Shuler's Model Of Advanced Practice Nursing

Direct clinical care provided by advanced practice nurses (APNs) is defined by six characteristics – use of a holistic perspective, formation of therapeutic partnerships with patients, expert clinical performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches to health and illness management1. APN practice is distinct from medicine in its holistic approach to patient care. As conceptualized in Shuler’s model, although advanced practice nursing does encompass certain aspects of medicine, it distinguishes itself from the medical model by merging both nursing and medical values.2 The holistic perspective emphasized in APN practice considers the patient as a whole, encompassing all dimensions

I will gain patient trust and respect by verbalizing and reaffirming at least one positive aspect of each patient I encounter, whether it be a positive health behavior, a decision to seek health care, or a commitment to healthier lifestyle choices. To understand cultural values and practices and individual expectations and goals, I will elicit patient preferences by using open-ended questions and clarifying them using reflective listening techniques such as “restating, rephrasing, reframing, and reflecting thoughts, feelings, and emotional undertones.” 4 I also maintain a keen self-awareness of my own biblical beliefs and values as a Christian. To ensure that my own biases do not interfere with my provider-patient relationships, I will verbally remind patients that my role as a clinician is to simply present medical facts and clinical options, while supporting their healthcare decisions. When necessary, I will debrief on interactions with my colleagues so that I can determine when it is appropriate to involve another clinician. When caring for infants and nonverbal children, I will use a soothing tone of voice and pay close attention to nonverbal cues5 such as grimacing and facial responses when

I will ensure my growth towards these competency areas by seeking consultation from more experienced colleagues when clinical data do not support my working diagnoses. To ensure safe clinical outcomes, I will act on the clinical intuition that I developed as an ICU nurse to rule out worst case scenarios, refine my 12-lead electrocardiogram interpretation skills as a bedside nurse, listen carefully to patients while charting accurately on electronic health records, and remaining cognizant of time pressures and increased susceptibility to errors in these situations. To proactively prevent future ethical dilemmas, I plan to address end-of-life directives with all appropriate patients in a sensitive manner while in the primary care setting.

Reflective practice is a learning method that consists of exploring both positive and negative experiences to elicit meaning and analyze critically in order to improve practice.6 I plan to apply this skill in my future practice, especially as a novice, by keeping a personal journal of my experiences in this new role, verbally reflecting with my NP colleagues and mentors, and analyzing how my own inherent assumptions and worldview influence my