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TheEssentialsofB accalaureateEducation
forProfessionalNursing Practice
October20,2008
TABLEOFCONTENTS
ExecutiveSummary 3
Background 5
NursingEducation 6
TheDisciplineofNursing 7
Assumptions 8
RolesfortheBaccalaureateGeneralistNurse 8
PreparationfortheBaccalaureateGeneralistNurse:
ComponentsoftheEssentials 10
TheEssentialsofBaccalaureateEducationforProfessionalNursingPractice
I. LiberalEducationforBaccalaureateGeneralistNursingPractice 10
II. BasicOrganizationalandSystemsLeadershipfor
QualityCareandPatientSafety 13
III. ScholarshipforEvidenceBasedPractice 15
IV. InformationManagementandApplicationofPatient
CareTechnology 17
V. HealthcarePolicy,Finance,andRegulatoryEnvironments 20
VI. InterprofessionalCommunicationandCollaborationfor
ImprovingPatientHealthOutcomes 22
VII. ClinicalPreventionandPopulationHealth 23
VIII. ProfessionalismandProfessionalValues 26
IX. BaccalaureateGeneralistNursingPractice 29
ExpectationsforClinicalExperienceswithintheBaccalaureateProgram 33
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Summary 35
Glossary 36
References 40
AppendixA:TaskForceontheRevisionoftheEssentialsofBaccalaureate
EducationforProfessionalNursingPractice 45
AppendixB:ConsensusProcessto RevisetheEssentialsofBaccalaureate 46
EducationforProfessionalNursingPractice
AppendixC:Participantswho AttendedStakeholderMeetings 47
AppendixD:SchoolsofNursingthatParticipatedintheRegionalMeetings 49
AppendixE:ProfessionalOrganizationsthatParticipatedintheRegionalMeetings 60
AppendixF: HealthcareSystemsthatParticipatedintheRegionalMeetings 61
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ExecutiveSummary
TheEssentialsofBaccalaureateEducation
forProfessionalNursingPractice(2008)
ThisEssentialsdocumentservestotransformbaccalaureatenursingeducationbyproviding
thecurricularelementsandframeworkforbuildingthebaccalaureatenursingcurriculumfor
the21
st
century.TheseEssentialsaddressthekeystakeholders’recommendationsand
landmarkdocumentssuchastheIOM’srecommendationsforthecoreknowledgerequiredof
allhealthcareprofessionals.Thisdocumentemphasizessuchconceptsaspatientcentered
care,interprofessionalteams,evidencebasedpractice,qualityimprovement,patientsafety,
informatics,clinicalreasoning/criticalthinking,geneticsandgenomics,culturalsensitivity,
professionalism,andpracticeacrossthelifespaninaneverchangingandcomplexhealthcare
environment
EssentialsIIXdelineatetheoutcomesexpectedofgraduatesofbaccalaureatenursing
programs.Achievementoftheseoutcomeswillenablegraduatestopracticewithincomplex
healthcaresystemsandassumetheroles:providerofcare;designer/manager/coordinatorof
care;andmemberofaprofession.EssentialIXdescribesgeneralistnursingpracticeatthe
completionofbaccalaureatenursingeducation.ThisEssentialincludespracticefocused
outcomesthatintegratetheknowledge,skills,andattitudesdelineatedinEssentialsI –VIII.
ThetimeneededtoaccomplisheachEssentialwillvary,andeachEssentialdoesnotrequirea
separatecourseforachievementoftheoutcomes.
ThenineEssentialsare:
· EssentialI: LiberalEducationforBaccalaureateGeneralistNursingPractice
o Asolidbaseinliberaleducationprovidesthecornerstoneforthepracticeand
educationofnurses.
· EssentialII:BasicOrganizationalandSystemsLeadershipforQualityCareand
PatientSafety
o Knowledgeandskillsinleadership,qualityimprovement,andpatientsafetyare
necessarytoprovidehighqualityhealthcare.
· EssentialIII:ScholarshipforEvidenceBasedPractice
o Professionalnursingpracticeisgroundedinthetranslationofcurrentevidence
intoone’spractice.
· EssentialIV:InformationManagementandApplicationofPatientCareTechnology
o Knowledgeandskillsininformationmanagementandpatientcaretechnologyare
criticalinthedeliveryofqualitypatientcare.
· EssentialV:HealthCarePolicy,Finance,andRegulatoryEnvironments
o Healthcarepolicies,includingfinancialandregulatory,directlyandindirectly
influencethenatureandfunctioningofthehealthcaresystemandtherebyare
importantconsiderationsinprofessionalnursingpractice.
· EssentialVI:InterprofessionalCommunicationandCollaborationforImproving
PatientHealthOutcomes
o Communicationandcollaborationamonghealthcareprofessionalsarecriticalto
deliveringhighqualityandsafepatientcare.
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· EssentialVII:ClinicalPreventionandPopulationHealth
o Healthpromotionanddiseasepreventionattheindividualandpopulationlevel
arenecessarytoimprovepopulationhealthandareimportantcomponentsof
baccalaureategeneralistnursingpractice.
· EssentialVIII:ProfessionalismandProfessionalValues
o Professionalismandtheinherentvaluesofaltruism,autonomy,humandignity,
integrity,andsocialjusticearefundamentaltothedisciplineofnursing.
· EssentialIX:BaccalaureateGeneralistNursingPractice
o Thebaccalaureategraduatenurseispreparedtopracticewithpatients,
includingindividuals,families,groups,communities,andpopulationsacross
thelifespanandacrossthecontinuumofhealthcareenvironments.
o Thebaccalaureategraduateunderstandsandrespectsthevariationsofcare,
theincreasedcomplexity,andtheincreaseduseofhealthcareresources
inherentincaringforpatients.
Learningopportunities,includingdirectclinicalexperiences,mustbesufficientin
breadthanddepthtoensurethebaccalaureategraduateattainsthesepracticefocused
outcomesandintegratesthedelineatedknowledgeandskillsintothegraduate’s
professionalnursingpractice. Clinicallearningisfocusedondevelopingandrefiningthe
knowledgeandskillsnecessarytomanagecareaspartofaninterprofessionalteam.
Simulationexperiencesaugmentclinicallearningandarecomplementarytodirectcare
opportunitiesessentialtoassumingtheroleoftheprofessionalnurse. A clinical
immersionexperienceprovidesopportunitiesforbuildingclinicalreasoning,
management,andevaluationskills.
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Introduction
TheEssentialsofBaccalaureateEducationforProfessionalNursingPracticeprovides
theeducational frameworkforthepreparation ofprofessionalnurses.Thisdocument
describestheoutcomesexpectedofgraduatesofbaccalaureatenursingprograms.
TheEssentialsapplytoall prelicensureandRNcompletionprograms,whetherthe
degreeisbaccalaureateor graduateentry.Programcurriculaaredesignedtoprepare
studentstomeettheendofprogramoutcomesdelineatedundereach Essential.
Background
Thehealthcaredeliverysystemhaschangeddramatically sinceTheEssentialsof
BaccalaureateEducationforProfessionalNursingPracticewasendorsedbythe
AmericanAssociationofCollegesofNursing(AACN,1998).Buildingasafer
healthcaresystemhasbecomethefocusofallhealthprofessionsfollowingnumerous
reportsfromtheInstituteofMedicine(IOM,2000,2001,2004),AmericanHospital
Association(2002),RobertWoodJohnsonFoundation(Kimball&O’Neill,2002),the
JointCommission(2002)andotherauthorities.Nursinghasbeenidentifiedashavingthe
potentialformakingthebiggestimpacton a transformationofhealthcaredeliverytoa
safer,higherquality,andmorecosteffectivesystem.Withtheincreasingawarenessof
theneedforchangeinthehealthcaresystem,theclinicalmicrosystems(small,functional
unitswherecareisprovidedwithinthelargersystem)havebecomeanimportantfocus
forimprovinghealthcareoutcomes(Nelson,Batalden,&Godfrey,2007).
Inadditiontotheconcernoverhealthcareoutcomes,theUnitedStatesandtheglobal
marketareexperiencinganursingshortagethatisexpectedtointensifyasthedemandfor
moreanddifferentnursingservicesgrows.Buerhaus,Staiger,andAuerbach (2008)
reportedthattheU.S. may experienceashortage ofmorethan500,000registerednurses
bytheyear2025.Despiteannualincreasesinenrollmentsinentrylevelbaccalaureate
nursingprogramssince2001(Fang,Htut,&Bednash,2008), theseincreasesarenot
sufficienttomeettheprojecteddemandfornurses.AccordingtoBuerhausetal.(2008),
enrollmentinnursingprogramswouldhavetoincreaseatleast40% annuallytoreplace
thenursesexpectedtoleavetheworkforcethroughretirementalone.Addressingtheneed
foranincreasednumberofbaccalaureatepreparednursesiscriticalbutnotsufficient.
Nursingmusteducatefutureprofessionalstodeliverpatientcenteredcareasmembersof
aninterprofessional team,emphasizingevidencebasedpractice,qualityimprovement
approaches,andinformatics(IOM,2003b).Nursingeducationandpracticemustwork
togethertobetteraligneducationwithpracticeenvironments(JointCommission,2002,
Kimball & O’Neill,2002;).
Theenvironmentsinwhichprofessionalnursespracticehavebecomemorediverseand
moreglobalinnature.Scientificadvances,particularlyintheareasofgeneticsand
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genomics,havehadandwillcontinuetohaveagrowingandsignificantimpacton
prevention,diagnosis,andtreatmentofdiseases,illnesses,andconditions.Theincreased
prevalenceofchronicillnessisaresultofanincreasinglyolderadultpopulation,
environmentalthreats, lifestylesthatincreaseriskofdisease,andenhancedtechnological
andtherapeuticinterventionsthatprolonglife.Increasesinlongevityoflifehavemade
theolderadultthefastestgrowingsegmentofthepopulation.In2003,12%ofthe
populationwasolderthan 65yearsofage.By2030, thispopulationwillincreaseto20%,
withalargemajority olderthan 80yearsofage(He,Sengupta,Velkoff,&DeBarros,
2005).Those olderthan 65yearsof agehadalmostfourtimesthenumberof
hospitalizationdaysthanthoseyoungerthan65yearsof age(CentersforDisease
Control,2007)
Educationforthebaccalaureategeneralistmustincludecontentandexperiencesacross
thelifespan,includingtheveryyoungwhoareespeciallyvulnerable.Thepercentageof
thepopulationunder18yearsofageis24.6%(U.S.CensusBureau,2008).U.S. infant
mortalityin2006ranked38
th
intheworld(WorldHealth Organization,2008).
Preventioniscriticalinaddressingbothacuteandchronicconditionsacrossthelifespan.
Theroleofthenurseinpreventioncontinuestobeofutmostimportance.
Increasingglobalizationofhealthcareandthediversityofthisnation’spopulation
mandatesanattentiontodiversityinordertoprovidesafe,highqualitycare.The
professionalnursepracticesinamulticulturalenvironmentandmustpossesstheskillsto
provideculturally appropriatecare.AccordingtotheU.S.CensusBureau(2008),the
nation'sminoritypopulationtotaled102millionor34%oftheU.S.populationin2006.
Withprojectionspointingtoevengreaterlevelsofdiversityinthecomingyears,
professionalnursesneedtodemonstrateasensitivitytoandunderstandingofavariety of
culturestoprovidehighqualitycareacrosssettings.Liberaleducation,includingthe
studyof asecondlanguage,facilitatesthedevelopmentofanappreciationfordiversity.
Strongforcesinfluencingtheroleofnursesinclude:
· scientificadvances,particularlyintheareaofgeneticsandgenomics,
· changingdemographicsofpatientpopulations,
· newcaretechnologies,and
· patientaccesstohealthcareinformation.
Theseforcescallfornewwaysofthinkingandprovidinghealth care.Nursingis
uniquely positionedtorespondtothesemajorforces,requiringanincreasedemphasison
designingandimplementingpatientcenteredcare, developingpartnershipswiththe
patient,andafocuson customerservice.
NursingEducation
Inresponsetocallsfortransformingthehealthcaresystemandhowhealthcare
professionalsareeducated,AACNhasmaintainedanongoingdialoguewithabroad
representationofstakeholdersinternalandexternaltonursing.Thedialoguehasfocused
ontheknowledge,skills,andattitudesneededbynursestopracticeeffectivelywithinthis
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complexandchangingenvironment.Newinnovativemodelsofnursingeducationhave
emerged,andAACNhastakenaleadershiproleincraftingapreferredvisionfornursing
education.
In2004,theAACNBoardofDirectorsreaffirmeditspositionthatbaccalaureate
educationistheminimumlevelrequiredforentryintoprofessionalnursingpracticein
today’scomplexhealthcareenvironment.Baccalaureategeneralisteducation,asdefined
inthisdocument,isthefoundationuponwhichall graduatenursingeducationbuilds.
Thepreferredvisionfornursingeducationincludesgeneralist,advancedgeneralist,and
advancedspecialtynursingeducation.Generalistnurseeducationoccursataminimumin
baccalaureatedegreenursingprograms.Advancedgeneralisteducationoccursin
master’sdegreenursingprograms,includingtheClinicalNurseLeader(CNL®),whichis
anadvancedgeneralistnursingrole.Advancedspecialtyeducationoccursatthedoctoral
levelin Doctorof NursingPractice(DNP)orresearchfocuseddegreeprograms(PhD,
DNS,orDNSc).Endofprogram outcomesforthebaccalaureate,master’s,anddoctoral
nursingprogramsbuildoneachother.
TheDisciplineofNursing
Rolesforthebaccalaureategeneralistnursearederivedfromthedisciplineofnursing.
Therolesofthebaccalaureategeneralistinclude:
· providerofcare,
· designer/manager/coordinatorofcare,and
· memberofaprofession.
Nursinggeneralistpracticeincludesbothdirectandindirectcareforpatients,which
includesindividuals,families,groups, communities,andpopulations.Nursingpracticeis
builtonnursingknowledge,theory,andresearch.Inaddition,nursingpracticederives
knowledgefromawidearrayofotherfieldsandprofessions,adaptingandapplyingthis
knowledgeasappropriatetoprofessional practice.
Intheseniorcollegeanduniversitysetting,everyacademicdisciplineisgroundedin
discreteinquirybasedapplicationsthataredistinctivetothatdiscipline.Scientific
advances,(particularlyintheareaofgeneticsandgenomics),changingdemographicsof
patientpopulations,newcaretechnologies,andpatientaccesstohealthcareinformation
callfornewwaysofthinkinganddoingintheprovisionofhealthcare.Theacademic
settingprovidesaforumforcontemplatingphysical,psychological,social,cultural,
behavioral,ethical,andspiritual problemswithinandacrossdisciplines.Facultyhavea
responsibilitytofacilitatethetranslationofknowledgefromaliberaleducationbaseinto
thepracticeofnursing.Nursingfacultyintroducenursingscienceandtheories,andguide
thestudentindevelopinganunderstandingofthedisciplineofnursing’sdistinctive
perspective.
