Advanced Practice Care of Adults in Acute Care Settings II Essay.

Advanced Practice Care of Adults in Acute Care Settings II Essay.

An Acute Care Nurse Practitioner (ACNP) is a nurse who is prepared in a master’s program to practice in an advanced nursing role in a variety
of acute or critical care settings. ACNPs are clinical experts who provide care to acutely or critically ill patients, many of whom may have chronic
health problems. ACNPs provide continuous and comprehensive care to patients who are acutely or critically ill. At times ACNPs may function
independently, but most often they function collaboratively with patients, their families, and other members of the health care team. The goals of the ACNP are to stabilize the patient, minimize complications, provide physical and psychological care, estore maximal health, and evaluate health risk factors. To achieve these goals A CNPs  provide direct patient care management; admit and discharge patients from the hospital;
perform histories and physicals; analyze clinical data; order and/or perform necessary diagnostic tests or procedures; develop, implement, and
evaluate the therapeutic regimen; teach and provide support for patients and their families; minimize fragmentation by providing coordination of
care; manage transition of the patient to step-down units or to out-patient settings; and serve as patient advocates.
Who employs ACNPs?
The ACNP may be employed by hospitals to work in intensive care units, step-down units, and general units. The ACNP may be employed by
physicians or physician groups to help manage the care of hospitalized patients, help patients make the transition to out-patient settings, and
manage patients in clinic settings.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
Can I specialize as an ACNP?
There is a dual program of studies available with the Registered Nurse First Assistant track. Electives are available for knowledge base
enhancement in subjects such as teaching, and diabetes management.
What kind of nursing experience do I need prior to entering the program?
The acute care faculty highly recommends that students admitted to the ACNP study option have at least one year, and preferably two years, of
professional nursing experience in the field of critical care nursing prior to enrolling in the advanced nursing clinical courses. Additionally, ACLS
certification is highly recommended. Your program of study can be arranged so that you can gain the required experience while you are taking
prerequisite courses. Should this be the case, you will have to pursue a part-time program of study.
What are the admission criteria?
 A nursing degree (BSN or higher) from a regionally accredited institution, equivalent to the one offered by UAB School of Nursing
 An undergraduate grade point average (GPA) of at least 3.0 on a 4.0 scale either cumulatively or on the last 60 semester credit hours
 (3) Letters of professional reference attesting to the applicant’s potential for graduate study
 Standardized test score (MAT, GRE, GMAT)* A minimum score of 410 on the MAT; or a minimum score of 480 on the GMAT; or a combined
score of 297 on the verbal and quantitative sections of the Graduate Record Examination (GRE)
 Possess an unencumbered nursing license to practice nursing in the state where you plan to conduct your clinical practicum
 Additional – Selected options may require experience prior to enrollment in a specialty courses.
* GRE/GMAT/MAT Waiver Process: https://www.uab.edu/nursing/home/images/stories/info_sa/GRE_MAT_Waiver.pdf
Approval for the GRE/GMAT/MAT Waiver does not imply or guarantee admission to the MSN program. When all of your transcripts are
evaluated, if you do not meet the requirements, you will be notified that you need to take the GRE/GMAT/MAT. Candidates not approved for
the GRE/GMAT/MAT waiver will be required to take the GRE/GMAT/MAT before final action on their application for master’s study. The School
of Nursing at UAB must receive the official score by the posted materials deadline. Applicants for the GRE/GMAT/MAT waiver must meet the
same requirements for admission to the MSN program as all other applicants.
***The following individuals are not eligible for the GRE waiver process:
• International applicants • Non-Native English speaking applicants • Dual degree seeking program applicants MSN/MPH
When will I receive confirmation that I have been accepted into the program?
You will be notified of your acceptance or denial within 60 days after the application submission deadline.
UAB is an equal education opportunity institution. 03/01/19 pt
For International Students:
 Prospective international students are asked to first contact International Recruitment and Student Services at isss@uab.edu,
(205), 934-3328, FAX 934-8664 to determine eligibility in order to submit an application into any academic program.
 All foreign transcripts evaluated by the Educational Credential Evaluators, Inc www.ece.org OR the World Education Services
www.wes.org, sent from the evaluators directly to the School of Nursing
 A degree equivalent to a bachelor’s degree from a regionally accredited educational institution in the United States
 A score of 500 or higher on the Test of English as a Foreign Language, TOEFL
 Standardized test score. A minimum combined score of 297 on the verbal and quantitative sections of the Graduate Record Examination
(GRE)
 Possess an unencumbered nursing license to practice nursing in the state where you plan to conduct your clinical practicum
What are the classroom and clinical requirements?
Total Credit Hours: 45; Didactic Hours: 32; Clinical Hours: 13; Total Hours of direct Patient Care: 600 contact hours
Descriptive narrative: The three distance accessible didactic graduate core courses provide you with a strong advanced generalist base for
managing the care of patients with common health problems and with complex problems that may require intensive collaborative management.
Clinical experiences will be in clinics or doctors’ offices, where you will manage common episodic and chronic health problems of patients, and
in acute and critical care settings where you will learn to manage the care of acutely or critically ill patients. You must come to the Birmingham
campus for an orientation and three additional visits for multiday intensives and you must pass a comprehensive examination in order to
graduate. Should academic problems arise, an additional visit to campus may be required.
How many semesters of study are required?
