers, and janitorial and office staff. All have
a
role in helping to make a diner’s experience pleasant.
This article begins with an overview of the restaurant industry.
It then looks at four occupations—cooks, executive chefs,
servers,
and bartenders—and describes their job duties; employment,
wages, and outlook; and skills and training. You’ll learn what
working in a restaurant is like, including its challenges and
rewards. Suggested resources for additional information on
restaurant careers are at the end.
More than food and drink:
Careers in
restaurants

22 Occupational Outlook Quarterly • Spring 2009
The restaurant
industry
The restaurant industry doesn’t just feed
people; it also employs them. In fact, the food
and drinking places industry, as defined by the
U.S. Bureau of Labor Statistics (BLS), had
more than 9 million workers in 2007, making
this industry one of the largest employers in
the country.
The food and drinking places indus-
try includes snack bars, fine dining—and
everything in between. Limited-service eat-
ing places, such as cafeterias and fast food
establishments, employ about 43 percent of
workers in food and drinking places. The
smallest segment of the industry comprises
special food services, such as caterers and
food-service contractors, and drinking places,
including pubs and nightclubs.
Full-service restaurants—in which diners
order, are served, and eat while seated—
employ almost 48 percent of workers in the
food and drinking places industry. It is this
latter type of establishment that is the focus of
the occupations covered in this article.
Popular belief holds that new restaurants

struggle to survive, and many close their
doors within the first couple of years. Al-
though restaurants are difficult to run, their
failure rate is reported to be about 60 per-
cent—similar to the failure rate for all new
businesses.
Restaurant
occupations
The following pages describe the job duties,
employment, wages, outlook, and skills and
training of cooks, executive chefs, servers,
and bartenders. Job titles vary depending on
the type and size of the restaurant, but work-
ers in these occupations have some similar
responsibilities.
High turnover in most restaurant occupa-
tions means that prospective workers usually
have excellent prospects. And because res-
taurants are in nearly every town or city, jobs
should be widely available.
More than food and drink:
Careers in
restaurants
Spring 2009 • Occupational Outlook Quarterly 23
Cooks

Restaurant cooks turn the food orders they
receive from servers into appetizing cuisine—
often while racing the clock. Some cooks are
referred to as chefs, usually because they have
additional skills or responsibilities. (See, for
example, executive chefs, described in more
detail beginning on the next page.)
For cooks, the kitchen’s pace becomes
hectic before diners arrive. “You’re always
busy,” says Jon Gatewood of Ludlow, Ver-
mont, who has worked as a cook. “There were
times when we were finishing prep work even
as the doors opened for business.”
Cooks follow recipes in preparing, mea-
suring, and mixing ingredients—and, often,
testing the final product—to create menu
items. And to make some dishes, cooks might
need to arrive several hours before serving
begins. In addition to cooking, preparations
might include a daily briefing from the execu-
tive chef on menu changes or kitchen per-
formance. Cooks also use their prep time to
ensure that all of the equipment in their work
areas is clean and fully functional.
Restaurant cooks use special, industrial-
grade equipment to prepare food. For ex-
ample, they might use step-in coolers, high-
quality knives, and meat slicers and grinders.
And most restaurants have multiple sets of
heavy-duty ovens and stovetop burners that
cooks use to prepare dishes simultaneously.

In most kitchens, cooks are assigned to
different stations, such as deep fryer, broiler,
or vegetables. Some restaurants may also
have cooks who specialize in a type of food
and work on a single course, such as pastries
or soup. Cooks may collaborate on a dish or
work individually. Either way, they frequently
work together under the direction of executive
chefs or their assistants, sous chefs.
The true test of kitchen skills is in
efficiently filling orders. Cooks receive din-
ers’ orders, called meal tickets, from servers.
To complete the ticket, cooks either prepare
a dish from scratch or combine ready-made
items. Many diners expect that when a server
brings their order from the kitchen it will be
pleasing to the eye, as well as to the palate. It
is the cook’s task to arrange the food into an
artistic presentation.
During mealtime in a busy restaurant,
cooks are constantly in motion and must often
change tasks while working on multiple meal
tickets simultaneously. It’s a steady pace that
lasts awhile. “We’d be very busy for 3 or 4
hours,” says Gatewood of his work as a cook.
“There really weren’t any breaks.”
Even with all that activity, cooks must
ensure that their work areas remain tidy and
hygienic. Doing so saves time and money: It
allows them to work efficiently without hav-
ing to search for utensils or ingredients, and it
prevents the need to remake a meal ruined by
unsanitary conditions.

To fill diners’ orders, cooks
either prepare a dish from
scratch or combine ready-
made items.
After serving hours, cooks also must
clean the kitchen. Depending on the restau-
rant, cooks might supervise cleaning work-
ers or do the cleanup themselves. And cooks
sometimes use this time to prepare for the
next day’s work.
Employment, wages, and outlook. Ac-
cording to BLS, there were almost 700,000
full-service restaurant cooks employed in the
United States in May 2007. Their median
annual wage was $20,970 in May 2007, with
the lowest 10 percent earning $15,040 or less.
The highest paid 10 percent earned $29,610
or more.
Employment of restaurant cooks is
projected to grow 12 percent overall between
2006 and 2016, about as fast as the average
for all occupations.
Skills and training. Restaurant cooking
requires a combination of skills and knowl-
edge. Some of these are best acquired on the
job, but others may be learned through formal
training.

Some kitchen skills, such as basic cook-
ing ability, may be expected even for entry-
level workers in these jobs. But succeeding as
a restaurant cook requires more than culinary
talent. For example, collaborating with other
cooks requires strong communication and
teamwork skills. Good manual dexterity,
attention to detail, and the ability to do many
tasks at once, often quickly, are also essential.
Finding a mentor is a great way for young
cooks to learn. And, contrary to popular
belief, not all chefs are temperamental. “My
first mentor never exhibited that classic chef
temper you see on television,” says Gatewood.
“He was always very level-headed and never
lost his cool on the line, and I modeled my
career on him.”
Because many cooking skills are learned
on the job, a good mentor can impact a cook’s
development. A mentor is also useful as a
career resource, providing both introductions
to other chefs and recommendations for jobs.
To refine skills and gain credentials, cooks
may also attend culinary schools and other
credential programs. Culinary schools and
programs teach different cuisines and tech-
niques—and may help give young cooks an
edge in jobseeking. Even experienced cooks
may benefit from taking classes to hone and
update their skills.