Baccalaureatepreparednursesprovidepatientcenteredcare thatidentifies,respects,and
addressespatients’ differences,values,preferences,andexpressedneeds(IOM,2003a).
Patientcenteredcarealsoinvolvesthecoordinationofcontinuouscare,listeningto,
8
communicatingwith,andeducatingpatientsandcaregiversregardinghealth,wellness,
anddiseasemanagementandprevention.Thegeneralistnurseprovidesthehumanlink
betweenthehealthcaresystemandthepatientbytranslatingtheplanofcaretothe
patient.Abroadbasedskillsetisrequiredtofillthishumaninterfacerole.Patient
centeredcarealsorequiresthedevelopmentofanursepatientpartnership.Patients,as
consumersofhealthcareservices,andasintegralmembersofthehealthcareteam,have
anincreasingroleandresponsibilityforthemutualplanningofcareandhealthcare
decisionmaking.
Thefundamentalaspectsofgeneralistnursingpracticeare:directcareofthesickinand
acrossallenvironments,healthpromotionandclinicalprevention,andpopulationbased
healthcare.Adefiningfeatureofprofessionalnursingpracticeisthefocusonhealth
promotionandriskreduction.Advancesinscienceandtechnologywillcontinueto
emerge,which willhelptopredictfuturehealthproblems.Nurseswilldesignand
implementmeasurestomodifyriskfactorsandpromotehealthylifestyles.Thesesame
advancesinscienceandtechnologyalsohaveallowedindividualstolivelongerandoften
withincreasingnumbersofchronicillnessesandconditions.Withanincreasingemphasis
oncostsavingsandcostbenefits,nurseswill play aleadingroleintheprovisionofcare.
Assumptions
Thebaccalaureategeneralistgraduateispreparedto:
· practicefromaholistic,caringframework;
· practicefromanevidencebase;
· promotesafe,quality patientcare;
· useclinical/criticalreasoningtoaddresssimpletocomplexsituations;
· assumeaccountabilityforone’sownanddelegatednursingcare;
· practiceinavarietyofhealthcaresettings;
· careforpatientsacrossthehealthillnesscontinuum;
· careforpatientsacrossthelifespan;
· carefordiversepopulations;
· engageincareofselfinordertocareforothers;and
· engageincontinuousprofessionaldevelopment.
RolesfortheBaccalaureateGeneralistNurse
BaccalaureateGeneralistnursesareprovidersofdirectand indirectcare.Inthisrole,
nursesarepatientadvocatesandeducators.Historically,thenursingrolehasemphasized
partnershipswithpatients–whetherindividuals,families,groups,communities,or
populations–inordertofosterandsupportthepatient’sactiveparticipationin
determininghealthcaredecisions.Patientadvocacyisahallmarkoftheprofessional
nursingroleandrequiresthatnursesdeliverhighqualitycare,evaluatecareoutcomes,
andprovideleadershipinimprovingcare.
9
Changingdemographicsandongoingadvancesinscienceandtechnologyarearealityof
healthcarepractice.Thegeneralistnurseprovidesevidencebasedcaretopatientswithin
thischangingenvironment.Thisclinicianusesresearchfindingsandotherevidencein
designingandimplementingcarethatismultidimensional,highquality,andcost
effective.Thegeneralistnursealsoispreparedfortheethicaldilemmasthatarisein
practiceandwillbeabletomakeandassistothersinmakingdecisionswithina
professionalethicalframework.Understandingadvancesinscienceandtechnologyand
theinfluencetheseadvanceshaveonhealthcareandindividualwellbeingisessential.
Understandingpatientsandthevaluestheybringtothehealthcarerelationshipisequally
important.
Thegeneralistnursepracticesfromaholistic,caringframework.Holisticnursingcareis
comprehensiveandfocuseson themind,body,andspirit,aswellasemotions.The
generalistnurserecognizestheimportantdistinctionbetweendiseaseandtheindividual’s
illnessexperience.Assistingpatients tounderstandthisdistinctionisanimportantaspect
ofnursing.Inaddition,nursesrecognizethatdeterminingthehealthstatusofthepatient
withinthecontextofthepatient’svaluesisessentialinprovidingaframeworkfor
planning,implementing,andevaluatingoutcomesofcare.
Thegeneralistnurseprovidescareinandacrossallenvironments.Nursesfocuson
individual,family,community,andpopulationhealthcare,asthey monitorandmanage
aspectsof theenvironmenttofosterhealth.
Baccalaureategeneralistnursesaredesigners,coordinators,andmanagersofcare.The
generalistnurse,preparedatthebaccalaureatedegreelevel,willhavetheknowledgeand
authoritytodelegatetaskstootherhealthcarepersonnel,aswellastosuperviseand
evaluatethesepersonnel.Ashealthcareproviderswhofunctionautonomouslyand
interdependentlywithinthehealthcareteam,nursesareaccountablefortheirprofessional
practiceandimage,aswellasfor outcomesoftheirownanddelegatednursingcare.
Nursesaremembersofhealthcareteams,composedofprofessionalsandotherpersonnel
thatdelivertreatmentandservicesincomplex,evolvinghealthcaresystems.Nursesbring
auniqueblendofknowledge,judgment,skills,andcaringtothehealthcareteam.
Baccalaureategeneralistnursesaremembersoftheprofessionandinthisroleare
advocatesforthepatientandthe profession.Theuseoftheterm“professional”implies
theformation ofaprofessionalidentityandaccountabilityforone’sprofessionalimage.
Asprofessionals,nursesareknowledgeworkerswhouseawelldelineatedandbroad
knowledgebaseforpractice.Professionalnursingrequiresstrongcriticalreasoning,
clinicaljudgment,communication,andassessmentskills.Theprofessionalnursealso
requiresthedevelopmentanddemonstrationofanappropriatesetofvaluesandethical
frameworkforpractice.Asadvocatesforhighqualitycareforall patients,nursesare
knowledgeableandactiveinthepolicyprocessesdefininghealthcaredeliveryand
systemsofcare.Thegeneralistnursealsoiscommittedtolifelonglearning,including
careerplanning,whichincreasinglywillincludegraduatelevelstudy.
10
PreparationfortheBaccalaureateGeneralistNurseRoles:Componentsof The
Essentials
Thissection outlinesthenineEssentialsofBaccalaureateEducationforProfessional
NursingPractice.TheseEssentialsarethecurricularelementsthatprovidethe
frameworkforbaccalaureatenursingeducation.Each Essentialisoperationalizedthrough
theprogram’scurriculum andisnotintendedtorepresentacourse.EssentialIXdescribes
baccalaureatenursingpracticeandintegratestheknowledge,skills,andattitudesfrom
EssentialsIVIII. Each Essentialincludesarationaleexplainingitsrelevanceforthe
educationoftheprofessionalnursetodayandin thefuture.Therationaleforeach
Essentialisfollowedby outcomesthatdelineatetheknowledge,skills,andattitudes
expectedofnewbaccalaureategeneralistgraduates.Theseoutcomesserveasaguideto
helpfacultyidentifyprogramandcourseobjectivesthatarespecificandmeasurable.
Next,samplecontentislistedtoaidfacultyinselectingmaterial suitedtoachievingthe
specificEssential.Thelistofcontentisnotinclusive,norisitintendedasrequired.A
vastselectionofcontentisavailableforeachEssential,andthespecificbaccalaureate
program’scurriculumwillspecifythecontentasappropriatetotheirmission,community
served,andstudentpopulation.TheEssential outcomescanbeobtainedthrougha
varietyofcontentapproaches,andpotentialcontentcanandwillevolveovertimeasnew
knowledgedevelops.Thesamplecontentisofferedasaguidetoprogramsortofurther
elucidatethenatureoftheEssentialwithwhichthecontentislisted.
TheEssentialsofBaccalaureateEducationfor ProfessionalNursingPractice
EssentialI:LiberalEducationfor BaccalaureateGeneralistNursingPractice
Rationale
AsdefinedbytheAssociationofAmericanCollegesandUniversities(AAC&U),a
liberaleducationisonethatintentionallyfosters,acrossmultiplefieldsofstudy,wide
rangingknowledgeofscience,cultures,andsociety;highlevelintellectualandpractical
skills;anactivecommitmenttopersonalandsocialresponsibility;andthedemonstrated
abilitytoapplylearningtocomplexproblemsandchallenges(AAC&U,2007,p.4). For
thepurposesofthisdocument,a liberaleducationincludesboththesciencesandthearts.
Thesciencesinclude:
· physicalsciences(e.g.,physicsandchemistry),
· lifesciences(e.g.,biologyandgenetics),
· mathematicalsciences,and
· socialsciences(e.g.,psychologyandsociology).
Theartsinclude:
· finearts(e.g.,paintingandsculpture),
· performingarts(e.g.,danceandmusic),and
· humanities(e.g.,literatureand theology).
11
Liberaleducationiscriticaltothegenerationofresponsiblecitizensinaglobalsociety.
Inaddition,liberaleducationisneededforthedevelopmentofintellectual andinnovative
capacitiesforcurrentandemergentgeneralistnursingpractice.Liberallyeducatednurses
workwithinahealthcareteamtoaddressissuesimportanttotheprofessionofnursing,
questiondominantassumptions,andsolvecomplexproblemsrelatedtoindividualsand
populationbasedhealthcare.Nursinggraduateswithaliberaleducationexercise
appropriateclinicaljudgment,understandthereasoningbehindpoliciesandstandards,
andacceptresponsibilityforcontinueddevelopmentofselfandthedisciplineofnursing.
Asolidbaseinliberaleducationprovidesthedistinguishingcornerstoneforthestudyand
practiceofprofessionalnursing.Studyingthehumanities,socialsciences,andnatural
sciencesexpandsthelearner’scapacitytoengageinsociallyvaluedworkandcivic
leadershipinsociety.Astrongfoundationinliberalartsincludesageneraleducation
curriculumthatprovidesbroadexposuretomultipledisciplinesandwaysofknowing.
Otherthanthenursingmajor,someaspectsof liberalartsstudywillbeprovidedas
discretepartsofthefulleducationalcurriculum;howevertherichanddiverse
perspectivesandknowledgeembeddedintheliberalartsandscienceswill beintegrated
throughoutthenursingcurriculum,astheseperspectivesareintegraltothefullspectrum
ofprofessionalnursingpractice(Hermann,2004).
Successfulintegrationofliberaleducationandnursingeducationprovidesgraduateswith
knowledgeofhumancultures,includingspiritualbeliefs,andthephysicalandnatural
worldssupportinganinclusiveapproach topractice.Thestudyofhistory,finearts,
literature, andlanguagesareimportantbuildingblocksfordevelopingcultural
competenceandclinicalreasoning.Furthermore,theintegrationofconceptsfrom
behavioral,biological,andnaturalsciencesthroughoutthenursingcurriculumpromotes
theunderstandingofselfandothersandcontributestosafe,qualitycare.Theintegration
ofconceptsfrom theartsandsciencesprovidesthefoundationforunderstandinghealth
aswellasdiseaseprocesses,andformsthebasisforclinicalreasoning.Asnotedbythe
CarnegieFoundationfortheAdvancementofTeaching,thesciencesareacriticalaspect
ofliberaleducationfornurses. Sciencesthathaveclinical relevanceareespecially
importanttotheprofessionofnursingtoensurethatgraduateshavetheabilitytokeep
pacewithchangesdrivenbyresearchandnewtechnologies(CarnegieFoundation,in
press).
Aliberaleducationfornursesformsthebasisforintellectualandpracticalabilitiesfor
nursingpracticeaswellasforengagementwiththelargercommunity,bothlocallyand
globally.Skillsofinquiry,analysis,criticalthinking,andcommunicationinavarietyof
modes,includingthewrittenandspokenword,preparebaccalaureategraduatesto
involveothersinthecommongoodthroughuseofinformationtechnologies,teamwork,
andinterprofessionalproblemsolving.Liberaleducation,includingthestudyof asecond
language,facilitatesthedevelopmentofanappreciationforculturalandethnicdiversity.
Strongemphasisonthedevelopmentofapersonalvaluessystemthatincludesthe
capacitytomakeandactuponethicaljudgmentsisahallmarkofliberaleducation.
Studentseducatedinaliberaleducationenvironmentareencouragedtopursue
12
meaningfulpersonalandprofessionalgoalsaswellastocommittohonestyin
relationshipsandthesearchfortruth.Thedevelopmentofleadershipskillsand
acceptanceofresponsibilitytopromotesocialjusticeareexpectedoutcomesofaliberal
education.
Liberaleducation allowsthegraduate toformthevaluesandstandardsneededtoaddress
twentyfirstcenturychangesintechnology,demographics,andeconomics.Thesetrends
includeanagingpopulation,diversefamilyandcommunitystructures,andincreasing
globalinterdependence,aswellaseconomicandpoliticalchangesintheUnitedStates
healthcaresystem.Liberaleducationprovidesthebaccalaureategraduatewiththeability
tointegrateknowledge,skills,andvaluesfromtheartsandsciencestoprovide
humanistic,safequalitycare;toactasadvocatesforindividuals,families,groups,
communities,and/orpopulations;andtopromotesocialjustice.Liberallyeducated
graduatespracticefromafoundationofprofessionalvaluesandstandards.
Thebaccalaureateprogrampreparesthegraduateto:
1. Integratetheoriesandconceptsfromliberaleducationintonursingpractice.
2. Synthesizetheoriesandconceptsfromliberaleducation tobuildan understandingof
thehumanexperience.
3. Useskillsofinquiry,analysis,andinformationliteracy toaddresspracticeissues.
4. Usewritten,verbal,nonverbal,andemergingtechnologymethodstocommunicate
effectively.
5. Applyknowledgeofsocialandculturalfactors tothecareofdiversepopulations.
6. Engageinethicalreasoningandactionstoprovideleadershipin promotingadvocacy,
collaboration,andsocialjusticeasasociallyresponsiblecitizen.
7. Integrate theknowledgeandmethodsofavarietyofdisciplinestoinform decision
making.
8. Demonstratetolerancefortheambiguityandunpredictabilityof theworldandits
effectonthehealthcaresystem.
