using nursing models in [nurse practitioner] practice relates to vocabulary and communication….” Despite progress, this challenge remains. For example, in the United States, advanced practice nursing is the term that is used but the ICN and CNA use the term advanced nursing practice . Furthermore, the role and functions of APNs could be better conceptualized. Although the use of competency is becoming more common, concepts about APN work are variously termed roles, hallmarks, competencies, functions, activities, skills, and abilities . Few models of APN practice address nursing's metaparadigm (person, health, environment, nursing) comprehensively. The problem in comparing, refining, or developing models is that terms are used with no universal meaning or frame of reference; occasionally, no definition is offered at all, or terms are used inconsistently. This instability and inconsistency are evident in many models cited in this chapter. It is rightly anticipated that conceptual models of the field and its practice change over time. However, the evolution of advanced practice nursing and its comprehension by nurses, policymakers, and others will be enhanced if scholars and practitioners in the field agree on the use and definition of fundamental terms of reference.
The second issue is that many attempts to articulate models of advanced practice nursing fail to consider extant literature that is directly relevant to such conceptualizing activities. In part, this may be a result of the lag between the conceptualizing effort and its ultimate publication, the knowledge explosion, and the role of the Internet and social media in the generation and dissemination of knowledge. For example, some recently published articles reviewed for this chapter cited work from the 1980s and 1990s; revised publications of these earlier cited works, although apparently available, were not cited. This caution should be considered when proposing, evaluating, or refining advanced practice nursing models. The third issue is a lack of clarity regarding conceptualizations that differentiate between and among levels of clinical practice: •Does the practice of APNs differ from the practice of registered nurses (RNs) who are experts by experience (i.e., no graduate degree in advanced practice)? •How does the practice of an APN certified in a subspecialty such as oncology differ from the practice of a non—master's prepared clinician who is certified at the basic level in the oncology subspecialty? •With the definition of population foci and subspecialty advanced in The APRN Consensus Model, how does certification in one or more subspecialties influence the quality and outcomes of care? •How does the care provided by an adult health NP with a subspecialty APN certification in oncology or critical care differ from one who is certified in adult health only?
- Winter '17
- Nursing, advanced practice nursing