As with any job, however, a cook’s suc-
cess might start with a lucky break. Dean
Thomas of San Diego, California, got his
first cooking job while working as a restau-
rant dishwasher. One day, he was asked to
fill in for a cook and was told to join the line.
Thomas, now certified as both an executive
chef and a culinary educator, has been in the
kitchen ever since.
Executive chefs
The domain of executive chefs spans both the
kitchen and the office. Executive chefs usually
have years of experience as cooks and, after
finding success on that level, are ready to as-
sume responsibilities outside of the kitchen.
Although both executive chefs and cooks
are kitchen experts, executive chefs are also
responsible for behind-the-scenes work. “The
primary difference between a chef and a cook
is paperwork,” says executive chef Steve
Armstrong of Enfield, North Carolina. “An
executive chef does all the things to keep the
restaurant running that you don’t see on the
plate.”
Thomas agrees, specifying the executive
chef’s broad range of possible duties. “Any
executive chef in any operation needs to be
a jack-of-all-trades,” he says. “Sometimes
you’re a chef. Other times, maybe a human
resources consultant, purchaser, businessman,
or health inspector.” In some establishments,
these tasks are handled by restaurant manag-
ers or owners.

Executive chefs are divided into two
categories: “working” and “nonworking.” The
two types differ in how much time they spend
in the kitchen and on administrative duties.
Working executive chefs prepare food along-
side their cooks during mealtime. Nonwork-
ing executive chefs, especially in larger res-
taurants, are busy with administrative duties.
Executive chefs make most of the
restaurant’s administrative decisions. These
decisions include designing the menu, setting
prices, reviewing food and beverage pur-
chases, and planning special menu items.
Most executive chefs are also responsible for
interviewing and hiring prospective kitchen
workers and investing in employee develop-
ment and training.
During mealtime, the chef may do admin-
istrative work or, depending on how busy the
restaurant is, help the cooks in the kitchen.
Executive chefs can’t oversee everything that
occurs during mealtime, so they must delegate
some tasks to sous chefs or cooks.
After the day’s cooking shifts are com-
plete, the executive chef gives and receives
feedback from cooks, initiates cleanup, and
logs the day’s sales.

Employment, wages, and outlook. BLS
data show that in May 2007, there were about
50,000 chefs and head cooks—the occupation
that includes executive chefs—employed in
full-service restaurants in the United States.
They had a median annual wage of $34,970 in
May 2007, with the lowest earning 10 percent
making $20,720 or less. However, chefs and
head cooks may also earn bonuses, based on
sales volume and revenue. The highest paid
10 percent earned $60,770 or more.
Employment of chefs and head cooks is
projected to grow 8 percent overall during the
2006–16 decade, more slowly than the aver-
age for all occupations. But most of the new
jobs for these workers are expected to be in
full-service restaurants.
Skills and training. Running a kitchen
requires both general skills and specialized
knowledge. Most executive chefs have gained
these skills and knowledge through training
or experience working as cooks or in other
restaurant jobs.
Communications skills, especially for
leading and directing the kitchen staff, are im-
portant for executive chefs. “Long-term suc-
cess results from awareness of other people,”
says chef Scott Neuman of Portland, Oregon.
“You have to be able to get your staff to work
well as a team and convince them we’re all
in this together.” Executive chefs also need to
be effective communicators to negotiate with

vendors and suppliers.
Prospective executive chefs should also
learn the business of restaurant work. Admin-
istrative skills, such as accounting and em-
ployee counseling, are important to keep the
restaurant running. Executive chefs must also
know how to direct staff and delegate tasks.
Many executive chefs first gain managerial
experience by working as sous chefs.
Cooks who are interested in advancing
to executive chef positions should commit
to practicing new recipes. Because executive
chefs are often responsible for developing
a menu, they must be able to create unique
meals that are easily reproduced.
As with cooks, executive chefs don’t
necessarily need to attend school. However,
credential programs provide their students
with specialized knowledge. And continued
learning keeps chefs updated with new tech-
niques, business models, and recipes.
Servers
Servers are a restaurant’s frontline workers.
Their interactions with customers may turn
new diners into regular ones. What comes
from the kitchen may get diners’ attention, but
Executive chefs delegate
some tasks to sous chefs
and cooks.

the serving staff gives them the restaurant’s
first impression.
As the link between the dining room and
the kitchen, servers affect a diner’s experi-
ence. Servers interact with diners several
times per visit, but knowing when and how to
approach each table isn’t always easy. “Con-
sumers have an internal clock that says when
they expect to receive service,” says server
Paul Paz of Beaverton, Oregon. “Anticipating
customers’ needs is a difficult skill to learn.”
Shortly after diners are seated, servers
greet them and may take orders for drinks
and appetizers. Because servers attempt to
customize dining experiences, they tailor their
behavior to diners’ preferences. For example,
some diners enjoy conversing with their
server; others prefer more restraint. The best
servers figure out their customers’ preferences
and adjust accordingly.
Servers usually stop by a table several
times during a meal: to take food and drink
orders; to present drinks and food, sometimes
in several courses; to check on diners during
the meal; and to bring the bill after everyone
has finished eating. In most restaurants, dining
tables are divided into groups, or stations,
based on the number of servers working the
shift. Servers wait on the diners seated at

tables in their assigned station.
When diners are ready to order, servers
must be prepared to answer questions about
menu items—and to ask diners to choose
among options that may be available to them,
such as types of salad dressing or side dishes.
Diners who are indecisive may ask servers
for advice. If this happens, servers use their
knowledge of the restaurant’s dishes to sug-
gest items that fit the diners’ tastes.
Servers bring food to diners’ tables, some-
times with flourish. Knowledgeable servers
might describe how the food was created in
the kitchen. “It’s not just about how the food
tastes,” says Bernard Martinage, president of
To customize the
dining experience,
servers assess diners’
preferences and tailor
interactions to match.
the Federation of Dining Room Professionals
in Fernandina Beach, Florida. “Diners want
dinner theater.”
Servers check on tables throughout the
meal to ensure that diners are satisfied and to
remove any finished items. Toward the end of
the meal, servers may take orders for desserts

or after-dinner drinks. After these are finished,
the server brings diners the bill and collects
payment.
The extent of service provided by servers
may depend on the type of restaurant, its vol-
ume of business, and the availability of floor
staff. For example, some servers know which
wines fit well with certain foods. But at other
restaurants, such suggestions are the job of the
restaurant’s sommelier, an expert in pairing
food and wine. In addition, some restaurants
focus server duties more narrowly by assign-
ing different staff members to deliver food,
refill water glasses, or clear tables.
Employment, wages, and outlook. Ac-
cording to BLS, there were about 1,750,000
waiters and waitresses (servers) employed in
full-service restaurants in the United States
in May 2007. Their median annual wages,
including tips, were $15,800 in May 2007.
The lowest earning 10 percent made $13,090
or less, and the highest paid 10 percent earned
$27,700 or more.
Those data include wages for many serv-
ers who are in the occupation temporarily;
career servers at upscale restaurants have
the potential for higher earnings. For most
servers, higher earnings result from receiving
more in tips, not higher hourly wages. Be-
cause tips are usually calculated as a per-
centage of diners’ bills, servers at expensive
restaurants generally earn more.