9. Valuetheidealof lifelonglearningtosupportexcellenceinnursingpractice.
SampleContent
· selectedconceptsandwaysofknowingfrom thesciences
· selectedconceptsandwaysofknowingfromthearts
· principlesrelated toworkingwith peoplesfrom diversecultures
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· conceptsrelatedtointellectual diversity,tolerance,andsocialjustice
· conceptsrelatedtoglobalizationandmigrationofpopulations
EssentialII:BasicOrganizationalandSystemsLeadershipforQualityCareand
PatientSafety
Rationale
Organizationalandsystemsleadership,qualityimprovement,andsafetyarecritical to
promotinghighqualitypatientcare. Leadershipskillsareneededthatemphasizeethical
andcriticaldecisionmaking,initiatingandmaintainingeffectiveworkingrelationships,
usingmutuallyrespectful communicationandcollaborationwithininterprofessional
teams,carecoordination,delegation,anddevelopingconflictresolutionstrategies.Basic
nursingleadershipincludesanawarenessofcomplexsystems,andtheimpactofpower,
politics,policy,andregulatoryguidelinesonthesesystems.Tobeeffective,
baccalaureategraduatesmustbeabletopracticeatthemicrosystemlevel withinanever
changinghealthcaresystem.Thispracticerequirescreativityandeffectiveleadershipand
communicationskillstoworkproductivelywithininterprofessionalteamsinvarious
healthcaresettings.
Asamemberofahealthcareteam,baccalaureategraduateswill understandanduse
qualityimprovementconcepts,processes,andoutcomemeasures.Inaddition,graduates
will beabletoassistorinitiatebasicqualityandsafetyinvestigations;assistinthe
developmentofqualityimprovementactionplans;andassistinmonitoringtheresultsof
theseactionplanswithintheclinicalmicrosystem,whichisembeddedwithinalarger
system ofcare.
Animportantcomponentofqualityissafety.Safetyinhealthcareisdefinedasthe
minimizationof“riskofharmtopatientsandprovidersthroughbothsystemeffectiveness
andindividualperformance”(Cronenwettetal.,2007).Researchhasdemonstratedthat
nursesmore thananyotherhealthcareprofessionalareabletorecognize,interrupt,
evaluate,andcorrecthealthcareerrors(Rothschildetal.,2006)Thebaccalaureate
graduateimplementssafetyprinciplesandworkswithothersontheinterprofessional
healthcareteamtocreatea safe,caringenvironmentforcaredelivery.
Baccalaureategraduateswill beskilledinworkingwithinorganizationalandcommunity
arenasandintheactualprovisionofcarebythemselvesand/orsupervisingcareprovided
byotherlicensedandnonlicensedassistivepersonnel.They willbeabletorecognize
safety andquality concernsandapplyevidencebasedknowledgefromthenursing
professionandotherclinicalsciencestotheirpractice.Baccalaureatenursinggraduates
aredistinguishedbytheirabilitiestoidentify,assess,andevaluatepracticeincare
deliverymodelsthatarebasedincontemporarynursingscienceandarefeasiblewithin
currentcultural,economic,organizational,andpoliticalperspectives.
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Thebaccalaureateprogrampreparesthegraduateto:
1.Applyleadershipconcepts,skills,anddecisionmakingintheprovision ofhighquality
nursingcare,healthcareteamcoordination,andtheoversightandaccountability forcare
delivery inavarietyofsettings.
2.Demonstrateleadershipandcommunicationskillstoeffectivelyimplementpatient
safetyandqualityimprovementinitiativeswithinthecontextoftheinterprofessional
team.
3.Demonstrateanawarenessofcomplex organizational systems.
4.Demonstrateabasicunderstandingoforganizationalstructure,mission,vision,philosophy,
andvalues.
5. Participatein qualityandpatientsafety initiatives,recognizingthatthesearecomplexsystem
issues,whichinvolveindividuals,families,groups, communities,populations,andother
membersofthehealthcareteam.
6.Applyconceptsofqualityandsafetyusingstructure,process,andoutcomemeasuresto
identifyclinicalquestionsanddescribetheprocessofchangingcurrentpractice.
7.Promotefactorsthatcreateacultureofsafety andcaring.
8. Promoteachievementofsafeandqualityoutcomesofcarefordiversepopulations.
9. Applyqualityimprovementprocessestoeffectivelyimplementpatientsafetyinitiativesand
monitorperformancemeasures,includingnursesensitiveindicatorsinthemicrosystemof
care.
10.Useimprovementmethods,basedondatafromtheoutcomesofcareprocesses,todesignand
testchangestocontinuouslyimprovethequalityandsafetyofhealthcare.
11.Employprinciplesofqualityimprovement,healthcarepolicy,andcosteffectivenesstoassist
inthedevelopmentandinitiationofeffectiveplansforthemicrosystemand/orsystemwide
practiceimprovementsthatwillimprovethequalityofhealthcaredelivery.
12.Participatein thedevelopmentandimplementationof imaginativeandcreative
strategiestoenablesystemstochange.
SampleContent
· leadership,includingtheory,behaviors,characteristics,contemporary
approaches,leadershipdevelopment,andstylesofleadership
15
· leadershipskillsandstrategies(negotiating,collaborating,coordinating);
decisionmakingtopromotequality patientcareinavarietyofhealthcaresettings
· changetheoryandcomplexityscience
· communityorganizingmodels
· socialchangetheories
· creativeandimaginativestrategiesinproblemsolving
· communication,includingelements,channels,levels,barriers,models,
organizationalcommunication,skill development,workplacecommunication,
conflictresolution,optimizingpatientcareoutcomes,andchainofcommand
· principlesofinterpersonalinteractions/communication
· healthcaresystems(structureandfinance)andorganizationalstructuresand
relationships(e.g.,betweenfinance,organizationalstructure, anddeliveryof
care,particularlyatthemicrosystemlevel,includingmission/vision/philosophy
andvalues)
· reliabilityandreliabilitysciencesinhealthcare
· operationsresearch,queuingtheory,andsystemsdesignsinhealthcare
· teamworkskills,includingeffectiveteams/characteristics,applicationtopatient
careteams,teamprocess,conflictresolution,delegation,supervision,and
collaboration
· microsystemsandtheirrelationshiptocomplexsystems,qualitycare,andpatient
safety
· patientsafety principles,includingsafetystandards,organizationalsafety
processes,reportingprocesses,departmentalresponsibilities,ownership,national
initiatives,andfinancialimplications
· quality improvement(QI), includinghistory,elements,ContinuousQuality
Improvement(CQI)models,concepts,principles,benchmarking,processes,
tools,departmentalownership,roles/responsibility,methodologies,regulatory
requirements,organizationalstructuresforQI,outcomes,monitoring,Quality
Assurance(QA)vs.QI,beginningresourceneedassessment,andresource
identification,acquisition,andevaluation
· overviewof QIprocesstechniques,includingbenchmarks,basicstatistics,root
causeanalyses,andFailureModeEffectsAnalysis(FMEA)inthequality
improvementprocess
· principlesofnursingcaredeliverymanagementandevaluation
EssentialIII:ScholarshipforEvidenceBasedPractice
Rationale
Professionalnursingpracticeisgroundedinthetranslation ofcurrentevidenceinto
practice.Scholarshipforthebaccalaureategraduateinvolvesidentificationofpractice
issues; appraisal andintegration ofevidence;andevaluationofoutcomes.As
practitionersatthepointofcare,baccalaureatenursesareuniquelypositionedtomonitor
patientoutcomesandidentifypracticeissues.Evidencebasedpracticemodelsprovidea
16
systematicprocessfortheevaluationandapplicationofscientificevidencesurrounding
practiceissues(IOM,2003b).Disseminationisacriticalelementofscholarlypractice;
baccalaureategraduatesarepreparedtoshareevidenceofbestpracticeswiththe
interprofessionalteam.
Baccalaureateeducationprovidesabasicunderstandingofhowevidenceisdeveloped,
includingtheresearchprocess,clinicaljudgment,interprofessionalperspectives,and
patientpreferenceasappliedtopractice.Thisbasicunderstandingservesasafoundation
formorecomplexapplicationsatthegraduatelevel(AACN,2006a).Baccalaureate
nursesintegratereliableevidencefrommultiplewaysofknowingtoinformpracticeand
makeclinicaljudgments.Incollaborationwithotherhealthcareteammembers,graduates
participateindocumentingandinterpretingevidenceforimprovingpatientoutcomes
(AACN,2006b).
Inallhealthcaresettings,ethicalandlegalpreceptsguideresearchconducttoprotectthe
rightsofpatientseligiblefor, orparticipatingin,investigations.Professionalnurses
safeguardpatientrights,includingthoseofthemostvulnerablepatients,insituations
whereanactualorpotentialconflictofinterest,misconduct,orthepotentialforharmare
identified.
Thebaccalaureateprogrampreparesthegraduateto:
1.Explaintheinterrelationshipsamongtheory,practice,andresearch.
2.Demonstrateanunderstandingofthebasicelementsoftheresearchprocessand
modelsforapplyingevidencetoclinical practice.
3.Advocatefortheprotectionofhumansubjectsintheconductofresearch.
4.Evaluate thecredibilityof sourcesof information,includingbutnotlimitedto
databasesandInternetresources.
5.Participatein theprocessofretrieval,appraisal,andsynthesisofevidencein
collaborationwithothermembersofthehealthcareteam toimprovepatientoutcomes.
6.Integrateevidence,clinicaljudgment,interprofessionalperspectives,andpatient
preferencesinplanning,implementing,andevaluatingoutcomesof care.
7.Collaborateinthecollection,documentation,anddisseminationof evidence.
8.Acquireanunderstandingoftheprocessforhownursingandrelatedhealthcarequality
andsafetymeasuresaredeveloped,validated,andendorsed.
9.Describemechanismstoresolveidentifiedpracticediscrepanciesbetweenidentified
standardsandpracticethatmayadverselyimpactpatientoutcomes.
17
SampleContent
· principlesandmodelsofevidencebasedpractice
· nursesensitivequalityindicators(National Quality Forum,2004),performance
measures
· overviewof qualitativeandquantitativeresearchprocesses
· methodsforlocatingandappraisinghealth andotherrelevantresearchliterature
andothersourcesofevidence
· basicappliedstatistics
· basicdesigns,correspondingquestions,analyticalmethodsrelatedtoresearch
questions,andlimitsonimplicationsoffindings(e.g.,causalvs.relational)
· ethicalconductofresearchandscholarlywork
· linkagesamongpractice,researchevidence,patientoutcomes,andcost
containment
· forcesdrivingresearchagendas
· locatingandevaluatingsourcesofevidence
· electronicdatabasesearchstrategies(e.g., CINAHL,PubMed)
· systematicapplicationofinformation
· levelsofevidence:textbooks,casestudies,reviewsofliterature,research
critiques,controlledtrials,evidencebasedclinicalpracticeguidelines(
www.guideline.gov),metaanalyses,andsystematicreviews(e.g.,theCochrane
DatabaseofSystematicReviews)
· differentiationofclinicalopinionfromresearchandevidencesummaries
· scholarshipdisseminationmethods:oral/visual presentations,publications,
newsletters,etc.
EssentialIV:InformationManagementandApplicationofPatientCareTechnology
Rationale
Knowledgeandskillsininformationandpatientcaretechnologyarecriticalinpreparing
baccalaureatenursinggraduatestodeliverqualitypatientcareinavarietyofhealthcare
settings(IOM,2003a).Graduatesmusthavebasiccompetenceintechnicalskills,which
includestheuseofcomputers,aswellastheapplicationof patientcaretechnologiessuch
asmonitors,datagatheringdevices,andothertechnologicalsupports forpatientcare
interventions.Inaddition,baccalaureategraduatesmusthavecompetenceintheuseof
informationtechnologysystems,includingdecisionsupportsystems,togatherevidence
toguidepractice.Specificintroductory levelnursinginformaticscompetenciesinclude
theabilitytouseselectedapplicationsinacomfortableandknowledgeableway.
Computerandinformationliteracyarecrucialtothefutureofnursing.Improvementof
costeffectivenessandsafetydependonevidencebasedpractice,outcomesresearch,
interprofessional carecoordination,andelectronichealthrecords,allofwhichinvolve
informationmanagementandtechnology(McNeiletal.,2006).Therefore,graduatesof
18
baccalaureateprogramsmusthavecompetenceinusingbothpatientcaretechnologies
andinformationmanagementsystems.
Inaddition,baccalaureategraduatesethicallymanagedata,information,knowledge,and
technologytocommunicateeffectively;providesafeandeffectivepatientcare;anduse
researchandclinicalevidencetoinformpracticedecisions.Graduateswillbeawarethat
newtechnology often requiresnewworkflowpatternsandchangesinpracticeapproaches
topatientcarepriortoimplementation.
Theuseandunderstandingofstandardizedterminologiesarefoundationaltothe
developmentofeffectiveclinicalinformationsystems(CIS).Integrationof standardized
terminologiesintotheCISnotonlysupportsdaytodaynursingpracticebutalsothe
capacitytoenhanceinterprofessional communicationandautomaticallygenerate
standardizeddatatocontinuouslyevaluateandimprovepractice(American Nurses
Association,2008). Baccalaureategraduatesarepreparedtogatheranddocumentcare
datathatserveasafoundationfordecisionmakingforthehealthcareteam.
Courseworkandclinicalexperienceswillprovidethebaccalaureategraduatewith
knowledgeandskillstouseinformationmanagementandpatientcaretechnologiesto
deliversafeandeffectivecare.Graduateswillhaveexposuretoinformationsystemsthat
providedataaboutqualityimprovementandrequiredregulatoryreportingthrough
informationsystems.Courseworkandclinicalexperienceswillexposegraduatestoa
rangeoftechnologiesthatfacilitateclinicalcare,includingpatientmonitoringsystems,
medicationadministrationsystems,andothertechnologiestosupportpatientcare.
Integraltothesebasicskillsisanattitudeofopennesstoinnovationandcontinual
learning,asinformationsystemsandpatientcaretechnologiesareconstantlychanging.
Thebaccalaureateprogrampreparesthegraduateto:
1. Demonstrateskillsinusingpatientcaretechnologies,informationsystems,and
communicationdevicesthatsupportsafenursingpractice.
2. Usetelecommunicationtechnologiestoassistineffectivecommunicationinavariety
ofhealthcaresettings.
3. Applysafeguardsanddecisionmakingsupporttoolsembeddedinpatientcare
technologiesandinformationsystemstosupportasafepracticeenvironmentforboth
patientsandhealthcareworkers.
4. UnderstandtheuseofCISsystemstodocumentinterventionsrelatedtoachieving
nursesensitiveoutcomes.
5. Usestandardizedterminologyinacareenvironmentthatreflectsnursing’sunique
contributiontopatientoutcomes.
19
6. Evaluatedatafrom allrelevantsources,includingtechnology,toinformthedelivery
ofcare.
7. Recognizetheroleofinformationtechnologyinimprovingpatientcareoutcomesand
creatingasafecareenvironment.
