Conceptual Models in Advanced Nurse Practitioner Practice
Nature, Purposes, and Components of Conceptual Models
A conceptual model is a critical part of the structure of nursing knowledge, encompassing various levels from abstract to concrete. This structure includes metaparadigms, philosophies, conceptual models, theories, and empirical indicators (Fawcett & Desanto-Madeya, 2013). Traditionally, key concepts in the metaparadigm of nursing are humans, the environment, health, and nursing (Fawcett & Desanto-Madeya, 2013).
What is a Conceptual Model?
Fawcett and Desanto-Madeya (2013) described a conceptual model as:
- A set of relatively abstract and general concepts addressing the phenomena central to a discipline.
- Propositions that broadly describe these concepts.
- Propositions that state relatively abstract and general relations between two or more of the concepts.
Additionally, a conceptual model is a distinctive frame of reference that guides observation and interpretation of phenomena of interest to the discipline. It provides alternative ways to view the subject matter, without a single “best” way (Fawcett & Desanto-Madeya, 2013).
Importance in Advanced Nurse Practitioner Roles
Evolving a more uniform and explicit conceptual model for advanced practice nursing benefits patients, nurses, and other stakeholders by:
- Facilitating communication.
- Reducing conflict.
- Ensuring consistency in advanced practice nursing.
This systematic approach enhances nursing research, education, administration, and practice (Institute of Medicine, 2011).
Applications of Conceptual Models in Advanced Nurse Practitioner Practice
Professional Identity and Clinical Practice
Conceptual models help Advanced Nurse Practitioners (ANPs) articulate professional role identity and function. These models serve as frameworks for:
- Organizing beliefs and knowledge about professional roles and competencies.
- Further development of knowledge.
In clinical practice, ANPs use conceptual models for holistic, comprehensive, and collaborative care (Carron & Cumbie, 2011; Dunphy, Winland-Brown, Porter, Thomas & Gallagher, 2011; Elliott & Walden, 2015; Musker, 2011).
Differentiation in Nursing Practice
Conceptual models differentiate among levels of nursing practice, such as:
- Staff nursing vs. advanced practice nursing (Gardner et al., 2013).
- Clinical nurse specialists (CNSs), nurse-midwives (CNMs), and nurse practitioners (NPs; Begley et al., 2013).
Guiding Research and Theory Development
Conceptual models guide research and theory development by focusing on specific concepts or examining relationships among select concepts to elucidate testable theories. For example, Gullick and West (2016) evaluated Wenger’s community of practice framework to enhance research capacity and productivity for CNSs and NPs in Australia.
Educating Future Advanced Nurse Practitioners
Faculty use conceptual models to plan curricula for APRN roles, identifying key concepts and their relationships, and making choices about course content and clinical experiences (Perraud et al., 2006; Wong et al., 2010).
Conceptual Questions in Advanced Practice
Fawcett and Graham (2005) and Fawcett et al. (2004) have posed important questions about advanced practice:
- What do ANPs do that makes their practice “advanced”?
- To what extent does incorporating activities traditionally done by physicians qualify nursing practice as “advanced”?
- Are there nursing activities that are also advanced?
Direct Clinical Practice and APRN Competencies
Direct clinical practice is central to ANP competency, raising questions about the meaning of “clinical” in various settings, such as hospitals or clinics. These questions are crucial given the APRN Consensus Model and the evolving role of ANPs in healthcare (Hamric, 2014).
Innovations and Reforms in Advanced Nurse Practitioner Practice
Healthcare legislation changes and regulations emphasize the need for ANPs to be explicitly engaged in delivering care across settings, including:
- Nursing clinics.
- Palliative care settings.
- Interprofessional teams.
Theoretical Questions and Conceptualization
Theoretical questions about the conceptualization of advanced practice nursing include:
- Epistemologic, philosophic, and ontologic underpinnings of advanced practice.
- Application of nursing theory in practice.
- Differences between specialty, advanced practice, and advancing practice.
Summary
Well-thought-out, robust conceptual models are essential for guiding ANP practice. Conceptual clarity benefits patients, the nursing profession, and interprofessional education and practice (CIHC, 2010; Health Professions Network Nursing and Midwifery Office, 2010; IPEC Expert Panel, 2016). It supports the creation of accountable care organizations and builds systems for effective communication, collaboration, and coordination, leading to high-quality care and improved outcomes.