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Journal of Professional Nursing.

Brown, S.J. (1998). A framework for advanced practice nursing. Journal of Professional Nursing, 14(3), 157-164.

Summary. The purpose of this article was to describe a comprehensive, coherent, and useful framework for advanced practice nursing in order to guide curriculum development, shape role descriptions and practice agreements, inform policy developers, and guide research agendas. To develop this framework, the author identified ideas and broad concepts about advanced practice nursing, definitions of and links between concepts, and explicit assumptions upon which the framework was based. Sources for the ideas contained in the framework represent a comprehensive review of relevant literature.

The resulting framework consists of four main concepts: environment (the multiple contexts within which advanced practice nursing is undertaken), role legitimacy (the education and credentials required for advanced practice nursing), advanced practice nursing (defined by five attributes: focus, orientation, domains of activity, scope, and competencies), and outcomes attributable to the role (categorized as patient outcomes, health care system outcomes, professional nursing outcomes, and individual practitioner outcomes). The framework provides the basis for the definition of advanced practice nursing as "professional health care activities that (1) focus on clinical services rendered at the nurse-client interface, (2) use a nursing orientation, (3) have a defined but dynamic and evolving scope, and (4) are based on competencies that are acquired through graduate nursing education" (p. 161).

Commentary. This important article provides a comprehensive framework for advanced practice nursing that describes four main concepts of the role: environment, role legitimacy, nature of advanced practice, and outcomes attributable to the role. By emphasizing the larger picture, the author makes it possible to apply the framework broadly across multiple practice settings with respect to role preparation, implementation, and outcomes. This article is by no means a step-by-step description of the role, but provides anyone who prepares APNs, practices as an APN, or is otherwise interested in APNs, with the basis for some thoughtful analysis of the role.

Heather Locking-Cusolito, MScN, RN, CNeph(C), is a nurse practitioner/CNS in dialysis at St. Joseph's Health Centre, London, Ontario, Canada.

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Author:Locking-Cusolito, Heather
Publication:Nephrology Nursing Journal
Geographic Code:1USA
Date:Apr 1, 2000
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