Employment of waiters and waitresses is
projected to increase 11 percent overall during
the 2006–16 decade, about the average for all
occupations.
Skills and training. Most servers receive
their training on the job, but when hiring,
employers often seek out applicants with
some basic skills. These abilities include
interacting well with others, following safe
food-handling procedures, and carefully
maneuvering through a busy dining room.
Servers must also be personable, well
groomed, and neatly dressed and should enjoy
interacting with diners.
Restaurants may differ in their specific
practices, but many serving techniques are
common. And some techniques that are taught
on the job may require practice outside work-
ing hours. For example, maneuvering trays
full of food can be difficult. Paz trains by
carrying a tray with multiple plates, each with
several golf balls on it, to simulate a sauce or
delicate part of a dish. As he walks around a
room, Paz keeps the tray balanced to prevent
the golf balls from rolling around on the
plates.
Many servers gain experience in infor-
mal restaurants and use their experience to
advance to more prestigious—and pricey—
restaurants. Skilled servers are more likely to
make a career in fine dining.

In addition to getting on-the-job training,
servers can enroll in certification programs.
The number of these programs has been
increasing as restaurants place more empha-
sis on training their dining-room staff. “The
industry has been becoming more formal,”
says Martinage. “And the number of educa-
tion programs is rising to meet the needs of
restaurant managers and servers.”
Not surprisingly, the number of career
servers with culinary and college degrees
is also increasing. Upscale restaurants may
prefer servers who have culinary degrees: The
training helps servers translate diners’ desires
into kitchen terminology that cooks can
understand. And sometimes, culinary school
students might start training to be chefs but
discover that they prefer interacting with
diners.
In some States, servers must pass an
alcohol server education course before being
certified to serve alcoholic beverages. States
also vary in their minimum age requirements
for serving alcohol.
Bartenders
Bartenders in restaurants pour and serve
mixed drinks, beer, wine, and other beverages
to restaurant diners and bar patrons. Although

they’re working hard, bartenders also enjoy
the social scene. “It’s almost like being a rock
star,” jokes bartender Christopher Shelley of
Bethesda, Maryland, adding, “You meet a lot
of people, and it can be a ton of fun.”
During busy periods, many people might
order drinks at the same time, and servers also
place drink orders from diners. So, bartend-
ers must know how to mix a variety of drinks
quickly and efficiently, because they usually
don’t have time to consult recipes in preparing
orders. Their task is even more difficult when
they receive large numbers of drinks, all of
which may require different ingredients and
procedures to make.
Attending to diners at the bar or in the
lounge area requires the bartender to perform
the duties of a server: taking food and drink
orders, relaying food orders to the kitchen,
serving the order, and delivering the bill.
In addition, however, bartenders are
responsible for preparing and serving
drinks—not only for those customers, but
also for others in the bar and restaurant.
“Sometimes, I’ll be serving several cocktail
customers and the bar at the same time,” says
Shelley. “I have to make sure everything is
running smoothly at all locations.”
Because bartenders focus on preparing
drinks and serving customers, they have few
administrative duties. And during a slow shift,
a bartender may take stock of supplies and

write a list of needed items for the barbacks—
bartending assistants who don’t serve custom-
ers. Most administrative decisions involving
the bar are made by executive chefs or kitchen
managers.
Employment, wages, and outlook. There
were almost 200,000 bartenders employed in
full-service restaurants in the United States in
May 2007, according to BLS. They had me-
dian annual wages, including tips, of $17,550
in May 2007. The lowest earning 10 percent
made $13,850 or less, and the highest paid 10
percent earned $31,890 or more.
Like servers, bartenders depend on tips
for a large part of their earnings. These tips
vary, depending on the shifts a bartender
works. In a popular restaurant bar on Friday
and Saturday nights, tips may be substantial.
But there is keen competition for these lucra-
tive shifts, and they may be assigned based
on seniority. Bartenders at upscale restaurants
also usually earn more because their tips,
based on a percentage of the bill, are likely to
be higher.
Employment of bartenders is expected
to grow 11 percent overall between 2006 and
2016, about the average for all occupations.
Skills and training. Bartending requires
a mix of personality, skills, and on-the-job
training; experience is also helpful. Formal
training programs are available, but atten-

dance in them is largely voluntary. Bartenders
also might have to meet State requirements.
Bartenders should be friendly and ap-
proachable. Those who are not are unlikely
to be tipped well and will find it difficult to
advance to more prestigious restaurants. “A
bartender’s success is largely determined by
personality,” says Shelley. “I’ve known people
who were extremely fast and could handle
large-volume orders but just didn’t have the
right personalities.”
Some skills are necessary for bartend-
ers to have before they come to the job. For
example, they need to have excellent hand-eye
coordination to work in a small area sur-
rounded by glass. Bartenders must also be
Bartenders perform the
duties of a server when
attending to diners seated
at the bar.
able to memorize complicated drink orders
and reproduce them without hesitation.
Bartenders learn other skills, especially
those specific to the occupation, on the
job—often through practice. To make mixed
drinks, for example, bartenders must master
the pour count: the number of seconds it takes

a bottle’s spout to pour one ounce of liquid.
Because every type of spout pours at a dif-
ferent rate, bartenders practice until they are
comfortable with pour counts.
Restaurant experience isn’t necessarily a
prerequisite for bartending jobs, but it helps.
Many bartenders have previous experience in-
teracting with customers as servers, for exam-
ple. Shelley was a senior server when he was
approached about a bartending position. He
first worked as a bartender on slow shifts, to
familiarize himself with the bar and its duties,
before taking busier shifts. Other bartenders
may start as barbacks to gain experience.
Bartending schools are another way to
learn basic skills and recipes. These schools,
however, are not formally recognized and
are not a substitute for practical experience.
But bartending schools may offer classes in
specialized skills. For example, flair bartend-
ing, in which bartenders entertain guests by
manipulating bar tools and bottles in creative
ways, might be difficult to learn without
instruction.
Like servers, bartenders must be of a legal
minimum age to serve alcohol; age require-
ments vary by State. Some States also require
that, to serve alcohol, bartenders have certifi-
cation from State-approved schools.
The restaurant
lifestyle