Students who start course work in the summer semester will take seven semesters to complete the program and students starting in the fall
semester will take six semesters. Advanced Practice Care of Adults in Acute Care Settings II Essay. The programs of study are listed below.
Distance Accessibility
Applicants to any of our distance-accessible programs should become familiar with the regulations governing distance accessible programs in
their state. Prospective students residing in states other than Alabama should contact their state’s Board of Nursing and Department of
Education for specific rules and regulations pertaining to completion of clinical learning experiences in that state when enrolled in a distance
accessible program. The ability to conduct course work is only guaranteed for student is Alabama and in states with an established agreement.
Will I be able to apply to take a nurse practitioner certification examination when I complete the program?
Once you successfully complete the program, you will be awarded a Master of Science in Nursing degree and you will be able to apply to take
both the national certification examination for Adult Acute Care NPs offered by both the American Nurses Credentialing Center and the
American Association of Critical Care Nurses.
How do I become eligible to practice as a Nurse Practitioner in my state of residence?
Nurse Practitioners are licensed by the states in which they practice and are subject to the rules and regulations thereof. You will need to
contact your state’s board of nursing to determine their requirements.

The aim of this assignment is to critically discuss the nursing assessment individualised care and nursing interventions of the acutely ill patient. The patient discussed developed severe sepsis due to a urinary tract infection and her condition deteriorated during the recovery process in the nurse’s care. Lovick (2009) defines sepsis ‘as a known or suspected infection accompanied by evidence of two or more of the SIRS criteria’. SIRS is outlined as a ‘systemic inflammatory response’ consisting of two or more of the following symptoms ‘temperature >38 degrees Celsius or 90 beats per minute, respiratory rates greater than 20 breaths per minute and white blood count higher than 12,000 cells per microliter or lower than 4000 cells per …show more content…
The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
How does an ACNP differ from the traditional primary care nurse practitioner?
Although there are many similarities among the various types of nurse practitioners, there are some distinct differences, too. The
primary care nurse practitioner is academically prepared to manage common episodic and chronic health problems of adults or children
in primary care settings. Their clinical experiences are in out-patient clinics or health departments. Acute care nurse practitioners are
prepared to manage health problems that require secondary or tertiary interventions by health care providers. Often those interventions
are of a nature that hospitalization is required or they are best provided by specialists in a particular field of health care.
Who employs ACNPs?
The ACNP may be employed by hospitals to work in intensive care units, step-down units, and general units. They also may be
employed by physicians to help manage the care of hospitalized patients, help patients make the transition to out-patient settings, and
manage patients in clinic settings. They may be employed by specialty clinics or home health agencies to manage the health care of
acutely ill or chronically critically ill patients in those settings. Graduates of the program have taken positions with nursing service
departments, anesthesiologists, cardiologists, cardiovascular surgeons, internists, nephrologists, neurologists, oncologists, and
pulmonologists.
Can I specialize as an ACNP?
Students in the ACNP program of study may further their knowledge base through elective course(s). UAB School of Nursing offers
specialty courses in cardiovascular nursing, advanced diabetes management and others that required advanced generalist curriculum
that prepares students to mange a variety of health problems. In addition, clinical experiences may be set up in these specialty areas.
What are the classroom content and clinical requirements for the Acute Care Nurse Practitioner student?
The distance accessible didactic graduate core courses provide students with a strong advanced generalist base for managing the care
of patients with common health problems and with complex problems that may require intensive collaborative management. Advanced Practice Care of Adults in Acute Care Settings II Essay.As a part
of the clinical courses you will be in clinical conferences with other ACNP students. During these conferences students and faculty
discuss the continuum of care for the client whose illness becomes more severe or complex and requires hospitalization. Clinical
experiences will be in clinics or doctors’ offices, where you will manage common episodic and chronic health problems of patients and
in acute and critical care settings where you will learn to manage the care of acutely or critically ill patients. Students complete a
minimum of 675 preceptor hours of clinical practice.

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Who will serve as my preceptor in the clinical courses?
A preceptor may be either an acute care nurse practitioner or a physician. It should be someone who has an active clinical practice and
is willing to let you participate in the management of patients in the practice setting. This may be someone you know or with whom you
have worked in the past, and it can be someone from your local area if you live outside of Birmingham. If you do not know anyone who
could serve as your preceptor, your advisor can help you identify an appropriate preceptor. A preceptorship orientation session will be
held during the semester before you begin the clinical courses to help you with the process of securing a preceptor.
How long is the program of study?
The ACNP program of study requires a minimum of 18 months (5 semesters) of full-time study. However, many students choose to
complete the program in 24 to 36 months (6-7 semesters) of part-time study.
UAB is an equal education opportunity institution. 01/30/09 pmt
How do I become eligible to practice as an ACNP in my state of residence?
Individual states have different requirements regarding licensure for advanced practice nurses. You will need to contact your state’s
board of nursing to learn their particular requirements.
Will I be eligible to take a nurse practitioner certification examination if I complete this program?
Once you complete the program, you will be eligible to sit for the national certification examination for Acute Care Nurse Practitioners
offered by either the American Nurses Credentialing Center or the American Association of Critical-Care Nurses. Our graduates have
been very successful in writing this examination.
What kind of nursing experience do I need prior to entering the program?
