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 : hospital-based courses in anesthesia, OR, & obstetrical nursing Post WWII: development CNS role/Nurse Training Act 1965: 1 st 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……