NSG 6006 pre-specialty health policy/theory/APN roles exam |167 questions and answers.

Advanced practice nursing is the patient-focused application of an expanded range of competencies to improve health outcomes for patients and populations within a specialized clinical area of the larger discipline of nursing" Hamric's definition of advanced practice nursing What is the central competency of any advanced practice nursing regardless of role? direct clinical practice ___________________________ and ___________________________ have distinct definitions and cannot be seen as interchangeable. Advanced practice nursing/advanced nursing practice The term ____________________________ is characterized by the integration an application of a broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education Advanced nursing practice Who started the first nurse practitioner program in 1965 at the University of Colorado? Henry Silver and Loretta Ford What has influenced the history of advanced practice nursing? Societal forces including wars, the economic climate, and health care policy The APN movement consists of? Society War Economicclimate Healthcare Policy What is the oldest recognized role of the APN? CRNA What are the 4 recognized roles of the APN? NP CRNA CNS CNM List the core competencies of practice. Direct care, guidance & coaching, consultation, evidence-based practice, leadership, collaboration, and ethical-decision making The consensus model for the APN regulation addresses what 4 areas? Specialty areas Roles and titles Population Foci Preparation for APN roles Which group of nurse specialist was the first to receive direct reimbursement for services rendered? CRNA scope of practice - Describes practice limits and sets parameters within which nurses in various APRN specialties may practice- Differs from state to state; based on state statues promulgated by various state nurse practice acts and rules and regulations for APRN practice Scope of practice Must practice and be certified in the specific specialty Graduate education ANA definition of scope of practice "The description of the who, what, where, when, why, and how of nursing practice" Nursing scope of practice acts are most closely tied to the ______________________ of practice state The Novice to Expert Theory is described by The Dreyfus Model Calkin's Model of Advanced Nursing Practice developed the model to help nurse administrators differentiate advanced practice nursing from other levels of clinical practice in personnel policies, and proposed that this could be accomplished by matching patient responses to health problems with the skill and knowledge levels of nursing personnel; three curves were overlaid on a normal distribution chart. Calkin depicted the skills and knowledge of novices, experts by experience, and APNs in relation to knowledge required to care for patients whose responses to health care problems (i.e., health care needs) ranged from simple and common to complex and complicated unclear expectations, diffuse responsibilities, uncertainties about sub-roles Role ambiguity role ambiguity incompatibility between skills and abilities, personal values, self concept, and obligations role incongruity when role expectations are perceived to be mutually exclusive or contradictory role conflict Perceived economic threat of competition, lack of experience working together, and historical hierarchy interprofessional role conflicts a dynamic process of change over time as new roles are acquired role transition a situation of increased role; performance demand role stress master or doctoral prepared registered nurses who practice as full time or adjunct faculty in college/universities, hospital based educational residency programs, and/or health care facilities. Responsibilities for both classroom and practical setting include mentoring and preparing future generations of nurses and current nurses in practice. They play a vital role in serving as role models, while strengthening the nursing workforce, by assuring quality educational opportunities, guiding employees and/or students through the learning process, as well as implementing evidenced based research into practice; they also play a role in evaluating and documenting educational learning experiences or outcomes. nurse educator a set of relatively abstract and general concepts that address the phenomena of central interest to a discipline, the propositions that broadly describe those concepts, and the propositions that state relatively abstract and general relations between two or more concepts. conceptual model one or more relatively concrete and specific concepts that are derived from a conceptual model, the propositions that narrowly describe those concepts, and the propositions that state relatively concrete and specific relations between two or more concepts theories abstract, broad theory consists of propositions that are less broad and abstract than a conceptual model, but not as specific and concrete as middle range theory grand theory The concepts of a ______________________________ are so abstract and general that they often cannot be observed or tested directly and may not even be defined. conceptual model Hamric's Integrative Model - Proposed an integrative understanding of the core of advanced practice nursing, based on literature from all APN specialties - Hamric proposed a conceptual definition of advanced practice nursing and defining characteristics that included primary criteria (graduate education, certification in the specialty, and a focus on clinical practice with patients) - and a set of core competencies (direct clinical practice, collaboration, guidance and coaching, evidence-based practice, ethical decision making, consultation, and leadership). Fenton's and Brykczynski's Expert Practice Domains of the Clinical Nurse Specialist and Nurse Practitioner Their findings further illuminate why Benner's work has influenced descriptions of advanced practice. By examining the extent to which APNs demonstrate the seven domains found in experts by experience and uncovering differences, the findings offer a possible explanation of the differences between expert and advanced practice. In addition, they also describe ways in