Historical & Theoretical Foundations of Advanced Practice Nursing

1. Historical & Theoretical Foundations of Advanced Practice Nursing Kathryn Kornegay, PhD, RN, Certified Addictions Registered Nurse: Advanced Practice (CARN-AP)

2. 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

3. 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

4. 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

5. Direct Care Focus  autonomy Initial education was not all initially at graduate level Direct & Indirect Care Focus Merged into management hierarchy Heavy theoretical basis NP Role CNS Role

6. Nurse Practitioners • NP Movement started as joint effort between nursing & medicine • Original programs taught physical diagnosis & prescription • Usually relied on pathophysiological theoretical model

7. 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

8. 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

9. 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

10. 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

11. 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)

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