The acute and continuing care faculty highly recommend that students admitted to the ACNP study option have at least one year, and
preferably two years, of professional nursing experience in the field of critical care nursing prior to enrolling in the advanced nursing
clinical courses. Additionally, ACLS certification is highly recommended. Graduates of this program and employers of our graduates
comment about the value of this prior clinical experience. Your program of study can be arranged so that you can gain the required
experience while you are taking prerequisite courses.
What are the admission criteria?
BSN degree from a regionally accredited institution, equivalent to the one offered by the School of Nursing at UAB
A grade point average (GPA) of at least 3.0 on a 4.0 scale either cumulative or on the last 60 semester credit hours
Letters of professional reference attesting to the applicant’s potential for graduate study
A minimum of 410 on the MAT, or a minimum of 480 on the GMAT or a combined score of 1000 on the verbal and quantitative
sections of the Graduate Record Examination (GRE)*
*An interview may be required based on the student’s means of entry into the program. All students need to be prepared
to schedule an interview.
*GRE, MAT, GMAT is waived for students with a 3.2 or better GPA. For complete details, please visit
http://www.uab.edu/images/sonimg/PDF/GREMAT_waiver.pdf
If I do not meet the requirements, can I be admitted on probation?
No, probationary admission is not available to students who do not meet these requirements.
When will I receive confirmation that I have been accepted into the program?
You will be notified by Email of your acceptance or denial within 30 days after the application submission deadline.
For International Students: If your Visa status is F1 or J1, make an appointment with your course faculty by week 2 of each
semester to plan how you will meet Federal Regulations
What is a typical Program of Study like?
Fall – Year I
*NUR 614* Assessment and Diagnostic Reasoning
for Advanced Practice Nursing…………………..4
NUR 600 Research and Statistics for Advanced
Practice ………………………………………………….3
NUR 612 Advanced Pathophysiology ……………………….3
Spring – Year I
*NCA 616* Diagnostic and Therapeutic Procedures I ……1
*NCA 621* Advanced Adult Acute Care Nursing I…………4
NUR 601 Role Development for Advanced Nursing
Practice ………………………………………………….3
NUR 613 Pharmacology and Therapeutics………………..3
Summer – Year I
*NCA 617* Diagnostic and Therapeutic Procedures II …..1
*NCA 622* Advanced Adult Acute Care Nursing II………..3
NCA 685 Practicum I: Adult Acute Care Nurse
Practitioner……………………………………………..3
Fall – Year II
*NCA 623* Advanced Adult Acute Care Nursing III………. 3
NCA 686 Practicum II: Adult Acute Care Nurse
Practitioner…………………………………………….. 3
*NCV 631* Electrocardiography for Advanced Practice … 3
NUR 602 Issues Affecting Advanced Nursing
Practice…………………………………………………. 3
Spring – Year II
*NCA 692* Residency: Adult Acute Care Nurse
Practitioner…………………………………………….. 6
Total ………………………………………..46 credits
(*) Online courses which may also meet on campus several
hours per semester; and/or require students to be online as
specific times.
Note: Electives NUR 611 and NUR 630 are offered online
during the summer term.

The national Consensus Model for APRN Regulation: Licensure, Accreditation,
Certification, and Education (LACE), finalized in 2008, defines advanced practice
registered nurses (APRNs) and standardized requirements for each of the four APRN
regulatory components included in LACE. Under this regulatory model, now endorsed by
48 national nursing organizations, the certified nurse practitioner (CNP) is defined as one
of four APRN roles. In addition to the four roles, APRNs are educated and practice in at
least one of six population foci: family/individual across the lifespan, adult-gerontology,
pediatrics, neonatal, women’s health/gender-related or psych/mental health. The APRN
Consensus regulatory model is shown in Diagram 1.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
APRN SPECIALTIES
Focus of practice beyond role and population focus
linked to health care needs
Examples include but are not limited to: Oncology, Older Adults, Orthopedics,
Nephrology, Palliative Care

Licensure occurs at Levels of
Role & Population Foci
Family/Individual
Across Lifespan
AdultGerontology* Neonatal Pediatrics
    
POPULATION FOCI
APRN ROLES
Nurse
Anesthetist
NurseMidwife Clinical Nurse
Specialist
Nurse
Practitioner
Women’s
Health/Gender
– Related
PsychiatricMental Health
Diagram 1: Consensus Model for APRN Regulation: Licensure, Accreditation,
Certification and Education (2008). (http://www.aacn.nche.edu/educationresources/APRNReport.pdf.)
Certified Nurse Practitioners (CNPs), referred to in this document as NPs, are educated
across the wellness-illness continuum. Adult-Gerontology NPs are prepared with the Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
acute care NP competencies and/or the primary care NP competencies. Significant
overlap in the acute care and primary care NP competencies does exist; however, the
practice of the acute care and primary care adult-gerontology NP differs. The scope of
practice of the primary care or acute care adult-gerontology NP is not setting-specific but
rather is based on patient care needs. This document delineates the competencies needed
by all adult-gerontology NPs prepared for acute care practice. A companion document,
Adult-Gerontology Primary Care NP Competencies was developed in 2010 and can be
located at http://www.aacn.nche.edu/geriatric-nursing/adultgeroprimcareNPcomp.pdf. If
programs prepare graduates across both the adult-gerontology acute care NP and adultgerontology primary care NP roles, the graduate must be prepared with the consensusbased competencies for both roles.
