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Essential elements of independent nursing practice: Person, Health, Environment, Nursing

Those four ideas or concepts are common to all nursing theory, whether grand theory or middle-range theory. Therefore, they form the conceptual framework for nursing practice, known as Nursing's Metaparadigm.

 A specific nursing theory is identified and adopted depending on the stage of development of the specific practice. Stages of development are assessment and/or identification of the following:

  1. population served; 
  2. environment where practice will take place; 
  3. level of health of the population or individuals for whom nursing care is being planned;
  4. RN competence skills/knowledge development and confidence in the level of nursing knowledge development and nurse's competence n the area of nursing practice.

Experience demonstrates that the process of assessing feasibility of establishing an independent nursing practice must preceed adoption of an appropriate nursing theory.

Generic Blueprint for Establishing Independent Nursing Practice

A detailed plan of action that can be used to develop and implement the delivery of population-focused, community-based nursing care. Nurse entrepreneurs are encouraged to provide leadership in their communities using this or a similar framework to provide community nursing care that focuses on health promotion, prevention and management of chronic illnesses.

The six steps of the blueprint below were used to successfully establish a nurse-managed health center in a Massachusetts community: 

1. Assess need and feasibility of an initiative; 

   a. Explore suitable locations 

   b. identify potential funding sources, private and public

2. Identify community stakeholders 

   a. Assemble an Advisory Group

   b. Designate a Leader 

   c. Define role and responsibilities of the Advisory Group. 

4. Develop a Nursing practice model managed by a Registered Nurse

   a. Policies and procedures for the Nursing Center

     1. Hours of operation

     2. Staffing

     3. Computerized Health Records

     4. Oversight, if indicated

   b. ANA Scope and Standards of Practice specific to level and specialized care delivered. 

   c. Publicize and recruit RN nurse manager 

5. Identify measurable outcomes of care consistent with the specific mission and vision of the Nursing Center

6. Formulate methods to systematically evaluate the effect of health services on the population and community served. 

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