For those who want to make a career in
restaurant jobs, satisfying diners makes the
hard work rewarding. Restaurants play host to
many important life events, including engage-
ment proposals, business meetings, and birth-
day and anniversary celebrations. “We help
create memories for people,” says Martinage.
“Every day, we are a part of those memories.”
But making a career in a restaurant isn’t
easy. Workers in both the kitchen and din-
ing room are subject to two major challenges
common in restaurant jobs: high levels of
stress and often-erratic schedules.
Stress
Satisfying the different demands of many din-
ers can create a stressful environment for res-
taurant workers. Many restaurant employees
enjoy the adrenaline rush, but even longtime
workers admit it can be overwhelming at
times.
Different restaurant occupations have dif-
ferent sources of stress. Cooks, for example,
need to produce quality food consistently. And
unlike many jobs, which may have deadlines
every couple of days or weeks, kitchen work
must sometimes be completed within min-
utes—and successfully—every time. “You
have to get excited about every order, day in
and day out,” says chef Neuman. “You’re only
as good as the last plate you’ve put out.”
But it’s not only cooks who feel the
kitchen’s heat. Executive chefs have even

more responsibility. To many chefs, the added
authority is appealing, but it can also be
stressful. “When you’re the executive chef,
you’re the king,” executive chef Armstrong
says. “But that means when something goes
wrong, it’s always your fault.”
To experience kitchen stress during
its busiest time, Neuman recommends job
shadowing. He suggests that would-be cooks,
especially those considering culinary school,
contact a local restaurant and ask to shadow
a chef or cook to get a feel for the kitchen’s
atmosphere during mealtime.
For servers and bartenders, interaction
with customers is a common source of stress.
These workers rarely have downtime, yet they
are expected to display a pleasant demeanor in
all circumstances. “We’re performers, and we
have to keep a smile on our faces even when
we’re stressed or working hard,” says server
Paz. “It can be very difficult, especially for
new workers.”
Schedules
In most restaurants, staff schedules are vari-
able. Workers must cover shifts on weekends
and holidays, as these are often restaurants’
busiest days. And on these occasions, creative
workers still find ways to please diners. Server
Paz, for example, brought a digital camera to

work one Thanksgiving and offered to take
family pictures of his diners. “Everyone was
thrilled by the offer,” Paz says. “It’s what the
hospitality business is all about.”
Working on holidays may sound difficult,
but even normal days in a restaurant are long.
A cook’s shift, for example, may require be-
ing at the restaurant for up to 10 hours—with
little time for rest in the rush to meet diners’
demands.
Executive chefs frequently work even
longer than cooks. Most do their inventory
and planning work in the mornings and stay
until dinner service is finished. Many culinary
students, unprepared for an executive chef’s
workload, find the experience an eye opener.
“These are long hours,” warns executive chef
Thomas. “It’s not all the glory you see on
television.”
Servers and bartenders usually have flex-
ible schedules, and some may work a couple
of shifts at multiple restaurants each week.
Bartenders’ shifts are both long and unusual.
Shelley, for example, tends bar for 12-hour
shifts on Fridays and Saturdays, from 4 p.m.
to 4 a.m. And because weekend nights are
usually busy, Shelley frequently finds himself
on his feet the entire time.
The inconsistent work has other draw-
backs for restaurant workers. Many, especially
servers and bartenders, receive hourly wages

plus tips instead of salaries, and few get
benefits through their employers. The result
is that many restaurant workers are paid only
for the hours they work and aren’t paid on
days they are sick, for example. Usually, large
corporations are the only employers that may
provide benefits.
Still, not all restaurant workers regard the
stress and long hours of their jobs as draw-
backs. For example, many cite the strong
bonds between coworkers that result from
the challenging circumstances. “At times, the
Even with the stress of
a restaurant’s fast pace,
many workers enjoy the
friendly atmosphere.
pressure can make working in a restaurant
very regimented and militaristic,” says execu-
tive chef Gatewood. “But the atmosphere
can also be relaxed and family-like, because
everyone usually becomes good friends.”
For more
information

To learn more about jobs in restaurants, begin
paying closer attention to the work atmo-
sphere when you dine out. But you’ll also
want to visit your public library, school coun-
seling office, or career center. To find a career
center near you, go to www.servicelocator.
org; call toll free, 1 (877) US2-JOBS (872-
5627) or TTY 1 (877) 889-5627; or e-mail
[email protected] The Web site also
has links to career exploration tools and other
job-related resources.
Another helpful source for career
information, available at many libraries and
career centers, is the Occupational Outlook
Handbook. The Handbook is also available
online at www.bls.gov/ooh. This resource has
detailed descriptions of hundreds of occupa-
tions, including some of the ones described in
this article.
Articles in previous issues of the Occupa-
tional Outlook Quarterly describe occupations
related to restaurants. “You’re a what? Som-
melier,” online at www.bls.gov/ooq/2003/
summer/yawhat.pdf, profiles a restaurant
worker whose expertise is pairing wine with
food. “You’re a what? Research chef,” online
at www.bls.gov/ooq/2002/fall/yawhat.pdf,
describes the work of a chef who develops
new recipes for a restaurant chain.
For first-hand information about what
it’s like to work in a kitchen, contact a local
restaurant and ask to speak with the workers
there. Job shadowing, in which you observe

a trained worker in an occupation that inter-
ests you, may help you decide if a restaurant
career is for you.
The following associations provide
general information for those interested in
restaurant jobs:
National Restaurant Association
1200 17 St. NW.
Washington, DC 20036
(202) 331-5900
[email protected]
www.restaurant.org
Food Service Interactive
7702 E. Doubletree Ranch Rd., Ste. 300
Scottsdale, AZ 85285
(623) 433-9690
www.foodservice.com
The following associations provide certifi-
cation information:
National Restaurant Association
Educational Foundation
175 W. Jackson Blvd., Ste. 1500
Chicago, IL 60604
Toll free: 1 (800) 765-2122
[email protected]
www.nraef.org
American Culinary Federation
180 Center Place Way
St. Augustine, FL 32095