8. Upholdethicalstandardsrelatedtodatasecurity,regulatoryrequirements,
confidentiality,andclients’righttoprivacy.
9. Applypatientcaretechnologiesasappropriatetoaddresstheneedsofadiverse
patientpopulation.
10. Advocatefortheuseofnewpatientcaretechnologiesforsafe,qualitycare.
11. Recognizethatredesignof workflowandcareprocessesshouldprecede
implementationofcaretechnology tofacilitatenursingpractice.
12. Participateinevaluationofinformationsystemsinpracticesettingsthroughpolicy
andproceduredevelopment.
SampleContent
· useofpatientcaretechnologies(e.g.,monitors,pumps,computerassisted
devices)
· useoftechnologyandinformationsystemsforclinicaldecisionmaking
· computerskillsthatmayincludebasicsoftware,spreadsheet,andhealthcare
databases
· informationmanagementforpatientsafety
· regulatoryrequirementsthroughelectronicdatamonitoringsystems
· ethicalandlegalissuesrelatedtotheuseofinformationtechnology,including
copyright,privacy,andconfidentialityissues
· retrievalinformationsystems,includingaccess,evaluationofdata,and
applicationofrelevantdatatopatientcare
· onlineliteraturesearches
· technologicalresourcesforevidencebasedpractice
· webbasedlearningandonlineliteraturesearchesforselfandpatientuse
· technologyandinformationsystemssafeguards(e.g., patientmonitoring,
equipment,patientidentificationsystems,drugalertsandIVsystems,and
barcoding)
· interstatepracticeregulations(e.g.,licensure,telehealth)
· technologyforvirtualcaredeliveryandmonitoring
· principlesrelatedtonursingworkloadmeasurement/resourcesandinformation
systems
· informationliteracy
· electronichealthrecord/physicianorderentry
20
· decisionsupporttools
· roleofthenurseinformaticistinthecontextofhealthinformaticsandinformation
systems
EssentialV:HealthcarePolicy,Finance,andRegulatoryEnvironments
Rationale
Healthcarepolicies,includingfinancialandregulatory policies,directlyandindirectly
influencenursingpracticeaswellasthenatureandfunctioningofthehealthcaresystem.
Thesepoliciesshaperesponsestoorganizational,local,national,andglobalissuesof
equity,access,affordability,andsocialjusticeinhealthcare. Healthcarepoliciesalsoare
centraltoanydiscussionaboutqualityandsafetyinthepracticeenvironment.
Thebaccalaureateeducatedgraduatewillhaveasolidunderstandingofthebroader
contextofhealthcare,includinghowpatientcareservicesareorganizedandfinanced,
andhowreimbursementisstructured. Regulatoryagenciesdefineboundariesofnursing
practice,andgraduatesneedtounderstandthescopeandroleoftheseagencies.
Baccalaureategraduatesalsowill understandhowhealthcareissuesareidentified,how
healthcarepolicyisbothdevelopedandchanged,andhowthatprocesscanbeinfluenced
throughtheeffortsof nurses,andotherhealthcareprofessionals,aswellaslayand
special advocacygroups.
Healthcarepolicyshapesthenature,quality,andsafetyofthepracticeenvironmentand
allprofessionalnurseshavetheresponsibilitytoparticipateinthepoliticalprocessand
advocateforpatients,families,communities,thenursingprofession,andchangesinthe
healthcaresystemasneeded. Advocacy forvulnerablepopulationswith thegoal of
promotingsocialjusticeisrecognizedasmoralandethicalresponsibilitiesofthenurse.
Thebaccalaureateprogrampreparesthegraduateto:
1. Demonstratebasicknowledgeofhealthcarepolicy,finance,andregulatory
environments,includinglocal,state, national,andglobal healthcaretrends.
2. Describehowhealthcareisorganizedandfinanced,includingtheimplicationsof
businessprinciples,suchaspatientandsystem costfactors.
3. Comparethebenefitsandlimitationsofthemajorformsof reimbursementonthe
deliveryof healthcareservices.
4. Examinelegislativeandregulatoryprocessesrelevanttotheprovisionofhealth
care.
21
5. Describestate andnational statutes,rules,andregulationsthatauthorizeand
defineprofessionalnursingpractice.
6. Explore theimpactofsociocultural,economic,legal,andpoliticalfactors
influencinghealthcaredeliveryandpractice.
7. Examinetherolesandresponsibilitiesoftheregulatoryagenciesandtheireffect
on patientcarequality,workplacesafety,andthescopeofnursingandotherhealth
professionals’ practice.
8. Discusstheimplicationsofhealthcarepolicyonissuesofaccess,equity,
affordability,andsocialjusticeinhealthcaredelivery.
9. Useanethicalframeworktoevaluatetheimpactofsocialpoliciesonhealthcare,
especiallyforvulnerablepopulations.
10. Articulate,throughanursingperspective,issuesconcerninghealthcaredelivery
todecisionmakerswithinhealthcareorganizationsandotherpolicyarenas.
11. Participateasanursingprofessional inpoliticalprocessesandgrassroots
legislativeeffortstoinfluencehealthcarepolicy.
12. Advocateforconsumersandthenursingprofession.
SampleContent
· policydevelopmentandthelegislativeprocess
· policydevelopmentandtheregulatoryprocess
· licensureandregulationofnursingpractice
· socialpolicy/publicpolicy
· policyanalysisandevaluation
· healthcarefinancingandreimbursement
· economicsofhealthcare
· consumerism andadvocacy
· politicalactivismandprofessionalorganizations
· disparitiesinthehealthcaresystem
· impactofsocial trendssuchasgeneticsandgenomics,childhoodobesity,and
agingonhealthpolicy
· roleofnurseaspatientadvocate
· ethicalandlegalissues
· professionalorganizations’ roleinhealthcarepolicy,financeandregulatory
environments
· scopeofpracticeandpolicyperspectivesofotherhealthprofessionals
· negligence,malpractice,andriskmanagement
· NursePracticeAct
22
EssentialVI:Interprofessional CommunicationandCollaborationforImproving
PatientHealthOutcomes
Rationale
Effectivecommunicationandcollaborationamonghealthprofessionalsisimperativeto
providingpatientcenteredcare.Allhealthprofessionsarechallengedtoeducatefuture
clinicianstodeliverpatientcenteredcareasmembersofaninterprofessionalteam,
emphasizingcommunication,evidencebasedpractice,qualityimprovementapproaches,
andinformatics(IOM,2003a).Interprofessionaleducationisdefinedasinteractive
educationalactivitiesinvolvingtwoormoreprofessionsthatfostercollaborationto
improvepatientcare(Freeth,Hammick,Koppel,& Reeves,2002). Teamworkamong
healthcareprofessionalsisassociatedwithdeliveringhighqualityandsafepatientcare
(Barnsteiner,Disch,Hall,Mayer,&Moore,2007).Collaborationisbasedonthe
complementaritiesofrolesandtheunderstandingof theserolesbythemembersofthe
healthcareteams.
Interprofessionaleducationenablesthebaccalaureategraduatetoentertheworkplace
withbaselinecompetenciesandconfidenceforinteractionsandwith communication
skillsthatwillimprovepractice,thusyieldingbetterpatientoutcomes. Interprofessional
educationcanoccurinavarietyofsettings. Anessentialcomponentforthe
establishmentofcollegialrelationshipsisrecognitionoftheuniquedisciplinespecific
practicespheres.Fundamentaltoeffectiveinterprofessionalandintraprofessional
collaborationisadefinitionofsharedgoals;clearroleexpectationsofmembers;a
flexibledecisionmakingprocess;andtheestablishmentofopencommunicationpatterns
andleadership.Thus,interprofessionaleducationoptimizesopportunitiesforthe
developmentofrespectandtrustforothermembersofthehealthcareteam.
Thebaccalaureateprogrampreparesthegraduateto:
1. Compare/contrasttherolesandperspectivesofthenursingprofessionwithother
careprofessionalsonthehealthcareteam (i.e.,scopeofdiscipline,educationand
licensurerequirements).
2. Useinterandintraprofessional communicationandcollaborativeskillstodeliver
evidencebased,patientcenteredcare.
3. Incorporateeffectivecommunicationtechniques,includingnegotiationand
conflictresolution toproducepositiveprofessionalworkingrelationships.
4. Contributetheuniquenursingperspectivetointerprofessionalteamstooptimize
patientoutcomes.
5. Demonstrateappropriateteambuildingandcollaborativestrategieswhenworking
withinterprofessionalteams.
23
6. Advocateforhighqualityandsafepatientcareasamemberofthe
interprofessionalteam.
SampleContent
· interprofessional andintraprofessional communication,collaboration,and
socialization,withconsiderationofprinciplesrelatedtocommunicationwith
diversecultures
· teamwork/conceptsofteambuilding/cooperativelearning
· professionalroles,knowledgetranslation,roleboundaries,anddiverse
disciplinaryperspectives
· relationshipbuilding
· navigatingcomplexsystems,systemfacilitation
· interdependenceandresourcesharingofhealthcareprofessions
· individualaccountability/sharedaccountability
· advocacy
· ethicalcodesandcorevaluesofdifferenthealthcareprofessions
· autonomy
· safety
· scopesofpractice
· conflictmanagement,conflictresolutionstrategies,andnegotiation
· groupdynamics
· principlesofreferralprocessforspecializedservices
· participatorydecisionmaking
· caring
EssentialVII:ClinicalPreventionandPopulationHealth
Rationale
Healthpromotion,disease,andinjurypreventionacrossthelifespanareessential
elementsofbaccalaureatenursingpracticeattheindividualandpopulationlevels.These
conceptsarenecessarytoimprovepopulationhealth.Epidemiologicstudiesshowthat
lifestyle,environmental,andgeneticfactorsaremajordeterminantsof populationhealth
inareasofhealth,illness,disease,disability,andmortality (U.S.DepartmentofHealth
andHumanServices,2000a). Thus,acutecareanddiseasebasedepisodicinterventions
aloneareinadequateforimprovinghealth(Allanetal.,2004;Allan,Stanley,Crabtree,
Werner,&Swenson,2005). Healthpromotionalongwithdiseaseandinjuryprevention
areimportantthroughoutthelifespanandincludeassistingindividuals,families,groups,
communities,andpopulationstoprepareforandminimizehealthconsequencesof
emergencies,includingmasscasualtydisasters.
24
Clinicalpreventionreferstoindividuallyfocusedinterventionssuchasimmunizations,
screenings,andcounselingaimedatpreventingescalationofdiseasesandconditions.
(Allan,Stanley,Crabtree,Werner,&Swenson,2005) Becausetheseinterventionsare
relevantacross thelifespan,nursesneedknowledgeaboutgrowthanddevelopmentas
wellasevidencebasedclinicalpreventionpractices.Nursescollaboratewithother
healthcareprofessionalsandpatientsforimprovinghealththroughclinicalprevention.
Inpopulationfocusednursing,theaggregate,community,orpopulationistheunitof
care.Emphasisisplacedonhealthpromotionanddiseaseprevention.Because
populationfocusedcareisfundamentaltonursingpractice,andbecauseabaccalaureate
degreeinnursingistherecommendedminimaleducationalcredentialforpopulation
focusedcare,baccalaureateprogramspreparegraduatesforpopulationhealthaswellas
clinicalprevention(AACN,1998;AmericanPublicHealthAssociation,1996; Quad
CouncilofPublicHealthNursingOrganizations,2004). Populationfocusednursing
involvesidentifyingdeterminantsofhealth,prioritizingprimarypreventionwhen
possible,activelyidentifyingandreachingouttothosewhomightbenefitfromaservice,
andusingavailableresourcestoassurebestoverallimprovementinthehealthofthe
population(AmericanNursesAssociation,2007). Forinstance,populationfocused
interventionsinvolvereachinganappropriatelevelofherdimmunityinthecommunity
andensuringthatinformationaboutappropriatescreeningsreachtheentirepopulation,
notjustthosewhochoosetocometohealthcarefacilities.Collaborationwithother
healthcareprofessionalsandpopulationsisnecessarytopromoteconditionsandhealthy
behaviorsthatimprovepopulationhealth.
Thebaccalaureateprogrampreparesthegraduateto:
1. Assessprotectiveandpredictivefactors,includinggenetics,whichinfluencethe
healthofindividuals,families,groups,communities,andpopulations.
2. Conductahealthhistory,includingenvironmentalexposureandafamilyhistory
thatrecognizesgeneticrisks,toidentifycurrentandfuturehealthproblems.
3. Assesshealth/illnessbeliefs,values,attitudes,andpracticesof individuals,
families,groups, communities,andpopulations.
4. Usebehavioralchangetechniquestopromotehealthandmanageillness.
5. Useevidencebasedpracticestoguidehealthteaching,healthcounseling,
screening,outreach,diseaseandoutbreakinvestigation,referral,andfollowup
throughoutthelifespan.
6. Useinformationandcommunicationtechnologiesinpreventivecare.
7. Collaboratewithotherhealthcareprofessionalsandpatientstoprovidespiritually
andculturallyappropriatehealthpromotion anddiseaseandinjury prevention
interventions.
25
8. Assessthehealth,healthcare,andemergency preparednessneedsofadefined
population.
9. Useclinicaljudgmentanddecisionmakingskillsinappropriate,timelynursing
careduringdisaster,masscasualty,andotheremergencysituations.
10. Collaboratewithotherstodevelopaninterventionplanthattakesintoaccount
determinantsofhealth,availableresources,andtherangeofactivitiesthat
contribute tohealthandthepreventionofillness,injury,disability,andpremature
death.
11. Participatein clinicalpreventionandpopulationfocusedinterventionswith
attentiontoeffectiveness,efficiency,costeffectiveness,andequity.
12. Advocateforsocialjustice,includingacommitmenttothehealthofvulnerable
populationsandtheeliminationofhealthdisparities.
13. Useevaluationresultstoinfluencethedeliveryofcare,deploymentofresources,
andtoprovideinputintothedevelopmentofpoliciestopromotehealthand
preventdisease.