Under the Consensus Model for APRN Regulation, APRNs must be educated, certified,
and licensed to practice in a role and a population. This document delineates entry-level
competencies for graduates of master’s, doctorate of nursing practice (DNP), and postgraduate certificate programs preparing acute care NPs who serve the adult-gerontology
population. The competencies are intended to be used in conjunction with—and build
upon—the graduate core competencies delineated in the AACN (2006) Essentials of
Doctoral Education for Advanced Nursing Practice or the AACN (2011) Essentials of
Master’s Education in Nursing. The APRN Core: advanced physiology/pathophysiology,
advanced pharmacology, and advanced health assessment, must include at a minimum
three separate comprehensive graduate-level courses. The individual APRN Core
competencies are delineated in the 2006 Essentials of Doctoral Education for Advanced
Nursing Practice (pp. 23-24) or the 1996 Essentials of Master’s Education for Advanced
Practice Nursing (pp. 12-14). In addition, these competencies build upon the NONPF
(2006) core competencies for all nurse practitioners (see discussion related to use of the
2006 NONPF Core Competency framework on pp. 6 of this document). These
competencies focus on the unique practice knowledge, skills, and attitudes of the adultgerontology acute care NP. As an NP gains experience, his or her practice may include
more advanced and additional skills and knowledge not included in these entry-level
competencies. A model describing the foundations and components of the advanced
practice curriculum is shown in Diagram 2. The Adult-Gerontology Acute Care NP
curriculum must prepare graduates with the Graduate Core, APRN Core, Role and
Population-focused competencies and must ensure that graduates are eligible for national
certification as an Adult-Gerontology Acute Care NP. In addition, the education program
may prepare the graduates with additional competencies in a specialty or more narrow
area of practice (e.g. palliative care, orthopedics, or cardiology). Preparation in a
specialty area of practice is optional but if offered should prepare the graduate for
professional certification in that specialty in addition to national certification in the role
and population – Adult-Gerontology Acute Care NP.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
Diagram 2: Building an APRN Curriculum within the Consensus APRN Regulatory
Model
These competencies, in addition to the core competencies for all NP practice, reflect the
current knowledge base and scope of practice for entry-level adult-gerontology acute care
NPs. As scientific knowledge expands and the healthcare system and practice evolve in
response to societal needs, NP competencies also will evolve. The periodic review and
updating of these competencies will ensure their currency and reflect these changes.
CURRICULAR AND CLINICAL EXPECTATIONS FOR THE ADULTGERONTOLOGY ACUTE CARE NP EDUCATION PROGRAM
The adult-gerontology acute care NP program provides sufficient didactic and clinical
experiences to prepare the graduate with the competencies delineated in this document as
well as the NP core competencies. It is expected that faculty assess the types of
experiences, patient population and settings, and length of experiences afforded each
student to ensure that he/she is prepared to provide care to the entire adult-older adult age
spectrum and across the continuum of care from wellness to illness, including the frail
elderly. The degree of wellness care provided by the adult-gerontology acute care NP
differs from that of the adult-gerontology primary care NP and is reflected in this
document.
By merging the adult and gerontology NP curricula, the expectation is that opportunities
to enhance or focus the clinical experiences within currently used clinical settings be
sought. Practice experiences should focus on the full spectrum of adult-older adult care
and should provide the student with the opportunity to focus on the differing and unique
developmental, life-stage needs that impact a patient’s care across the entire adult age
spectrum particularly those with acute care needs. Practice experiences may include a
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
variety of experiences (e.g., virtual experiences, case studies, and simulation experiences)
to enhance the student’s preparation with these competencies.
In addition, preceptors and faculty with responsibility for oversight of these clinical and
practice experiences should represent broad-based and varied expertise to ensure that the
adult-gerontology acute care NP graduate is prepared to provide care to the entire adultolder adult age spectrum and across the wellness-illness continuum, including the frail
elderly, with a focus on acute illness care. In this document the term acute care includes
care of patients with complex acute, critical and chronic illness, disability, and/or injury.
ADULT-GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER COMPETENCIES
These are entry-level competencies for all adult-gerontology acute care nurse
practitioners. These adult-gerontology population-focused competencies build on the
graduate and APRN core competencies, and NP core competencies. Significant overlap
in the acute care and primary care NP competencies does exist; however, the practice of
the acute care and primary care adult-gerontology NP differs. The scope of practice of
either the acute care or primary ca e NP is not setting specific but rather is based on
patient care needs.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
The patient population of the Adult-Gerontology Acute Care NP practice includes young
adults (including late adolescents and emancipated minors), adults, and older adults
(including young-old, old, and old-old adults). Preparation of the graduate with the
entry-level competencies delineated in this document, unless otherwise specified,
includes preparation across the entire adult-older adult age spectrum.
The focus of the adult-gerontology acute care NP is to provide patient-centered, quality
care to the adult and older adult population. The adult-gerontology acute care NP applies
evidence in practice designed to improve quality of care and health outcomes.
The adult-gerontology acute care NP competencies are delineated in Table 1. The adultgerontology population-focused competencies build on the NP Core Competencies
(NONPF, 2006). The Domains of NP Practice (NONPF, 2006) provide the framework for
the adult-gerontology acute care NP competencies.1
In addition, the categories under
each Domain reflect those used in the AACN (2010) Adult-Gerontology Primary Care
Nurse Practitioner Competencies

1
See discussion related to use of the 2006 NONPF Core Competency framework on pp.6 of this document.