Toll free: 1 (800) 624-9458
[email protected]
www.acfchefs.org
Federation of Dining Room Professionals
1417 Sadler Rd., No. 100
Fernandina Beach, FL 32034
Toll free: 1 (877) 264-FDRP (3377)
[email protected]
www.fdrp.com
National Bartenders’ Association
(770) 864-7811
[email protected]
www.bartender.org
WaitersWorld
14314 SW. Allen Blvd., No. 507
Beaverton, OR 97005
(503) 524-0788
[email protected]
www.waitersworld.com
Reproduced with permission of the copyright owner. Further
reproduction prohibited without permission.
YUM! Careers In Food
Daily, Laura

Career World; Apr/May 2005; 33, 6; ProQuest Central
pg. 18
Running head: NURSE PRACTITIONER CARE MODEL 1
NURSE PRACTITIONER CARE MODEL 7
Model of Practice Class MN502 Unit 7
This Assignment targets this course outcome:
MN502-3: Evaluate the application of models of practice to the
advanced nurse roles.
What is the difference between a model and a theory?
A model demonstrates the researcher's interpretation of how
concepts are related to one another and is developed based on
qualitative research. A theory is a hypothesis tested and
measured to explain, predict, describe, and prescribe
relationships between concepts and is developed through
quantitative research.
In short, the difference between a model and a theory is the
amount of proof that exists in demonstrating the outcomes they
predict.

What do models and theories have in common?
Both models and theories show relationships between concepts.
Models often are precursors to theory development.
Directions
Locate a model of practice that you could apply to nursing. It
does not need to be a nursing model. Models of practice can be
found in leadership, business, education, and technology.
Explain how you will use the model you chose in your advanced
practice role.
Use the table template to organize your thoughts and
present them for this Assignment. In the first column, list the
characteristics of the model of practice you chose. In the second
column, list your application to your advanced nursing practice
role upon graduation. In the first row, in the first column, write
the name of your chosen model. An example has been provided
in the first rows to guide you. Please remove the examples when
entering your information.
MN502 Unit 7 Assignment

In a fast-changing clinical environment, designing
organizational delivery systems is essential for the production
of high-quality clinical care services that are not only efficient
but also cost effective. At the epitome of the restructuring of
care delivery plan is the changing role of nurse practitioners
(NPs)as a member of interdisciplinary team in clinical practice.
It is also informed by the need to integrate the role of the NP
into the health care. The role of the NP is called for by the
growing number of patients requiring holistic, long-term, and
coordinated care (such as the elderly and the chronically ill)
(Roger, et al., 2012). This discussion considers the main
characteristics of the model and postulates the applications of
the model characteristics in advanced nurse practice. It is
underscored that the model offers a platform for providing
clinical responses that are proactive and innovative towards the
changing of clinical environment.
Model Characteristics for the Nurse Practitioner Care Model
Application to Advanced Practice Role
Utilizing of the advanced clinical judgment through expert
clinical practice cognizant of systems thinking while upholding
accountability when providing evidence-based health care at
advanced nurse practice level.
Clinical judgment will be essential in evaluation of the impact
of the continuous changes common in clinical practice (National
Institutes of Health., 2015). Particularly, this characteristic will
help in formulation of clinical recommendations in regard to the

appropriateness of care and its cost effectiveness.
Consultation at intra and inter-professional levels as a nurse
practitioner.
It is important that clinical practice delivers direct care in a
coordinated and interdisciplinary plan to all patients seeking
care from a health care facility. The model characteristic
informs the role of an advanced nurse practitioner as a
consultant facilitating improvements in the care on the basis of
expertise in specific areas of specialization (Kutzleb, et al.,
2015). Therefore, as an advanced practitioner applying this
model, it is expected that the nurse:
• provides needful professional guidance that would enable the
effective implementation of the roles of a nurse practitioner
according to legislation and professional requirements.
• monitors the process of role implementation and its progress.
• ensures that the clinical practice is safe to patients and that
quality outcomes offer information for future service
development or improvement.
Ongoing research-based practice that enable continuous
designing of standards of care that are specific to a particular
population of patients.
For progressive practice, it is essential that learning needs are
identified for the different populations handled. It should
essentially contribute to the process improvement and
development of service educational programs for human
resource improvement. For instance, it may be needful to
identify if there are marginalized community groups and how
such groups can be helped to access traditional health services
(Bahouth, Blum, & Simone, 2012). These groups may include
clients having health problems like mental health, substance
abuse disorders, sexual health, or may be homeless individuals.
Provision of leadership on the basis of clinical, professional,
and systems standards.
In practice, this characteristic is helpful in enhancement of the
delivery of comprehensive health care for patients. It therefore
will enable a nurse practitioner and the inter-professional team

to identify opportunities for focusing the care plan on the
appropriateness of interventions in complex and highly
reimbursed scenarios of patients (Stewart, &DeNisco, 2013). As
an agent of change, the NP is skilled to assess and reassess
complex patient scenarios that may require systemic changes in
the health care. Therefore, this characteristic place the NP in
position to provide assistance for clinicians and other providers
in the care team to master the new knowledge acquired out of
clinical experience and change behavior.
Collaboration among members of the multidisciplinary health
care team
It is the duty of the NP to identify and ensure collaborative
relationships are built and maintained with physicians and other
care teams in the health care. The focus of the NP in this model
characteristic is on how to coordinate care services in order to
promote the needed interdisciplinary collaboration (Buttaro,
Trybulski, Polgar-Bailey & Sandberg-Cook, 2012). The
collaboration should be aimed at ensuring the effective
management of the needs of individual patient. Therefore, when
implementing the care model, it will be the focus of
collaborating members to ensure that the needs of individual
patients, clinical staffs, and the entire care organization are met
in order to attain successful patient outcomes.
In conclusion, the NP Model of Care has its focus on the overall
coordination of health care services targeting the interaction
between a nurse and patient as well as the collaboration with
other members of the health care teams in both acute and post-
acute care.
References

