Historical & Theoretical

Foundations of Advanced Practice

Nursing

Kathryn Kornegay, PhD, RN, Certified Addictions Registered

Nurse: Advanced Practice (CARN-AP)

Our Early Journey• Florence Nightingale elevated

profession to respectable status by establishing St. Thomas Hospital School of Nursing

• Hospitals became arena for educating nurses

• Early Masters’ programs focused on med-surg, psych, public health, teaching, & administration

Advanced Practice Nursing

Time-Line

• 1900-1930: hospital-based courses in anesthesia, OR, & obstetrical nursing

• Post WWII: development CNS role/Nurse Training Act

• 1965: 1st NP Program Loretta Ford & Henry Silver

• Only in the past generation has nursing as a profession been transformed from a feminine duty & obligation to care for the ill in times of need to a theory-based profession grounded in scientific inquiry & clinical practice

NP Role CNS Role

• Direct Care Focus

autonomy• Initial

education was not all initially at graduate level

• Direct & Indirect Care Focus

• Merged into management hierarchy

• Heavy theoretical basis

Nurse Practitioners

• NP Movement started as joint effort between nursing & medicine

• Original programs taught physical diagnosis & prescription

• Usually relied on pathophysiological theoretical model

NP Credentialing• Certification offered as competition

with academic credentials

• Now most NPs must have both a master’s degree and certification

• Was originally feared NPs would forget origins & identify with MDs

• Trend is for MDs to view NPs as competition; have been viewed as means to MD’s income

Theoretical Models for Advanced Practice

• Originally none for advanced practice

• Have predominately adopted nursing theories already in place

• Growth of AP roles have created need for AP role-specific & specialty=specific theories

Practitioner Role-Specific Theory

• Schuler (1993): based on wellness model & nursing process, claims to have advanced holistic approach to clients

• Campbell & Co-workers (1995): Blends NP, CNS, and case manager roles in collaborative practice model with MDs

APN Skills & Abilities

• Advanced Assessment• Synthesize & analyze data• Apply nursing principles• Provide expert guidance &

teaching• Work with clients, families, &

healthcare workers• Manage clients’ health-illness

status

Additional Advanced Practice Skills &

Abilities• Recognize practice limits• Use abstract thinking &

conceptualization• Make decisions independently• Diagnose & prescribe• Consult with/refer to other

healthcare workers (Adapted from Natl. Counsel

State Boards of Nursing, 1992)

• Now, tell me what your thoughts are about advanced practice nursing……