Patients' capacity for health and their vulnerability to illness are influenced by biologic, genetic, psychological, and socioecologic determinants. The Synergy Model posits a unique cluster of personal characteristics that arise from these determinants and exist along a continuum that parallels health and illness states—stability, complexity, predictability, resiliency, vulnerability, participation in decision making and care, and resource availability (Table 2-4). An important function of the nurse is to ensure the patient's safe passage through the health care system (Hamric 55) ii. Dunphy and Winland-Brown Circle of Caring 1. A central premise of Dunphy and Winland-Brown's model (1998) is that the health care needs of individuals, families, and communities are not being met in a health care system that is dominated by medicine and one Page 15 of 2 NSG 6006 Pre-Specialty Evaluation ©2017 South University
The Role of the Advanced Practice Nurse NSG 6006 Week 2 in which medical language (i.e., the International Classification of Disease Codes [ICD-10-CM]) is the basis for reimbursement. They proposed the “Circle of Caring: A Transformative Model” to foster a more active and visible nursing presence in the health care system and to explain and promote medical-nursing collaboration. Dunphy and Winland-Brown's transformative model, which has been slightly revised since its original publication (Dunphy, Winland-Brown, Porter, et al., 2011; Fig. 2-12) is a synthesized problem-solving approach to advanced practice nursing that builds on nursing and medical models (Dunphy & Winland-Brown, 1998). (Hamric 57-58) e. Advanced Practice Professional Organizational Perspectives i. APRN Consensus Model for Regulation: LACE L icensure, A ccreditation, C ertification, E ducation Before a discussion of regulation can take place, it is important to understand the progress to date surrounding the Consensus Model and the Nursing Model Act and Rules for APRN licensure (NCSBN, 2011). Credentialing for APRNs is composed of four components—licensure, accreditation, certification, and education (LACE). Several years ago, the NCSBN's Advanced Practice Committee created a vision paper that spoke to the recommendations of the Quality Chasm report (Committee on Quality of Health Care in America, IOM, 2001) and the concerns surrounding multiple roles and specialties for APRNs. At about the same time that the NCSBN began its work (March, 2004), various stakeholders, including leaders from the American Association of Colleges of Nursing (AACN; NCSBN, 2008), National Organization of Nurse Practitioner Faculties (NONPF), National Association of Clinical Nurse Specialists (NACNS), American Association of Nurse Anesthetists (AANA), American College of Nurse-Midwives (ACNM), and several APRN certifying bodies, accreditors, and regulators met to establish a process that would result in a consensus statement on the credentialing of APRNs. Both groups worked toward consensus about a regulatory model that would establish a model of education, certification accreditation, and licensure to strengthen and standardize the public and private regulatory scene. The IOM reports of 2000 and
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