Bahouth, M. N., Blum, K., &Simone, S. (2012). Transitioning
into hospital based practice: A guide for nurse practitioners and
administrators. New York, NY: Springer Publishing Company.
Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-
Cook, J. (2012). Primary care - e-book: a collaborative practice.
Amsterdam: Elsevier Health Sciences.
Kutzleb, J., Rigolosi, R., Fruhschien, A... et al. (2015). Nurse
practitioner care model: meeting the health care challenges with
a collaborative team. Nursing Economics, 33(66), 297-304.
National Institutes of Health. (2015). Nurse practitioners at the
NIH. Retrieved from http://www.cc.nih.gov/c
Roger, V. L., Go, A. S., Loyd-Jones, D. M., Benjamin, E. J.,
Berry, J.D., Borden, W.B., … Turner, M.B. (2012). Heart
disease and stroke statistics 2012 update: A report from the
American Heart Association. Circulation, 125(1), e2-e220
Stewart, J. G., &DeNisco, S. N. (2013). Role development for
the nurse practitioner. New York, NY: Jones & Bartlett
Publishers.
Running head: THEORY DEVELOPMENT 1
THEORY DEVELOPMENT 2
Class MN502 Unit 5Where Did the Theory Come From
This Assignment addresses this course outcome:
MN502-2:Explain how theoretical frameworks influence
advance.
Purpose
The purpose of this Assignment is to explore how a theorist
explicates his or her philosophy and thoughts behind a
theoretical field. As in other fields of study, nursing has a
plethora of theorists and theories. These theorists have
developed their paradigm over time enriching it with research
and dialogue with other theorists.
Directions

You are going to explore how a theorist of your choice created
his or her theory. Did it develop as an acorn becoming a mighty
oak over the decades? Did it arrive as a burst of light like the
big bang as some believe created our universe? Was it
developed from a blueprint like a spaceship where thousands of
scholars worked together to create a rocket to the moon? In
point of fact, how is a theory developed? This is what we are
exploring.
You will pick a theorist who interests you, it does not have to
be a nurse theorist. You may also choose from other disciplines
such as: behavioral, leadership, business, education, technology.
You will become the theorist immersing yourself in the writings
from the earliest mentioned to the most current.
As you read, look at how you (taking on the persona of the
theorist) developed the theory.
In the first stage, theorizing occurs. This is where you, as the
theorist, identify the concepts of what nursing is and is not.
Perhaps you questioned what concepts were guiding those in
nursing practice and then started to question your role. You
started asking yourself, “Where am I in nursing, and where the
profession is going? Is there some overarching concept that
guides the professional in his or her practice?” This is where
you recognize that a theory is needed.
In the second stage, syntax is developed. This is where you will
define the terms. Look for changing definitions of terms.
Consider, for example, Jean Watson. She starts by defining the
word “caring.” Within the last ten years she has refined her
terminology changing the term caring to caritas. This
demonstrates a growth and maturation from decades of research
she and other scholars did to produce the theory of caring.
The third stage is theory testing. Defined as the phenomena
behind the theory that are exposed through research. The
definitions of terms are refined. The theorists and other
researchers consider whether this theory helps answer questions
that arise in practice. This is where your theory is used in by a
widening group of researchers. For example, graduate nursing

students request the tool you developed while testing your
theory.
Thefourth and last stage is evaluation. This is where
philosophical debate occurs as the concepts are applied through
evidenced based practice in the act of providing nursing care.
Assignment Details
For this Assignment, you are going to write an article for a
nursing journal explaining how you developed your theory
through the four stages (theorizing, syntax, theory testing, and
evaluation). Your paper must be 3 to 5 pages, not including the
title and reference pages.
Human to Human Relationship Model by Joyce Travelbee
Human to Human Relationship Model
The Human-to-Human Relationship Model was developed by
Joyce Travelbee (1926-1973). The theorist dealt with
interpersonal relationship aspects in the nursing profession. In
the theory, she sought to explain the human-to-human

relationship as a means for fulfilling the purpose of nursing.
The theorist was a psychiatric nurse and an educator who
completed her BSN degree a Master of Science Degree in
Nursing. She worked as a Psychiatric Nursing Instructor in New
Orleans at the DePaul Hospital Affiliate School. This discussion
considers the processes that the theory has gone through from
its inception to the current application in the field of nursing.
Theorizing
The Human to Human Relationship Model looks into the
interpersonal aspects in the nursing profession. It specifically
focuses on the mental health aspect of nursing. According to
Joyce Travelbee, human-to-human relationship forms the
foundation of fulfilling the very purpose of nursing. The
theorist based her assumptions on the existentialism and
logotherapy concepts developed by Kierkegaard and Frankl
respectively (Stasková, &Tóthová, 2015). From the
existentialism concept the theory asserts that humans are
constantly faced with choices and conflicts and that they are
accountable to every choice made in their lives. According to
Novianaet al. (2016), the logotherapy in the theory follows a
meaning-centered psychotherapy whose basis is the assumption
that fulfillment of meaning in life is the sure way to assure
protection of an individual against challenges of emotional
instability.
With these in mind, the Model of Nursing was developed to
offer several important concepts applicable in the nursing
practice and profession. First, it is considered that suffering in
an individual is an experience varying widely in terms of its
intensity, the duration, and the depth. Therefore, it is a feeling
that makes one uneasy to the extent of causing discomfort
mentally, physically, or emotionally. Further, the theory
considers meaning in relationship building as a person-specific
reason (Haugan, 2014). Conception of the theory was the need
for personal relationship between the patient and the nurse as a
therapeutic approach to emotional, mental and physical relief of
pain.