SampleContent
· preventionandharmreduction
· ecologicalmodelasframeworkforunderstandingdeterminantsofhealth
· publichealthprinciples
· fundamentalsofepidemiologyandbiostatistics(distribution,incidence,prevalence,
rates,riskfactors,healthstatusindicators,andcontrolofdiseaseinpopulations)
· publichealthcorefunctions
· systemstheory
· ethical,legal,andeconomicprinciplesrelatedtoclinicalpreventionandpopulation
health
· cultural,psychological,andspiritualimplicationsofclinicalpreventionand
populationhealth
· environmentalhealthrisks
· healthliteracy
· healthbehaviorchangetheories
· theoreticalfoundationsandprinciplesofindividualandpopulationfocused
educationandcounseling
· geneticsandgenomics
· nutrition
· globalhealth
· occupationalhealth,includingergonomics
26
· evidencebasedclinicalpreventionpractices
· complementaryandalternativetherapies
· populationassessment
· individualandpopulationfocusedinterventions(e.g.weightcontrol,nicotine
management,socialmarketing,policy development)
· healthsurveillance
· healthdisparitiesandvulnerablepopulations
· screening
· immunization
· pharmaceuticalpreventivestrategies
· communicatingandsharinghealthinformationwiththepublic
· riskcommunication
· emergency preparednessanddisasterresponseincludingselfprotection
· usingtechnologyinpopulationfocusedcareandclinicalprevention
· outcomemeasurement
· pedigreefromathreegenerationfamilyhealthhistoryusingstandardizedsymbols
andterminology
EssentialVIII:ProfessionalismandProfessionalValues
Rationale
Professionalvaluesandtheirassociatedbehaviorsarefoundationaltothepracticeof
nursing.Inherentinprofessionalpracticeisanunderstandingofthehistorical,legal,and
contemporarycontextofnursingpractice.Professionalismisdefinedastheconsistent
demonstrationofcorevaluesevidencedbynursesworkingwithotherprofessionalsto
achieveoptimalhealthandwellnessoutcomesinpatients,families,andcommunitiesby
wiselyapplyingprinciplesofaltruism,excellence,caring,ethics,respect,
communication,andaccountability(InterprofessionalProfessionalismMeasurement
Group,2008). Professionalismalsoinvolvesaccountabilityforone’sselfandnursing
practice,includingcontinuousprofessionalengagementandlifelonglearning.As
discussedintheAmericanNursesAssociationCodeofEthicsforNursing(2005,p.16),
“Thenurseisresponsibleforindividualnursingpracticeanddeterminestheappropriate
delegationoftasksconsistentwiththenurse’sobligationtoprovideoptimumpatient
care.”Also,inherentinaccountabilityisresponsibilityforindividualactionsand
behaviors,includingcivility.Inordertodemonstrateprofessionalism,civilitymustbe
present.Civilityisafundamental setofacceptedbehaviorsforasociety/cultureupon
whichprofessionalbehaviorsarebased(Hammer,2003).
Professionalnursinghasenjoyedalongtraditionofhighrespectfromthepublic(Gallup
Poll,2006).Aprimary reasonforthisrecognitionisthecaringandcompassionofthe
nurse.Caringisaconceptcentraltoprofessionalnursingpractice.Caringasrelatedto
thisEssentialencompassesthenurse’sempathyfor,connectionto, andbeingwiththe
patient,aswellastheabilitytotranslatetheseaffectivecharacteristicsinto
compassionate,sensitive,andpatientcenteredcare.Historically,nurseshaveprovided
27
careforpatientswithinacontextofprivilegedintimacy;aspaceintowhichanurseis
allowedandinpartnershipwiththepatientcreatesaunique,healingrelationship.
Throughthisconnection,thenurseandpatientworktowardanunderstandingofawide
varietyofphysical,psychosocial,cultural,andspiritualneeds,healthillnessdecisions,
andlifechallenges.Professionalnursingrequiresabalancebetweenevidencebased
knowledge,skills,andattitudesandprofessionalconfidence,maturity,caring,and
compassion.Inthisglobalsociety,patientpopulationsareincreasinglydiverse.
Therefore,essentialtothecareofdiversepopulationsistheneedforevidencebased
knowledgeandsensitivitytovariablessuchasage,gender,culture,healthdisparities,
socioeconomicstatus,race,andspirituality.Baccalaureategraduatesare preparedtocare
foratriskpatients,includingtheveryyoungandthefrailelderly,andtoassistpatients
withdecisionmakingaboutendoflifeconcernswithinthecontextofthepatient’svalue
system.Inaddition,nursesarepreparedtoworkwithpatientsacrossthelifespanwho
requiregenetictechnologiesandtreatments.
Baccalaureateeducationincludesthedevelopmentofprofessionalvaluesandvaluebased
behavior.Understandingthevaluesthatpatientsandotherhealthprofessionalsbringto
the therapeuticrelationshipiscriticallyimportanttoprovidingqualitypatientcare.
Baccalaureategraduatesare preparedforthenumerousdilemmasthatwillarisein
practiceandareabletomakeandassistothersinmakingdecisionswithinaprofessional
ethicalframework.Ethicsisanintegralpartofnursingpracticeandhasalwaysinvolved
respectandadvocacyfortherightsandneedsofpatientsregardlessofsetting. Honesty
andactingethicallyaretwokeyelementsofprofessionalbehavior,which haveamajor
impactonpatientsafety.Ablamefreecultureofaccountability andan environmentof
safety areimportantforencouragingteammemberstoreporterrors.Suchanenvironment
enhancesthesafetyofallpatients.
Thefollowingprofessional valuesepitomizethecaring,professionalnurse.Nurses,
guidedbythesevalues,demonstrateethicalbehaviorinpatientcare.
Altruismisaconcernforthewelfareandwellbeingofothers.Inprofessionalpractice,
altruismisreflectedbythenurse’sconcern andadvocacy forthewelfareofpatients,
othernurses,andotherhealthcareproviders.
Autonomy istherighttoselfdetermination.Professionalpracticereflectsautonomy
whenthenurserespectspatients’rightstomakedecisionsabouttheirhealthcare.
HumanDignityisrespectfortheinherentworthanduniquenessofindividualsand
populations.Inprofessionalpractice,concernforhumandignityisreflectedwhenthe
nursevaluesandrespectsallpatientsandcolleagues.
Integrityisactinginaccordancewithanappropriatecodeofethicsandaccepted
standardsofpractice.Integrityisreflectedinprofessionalpracticewhenthenurseis
honestandprovidescarebasedonanethicalframeworkthatisacceptedwithinthe
profession.
28
SocialJusticeisactinginaccordancewithfairtreatmentregardlessofeconomicstatus,
race,ethnicity,age,citizenship,disability,orsexualorientation.
Thebaccalaureateprogrampreparesthegraduateto:
1. Demonstratetheprofessionalstandardsofmoral,ethical,andlegalconduct.
2. Assumeaccountabilityforpersonalandprofessionalbehaviors.
3. Promotetheimageofnursingbymodelingthevaluesandarticulatingthe
knowledge,skills,andattitudesofthenursingprofession.
4. Demonstrateprofessionalism,includingattentiontoappearance,demeanor,
respectforselfandothers,andattentiontoprofessional boundarieswithpatients
andfamiliesaswellasamongcaregivers.
5. Demonstrateanappreciationofthehistory of andcontemporaryissuesin nursing
andtheirimpactoncurrentnursingpractice.
6. Reflecton one’sown beliefsandvaluesasthey relatetoprofessionalpractice.
7. Identifypersonal,professional,andenvironmentalrisksthatimpactpersonaland
professionalchoicesandbehaviors.
8. Communicatetothehealthcareteamone’spersonalbiasondifficulthealthcare
decisionsthatimpactone’sabilitytoprovidecare.
9. Recognizetheimpactofattitudes,values,andexpectationsonthecareofthevery
young,frail olderadults,andothervulnerablepopulations.
10. Protectpatientprivacyandconfidentialityofpatientrecordsandotherprivileged
communications.
11. Accessinterprofessional andintraprofessional resourcestoresolveethical and
otherpracticedilemmas.
12. Acttopreventunsafe,illegal,orunethicalcarepractices.
13. Articulatethevalueofpursuingpracticeexcellence,lifelonglearning,and
professionalengagementtofosterprofessionalgrowthanddevelopment.
14. Recognizetherelationshipbetweenpersonalhealth,selfrenewal,andtheability
todeliversustainedqualitycare.
29
SampleContent
· NursePracticeActsandscopeof practice
· professionalcodesofconductandprofessionalstandards(e.g.,ANA,Codeof
EthicsforNurseswithInterpretiveStatements,2005; International Councilof
Nursing,CodeofEthics forNurses,2006, andAACN’sHallmarksofthe
ProfessionalNursingPracticeEnvironment, 2002)
· ethicalandlegalframeworksandsocialimplications
· communication
· interprofessionalteamsandteambuildingconcepts
· cultural humility andspiritual awareness
· healthdisparities
· historyofnursing
· contemporarynursingissues
· problemsolvingmethodssuchasappreciativeinquiry
· professionalaccountability
· stereotypesandbiases,suchasgender,race,andagediscrimination
· nurseself care/stressmanagementstrategies
· humanrights
· informedconsent
· professionalidentity formation
· privacy,confidentiality
· moralagency
· professionalimage
· selfreflection,personalknowing,personalselfcareplan
· professionalorganizations,particularlynursingandhealthcareorganizations
EssentialIX:BaccalaureateGeneralistNursingPractice
Rationale
EssentialIXdescribesgeneralistnursingpracticeatthecompletionofbaccalaureate
nursingeducation.ThisEssentialincludespracticefocusedoutcomesthatintegratethe
knowledge,skills,andattitudesdelineatedinEssentialsIVIIIintothenursingcareof
individuals,families,groups,communities,andpopulationsinavarietyofsettings.
Becauseprofessionalnursesarethehumanlinkbetweenthepatientandthecomplex
healthcareenvironment, theymustprovidecompassionatecareinformedbyascientific
baseofknowledge,includingcurrentevidencefromnursingresearch.EssentialIX
recognizesthattheintegrationofknowledgeandskillsiscriticaltopractice.Practice
occursacrossthelifespanandinthecontinuumofhealthcareenvironments.The
baccalaureategraduatedemonstratesclinicalreasoningwithinthecontextofpatient
centeredcaretoformthebasisfornursingpracticethatreflectsethicalvalues.
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Knowledgeacquisitionrelatedtowellness,healthpromotion,illness,disease
managementandcareofthedyingiscoretonursingpractice.Inaddition,acquisitionof
communicationandpsychomotorskillsiscriticaltoprovidingnursingcare.Skill
developmentwillfocusonthemasteryofcorescientificprinciplesthatunderlieallskills,
thuspreparingthebaccalaureategraduatetoincorporatecurrentandfuturetechnical
skillsintoothernursingresponsibilitiesandapplyskillsindiversecontextsofhealthcare
delivery.Directcaremaybedeliveredinpersonorvirtuallyandthatcareisbasedona
sharedunderstandingwiththepatientandthehealthcareteam.Thisbaseofknowledge
andskillspreparesthegraduateforpracticeasamemberandleaderofthe
interprofessionalhealthcareteam.
Baccalaureateeducatednurseswillbepreparedtocareforpatientsacrossthelifespan,
from theveryyoungtotheolderadult.Specialattention willbepaidtochanging
demographics.Amongthesedemographicsaretheincreasedprevalenceofchronic
illnessesandcomorbiditiesamongallages,includingthoserelatedtomental disorders,
specificallydepression.However,thereisclearevidencethatthelargestgroupseeking
andreceivinghealthcareservicesistheolderadultpopulation.Thegraduatewill
understandandrespectthevariationsofcare,theincreasedcomplexity,andtheincreased
useofhealthcareresourcesinherentincaringforpatientswhoarevulnerableduetoage,
theveryyoungandveryold,aswellasdisabilitiesandchronicdisease.
Theincreasingdiversityofthisnation’spopulationmandatesanattentiontodiversityin
ordertoprovidesafe,humanistichighqualitycare.Thisincludescultural,spiritual,
ethnic,gender,andsexual orientation diversity.Inaddition,theincreasingglobalization
ofhealthcarerequiresthatprofessionalnursesbepreparedtopracticeinamulticultural
environmentandpossesstheskillsneededtoprovideculturallycompetentcare.
Baccalaureategraduateswill haveknowledge,skills,andattitudesthatpreparethemfora
longtermcareerinachangingpracticeenvironment.Theincreasedprevalenceofchronic
illnessisaresultofanincreasinglyolderadultpopulation,environmentalthreats,
lifestylesthatincreaseriskofdisease,andenhancedtechnologicalandtherapeutic
interventionsthatprolonglife.Inadditiontoprimaryprevention,theprofessionalnurse
providessupportformanagementofchronicillness,healtheducation,andpatient
centeredcareinpartnershipwiththepatientandtheinterprofessionalteam.Patientsand
theirfamiliesoftenareknowledgeableabouthealthcare;therefore,thegraduatewillbe
abletocommunicatewiththeseconsumersandappreciatetheimportanceofthecare
partnership.
Graduatestranslate,integrate,andapplyknowledgethatleadstoimprovementsinpatient
outcomes.Knowledgeisincreasinglycomplexandevolvingrapidly.Forexample,
geneticsandgenomicsareareaswhereknowledgeisescalatingandthegraduatewill be
cognizantofcustomizedtherapiesdesignedtoimprovecareoutcomes.Therefore,
baccalaureategraduateswillbeexpectedtofocusoncontinuousselfevaluationand
lifelonglearning.
31
Thebaccalaureateprogrampreparesthegraduateto:
1. Conductcomprehensiveandfocusedphysical,behavioral,psychological,
spiritual,socioeconomic,andenvironmentalassessmentsofhealthandillness
parametersinpatients,usingdevelopmentallyandculturallyappropriate
approaches.
2. Recognizetherelationshipofgeneticsandgenomicstohealth,prevention,
screening,diagnostics,prognostics,selectionoftreatment,andmonitoringof
treatmenteffectiveness,usingaconstructedpedigreefromcollectedfamily
historyinformation aswellasstandardizedsymbolsandterminology.
3. Implementholistic,patientcenteredcarethatreflectsanunderstandingof human
growthanddevelopment,pathophysiology,pharmacology,medicalmanagement,
andnursingmanagementacrossthehealthillnesscontinuum,acrossthelifespan,
andinallhealthcaresettings.
4. Communicateeffectivelywith allmembersofthehealthcareteam,includingthe
patientandthepatient’ssupportnetwork.
5. Delivercompassionate,patientcentered,evidencebasedcarethatrespectspatient
andfamilypreferences.
6. Implementpatientandfamilycarearoundresolutionofendoflifeandpalliative
careissues,suchassymptommanagement,supportofrituals,andrespectfor
patientandfamilypreferences.
7. Provideappropriatepatientteachingthatreflectsdevelopmentalstage,age,
culture,spirituality,patientpreferences,andhealthliteracyconsiderationsto
fosterpatientengagementin theircare.
8. Implementevidencebasednursinginterventionsasappropriateformanagingthe
acuteandchroniccareofpatientsandpromotinghealth acrossthelifespan.
9. Monitorclientoutcomestoevaluatetheeffectivenessofpsychobiological
interventions.
10. Facilitatepatientcenteredtransitionsofcare,includingdischargeplanningand
ensuringthecaregiver’sknowledgeofcarerequirementstopromotesafecare.
11. Providenursingcarebasedonevidencethatcontributestosafeandhighquality
patientoutcomeswithinhealthcaremicrosystems.
