Clinical meaning
Nurse practitioners operate at an advanced practice level requiring communication skills that integrate clinical authority with therapeutic empathy. Shared decision-making involves presenting evidence-based options, discussing risks and benefits in language the patient can understand, and collaboratively selecting a plan that aligns with the patient's values and preferences. Motivational interviewing at the advanced practice level focuses on sustained behavior change for chronic disease management, substance use reduction, and treatment adherence using the stages of change model (precontemplation, contemplation, preparation, action, maintenance). Breaking bad news frameworks such as SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary) provide structured approaches for delivering difficult diagnoses or prognosis information while maintaining therapeutic rapport.
Diagnosis & workup
Diagnostics & workup: - Health literacy assessment using validated tools such as REALM or TOFHLA - Decision-making capacity assessment evaluating understanding, appreciation, reasoning, and ability to express a choice - Readiness for change assessment using the stages of change model - Cultural assessment to identify health beliefs, practices, and communication preferences