1 1
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
TABLE 1: Adult-Gerontology Acute Care Nurse Practitioner Competencies
ADULT-GERONTOLOGY ACUTE CARE NP COMPETENCIES
The patient population of the adult-gerontology acute care NP practice includes the entire spectrum of adults including young adults, adults and
older adults. The adult–gerontology ACNP provides care to patients who are characterized as “physiologically unstable, technologically
dependent, and/or are highly vulnerable to complications” (AACN Scope and Standards, 2006, p 9). These patients may be encountered across
the continuum of care settings and require frequent monitoring and intervention. The role encompasses the provision of a spectrum of care
ranging from disease prevention to acute and critical care management to “stabilize the patient’s condition, prevent complications, restore
maximum health and/or provide palliative care” (AACN p. 10). It is assumed that preparation of the graduate with these competencies unless
otherwise specified includes preparation across the entire adult-older adult age spectrum. It also is assumed that the graduate is prepared to
implement the full scope of the adult-gerontology acute care NP role.
The adult-gerontology acute care nurse practitioner is a provider of direct health care services. Within this role, the adult-gerontology acute care
NP synthesizes theoretical, scientific, and contemporary clinical knowledge for the assessment and management of both health and illness
states. These competencies incorporate disease prevention, and management focus of the adult-gerontology acute care NP practice.
I. HEALTH PROMOTION, HEALTH PROTECTION, DISEASE PREVENTION, AND TREATMENT
A. Assessment of Health Status:
These competencies describe the role of the adult-gerontology acute care NP (ACNP) in terms of assessing the individual’s health status,
including assessment of the health promotion, health protection, and disease prevention needs of the acute, critical, and chronically ill or injured
patient. Activities include risk stratification, disease specific screening activities, diagnosis, treatment and follow-up of acute illness, and
appropriate referral to specialty care.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
1. Assesses the complex acute, critical, and chronically-ill patient for urgent and emergent conditions, using both physiologically and
technologically derived data, to evaluate for physiologic instability and risk for potential life-threatening conditions.
2. Obtains relevant comprehensive and problem-focused health histories for complex acute, critical, and chronically-ill patients using
collateral sources as necessary.
3. Evaluates signs and symptoms, including age appropriate changes, noting pertinent positives and negatives.
4. Prioritizes data collection, according to the patient’s age, immediate condition or needs, as a continuous process in acknowledgement of
the dynamic nature of complex acute, critical, and chronic illness or injury.
5. Accurately documents relevant comprehensive and problem-focused health histories.
6. Performs and accurately documents a pertinent, comprehensive, and focused physical, mental health and cognitive assessment,
13
Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
demonstrating knowledge about developmental, age related, and gender specific variations.
7. Assesses the impact of an acute, critical, and /or chronic illness or injury and the health promotion needs, social support and physical and
mental health status using age, gender, and culturally appropriate standardized assessment instruments or processes in relationship to:
a. Functional or activity level
b. Mobility
c. Cognition
d. Decision-making capacity
e. Pain
f. Skin integrity
g. Nutrition
h. Sleep and rest patterns
i. Sexuality
j. Spirituality
k. Immunization status
l. Neglect and abuse
m. Substance use and abuse
n. Quality of life
o. Family and social relationships
p. Genetic risks
q. Health risk behaviors
r. Safety
s. Advance care planning preferences and end of life care
8. Distinguishes cultural, spiritual, ethnic, gender, sexual orientation, and age cohort differences in presentation, progression, and treatment
response of common acute, critical, and chronic health problems.
9. Provides for the promotion of health and protection from disease by assessing for risks associated with care of complex acute, critical, and
chronically-ill patients, such as:
a. Physiologic risk, including, but not limited to, immobility, impaired nutrition, fluid and electrolyte imbalance, and adverse effects of
diagnostic/therapeutic interventions.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
b. Psychological risk, including, but not limited to, pain, impaired sleep and communication, crisis related to threat to life, finances, and
altered family and social network dynamics.
c. Healthcare system risks associated with care of complex patients, including but not limited to multiple caregivers, continuity of care,
coordination of the plan of care across levels and settings of care, complex medical regimens, low or poor health literacy, and
communication with family or between multiple care providers.
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
10. Assesses the impact of family, community, and environment, including economic, work, institutional, school, social, and living
environments, on an individual’s health status and quality of life.
11. Screens for acute and chronic mental health and behavioral problems and disorders, adapting for the cognitively impaired.
12. Obtains health information from collateral sources, including electronic health records and databases, and other healthcare providers and
family members, as needed, e.g., with cognitively impaired, sensory impaired, or non-self-disclosing patients, applying ethical and legal
standards of care.
13. Assesses individuals with complex health issues and co-morbidities, including the interaction with aging and acute and chronic physical
and mental health problems.
14. Analyzes the relationship among development, normal physiology, and specific system alterations that can be produced by aging and/or
disease processes.
15. Assesses the individual’s and support system’s ability to cope with and manage developmental (life stage) transitions.
16. Determines the individual’s ability to participate in care, care decisions, work, school, physical, and social activities.
17. Assesses the effect of complex acute, critical and chronic illness, disability, and/or injury on the individual’s:
a. Functional status
b. Independence
c. Physical, mental, and cognitive status
d. Social roles and relationships
e. Sexual function and well-being
f. Economic or financial status
g. Risk for addictive behavior
h. Risk for abuse and neglect
18. Conducts a pharmacologic assessment addressing pharmacogenetic risks, complex medical regimens, drug interactions and other adverse
events; over-the-counter; complementary alternatives; and the patient’s and caregiver’s ability to self-manage medications safely and
correctly.
