Practice Models Applied to Advanced Nurse Roles

The contemporary advanced practice nursing is vastly shaped by various theoretical frameworks, which are designed to improve the quality of caregiving by producing new knowledge (Butts & Rich, 2015). However, it should be mentioned that in the majority of cases theories are developed from the models of practice (Chism, 2017). The implementation of these models correlates with the advanced nursing practice roles, which can be described as a set of distinct competencies. This paper aims to evaluate the application of a particular model of practice and to discuss its relationship with the chosen advanced practice role.

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Identifying Competences and Model of Practice

First of all, the advanced practice role and the model of practice, which will be later evaluated, should be defined. Among six primary nursing roles which are distinguished by numerous researchers, the role of clinical nurse specialist (CNS) is chosen (Sastre‐Fullana et al., 2014). It is argued that the primary competencies of a CNS are direct care, systems leadership, collaboration, coaching, consultation, research, and ethical decision-making, which includes moral agency and advocacy (DeNisco & Barker, 2015).

Based on the chosen role of clinical nurse specialist, it is possible to observe that one of the better fitting approaches appears to be the Roy’s Adaptation Model (RAM). The primary goal of this model is to promote individuals’ and groups’ adaptation that will advance their quality of life (Fawcett, 2017).

Correlation between Model and Role

Characteristics of Roy’s Adaptation Model Application to clinical nurse specialist’s role
Human adaptive system is a holistic concept which is divided into two primary dimensions: individuals and groups (or relational persons). CNS can apply the model to both individual and group levels in his clinical practice. However, the primary focus is on individuals.
Adaptive modes are defined as “ways in which human adaptive systems respond to stimuli from the environment” which are interrelated (Fawcett, 2017, p. 264). Clinical nurse specialist should make use of each mode to achieve significant results in advancing patient’s response to stimuli.
The first adaptive mode is physiologic mode. CNS should make sure that patient receives balanced activity and rest level, proper nutrition and oxygenation, elimination. Neurological and endocrine functions should be maintained.
The second adaptive mode is self-concept mode. CNS should maintain patient’s realistic appraisals of his or her physical self (including health, sexuality, and physical attributes) and personal self (including values, expectations, ethics, and self-ideal).
The third adaptive mode is role function mode. CNS should make sure that patient is successfully coping with his primary and secondary roles along with more specific behavioral patterns (tertiary role, role-taking, expressive and instrumental behavior).
The fourth adaptive mode is interdependence mode. CNS should make sure that patient is giving and receiving love and respect in natural, healthy, and sufficient manner.
The first aspect of RAM nursing process is assessment of behaviors. CNS should continuously collect data about patient’s current state of coping process and adaptation (Fawcett, 2017).
The second aspect of RAM nursing process is assessment of stimuli. CNS should identify “internal and external focal and contextual stimuli” that have a direct influence on patient’s behavior (Fawcett, 2017, p. 268).
The third aspect of RAM nursing process is nursing diagnosis. After assessing patient’s behavior and stimuli, CNS should state the current adaptation status of an individual.
The fourth aspect of RAM nursing process is goal setting. When the current adaptation status is identified, CNS should set a clear goal of desired behavioral outcomes.
The fifth aspect of RAM nursing process is intervention. By altering, removing, or maintaining the stimuli, CNS can manage to strengthen the patient’s adaptation process.
The sixth and final aspect of RAM nursing process is evaluation. Through the process of constant interpersonal communication, CNS and patient can evaluate the effectiveness of nursing interventions and alter them if it is needed (Fawcett, 2017).


Butts, J. B., & Rich, K. L. (Eds.). (2015). Philosophies and theories for advanced nursing practice (2nd ed.). Jones & Bartlett Learning, LLC.

Chism, L. A. (Ed.). (2017). The doctor of nursing practice: A guidebook for role development and professional issues (4th ed.). Jones & Bartlett Learning, LLC.

DeNisco, S., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning, LLC.

Fawcett, J. (2017). Applying conceptual models of nursing: quality improvement, research, and practice. New York, NY: Springer Publishing Company, LLC.

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Sastre‐Fullana, P., Pedro‐Gómez, D., Bennasar‐Veny, M., Serrano‐Gallardo, P., & Morales‐Asencio, J. M. (2014). Competency frameworks for advanced practice nursing: A literature review. International Nursing Review, 61(4), 534-542.

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