Conceptualizations of Advanced Practice Nursing
Conceptualizations of Advanced Practice Nursing
This overview of extant models of advanced practice nursing is necessarily cursory, primarily focused on western literature (Canada, Europe, United States). Although there is some agreement on selected elements of advanced practice, differences remain regarding the conceptualization of the ARPN. To promote a unified conceptualization of advanced practice nursing, the following recommendations are put forth:
Conceptualizations of Advanced Practice Nursing
1. 1. Conduct a rigorous content analysis of the statements published by national and international professional organizations that describe the advanced practice nursing of recognized APRNs (CNMs, CNSs, CRNAs, certified NPs). This would be a natural evolution of the work done by the APRN Consensus Work Group, the NCSBN APRN Advisory Committee, the CNA, and others to inform future work. As part of this analysis, an assessment of the extent to which nursing’s metaparadigmatic concepts are integrated into statements about the nature of advanced practice nursing should be undertaken.
2. 2. Conduct a content analysis of statements that address advanced practice nursing promulgated by specialty organizations.
3. 3. Review recent role delineation studies of the four APRN roles.
4. 4. Conduct a comprehensive integrative review of the advanced practice literature, building on the work of Mantzoukas and Watkinson (2007) and Lewandowski and Adamle (2009). This could be modeled on the work of Reeves et al. (2011) and their conceptualization of interprofessional education, identifying concepts and relationships that need further development.
5. 5. Synthesize results to collaboratively propose a definition of advanced practice nursing to be used nationally and globally.
6. 6. Create a common structure for organizational statements about APRNs that ensures nursing concepts are included:
· a. Definition of nursing and advanced practice nursing
· b. Specification of assumptions
· c. Incorporation of the metaparadigmatic elements (persons, health and illness, nursing, environment) into scopes and introductions to key documents
· d. Referencing documents such as the ANA’s social policy statement and the ICN’s statements on nursing
7. 7. Implement a structure for developing statements that define advanced practice nursing to explicate the foundational and philosophical underpinnings of each organization’s approach to defining advanced practice nursing.
8. 8. Use the results from recommendations 1 through 5 above to inform revisions of the DNP Essentials (AACN, 2006), standards, and other documents that address APRN LACE issues for APRN roles. Future revision of documents regarding APRNs should be informed by a clear conceptualization of advanced practice nursing and empirical evidence.
9. 9. Because the terms advanced practice nursing and advanced nursing practice are being used to refer to APRN work in different ways in the United States versus internationally, revisit the work on definitions of these terms done by Styles (1998) and Styles and Lewis (2000) and clarify these definitions as they relate to APRNs.
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