90 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
however, the defining factor for all [sic] APRNs is that a significant compo-
nent of the education and practice focuses on direct care of individuals- Whose practice builds on the competencies of RNs by demonstrating a greater
depth and breadth of knowledge, a greater synthesis of data, increased com-
plexity of skills and interventions, and greater role autonomy - Who is educationally prepared to assume responsibility and accountability for
health promotion and/ or maintenance as well as the assessment, diagnosis,
and management of patient problems, which includes the use and prescrip-
tion of pharmacologic and nonpharmacologic interventions - Who has clinical experience of sufficient depth and breadth to reflect the in-
tended license - Who has obtained a license to practice as an APRN in one of the four APRN
roles: CRNA, CNM, CNS, or CNP (APRN Consensus Workgroup and NCSBN
APRN Advisory Committee, 2008, pp. 7– 8)
■ UNIQUENESS OF APRN “PRACTICE”
Contemporary views of advanced nursing practice are grounded in the intersection of
medical knowledge and skills with nursing’s meta- paradigm and knowledge base. The
unique contribution that APRNs can make in the current health care system can be concep-
tualized to emerge from a distinctive blend of biomedical and nursing perspectives, skills,
and knowledge sets. One crucial challenge for contemporary and future advanced nurs-
ing practice is to fully elucidate and articulate the mechanisms by which this fusion occurs
(resulting in excellent, cost- effective nursing and excellent patient outcomes). Our disci-
pline’s appreciation of holism incorporates an understanding of persons as integrated,
continually interacting with their environment, and engaged in the creation of meaning,
and our disciplinary attention to the influences of life transitions and health conditions
on individuals, families, and communities form a matrix of underpinnings for advanced
nursing practice. Holism, patient/ client centeredness, respect for individual autonomy,
respectful communication with active listening, focused preventive care, health educa-
tion, and integration of services, all of which are combined with clinical knowledge and
expertise, are potentially some of the essential components of APRN effectiveness that
grow from the nursing meta- paradigm (Donnelly, 2003; Erikson, 2007; Neill, 1999).
Despite an evolving, but still small, evidence base for the uniqueness of APRN
practice, many of these disciplinary dimensions of practice need to be systematically
examined. For example, Charlton, Dearing, Berry, and Johnson (2008) reported find-
ings of their integrative review of NP communication styles. Their review suggested
that NPs patient- centered communication styles, which they termed “biopsychoso-
cial,” compared with “biomedical” styles (2008, p. 383), influenced patient satisfac-
tion, adherence, and health indicators, and was consistent with a specialized model
of APRN effectiveness based on nursing’s disciplinary perspective. Dunphy and
Winland- Brown (2006) proposed a model of APRN practice: the Circle of Caring , which
accounts for, and formalizes, the overlapping multidisciplinary perspectives inte-
grated in APRN practice through the standpoint of contextualized understanding in
a scientific caring framework. Dunphy and Winland- Brown state that “caring is sug-
gested as one way to bridge the gulf between holistic nursing theories and biomedical
nursing praxis” (2006, p. 288). Table 3.1 offers other perspectives by summarizing a
variety of studies that examined the influence of a nursing- disciplinary perspective as
the underpinning for effective patient care by NPs.