Chapter 2 Conceptualizations of Advanced Practice Nursing Judith A. Spross Why are conceptualizations of advanced practice nursing important for students and practicing advanced practice nurses (APNs) to understand? The content may seem dry to students, who are otherwise excited about learning new ways of caring for individuals, through their APN education. Concepts, models, and theories seem remote from the real work of eliciting histories, performing physicals, planning treatment, evaluating outcomes, and otherwise helping patients and families improve their health, cope with illnesses, and die with dignity. Whether one does so consciously, all these advanced practice activities are guided by some model or framework. Novices may rely more frequently on rules and guidelines to accomplish their work. Expert APNs may not consult rules and guidelines for common problems, but can improvise new ways of thinking (models) when faced with novel situations. Regardless of years of experience, APNs rely on common processes and language in their communications with colleagues about patient care and recognize when they must explain a clinical situation to someone unfamiliar with the patient. Similarly, it is important for the nursing profession and for individual APNs to understand the language of advanced practice nursing to communicate with each other, clients, and stakeholders. Currently, converging forces in the United States are moving rapidly, requiring the profession to advance a common understanding of advanced practice nursing, which is likely to inform future conceptualizations of advanced practice nursing. The development of a common language and conceptual framework for communication and for guiding and evaluating practice, education, policy, research, and theory is fundamental to sound progress in any practice discipline. Given the evolving changes in the U.S. health care system, such a foundation is particularly crucial at this stage in the development of advanced practice nursing. Since the last edition, a professional consensus on advanced practice nursing regulation has been reached in the United States—the Consensus Model for APRN Regulation (2008) and is being implemented. In addition, the Institute of Medicine [IOM] (2011) has called for integrating advanced practice nursing more completely into the U.S. health care delivery system. Other forces driving a common understanding of advanced practice nursing are the expansion of programs offering the Doctorate of Nursing Practice (DNP), the Patient Protection and Affordable Care Act (PPACA, 2010 ), accountable care organizations, and the promulgation of interprofessional competencies ( Canadian Interprofessional Health Collaborative [CIHC], 2010 ; Health Professions Networks, Nursing and Midwifery, & Human Resources for Health, 2010 ; Interprofessional Education Collaborative [IPEC] Expert Panel, 2011 ) and education
(see Chapters 12 and 22 ). Understanding what advanced practice nursing is, what APNs do, similarities and differences among APNs, and how APNs
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