12. Createasafecareenvironmentthatresultsinhighqualitypatientoutcomes.
32
13. Revisetheplanofcarebasedonanongoingevaluation ofpatientoutcomes.
14. Demonstrateclinicaljudgmentandaccountabilityforpatientoutcomeswhen
delegatingtoandsupervisingothermembersofthehealthcareteam.
15. Managecaretomaximizehealth,independence,andqualityoflifeforagroupof
individualsthatapproximatesabeginningpractitioner’sworkload
16. Demonstratetheapplicationofpsychomotorskillsfortheefficient,safe,and
compassionatedeliveryofpatientcare.
17. Developabeginningunderstandingofcomplementaryandalternativemodalities
andtheirroleinhealthcare.
18. Developanawarenessofpatientsaswellashealthcareprofessionals’spiritual
beliefsandvaluesandhowthosebeliefsandvaluesimpacthealthcare.
19. Managetheinteractionofmultiplefunctionalproblemsaffectingpatientsacross
thelifespan,includingcommongeriatricsyndromes.
20. Understandone’sroleandparticipationin emergency preparednessanddisaster
responsewithanawarenessofenvironmentalfactorsandtheriskstheyposeto
selfandpatients.
21. Engageincaringandhealingtechniquesthatpromoteatherapeuticnursepatient
relationship.
22. Demonstratetolerancefortheambiguityandunpredictabilityoftheworldandits
effectonthehealthcaresystemasrelatedtonursingpractice.
SampleContent
· theoriesofhumangrowthanddevelopment
· principlesofbasicnursingcare(e.g., skin,mobility,painmanagement,immediate
patientcareenvironment,etc.)
· patientandfamilycenteredcare
· managementofacuteandchronicphysicalandpsychosocialconditionsacrossthe
lifespan
· integrationof pathophysiologyintocare
· careacrossthelifespanfocusingonchangingdemographicswithanemphasison
careofolderadultsandtheveryyoung.
· palliativeandendoflifecare
· commongeriatricsyndromes
· geneticsandgenomics
33
· nutrition
· emergencypreparednessanddisasterresponse
· bioterrorism
· infectioncontrolissues,suchasdrugresistantorganismsandmanagement
· caringandhealingtechniques
· psychobiologicalinterventions
· milieutherapy
· depressionscreening
· healthpromotion
· patientadvocacy
· disparities
· complementaryandalternativetherapies
· spiritual care
· therapeuticcommunication
· culturallydiversecare
· evidencebasedpractice
· pharmacology/pharmacogenetics
· nursingcaremanagement
· prioritizationofpatientcareneeds
· principlesofdelegatingandmonitoringcare
· leadership
· informationmanagementsystems
· integratingtechnologyintopractice
· resourcemanagement
· teaching/learningprinciples
ExpectationsforClinicalExperienceswithintheBaccalaureateProgram
Baccalaureateprogramsproviderichandvariedopportunitiesforpracticeexperiences
designedtoassistgraduates toachievetheBaccalaureateEssentialsuponcompletionof
theirprogram.Clinical experiencesareessentialforbaccalaureatenursingprogramsto
preparestudentstocareforavarietyofpatientsacrossthelifespanandacrossthe
continuumofcare.Inadditionclinicalexperiencesassistthegraduateto:
· developproficiencyinperformingpsychomotorskills;
· applyprofessionalcommunicationstrategiestoclientandinterprofessional
interactions; and
· acquireaprofessionalidentity.
Clinicallearningisfocusedondevelopingandrefiningtheknowledgeandskills
necessarytomanagecareaspartofaninterprofessionalteam.Theoreticallearning
becomesrealityasstudentsarecoachedtomakeconnectionsbetweenthestandardcase
orsituationthatispresentedintheclassroom or laboratorysettingandtheconstantly
shiftingrealityofactualpatientcare. Clinicaleducatorsforbaccalaureateprogramsare
wellinformedaboutthespecificlearningthatistakingplaceintheclassroomand
34
laboratorysettingandfindclinical education opportunitiestoreinforceandapplythat
learning. Programsprovideclinicalplacementsacrosstherangeofpracticesettingsand
acrossthecontinuumofcarethataresafe,supportive,andconduciveforgroupsof
studentstopracticeandlearn professionalroles.Clinicalpracticeopportunitiesexpose
studentstopracticeissuessuchastechnologicalinnovations,acceleratedcaretransitions,
an unpredictablefastpacedenvironment,andcomplex systemissues,whichareall
importantin preparingthestudentsforpracticefollowinggraduation.Inaddition,clinical
practiceopportunitiesprovidestudentswithexperiencesandnursingrolemodelsthat
preparethemforpracticeincomplex,changinghealthcareenvironments.
Simulationexperiencesaugmentclinicallearningandarecomplementarytodirectcare
opportunitiesessentialtoassumingtheroleoftheprofessionalnurse.Laboratoryand
simulationexperiencesprovideaneffective,safeenvironmentforlearningandapplying
thecognitiveandperformanceskillsneededforpractice.Realitybased,simulatedpatient
careexperiencesincreaseselfconfidenceincommunicationandpsychomotorskills,and
professionalroledevelopment.Beginningresearchsupportstheuseofsimulationin
nursingeducation.Nehring,Ellis,andLashley(2001)describetheuseofhumanpatient
simulatorsinnursingeducationasanexcellenttooltomeasurecompetencyinthe
applicationofknowledgeandtechnicalskills.Debriefing,orfeedbacktothestudents,is
asessentialforsimulationasitisforinstructionintheclinicalsetting(National Council
of StateBoardsof Nursing,2005). Simulationisavaluableelementofclinical
preparation.However,patientcareexperienceswithactualpatientsformthemost
importantcomponentofclinical education.Overtime,asevidenceemergesregardingthe
useofsimulationasasubstituteforactualpatientexperience,thebalancebetweenactual
andsimulatedpatientcaremay change.
Directpatientcareclinical experiencesprovidevaluableopportunitiesforstudent
learningnotfoundinotherexperiences.Earlylearningexperiences,includingproviding
careforalimitednumberofpatients,allowstudentstoexplorethechallengingworldof
clinicalpractice.Asstudentsbecomemoreexperienced,increasinglycomplex clinical
learningopportunitiesareselectedtoprovideasufficientbreadthanddepthof learningto
developthecompetencenecessaryforentrylevel practicewith diversepatientsacrossthe
lifespaninvarioustypesofsettings.Through animmersionexperience,studentshave
theopportunitytodevelopincreasingautonomyandassumeanassignmentthatmore
closelyapproximatesarealisticworkloadofanovicenurseinthatenvironment.
A clinicalimmersionexperienceprovidesopportunitiesforbuildingclinicalreasoning,
management,andevaluationskills.Theseopportunitiesincreasethestudent’sself
confidence,professionalimage,andsenseof belongingthatfacilitatethetransitionto
competentandconfidentpractice.Immersionexperiencesallowstudentstointegrate
previouslearningandmorefully developtherolesofthebaccalaureategeneralistnurse:
· providerof care
evaluateclientchangesandprogressovertime
developabeginningproficiencyandefficiencyindeliveringsafecare
· designer/manager/coordinatorof care
managecaretransitions
35
beanactiveparticipantontheinterprofessionalteam
identifysystemissues
developworkingskillsindelegation,prioritization,andoversightofcare
· memberofaprofession
evaluateone’sownpractice
assumeresponsibilityforsupportingtheprofession
Animmersionexperienceprovidesfaculty opportunitiesto observestudentperformance
overtimeandmoreeffectively evaluatethestudent’sprofessional development.
Graduatesof alltypesof baccalaureateprogramsneedsufficientdidactic,laboratory,and
clinicalexperiencestoattaintheendofprogramoutcomesofthese Essentials. The
nursingprogramdeterminesandassessesclinicalsitestoensuretheclinical experiences
forstudentsprovide:
· patientsfromdiversebackgrounds,cultures,andofdifferinggender,religious,and
spiritual practices;
· thecontinuumofcare,includingpopulationfocusedcare;
· allagegroups,includingtheveryyoungandthefrail elderly;and
· comprehensivelearningopportunitiestopromoteintegrationofbaccalaureate
learningoutcomesthatpreparethegraduateforprofessionalnursingpractice.
Summary
TheEssentialsforBaccalaureateEducationforProfessionalNursingPracticeservesto
transform baccalaureatenursingeducationandareadramaticrevisionofthe1998
version.Further,theseEssentialsmeettheIOM’srecommendationsforcoreknowledge
neededforallhealthcareprofessionals(IOM,2003b).Duetotheeverchangingand
complexhealthcareenvironment, thisdocumentemphasizessuchconceptsaspatient
centeredcare,interprofessionalteams,evidencebasedpractice,qualityimprovement,
patientsafety,informatics,clinicalreasoning/criticalthinking,geneticsandgenomics,
culturalsensitivity,professionalism,practiceacrossthelifespan,andendoflifecare.
EssentialsIIXdelineatetheoutcomesexpectedforbaccalaureatenursingprogram
graduates.Achievementoftheseoutcomeswillenablethebaccalaureateprepared
generalistnursetopracticewithincomplexhealthcaresystemsandassumetheroles:
· providerof care
evaluateclientchangesandprogressovertime
developabeginningproficiencyandefficiencyindeliveringsafecare
· designer/manager/coordinator of care
managecaretransitions
beanactiveparticipantontheinterprofessionalteam
identifysystemissues
developworkingskillsindelegation,prioritization,andoversightofcare
· memberofaprofession
evaluateone’sownpractice
assumeresponsibilityforsupportingtheprofession
36
EssentialIXdescribesgeneralistnursingpracticeatthecompletionofbaccalaureate
nursingeducation.ThisEssentialincludespracticefocusedoutcomesthatintegratethe
knowledge,skills,andattitudesdelineatedinEssentialsI–VIII. Thetimeneededto
accomplish eachEssentialwillvary,andeachEssentialdoesnotrequireaseparatecourse
forachievementoftheoutcomes. Learningopportunities,includingclinicalexperiences,
mustbesufficientinbreadthanddepthtoensurethegraduateattainsthesepractice
focusedoutcomesandintegratesthisknowledgeandtheseskillsintoone’sprofessional
nursingpractice.
Baccalaureategraduatestranslate,integrate,andapplyknowledgethatleadsto
improvementsinpatientoutcomes.Knowledgeisincreasinglycomplexandevolving
rapidly.Therefore,baccalaureategraduatesareexpectedtofocusoncontinuousself
evaluationandlifelonglearning.
Glossary
CriticalThinking: Allorpartoftheprocessofquestioning,analysis,synthesis,
interpretation,inference,inductiveanddeductivereasoning,intuition,application,and
creativity(AACN,1998).Criticalthinkingunderliesindependentandinterdependent
decisionmaking.
ClinicalJudgment:Theoutcomesofcriticalthinkinginnursingpractice.Clinical
judgmentsbeginwithanendinmind.Judgmentsareaboutevidence,meaningand
outcomesachieved(Pesut,2001).
ClinicalReasoning:Theprocessusedtoassimilateinformation,analyzedata,andmake
decisionsregardingpatientcare (Simmons,Lanuza,Fonteyn,&Hicks,2003).
ClinicalPrevention:Individuallyfocusedinterventionssuchasimmunizations,
screenings,andcounseling,aimedatpreventingescalationofdiseasesandconditions.
Cultural Humility:Incorporatesalifelongcommitmenttoselfevaluationandself
critique,toredressingthepowerimbalancesinthepatientcliniciandynamic,andto
developingmutuallybeneficialandadvocacypartnershipswithcommunitiesonbehalfof
individualsanddefinedpopulations.Culturalhumilityisproposedasamoresuitablegoal
thanculturalcompetenceinhealthcareeducation (Tervalon& MurrayGarcia,1998).
CulturalSensitivity:Culturalsensitivityisexperiencedwhenneutrallanguage,both
verbalandnotverbal,isusedinawaythatreflectssensitivityandappreciationforthe
diversityofanother.Cultural sensitivitymaybeconveyedthroughwords,phrases,and
categorizationsthatareintentionallyavoided,especiallywhenreferringtoanyindividual
whomaybeinterpretedasimpoliteoroffensive(AmericanAcademyofNursingExpert
PanelonCulturalCompetence,2007).
37
DecisionSupportSystem (Clinical):Interactivecomputerprogramsdesignedtoassist
clinicianswithdecisionmakingtasks. Clinical decisionsupportsystemslinkhealth
observationswithhealthknowledgetoinfluencechoicesbycliniciansforimproved
healthcare.
Diversity: Therangeofhumanvariation,includingage,race,gender,disability,
ethnicity,nationality,religiousandspiritual beliefs,sexualorientation,politicalbeliefs,
economicstatus,nativelanguage,andgeographicalbackground.
EvidencebasedPractice:Carethatintegratesthebestresearchwithclinicalexpertise
andpatientvaluesforoptimumcare(IOM,2003b).
HealthDeterminants:Complexinterrelationshipsoffactors,suchasthesocialand
economicenvironment,thephysical environment,individualcharacteristics,and
behaviorsthatinfluencehealth.
HealthLiteracy: Thedegreetowhichindividualshavethecapacitytoobtain,process,
andunderstandbasichealthinformationandservicesneededtomakeappropriatehealth
decisions(U.S.DepartmentofHealthandHumanServices,2000b)
HealthcareTeam:Thepatientplusallofthehealthcareprofessionalswhocareforthe
patient.Thepatientisanintegralmemberofthehealthcareteam.
HerdImmunity:Immunityofasufficientproportionofthepopulationtoreducethe
probabilityofinfectionofsusceptiblemembersofthatpopulation.
ImmersionExperience: Clinicalexperienceswithasubstantivenumberofhoursina
consistentclinicalsettingoveraconcentratedperiodoftime.
InformationTechnology:Thestudy,design,developmentimplementation,support, or
managementofcomputerbasedinformationsystems,particularlysoftwareapplications
andcomputerhardware.
IntegrativeStrategiesfor Learning:Coherentorganizationofeducationalpracticesthat
integrategeneraleducationconceptsthroughoutthemajor,throughthewidespreaduseof
powerful,active,andcollaborativeinstructionalmethods(AssociationofAmerican
CollegesandUniversities,2004) .
Interprofessional:Workingacrosshealthcareprofessionstocooperate,collaborate,
communicate,andintegratecareinteamstoensurethatcareiscontinuousandreliable.
Theteamconsistsofthepatient,thenurse,andotherhealthcareprovidersasappropriate
(IOM,2003b).
Intraprofessional: Workingwithhealthcareteammemberswithintheprofessionto
ensurethatcareiscontinuousandreliable.