19. Assesses for syndromes and constellations of symptoms that may be manifestations of other common health problems, e.g., risk-taking
behaviors, stress, self-injury, incontinence, falls, dementia, delirium or depression.
20. Determines the need for transition to a different level of care or care environment based on an assessment of an individual’s acuity, frailty,
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
stability, resources, and need for assistance, supervision or monitoring.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
21. Assesses genetic risk factors related to the patient’s acute and chronic health conditions.
22. Participates in the determination of patient’s comprehension and decision-making capacity.
B. Diagnosis of Health Status
The adult-gerontology acute care NP is engaged in the diagnosis of health status in patients with physiologic instability or the potential to
experience rapid physiologic deterioration or life-threatening instability. This diagnostic process includes critical thinking, differential
diagnosis, and the identification, prioritization, interpretation and synthesis of data from a variety of sources. These competencies describe the
role of the adult-gerontology acute care NP related to diagnosis of health status.
1. Identifies across the entire adult age spectrum both typical and atypical presentations of complex acute, critical and chronic illnesses
including urgent and emergent physical and mental health conditions
2. Develops differential diagnoses by priority for new or recurring complex acute, critical, and chronic physical, mental health and
behavioral disorders and problems.
3. Identifies the presence of co-morbidities, age-related changes, their impact on presenting health problems, potential for rapid physiologic
and mental health deterioration or life-threatening instability and the risk for iatrogenesis.
4. Plans diagnostic strategies and appropriate uses of diagnostic tools to screen for and prevent sequelae of acute and critical illnesses and
iatrogenic conditions with consideration of the risks, benefits, and costs to individuals based on goals of care.
5. Manages the evaluation of acute, critical and chronically ill patients through ordering, interpretation, performance, and supervision of
diagnostic testing and clinical procedures taking into account the individual’s age, gender, genetic risks, and health status.
6. Performs specific diagnostic strategies and technical skills to monitor and sustain physiological function and ensure patient safety,
including but not limited to EKG interpretation, x-ray interpretation, respiratory support, hemodynamic monitoring, line and tube
insertion, lumbar puncture, and wound debridement.
7. Synthesizes data from a variety of sources to make clinical decisions regarding appropriate management, consultation, or referral.
8. Diagnoses complex acute, critical, and chronic physical illnesses and common mental health problems, recognizing disease progression,
multisystem health problems, associated complications, and iatrogenic conditions.
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
9. Reformulates diagnoses based on new or additional assessment data and the dynamic nature of complex acute, critical, and chronic illness.
10. Diagnoses common behavioral and mental health and substance use or addictive disorder/disease, such as anxiety, depression, PTSD, and
alcohol and drug use, in the presence of complex acute, critical, and chronic illness.
C. Plan of Care and Implementation of Treatment
The objectives of planning and implementing therapeutic interventions are to return the individual to stability and optimize the individual’s
health. These competencies describe the adult-gerontology acute care NP’s role in stabilizing the individual, minimizing physical and
psychological complications, maximizing the individual’s health potential, and assisting with palliative/end-of-life care management.
1. Formulates a plan of care to address complex acute, critical, and chronic physical and mental health care needs.
a. Integrates knowledge of rapidly changing pathophysiology of acute and critical illness in the planning of care and implementation of
treatment and referrals.
b. Prescribes appropriate pharmacologic and nonpharmacologic treatment modalities considering age and genetic profile.
c. Utilizes evidence-based practice in planning and implementing care.
d. Addresses cultural, spiritual, ethnic, gender, and age cohort differences in planning and implementing care.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
2. Plans and implements interventions to support the patient to regain and maintain age-specific physiologic and psychological stability
consistent with the patient’s goals of care.
3. Promotes safety and risk reduction through the use of interventions such as:
a. devices to promote mobility and prevent falls
b. cognitive and sensory enhancements
c. restraint-free care
d. judicious use of catheters and lines
e. monitoring and other technological devices.
4. Reduces patient risk by designing and implementing interventions to prevent:
a. decline in physical or mental function
b. impaired quality of life
c. social isolation
d. disability
e. increased cost

 

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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
5. Manages care through ordering, and performing interventions to monitor, sustain, or restore physiological and psychological function
including the patient with a rapidly deteriorating physiologic condition.
6. Implements interventions to support the patient with a rapidly deteriorating physiologic condition based on Advanced Cardiac Life Support
and Fundamentals of Critical Care Support.
7. Implements health promotion, health maintenance, health protection, and disease prevention initiatives that are age, gender, cultural, and
health status appropriate.
8. Provides anticipatory guidance and counseling to individuals and their families based on identified health promotion needs and goals;
complex acute, critical and chronic care needs; social support; and health and cognitive status.
9. Performs therapeutic interventions to stabilize acute and critical health problems, including but not limited to suturing; wound
debridement; lumbar puncture; airway, line and tube insertion and management.
10. Manages complex, acute, critical, and chronic physical problems.
11. Initiates treatment for common acute and critical mental health problems.
12. Implements care to prevent and manage geriatric syndromes such as falls, loss of functional abilities, dehydration, delirium, depression,
dementia, malnutrition, incontinence, and constipation.