Syntax development
The theory offers key definitions of health: the subjective and
objective definitions. According to the theory, an individual
subjectively defines health in terms of his/her state of well-
being depending on self-appraisal of one’s status physically,
emotionally, and spiritually. On the other hand, objective health
is considered in the theory as the absence of any discernible
disease of disability as determined after a physical examination,
a test in the laboratory, or an assessment by a psychological
counselor or a spiritual director. This means that the perception
of patients about their well-being is a function of their
individual judgment about their situation. This is largely
motivated by the relationship between the patients and the nurse
attending to them (Haugan, 2014).
It is also from the theory that we get the definition of nursing as
an interpersonal process, in which the professional nurse
practitioner plays the assistive role to individual patients,
family members of the patients or members of the community.
This makes the role of the nurse to be primary in the prevention
as well assisting patients and their families to cope with an
experience of pain or an illness. According to Haugan (2014),
through the relationships built, the nurse should be in position
to help the patients and their families to find possible meanings
of their experiences.
Theory Testing
Overall, the model emphasizes that nursing is be accomplished
through building of relationships among humans (nurses and
patients). This begins with the first encounter to the emerging
identities, development of empathetic and sympathetic feelings.
The theory has been helpful in the understanding of suffering as
a human experience that requires external motivation to help the
patients as well as their families to cope with the varying
intensities, durations of the experience and its depth. Through
the establishment of relationships, it has been possible to
alleviate feelings of unease among patients in long-term care
(Burack, et al., 2012). This includes patients with mild or

transient mental discomfort to those faced with extreme pain
experience.
It has also helped in redefining nursing practice as an assistive
role in patient care. For instance, nurses have lately been
required to assist patients to find meaning in their illness and
suffering experiences. They also have the responsibility of
helping individuals as well as their immediate families to find
such meanings. This means that the spiritual and ethical choices
of the nurses and the perceptions they have about the illness and
suffering of patients they are handling play a crucial role in
helping the patients find meaning they need about the pain and
suffering they are experiencing (Haugan, 2013).
Further, from the advances of the theory, the nurse has been
positioned as a hope giver in patient care. In this regard, it is
the role of the nurse to assist patients in maintaining hope while
avoiding hopelessness. The theory considers hope's core as a
fundamental trust that outlays the world of the patient in pain or
suffering by making them believe that others are available to
help them when they need such assistance. This means that in
such conditions, the patient is strongly dependent on the people
around him or her (Haugan, 2013). The theory has enabled
emphasis on the hope of patients as possessing courage that
would enable them to acknowledge possible shortcomings
and outlay any fears of pain or suffering while forging ahead
towards the goal of healing.
Theory Evaluation
Although there is little testing of the theory, there is substantial
evidence of its application in nursing practice. At hospital level,
the theory is functionally applied in self-actualizing of the life
experience of patients and their families through an
understanding they get about the meaning of life, sickness, and
death. In nursing education, the theory can be applied to teach
nurses how to understand and communicate meanings of illness
and suffering to patients they are attending to. Last, it can be
applied in research as a methodological approach to the theory
of long-term patient care such as cancer patients (Burack, et al.,

2012).
Conclusion
In conclusion, the human-to-human relationship model is
founded on derivable consequences in developing quality care.
It offers a description, explanation, prediction, and control of
patient care phenomena. Fundamentally, it offers an explanation
of variables affecting the development of therapeutic
relationships between a nurse and her patients in a care
environment.
References
Burack, O.R., Weiner, A.S., Reinhardt, J.P., &Annunziato, R.A.
(2012). What matters most to nursing home elders: Quality of
life in the nursing home. J Am Med Dir Assoc.13(1), 48–53.
Haugan, G. (2013). Nurse–patient interaction is a resource for
hope, meaning in life and self-transcendence in nursing home
patients. Scandinavian Journal of Caring Sciences, 28(1), 1–
211Haugan, G. (2014). Relationship between nurse–patient
interaction and meaning-in-life in cognitively intact nursing
home patients. Journal of American Nursing, 70(1), 107–120.
DOI: 10.1111/jan.12173
Stasková, V., &Tóthová, V. (December 2015). Conception of
the human-to-human relationship in nursing. Kontakt, 17(4),
e184-e189Noviana, U. et al. (2016). Meaning in life: A
conceptual model for disaster nursing practice. The Journal of
Nursing & Human Sciences (JNHS), 22(S1), 65–75.
Running head: NURSING PHILOSOPHY 1
NURSING PHILOSOPHY 2
Personal Philosophy of Advanced Nurse Practice
Personal Philosophy of Advance Nursing Practice Narrative
This Assignment addresses this course outcome:
MN502-1: Formulate a professional nursing philosophy based

upon the role and responsibilities of the advanced nurse.
Introduction
The purpose of this Assignment is for you to present your
views, values, and beliefs about the four concepts of the nursing
metaparadigm (i.e., person, nursing, health, and environment)
and their interrelationship to one another as they guide
your current nursing practice. The process of identifying a
personal nursing philosophy of advanced nursing practice and
continuously examining, affirming, and validating this
philosophy through caring for patients, families, communities,
populations, and/or systems can foster professional and personal
growth that builds advanced practice expertise.
Directions
In this Assignment, you will develop the first draft of your
personal philosophy of advanced practice nursing. You will
continue to work on this document throughout the course, with
new drafts reflecting your growing sophistication as you reflect
on each week's lesson.
A philosophical statement includes these elements:
· An introduction that presents your thought processes used to
articulate a philosophy of advanced practice nursing. Note that
APA does not use a heading for the introduction, because it is
assumed that the first few paragraphs of a manuscript are the
introduction.
· Valued personal concepts, such as:
· Metaparadigm concepts such as person/client, nursing, health,
and environment
· Additional concepts you may find valuable to advanced
practice, such as IOM Future of Nursing, accountability,
interprofessional collaborative practice, social justice, and
professionalism
· Definition of each concept selected
· Relationships between and among concepts within your
personal philosophy as applied to your current practice. A
diagram with should be used to graphically depict these
interrelationships.

The general framework of the philosophy of the nursing as a

profession focuses primarily on providing quality and adequate
health care to the needs of the patients. Owing to
interrelationships that exist among affecting factors of
individuals, environment, nursing and health, personal
philosophy is important in providing a relationship that is
harmonized (Denehy, 2012). This paper is aimed at assessing
the values, personal beliefs, and views that are related to factors
that are related to the Advanced Professional Nursing roles.
Concepts of meta-paradigm Concepts
The core focus of the advanced nurse should always and will be
the patient. As it is expected and believed that nurses should
provide care that is compassionate to all victims with fairness
and love. Nurses should give empathetic care to the needs of the
patients. A nurse should nurture a good and healthy relationship
with the patients and take care of their requirements. Nurses
have improved their skill to universal care.
Nursing is perceived as an art based on the codes of ethics and
standards of practice that manages the interactions between
patients and nurses. In addition, these rules are aimed at
maintaining the relationships established in the setting of
healthcare. Being a nurse is a privilege, and it should, therefore,
be taken with the more seriousness as it touches human life.
Professional nurses are directly influenced by health as another
facet.
Nurses usually have a responsibility of making sure that the
patient's health is restored and there is the improvement in the
quality of their lives. Therefore, nurses have always to be
recalled that the health is an important section of the well-
being. The surrounding is wherever patients are rendered with
healthcare services. Nursing home, hospital or a clinic should
be setting of an establishing a healthcare.
Friendly atmosphere and cleanliness are elements that are non-
negotiable regardless of the setting. The care surrounding
should be inviting to patients as it is expected to be free of
infections. Future Professionalism, Nursing and
Interdisciplinary teams in collaboration with IOM observed that