38
Microsystem:Thestructuralunitresponsiblefordeliveringcaretospecificpatient
populationsorthefrontlineplaceswherepatients,families,andcareteamsmeet(Nelson,
Batalden,Godfrey,2007).
Moral Agency: A person’scapacityformakingethicaljudgments.Mostphilosophers
suggestthatonlyrationalbeings,peoplewhocanreasonandformselfinterested
judgments,arecapableofbeingmoralagents.
Multidimensional Care:Relatingtoorhavingseveraldimensions;itspeakstothe
fullnessofthepatientclinicianexperience,butalso topeople’slivesingeneral.
Spiritualityisoneofthosemanydimensions.
NurseSensitiveIndicators:Measuresofprocessesandoutcomes—andstructural
proxiesfortheseprocessesandoutcomes(e.g., skillmix,nursestaffinghours)—thatare
affected,provided,andinfluencedbynursingpersonnel,butforwhichnursingisnot
exclusivelyresponsible(National Quality Forum,2003).
Outcome:Broadperformanceindicator,relatedtotheknowledge,skills,andattitudes,
neededbyabaccalaureategraduate.
Patient: Therecipientofnursingcareorservices.Thistermwasselectedforconsistency
andinrecognitionandsupportofthehistoricallyestablishedtraditionofthenursepatient
relationship.Patientsmaybeindividuals,families,groups,communities,orpopulations.
Further,patientsmayfunctioninindependent,interdependent,ordependentroles,and
mayseekorreceivenursinginterventionsrelatedtodiseaseprevention,healthpromotion,
orhealthmaintenance,aswellasillnessandendoflifecare.Dependingonthecontext
orsetting,patientsmay,attimes,moreappropriatelybetermedclients,consumers,or
customersofnursingservices(AACN,1998,p.2).
PatientcenteredCare:Includesactionstoidentify,respectandcareaboutpatients’
differences,values,preferences,andexpressedneeds;relievepainandsuffering;
coordinatecontinuouscare;listento,clearlyinform,communicatewith,andeducate
patients;sharedecisionmakingandmanagement;andcontinuouslyadvocatedisease
prevention,wellness,andpromotionofhealthylifestyles,includingafocusonpopulation
health(IOM,2003b).
PopulationHealthInterventions:Actionsintendedtoimprovethehealthofacollection
ofindividualshavingpersonalorenvironmentalcharacteristicsincommon.Population
healthinterventionsarebasedonpopulationfocusedassessments.
ProfessionalNurse:Anindividualpreparedwithaminimumofabaccalaureatein
nursingbutisalsoinclusiveofonewhoentersprofessionalpracticewithamaster’s
degreeinnursingoranursingdoctorate(AACN,1998).
Simulation:Anactivity thatmimicstherealityofaclinicalenvironmentandisdesigned
todemonstrateprocedures,decisionmaking,andcriticalthinkingthroughtechniques
39
suchasroleplayingandtheuseofdevices(e.g.,interactivevideos,mannequins)
(National Councilof StateBoardsof Nursing,2005).
SpiritualCare:“Interventions,individualorcommunal,thatfacilitatetheabilityto
experiencetheintegrationofthebody,mind,andspirittoachievewholeness,health,and
asenseofconnectiontoself,others,andahigherpower” (AmericanNursesAssociation
andHealthMinistriesAssociation,2005,p.38).
Spirituality:Speakstowhatgivesultimatemeaningandpurposetoone’slife.Itisthat
partofpeoplethatseekshealingandreconciliationwithselforothers(Puchalski,2006).
VulnerablePopulations:Referstosocialgroupswithincreasedrelativerisk(i.e.,
exposuretoriskfactors)orsusceptibilitytohealthrelatedproblems.Thevulnerabilityis
evidencedinhighercomparativemortalityrates,lowerlifeexpectancy,reducedaccessto
care,anddiminishedqualityoflife(CenterforVulnerablePopulationsResearch,UCLA
SchoolofNursing,2008).
40
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45
APPENDIXA
TaskForceontheRevisionof TheEssentialsofBaccalaureate
EducationforProfessional Nursing
PatriciaMartin,PhD,RNchair
Dean,WrightStateUniversity
CollegeofNursingandHealth
Carol A.Ashton,PhD,RN
AssociateDean andDirector,
IdahoStateUniversity
SchoolofNursing
DerrylBlock,PhD,MPH,RN
Chair,UniversityofWisconsinGreen
Bay
ProfessionalPrograminNursing
DaisyCruzRichman,PhD,RN
Dean,SUNYDownstateMedicalCenter
CollegeofNursing
TeriMurray,PhD,RN
Dean,SaintLouisUniversity
SchoolofNursing
LindaNiedringhaus,PhD,RN, faculty
representative
ElmhurstCollege
DeickeCenterforNursingEducation
Donald"Chip"Bailey,PhD,RN, f aculty
representative
DukeUniversity
SchoolofNursing
JeanW.Lange,PhD,RN,CNL, faculty
representative
FairfieldUniversity
SchoolofNursing
RoxanneA.Moutafis,MS,RN,BC,
facultyrepresentative
TheUniversityofArizona
CollegeofNursing
JudithSands,EdD,RN, faculty
representative
UniversityofVirginia
SchoolofNursing
KarenDrenkard,PhD,RN,NEABC,
practicerepresentative
ChiefNurseExecutive,
INOVAHealthSystems
PollyBednash,PhD,RN,FAAN,staff
liaison
ExecutiveDirector
KathyMcGuinn,MSN,RN,CPHQ, staff
liaison
DirectorofSpecialProjects
JoanStanley,PhD,RN,FAAN,staff
liaison
SeniorDirectorofEducationPolicy
HoracioOliveira,staffliaison
EducationPolicyandSpecialProjects
Assistant
46
APPENDIXB
ConsensusProcesstoRevisetheEssentialsof
BaccalaureateEducation forProfessionalNursingPractice
In2006,theAACNBoardofDirectorsestablishedataskforceandchargedthisgroupto
reviseandupdatethe1998Essentialsdocument.Thistaskforcewascomprisedof
individualsrepresentinganarrayofexpertsinbaccalaureatenursingeducation,including
deansandfacultyrepresentatives.Additionally,achiefnurseexecutiverepresentedthe
practicesettingonthecommittee(seeAppendixA).Thetaskforcebegantheirworkby
reviewingtheliteratureandconsideringthechangesoccurringinhealthcare,higher
education,andhealthprofessionseducation.InFebruary2007,thetaskforceconveneda
groupof20stakeholdersrepresentingleadersfromhighereducation,professional
nursing,andinterprofessionaleducation;inJune2007,threeadditionalstakeholdersmet
withthetaskforce(seeAppendixC).Theseleaderswereaskedtoidentify,fromtheir
ownperspectives,theanticipatedroleoftheprofessionalnurseinthefuturehealthcare
systemandthecriticalcompetenciesneededtofunctioninthisrole.Thesewideranging
andlivelydiscussionsservedasthebasisforthedevelopmentofadraftdocumentthat
wasthensharedwithnursingprofessionalsontheAACNWebsiteinAugust2007,prior
tothebeginningofthenextphaseoftherevisionprocess.
ThenextphaseconsistedofaseriesoffiveregionalmeetingsfromSeptember2007to
April2008.Thepurposeofthesemeetingswastogatherfeedbackandtobuildconsensus
abouttheEssentialsdraftdocument.Participants,includingnurseeducators,clinicians,
administrators,andresearchersrepresentingarangeofnursingprograms,specialties,and
organizations,discussed,debated,andmaderecommendationsregardingthedraft
document.Over700individuals,representingall50statesandtheDistrictofColumbia,
participatedintheconsensusbuildingprocess.Inaddition,329schoolsofnursing,11
professionalorganizations,and13healthcaredeliverysystemswererepresented(see
AppendicesD,E, & F).Toensureabroadbaseofnursinginput,thetaskforcesoughtthe
participationofawiderangeofnursingorganizationsandmanyoftheseorganizations
suchastheAmericanAcademyofNursing,SigmaThetaTau,andAmerican
OrganizationofNurseExecutivessentwrittenfeedbacktothetaskforce.Nursing
administratorsandclinicianswerespecificallyaskedtoparticipatetoensurethatthe
recommendationsfornursingeducationwouldaddressfuturehealthcarepractice.
Participantsintheregionalmeetingswereaskedtofocusontherationalesupportingeach
Essentialandalistofendofprogramoutcomes.Inaddition,theparticipantsprovided
inputintothedevelopmentof supportingdocumentsincludingalistofintegrative
learningstrategies,qualityindicators,andclinicallearningenvironments.Theprocess
wasiterativeandfollowingeachoftheregionalmeetings,anupdateddocumentwas
postedontheAACNWebsiteforreviewandcomment.AACNmemberschoolsandthe
nursingcommunityatlargewereabletoprovideongoingfeedback.
OnJuly19,2008,theAACNBoardunanimouslyapprovedtherevisedEssentialsof
BaccalaureateNursingEducation.
47
AppendixC
ParticipantswhoattendedStakeholderMeetings(N=23)
AmyBerman
JohnA.HartfordFoundation,Inc.
ProgramOfficer
NewYork,NY
LindaCronenwett
QualityandSafetyEducationforNurses
(QSEN)
ChapelHill,NC
LisaDay
TheCarnegieFoundationforthe
AdvancementofTeaching
SanFrancisco,CA
JerryGaff
AssociationofAmericanColleges&
Universities(AAC&U)
SeniorFellow
Washington,DC
JodyGandy
InterprofessionalProfessionalismGroup,
AmericanPhysicalTherapyAssociation
(APTA)
Director,PhysicalTherapyEducation
Alexandria,VA
PamHagan
AmericanNursesAssociation(ANA)
ChiefProgramsOfficer
SilverSpring,MD
JanieE.Heath
AmericanAssociationofCriticalCare
Nurses(AACN)
PastBoardMember
AlisoViejo,CA
JeanJenkins
AdvisoryGroupforGeneticsandGenomics
NationalInstitutesofHealth(NIH),National
HumanGenomeResearchInstitute
(NHGRI)
SeniorClinicalAdvisor
Bethesda,MD
LindaOlsonKeller
AssociationofStateandTerritorial
DirectorsofNursing(ASTDN)
ProjectDirector
Arlington,VA
DarrellKirch
AssociationofAmericanMedicalColleges
(AAMC)
President
Washington,DC
EllenKurtzman
NationalQualityForum(NQF)
SeniorProgramDirector
Washington,DC
PamMalloy
EndofLifeNursingEducationConsortium
(ELNEC)
ProjectDirector,AACN
Washington,DC
JeanneMatthews
QuadCouncilofPublicHealthNursing
Organizations
Chairelect,APHAPublicHealthNursing
(PHN)SectionfortheQuadCouncil
Washington,DC
LeylaMcCurdy
NationalEnvironmentalEducation&
TrainingFoundation(NEETF)
SeniorDirector
Washington,DC
DulaPacquiao
AACNCulturalAdvisoryGroup,
AssociateProfessorandDirectorSchoolof
Nursing
UniversityofMedicine&DentistryofNJ
Newark,NJ
48
PatriciaRutherford
InstituteforHealthCareImprovement(IHI)
VicePresident
Cambridge,MA
DouglasScheckelhoff
AmericanSocietyofHealthSystem
Pharmacists(ASHP)
Director,PharmacyPracticeSections
Bethesda,MD
NancySpector
NationalCouncilofStateBoardsofNursing
(NCSBN)
DirectorofEducation
Chicago,IL
MollySutphen
TheCarnegieFoundationforthe
AdvancementofTeaching
ResearchScholar
Stanford,CA
ToddUhlmann
NationalStudentNursesAssociation
(NSNA)
President
Brooklyn,NY
TenerVeneema
DisasterPreparednessExpert
AssociateProfessorofClinicalNursing
UniversityofRochester
Rochester,NY
MaryWakefield
InstituteofMedicine(IOM)Chairof
QualityChasmSeries
HealthCareServicesBoard,
AssociateDeanforRuralHealth,
UniversityofNorthDakota
Washington,DC
JuliaWatkins
CouncilonSocialWorkEducation
ExecutiveDirector
Alexandria,VA
49
APPENDIXD
SchoolsofNursingthatParticipatedintheRegionalMeetings(N=329)
AdelphiUniversity
GardenCity,NY
ArizonaStateUniversity
Phoenix,AZ
ArkansasStateUniversity
StateUniversity,AR
ArmstrongAtlanticStateUniversity
Savannah,GA
AshlandUniversity
Ashland,OH
AuburnUniversity
Auburn,AL
AuburnUniversityatMontgomery
Montgomery,AL
AvilaUniversity
KansasCity,MO
AzusaPacificUniversity
Azusa,CA
BakerUniversity
Topeka,KS
BallStateUniversity
Muncie,IN
BaptistMemorialCollegeofHealth
Sciences
Memphis,TN
BarnesJewishCollegeofNursing
St.Louis,MO
BarryUniversity
MiamiShores,FL
BaylorUniversity
Dallas,TX
BeckerCollege
Worcester, MA
BemidjiStateUniversity
Bemidji,MN
BethuneCookmanUniversity
DaytonaBeach,FL
BinghamtonUniversity
Binghamton,NY
BiolaUniversity
LaMirada,CA
BoiseStateUniversity
Boise,ID
BostonCollege
ChestnutHill,MA
BradleyUniversity
Peoria,IL
BrenauUniversity
Gainesville,GA
BrighamYoungUniversity
Provo,UT
BryanLGHCollegeofHealthSciences
Lincoln,NE
CaliforniaBaptistUniversity
Riverside,CA
CaliforniaStateUniversityChannel
Islands
Camarillo,CA
50
CaliforniaStateUniversityBakersfield
Bakersfield,CA
CaliforniaStateUniversityChico
Chico,CA
CaliforniaStateUniversityDominguez