13. Analyzes the indications, contraindications, risk of complications, and cost-benefits of therapeutic interventions.
14. Individualizes the plan of care to reflect the dynamic nature of the patient’s condition, age, developmental and life transitions, patient’s and
family’s needs.
15. Uses pharmacologic and non-pharmacologic management strategies to ameliorate physical and behavioral symptoms in individuals who
have psychiatric/substance misuse disorders.
16. Prescribes medications maintaining awareness of and monitoring for adverse drug outcomes and complex medical regimens, especially in
high-risk and vulnerable populations.
17. Manages pain and sedation for patients with complex acute, critical and chronic illness.
a. Prescribes pharmacologic and nonpharmacologic interventions.
b. Monitors and evaluates the patient’s pain and sedation response considering possible concomitant use of alcohol, recreational drugs,
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
OTC, and other complementary products.  Advanced Practice Care of Adults in Acute Care Settings II Essay.
c. Modifies the plan of care according to patient reaction and treatment goals.
18. Initiates appropriate referrals and consultations.
19. Performs consultations based on one’s knowledge and expertise.
20. Modifies the plan of care after evaluating the patient’s response to therapeutic interventions and dynamic changes in condition.
21. Monitors and evaluates the safety and efficacy of pharmacologic, behavioral, and other therapeutic interventions.
22. Orders and implements palliative and end-of-life care in collaboration with the patient, family, and members of the healthcare team.
23. Provides leadership to coordinate the planning, delivery, and evaluation of care by the healthcare team
24. Develops a transition plan for long-term management of healthcare problems with the individual, family, and healthcare team.
25. Evaluates effectiveness and adequacy of individual’s and/or caregiver’s support systems.
26. Facilitates the patient’s transition within healthcare settings and across levels of care, including admitting, transferring, and discharging
patients.
27. Prescribes and monitors treatments and therapeutic devices as indicated, including but not limited to: oxygen, bi-level PAP, prosthetics,
splints, and adaptive equipment.
28. Prescribes and monitors the effect of therapies including but not limited to physical therapy, occupational therapy, speech therapy, home
health, palliative care, and nutritional therapy.
29. Evaluates risks for adverse outcomes due to treatment, including under or over treatment.
30. Implements interventions to support the individual with a rapidly deteriorating physiologic condition, including the application of basic and
advanced life support and other invasive interventions or procedures to regain physiologic stability.
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
II. NURSE PRACTITIONER-PATIENT RELATIONSHIP
Competencies in this area demonstrate the nurse practitioner-patient collaborative approach, which enhances the adult-gerontology acute care
NP’s effectiveness of care. The competencies speak to the critical importance of the interpersonal transaction as it relates to therapeutic
patient outcomes considering the cognitive, developmental, physical, mental, and behavioral health status of the patient across the adult
lifespan.
1. Identifies one’s personal biases related to culture, aging, gender, development, and independence that may affect the delivery of quality
care.
2. Provides appropriate and effective communication that builds therapeutic relationships with diverse individuals, families, and caregivers
facing acute onset or exacerbations of complex chronic physical and/or psychological conditions.
3. Assists individuals, families, and caregivers to support or enhance the patient’s right to self-determination, sense of safety, autonomy,
worth, and dignity
4. Engages the patient and family’s participation in the development and revision of the plan of care.
5. Uses communication skills adapted to the individual’s and family’s health literacy; and cognitive, developmental, physical, mental, and
behavioral health status.
6. Facilitates patient and family decision-making regarding complex acute, critical, and chronic illness treatment decisions, end-of-life care,
and organ/tissue donation in a manner that ensures informed decisions.
7. Applies principles of crisis management in assisting the patient and family experiencing complex acute, critical, and chronic physical and
mental illness during changes in status.
8. Advocates for the patient’s and family’s rights regarding healthcare decision-making such as emancipation, conservatorship, guardianship,
durable power of attorney, health care proxy, advance directives and informed consent, taking into account ethical and legal standards.
9. Initiates discussion of sensitive issues with the individual, family and other caregivers such as:
a. suicide prevention, self injury
b. sexually-related issues
c. substance use/abuse
d. risk-taking behavior
e. driving safety
f. independence
g. finances
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
h. violence, neglect, abuse, and mistreatment
i. prognosis
j care transitions, changes in levels of care
k. institutionalization
l. palliation and end-of-life care
III. TEACHING-COACHING FUNCTION
These competencies describe the adult-gerontology acute care NP’s ability to impart knowledge and associated psychomotor and coping skills
to individuals, family, and other caregivers. The coaching function involves the skills of interpreting and individualizing therapies through the
activities of advocacy, modeling and teaching.
1. Collaborates with the individual, family, and caregivers in the development of educational interventions appropriate to the complex acute,  Advanced Practice Care of Adults in Acute Care Settings II Essay.
critical, and chronically-ill patient’s needs, values, developmental and cognitive level, and health literacy.
2. Educates individuals, families, caregivers, and groups regarding strategies to manage the interaction among normal development, aging,
and mental and physical disorders.
3. Adapts teaching-learning approaches based on physiological and psychological changes, age, developmental stage, cognitive status,
readiness to learn, health literacy, the environment, and available resources.
4. Integrates, as appropriate, self-care activities for complex acute, critical, and chronically ill patients.
5. Teaches patients and families how to navigate the health care system effectively.
6. Educates professional and lay caregivers to provide culturally and spiritually sensitive appropriate care.
7. Demonstrates leadership of the healthcare team through teaching and coaching to advance the plan of care for complex acute, critical, and
chronically ill patients.