the nursing profession is expected to undergo drastic changes
brought about by the regulatory considerations. There is
tremendous demand for health services that are of good quality
calling for commitment and determination by the nurses to
maintain that objectives are still achievable.
It is equated by professionalism to practices that are acceptable,
and sustainability of services provision is ensured. This concept
can be achieved when standards of practice are embraced which
give acceptable behavior guidelines among their contacts and
caregivers with patients. Interdisciplinary collaborative practice
and team concept can be termed to be the close practitioners
association to ensure superiority healthcare services are
facilitated to all.
In conclusion, nursing can be seen as a way of giving back
to the society. A nurse should be willing to ready to help others.
Being able to show a person that you care is important to a
person spiritually.
References
Roussel, L. (2013). Management and leadership for nurse

administrators. Burlington, MA: Jones & Bartlett Learning.
Kouzes, J. & Posner, B. (2017). The leadership challenge: how
to make extraordinary things happen in organizations. Hoboken,
New Jersey: John Wiley & Sons, Inc.
Kikuchi, J. & Simmons, H. (1994). Developing a philosophy of
nursing. Thousand Oaks: Sage Publications.
Brencick, J. & Webster, G. (2000). Philosophy of nursing: a
new vision for health care. Albany, N.Y: State University of
New York Press.
Kim, H. (2015). The essence of nursing practice: philosophy
and perspective. New York, NY: Springer Publishing Company,
LLC.
Running head: NURSING PHILOSOPHY
1
NURSING PHILOSOPHY
2
Class MN502 Unit 1 Discussion
MAY 21, 2017

What does nursing philosophy have to do with your practice and
how you practice as an advanced practice nurse?
Nursing philosophy is based on both individual and professional
organization descriptions and definitions. Many issues and
factors both extrinsically and intrinsically influence an
individual’s personal perceptions of the nursing practice. Three
attributes of nursing philosophy have great influences and
impacts in my practice and how I practice as an advanced
practice nurse (Paley, 2014). These attributes are
accountability; compassion, and professionalism (Paley, 2014).
As a philosophy of nursing, accountability improves
professionalism through demonstrating a level of personal
control. Through accountability, I can practice autonomy within
the environment of a team while adhering directly to the rules,
guidelines, and principles of the nursing practice.
I will pursue high self-esteem, reduce self-limiting beliefs and
negative thoughts influence my nursing practice negatively
especially in advanced nursing practice. To be effective in the
nursing practice, tenacity, understanding and compassion are
significant especially when looking at the practice from an
advanced level. Delivery of care with utmost patience and
respect will is important to the practice to people of all
lifestyles and backgrounds (Paley, 2014). Nursing philosophy
emphasizes on the nurse-patient relationship which requires
nurses to respect the autonomy of nurses as people through
respect, worth and dignity.
In these professional relationships, advanced nurse practice
demands compassion without any restriction towards the
individual patients without regard to socioeconomic conditions
or diversity (Scott, Matthews, & Kirwan, 2014). The general
philosophy of nursing is about helping other people, which
forms the basis of my practice. Professionalism as an attribute
of nursing philosophy is defined through the applied perception
of individual beliefs or practitioners with regard to the
standards and scope of practice, social policy of nursing and

code of ethics of the practice (Scott, Matthews, & Kirwan,
2014). To me, the practice is not just a licensure or degree, but
also my personal image that displays high levels of
accountability, compassionate, and exhibits professionalism.
References.
Paley, J. (2014). Cognition and the compassion deficit: the
social psychology of helping behaviour in nursing. Nursing
Philosophy, 15(4), 274-287.
Scott, P. A., Matthews, A., & Kirwan, M. (2014). What is
nursing in the 21st century and what does the 21st-century
health system require of nursing?. Nursing Philosophy, 15(1),
23-34.

Purpose:
*Only to read: Overview and Outcomes of Class 2 Unit
10Assignment
Reflection and Assimilation
Bringing it all together!
This unit allows for reflection upon the use of philosophy,
models, and theories to the advanced nursing practice.
For the last nine weeks you explored nursing as a science,
interdisciplinary theories that are applicable to advance practice
nursing, models of advanced practice nursing, and the
refinement of a personal philosophy for use as an advanced
practice nurse.
In this last unit, look back to your first assignment that you
created as your personal philosophy of advanced practice
nursing and your Unit 9 Assignment, where you melded theory,
models, and philosophy into a unified whole. How have you
grown and matured toward your goal to becoming an advanced
practice nurse? While you are bringing it all together in this
unit, it is never "totally brought" together. This implies that as
you proceed through every course in within this MSN program
and after you graduate and practice at the advanced practice
level, you will still need to reflect upon what you know, what
you are learning, where you have been, and where you are going
as an APRN. This is one of the characteristics of professional
nursing.
After completing this unit, you should be able to:

· Summarize the unit outcomes.
· Predict how your advanced practice role, after graduation, will
reflect the content of this course.Reading Resources
Journal Readings
Please retrieve and read the following Journal articles from the
Kaplan University Library. Articles can be located through a
search in the CINAHL database, OVID database, Kaplan
University Library (links to these are located under the Student
Resources in Course Resources), or by using the link at the end
of the reference if provided.
Saifan, A., AbuRuz, M. E., & Masa’deh, R. (2015). Theory
practice gaps in nursing education: A qualitative perspective.
Journal of Social Sciences, 11(1), 20-29.
Purpose: Discussion
Discussion Details / Class 2 Unit 10
Unit 10: Discussion
Topic 1: Reflection
Think back upon your first topic question in Unit 1 and the four
assignments you completed in this course. What do you believe
about the influences of theory on nursing practice? What value
do you place on using a model for practice as an advanced
practice registered nurse? How has your philosophy of advanced
practice nursing changed over the last nine weeks?
THINGS TO REMEMBER:
Discussion post is at least 200 words.
Answers all questions with opinions/ideas creatively and
clearly. Supports post using several outside, peer-reviewed
sources.
3 References, find resources that are 5 years or less
No errors with APA format 6thEdition

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