which two advanced practice nursing roles, CNSs and NPs, may be different with regard to practice domains and competencies Calkin's Model of Advanced Nursing Practice developed the model to help nurse administrators differentiate advanced practice nursing from other levels of clinical practice in personnel policies, and proposed that this could be accomplished by matching patient responses to health problems with the skill and knowledge levels of nursing personnel; three curves were overlaid on a normal distribution chart. Calkin depicted the skills and knowledge of novices, experts by experience, and APNs in relation to knowledge required to care for patients whose responses to health care problems (i.e., health care needs) ranged from simple and common to complex and complicated Brown's Framework for Advanced Practice Nursing developed a conceptual framework for the entire field of advanced practice nursing, including the environments that surround and impact upon practice; 4 main and 17 specific concepts (specific concepts are in parentheses): environments (society, health care economy, local conditions, nursing, advanced practice community); role legitimacy (graduate education, certification, licensure); advanced practice nursing (scope, clinical care, competencies, managing health care environments, professional involvement in health care discourse); and outcomes (patient, health care system, the nursing profession, individual APN outcomes) They refer to practice by the term praxis, which captures the values-oriented, reflective, and creative nature of the work of nurses. They conceive of nursing as a dialectic (back and forth) process between the nurse's knowledge and his or her experiences and relationships with patients; As nurses accumulate experience, this dialectic process that occurs in relationships with patients contributes to developing expertise Oberle and Allen: The Nature of Advanced Practice Nursing a complex systems model that is holistic and wellness-oriented. It is definitive and detailed in terms of how the NP-patient interaction, patient assessment, intervention, and evaluation should occur; It is complex and its value for understanding NP practice may not become clear until one is in practice; is intended to describe the NP's combined functions (i.e., nursing and medicine), benefits for practitioner and patient, and a framework whereby NP services can be evaluated Shuler's Model of Nurse Practitioner Practice Subjects (N = 36) from the United States, Canada, United Kingdom, and Australia participated; they were required to be master's-prepared or graduate students preparing for an advanced practice role. The investigators conducted interviews and made observations of the participants over a 3-year period. The theory emerged from this study; work suggests that the activities of APNs, in this case NPs and CNSs, are strategic and focused and that some activities involve direct service to patients, whereas others are aimed at communication and system issues Ball and Cox: A Theory of Legitimate Influence Practice models for APN's AACN synergy model & Dunphy & Winland_Brown circle of caring a unique cluster of personal characteristics that arise from these determinants and exist along a continuum that parallels health and illness stating: stability, complexity, predictability, resiliency, vulnerability, participation in decision making and care, and resource availability. AACN synergy model for patient care 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. It is a synthesized problem-solving approach to advanced practice nursing that builds on nursing and medical models Dunphy and Winland-Brown Circle of caring APRN Consensus Model for Regulation includes Licensure, Accreditation, Certification and Education: LACE To advance and promote the improvement of health standards and the standards of nursing and to stimulate and promote the professional development of nurses and advance their economic and general welfare American Nurses Association (ANA) NONPF national organization of nurse practitioner faculties NACNS national association of clicinal nurse specialists AANA american association of nurse anesthetists ACNM american college of nurse midwives What are the barriers to the conceptualization of APN? Interprofessional education and practiceAbsence of well defined terms and referenceLack of clarity of conceptualizations of clinical practiceNeed to clarify APN vs MD the process of unlearning an old role and learning a new role; transforming one's identity from being an individual contributor as a staff nurse to being a leader as a nurse manager role transition What is the evolution of the APN? Specialist, Expanded Role, and now Advanced Practice relatively new, and involves the integration of the science of nursing, computer science, and management of information science to communicate data, knowledge, and information in nursing practice. generally have experience and training in both the practical setting and computer science, to better enhance the efficiency and effectiveness of the tools and strategies health care providers use as a means to improve the overall health care experience and communication between the patient and the nurses; work in a variety of settings, to include industrial, hospitals, and academic sectors that train current nurses in using technology more effectively. also take on administrative roles, where their responsibilities include overseeing technology for an entire medical institution or health care system. Such administrative roles, gives them the title and responsibilities of a Chief Information Office nurse informatics typically are Master prepared nurses, whose positions requires a strong knowledge base of nursing practice as well as the overall general field of healthcare. work primarily in managerial positions, and although they do not work closely with the patients, their responsibilities consist of ensuring the safety, welfare, and satisfaction of the patients, supervising employees of health care, facilitating communication among members of the health care team/staff and other areas of the healthcare system/organization, budgeting and decision making, as well as formulation of policy nurse administrator