IV. PROFESSIONAL ROLE
These competencies describe the varied role of the adult-gerontology acute care NP, specifi
Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
1. Develops effective collaboration with both formal and informal caregivers and professional staff to achieve optimal care outcomes during
complex acute, critical and chronic illness attending to variations across the lifespan.
2. Demonstrates leadership to promote improved health care outcomes for the adult–older adult population in practice, policy, and other
venues.
3. Coordinates comprehensive care in and across care settings for patients who have acute and chronic illness needs.
4. Promotes the delivery of evidence-based care for patients with complex acute, critical, and chronic physical and mental illness.
5. Analyzes the impact of participation in professional organizations to:
a. Influence health policy
b. Promote access to care for the population(s) served
c. Advocate on behalf of the population(s) served
d. Promote the adult-gerontology acute care NP and other advanced practice nursing roles.
6. Participates in the design and/or implementation, and evaluation of evidence-based, age-appropriate professional standards and guidelines
for care.
7. Contributes to knowledge development for improved care of the adult-gerontology acute care population, by participation in quality
improvement, program evaluation, translation of evidence into practice, and/or dissemination of evidence.
8. Serves as a knowledge resource regarding clinical and/or care issues related to the design and development of complex acute, critical, and
chronic health services for care of the adult-gerontology population.
9. Describes the current and evolving adult-gerontology acute care NP role to other healthcare providers and the public.
10. Applies stress management principles when faced with complex, acute or traumatic situations.
11. Advocates for a safe and healthy practice environment.
12. Engages in self reflection, performance appraisal, and peer-review to:
a. Identify lifelong learning needs
b. Enhance inter- and intra-professional relationships
c. Effect continuous quality improvement
d. Enhance professional development
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
13. Participates in the design and/or development, and evaluation of current and evolving healthcare services to optimize care and outcomes
for the adult-gerontology population.
14. Provides guidance, consultation, mentorship, and educational experiences to students, nurses, and other health professionals.
15. Advocates for implementation of the full scope of the adult-gerontology acute care NP role.
16. Advances the level of knowledge of adult-gerontology acute care nurse practitioners to improve healthcare delivery and patient outcomes
through presentations, publications, and/or involvement in professional organizations.
V. MANAGING AND NEGOTIATING HEALTHCARE DELIVERY SYSTEMS
These competencies describe the adult-gerontology acute care NP role in achieving improved health outcomes for individuals, communities,
and systems by overseeing and directing the delivery of clinical services within an integrated system of health care. In addition, the adult gerontology acute care NP addresses the development and implementation of system policies affecting services.
1. Assists individuals, their families, and caregivers to navigate transitions between levels of care and across the healthcare delivery
system(s).
2. Works collaboratively with a variety of health professionals to achieve patient care goals, promote stabilization and restoration of health in
complex acute, critical, and chronic illness.
3. Promotes collaboration among members of the multidisciplinary healthcare team to facilitate optimal care for patients with complex acute,
critical, and chronic illnesses considering variations across the adult lifespan.
4. Uses principles of case management when overseeing and directing healthcare services for complex acute, critical, and chronic illness.
5. Identifies processes, principles and regulations related to payer systems used in the planning and delivery of healthcare services.
6. Describes challenges to optimal care created by the competing priorities of patients, payers, providers and suppliers.
7. Promotes efficient use of resources and provision of safe, high quality care to achieve cost-effective outcomes
8. Analyzes system barriers to care delivery and coordination.
9. Applies knowledge of the type and level of services provided across healthcare and residential settings.
10. Advocates within healthcare systems for access to cost-effective, quality care.
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Adult-Gerontology Acute Care Nurse Practitioner Competencies, AACN, February 2012
11. Advocates for legislation and policy to promote health and improve care delivery models through collaborative and/or individual efforts.
12. Promotes equity in health and health care for peoples of diverse culture, ethnic, and spiritual backgrounds.
13. Describes institutional, local, and state emergency response plans and one’s potential role in each.
VI. MONITORING AND ENSURING THE QUALITY OF HEALTHCARE PRACTICE
These competencies describe the adult-gerontology acute care NP role in ensuring quality of care through consultation, collaboration,
continuing education, certification, and evaluation. The monitoring function of the role is also addressed relative to examining and improving
one’s own practice as well as engaging in interdisciplinary peer and colleague review.
1. Monitors one’s own practice by:
a. Applying evidence-based practice protocols and guidelines in providing quality care.
b. Participating in evaluation of scientific evidence through individual and group efforts.
c. Evaluating one’s own practice against identified benchmarks.
d. Engaging in peer review.
2. Functions within the national, state and institutional credentialing and scope of practice for adult-gerontology acute care NPs based upon
education, certification, and licensure criteria.
3. Improves practice outcomes within systems by:
a. Using technology and quality improvement methods to enhance safety and monitor health outcomes.
b. Developing strategies to reduce the impact of biases including ageism and sexism on healthcare policies and systems.
c. Advocating for access to quality, cost-effective health care.
d. Using internal and external agencies and resources
e. Addressing cultural, spiritual, ethnic, and intergenerational influences that potentially create conflict among individuals, families, staff,
and caregivers.
f. Contributing to health literacy of the public.  Advanced Practice Care of Adults in Acute Care Settings II Essay.

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