Hills
Carson,CA
CaliforniaStateUniversityEastBay
Hayward,CA
CaliforniaStateUniversityFullerton
Fullerton,CA
CaliforniaStateUniversityLongBeach
LongBeach,CA
CaliforniaStateUniversityLosAngeles
LosAngeles,CA
CaliforniaStateUniversitySan
Bernardino
SanBernardino,CA
CaliforniaStateUniversitySanMarcos
SanMarcos,CA
CaliforniaStateUniversityStanislaus
Turlock,CA
CapitalUniversity
Columbus,OH
CarlowUniversity
Pittsburgh,PA
CarsonNewmanCollege
JeffersonCity,TN
CedarCrestCollege
Allentown,PA
CentralConnecticutStateUniversity
NewBritain,CT
ChamberlainCollegeofNursing
Columbus,OH
CharlestonSouthernUniversity
Charleston,SC
ClaytonStateUniversity
Morro,GA
ClemsonUniversity
Clemson,SC
CoeCollege
CedarRapids,IA
ColbySawyerCollege
NewLondon,NH
CollegeofSaintCatherine
St.Paul,MN
CreightonUniversity
Omaha,,NE
CumberlandUniversity
Lebanon,TN
CurryCollege
Milton,MA
DrexelUniversity
Philadelphia,PA
DukeUniversity
Durham,NC
DuquesneUniversity
Pittsburgh,PA
EastCarolinaUniversity
Greenville,NC
EastTennesseeStateUniversity
JohnsonCity,TN
51
EasternIllinoisUniversity
Charleston,IL
EasternKentuckyUniversity
Richmond,KY
EasternMennoniteUniversity
Harrisonburg,VA
EasternMichiganUniversity
Ypsilanti,MI
ElmhurstCollege
Elmhurst,IL
ElmsCollege
Chicopee,MA
EmmanuelCollege
Boston,MA
EmoryUniversity
Atlanta,GA
ExcelsiorCollege
Albany,NY
FairfieldUniversity
Fairfield,CT
FairleighDickinsonUniversity
Teaneck,NJ
FairmontStateUniversity
Fairmont,WV
FelicianCollege
Lodi,NJ
FloridaA&MUniversity
Tallahassee,FL
FloridaAtlanticUniversity
BocaRaton,FL
FloridaInternationalUniversity
Miami,FL
FloridaSouthernCollege
Lakeland,FL
FortHaysStateUniversity
Hays,KS
FrancisMarionUniversity
Florence,SC
GeorgeMasonUniversity
Fairfax,VA
GeorgetownUniversity
Washington,DC
GeorgiaCollege&StateUniversity
Milledgeville,GA
GeorgiaSouthernUniversity
Statesboro,GA
GeorgiaStateUniversity
Atlanta,GA
GonzagaUniversity
Spokane,WA
GovernorsStateUniversity
UniversityPark,IL
GrandValleyStateUniversity
GrandRapids,MI
GrandViewCollege
DesMoines,IA
HopeCollege
Holland,MI
HunterCollegeofCUNY
NewYork,NY
52
HuntingtonUniversity
Huntington,IN
HussonCollege
Bangor,ME
IdahoStateUniversity
Pocatello,ID
IllinoisWesleyanUniversity
Bloomington,IL
IndianaUniversityBloomington
Bloomington,IL
IndianaUniversityNorthwest
Gary,IN
IndianaUniversitySouthBend
SouthBend,IN
IndianaUniversitySoutheast
NewAlbany,IN
IndianaWesleyanUniversity
Marion,IN
JacksonvilleStateUniversity
Jacksonville,AL
JacksonvilleUniversity
Jacksonville,FL
JamesMadisonUniversity
Harrisonburg,VA
JohnsHopkinsUniversity
Baltimore,MD
KaplanUniversity
Chicago,IL
KeanUniversity
Union,NJ
KennesawStateUniversity
Kennesaw,GA
KeukaCollege
KeukaPark,NY
LakeviewCollegeofNursing
Danville,IL
LamarUniversity
Beaumont,TX
LeMoyneCollege
Syracuse,NY
LinfieldCollege
Portland,OR
LomaLindaUniversity
LomaLinda,CA
LouisianaCollege
Pineville,LA
LouisianaStateUniversityHealth
SciencesCtr
NewOrleans,LA
LourdesCollege
Sylvania,OH
LutherCollege
Decorah,IA
LycomingCollege
Williamsport,PA
LynchburgCollege
Lynchburg,VA
MaconStateCollege
Macon,GA
MadonnaUniversity
Livonia,MI
53
MartinMethodistCollege
Pulaski,TN
MaryvilleUniversitySaintLouis
St.Louis,MO
MassachusettsCollegeofPharmacyand
AlliedHealthSciences
Boston,MA
McKendreeCollege
Lebanon,IL
McNeeseStateUniversity
LakeCharles,LA
MedcenterOneCollegeofNursing
Bismarck,ND
MedCentralCollegeofNursing
Mansfield,OH
MedicalCollegeofGeorgia
Augusta,GA
MedicalUniversityofSouthCarolina
Charleston,SC
MercyCollege
DobbsFerry,NY
MetropolitanStateUniversity
St.Paul,MN
MGHInstituteofHealthProfessions
Boston,MA
MichiganStateUniversity
EastLansing,MI
MilwaukeeSchoolofEngineering
Milwaukee,WI
MinnesotaIntercollegiateNursing
Consortium
Northfield,MN
MinnesotaStateUniversityMankato
Mankato,MN
MississippiCollege
Clinton,MS
MississippiUniversityforWomen
Columbus,MS
MissouriWesternStateUniversity
St.Joseph,MO
MontanaStateUniversityBozeman
Bozeman,MT
MoravianCollege
Bethlehem,PA
MountCarmelCollegeofNursing
Columbus,OH
MountMercyCollege
CedarRapids,IA
MountSaintMary'sCollege
LosAngeles,Ca
MuskingumCollege
NewConcord,OH
NationalUniversity
LaJolla,CA
NeumannCollege
Aston,PA
NewJerseyCityUniversity
JerseyCity,NJ
NewMexicoHighlandsUniversity
LasVegas,NM
NewYorkUniversity
NewYork,NY
54
NichollsStateUniversity
Thibodaux,LA
NorthParkUniversity
Chicago,IL
NortheasternUniversity
Boston,Mass.
NorthernArizonaUniversity
Flagstaff,AZ
NorthernIllinoisUniversity
DeKalb,IL
NorthwestUniversity
Kirkland,WA
NotreDameCollege
SouthEuclid,OH
OaklandUniversity
Rochester,MI
OldDominionUniversity
Norfolk,VA
OregonHealthandScienceUniversity
Portland,OR
OtterbeinCollege
Westerville,OH
PaceUniversity
NewYork,NY
PattyHanksSheltonSchoolofNursing
Abilene,TX
PiedmontCollege
Demorest,GA
PlattCollege
Aurora,Co
PointLomaNazareneUniversity
SanDiego,CA
PurdueUniversity
WestLafayette,IN
QueensUniversityofCharlotte
Charlotte,NC
ResearchCollegeofNursing
KansasCity.MO
RegisCollege
Weston,MA
RhodeIslandCollege
Providence,RI
RivierCollege
Nashua,NH
RobertMorrisUniversity
MoonTownship,PA
Rutgers,TheStateUniversityofNew
Jersey
Camden,NJ
SacredHeartUniversity
Fairfield,CT
SaginawValleyStateUniversity
UniversityCenter,MI
SaintAmbroseUniversity
Davenport,IA
SaintAnselmCollege
Manchester,NH
SaintAnthonyCollegeofNursing
Rockford,IL
SaintFrancisMedicalCenterCollegeof
Nursing
Peoria,IL
55
SaintJohnFisherCollege
Rochester,NY
SaintJoseph'sCollegeofMaine
Standish,ME
SaintLouisUniversity
SaintLouis,MO
SaintLuke'sCollegeofNursing
KansasCity,MO
SaintXavierUniversity
Chicago,IL
SamfordUniversity
Birmingham,AL
SamuelMerrittCollege
Oakland,CA
SanDiegoStateUniversity
SanDiego,CA
SanFranciscoStateUniversity
SanFrancisco,CA
SeattlePacificUniversity
Seattle,WA
SeattleUniversity
Seattle,WA
ShenandoahUniversity
Winchester,VA
SimmonsCollege
Boston,MA
SouthDakotaStateUniversity
Brookings,SD
SoutheastMissouriStateUniversity
CapeGirardeau,MO
SouthernIllinoisUniversity
Edwardsville
Edwardsville,IL
SouthernNazareneUniversity
Bethany,OK
SouthernUtahUniversity
CedarCity,UT
StonyBrookUniversity
StonyBrook,NY
SUNYDownstateMedicalCenter
Brooklyn,NY
SUNYInstituteofTechnologyat
Utica/Rome
Utica,NY
SUNYPlattsburgh
Plattsburgh,NY
SUNYUpstateMedicalUniversity
Syracuse,NY
TempleUniversity
Philadelphia,PA
TennesseeTechnologicalUniversity
Cookeville,TN
TennesseeWesleyanCollege
Knoxville,TN
TexasA&MHealthScienceCenter
CollegeStation,TX
TexasA&MUniversityCorpusChristi
CorpusChristi,TX
TexasChristianUniversity
FortWorth,TX
TexasTechUniversityHealthSciences
Center
56
Lubbock,TX
TexasWoman'sUniversity
Denton,TX
TheCatholicUniversityofAmerica
Washington,DC
TheCollegeofSt.Scholastica
Duluth,MN
TheOhioStateUniversity
Columbus,OH
TheSageColleges
Troy,NY
TheUniversityofAlabama
Tuscaloosa,AL
TheUniversityofAlabamainHuntsville
Huntsville,AL
TheUniversityofLouisianaatLafayette
Lafayette,LA
TheUniversityofLouisianaatMonroe
Monroe,LA
TheUniversityofNorthCarolina
ChapelHill
ChapelHill,NC
ThomasJeffersonUniversity
Philadelphia,PA
TouroUniversity
Henderson,NV
TuskegeeUniversity
Tuskegee,AL
UniversityatBuffalo
Buffalo,NY
UniversityofAlabamaatBirmingham
Birmingham,AL
UniversityofAlabamainHuntsville
Huntsville,AL
UniversityofAlaskaAnchorage
Anchorage,AK
UniversityofArizona
Tuscon,AZ
UniversityofArkansasforMedical
Sciences
LittleRock,AR
UniversityofArkansasFayetteville
Fayetteville,AR
UniversityofCaliforniaDavis
Davis,CA
UniversityofCaliforniaLosAngeles
LosAngeles,CA
UniversityofCentralArkansas
Conway,AR
UniversityofCincinnati
Cincinnati,OH
UniversityofColoradoatColorado
Springs
ColoradoSprings,CO
UniversityofColoradoDenver
Aurora,CO
UniversityofConnecticut
Storrs,CT
UniversityofDelaware
Newark,DE
UniversityofDetroitMercy
Detroit,MI
57
UniversityofFlorida
Gainesville,FL
UniversityofHawaiiatManoa
Honolulu,HI
UniversityofIllinoisatChicago
Chicago,IL
UniversityofIowa
IowaCity,IA
UniversityofKansas
KansasCity,KS
UniversityofLouisianaatMonroe
Monroe,LA
UniversityofLouisville
Louisville,KY
UniversityofMary
Bismark,ND
UniversityofMaryland
Baltimore,MD
UniversityofMassachusettsAmherst
Amherst,MA
UniversityofMassachusettsLowell
Lowell,MA
UniversityofMedicine&Dentistryof
NewJersey
Newark,NJ
UniversityofMemphis
Memphis,TN
UniversityofMichigan
AnnArbor,MI
UniversityofMinnesota
Minneapolis,MN
UniversityofMississippiMedical
Center
Jackson,MS
UniversityofMissouriColumbia
Columbia,MO
UniversityofMissouriKansasCity
KansasCity,MO
UniversityofMissouriSaintLouis
St.Louis,MO
UniversityofNevadaLasVegas
LasVegas,NV
UniversityofNevadaReno
Reno,NV
UniversityofNewHampshire
Durham,NH
UniversityofNewMexico
Albuquerque,NM
UniversityofNorthCarolinaat
Greensboro
Greensboro,NC
UniversityofNorthCarolinaCharlotte
Charlotte,NC
UniversityofNorthDakota
GrandForks,ND
UniversityofNorthFlorida
Jacksonville,FL
UniversityofNorthernColorado
Greeley,CO
UniversityofOklahoma
OklahomaCity,OK
UniversityofPennsylvania
Philadelphia,PA
58
UniversityofPhoenix
Phoenix,AZ
UniversityofPittsburgh
Pittsburgh,PA
UniversityofPortland
Portland,OR
UniversityofRhodeIsland
Kingston,RI
UniversityofSaintFrancisIndiana
FortWayne,IN
UniversityofSaintMary
Leavenworth,KS
UniversityofSanDiego
SanDiego,CA
UniversityofSanFrancisco
SanFrancisco,CA
UniversityofSouthAlabama
Mobile,AL
UniversityofSouthCarolina
Columbia,SC
UniversityofSouthCarolinaAiken
Aiken,SC
UniversityofSouth CarolinaUpstate
Spartanburg,SC
UniversityofSouthernMaine
Portland,ME
UniversityofSouthernMississippi
Hattiesburg,MS
UniversityofSt.FrancisIllinois
Joliet,IL
UniversityofTennessee–Knoxville
Knoxville,TN
UniversityofTennesseeHealthScience
Center
Memphis,TN
UniversityofTennesseeChattanooga
Chattanooga,TN
UniversityofTexasHealthScience
Center– Houston
Houston,TX
UniversityofTexasHealthScience
CenterSanAntonio
SanAntonio,TX
UniversityofTexasElPaso
ElPaso,TX
UniversityofTexasTyler
Tyler,TX
UniversityoftheIncarnateWord
SanAntonio,TX
UniversityofToledo
Toledo,OH
UniversityofUtah
SaltLakeCity,UT
UniversityofVermont
Burlington,VT
UniversityofVirginia
Charlottesville,VA
University ofWestGeorgia
Carrollton,GA
UniversityofWisconsinEauClaire
EauClaire,WI
UniversityofWisconsinGreenBay
GreenBay,WI
59
UniversityofWisconsinMilwaukee
Milwaukee,WI
UniversityofWisconsinOshkosh
Oshkosh,WI
UniversityofWyoming
Laramie,WY
UpperIowaUniversity
Fayette,IA
UrsulineCollege
PepperPike,OH
UticaCollege
Utica,NY
ValdostaStateUniversity
Valdosta,GA
ValparaisoUniversity
Valparaiso,IN
VanguardUniversityofSouthern
California
CostaMesa,CA
VillaJulieCollege
Stevenson,MD
WagnerCollege
StatenIsland,NY
WashburnUniversity
Topeka,KS
WashingtonStateUniversity
Spokane,WA
WaynesburgUniversity
Waynesburg,PA
WestChesterUniversity
WestChester,PA
WestTexasA&MUniversity
Canyon,TX
WestVirginiaUniversity
Morgantown,WV
WesternCarolinaUniversity
Cullowhee,NC
WesternKentuckyUniversity
BowlingGreen,KY
WesternMichiganUniversity
Kalamazoo,MI
WichitaStateUniversity
Wichita,KS
WidenerUniversity
Chester,PA
WilkesUniversity
WilkesBarre,PA
WilliamCareyUniversity
Hattiesburg,MS
WilliamJewellCollege
Liberty,MO
WilliamPatersonUniversity
Wayne,NJ
WilmingtonUniversity
NewCastle,DE
WinstonSalemStateUniversity
WinstonSalem,NC
WisconsinLutheranCollege
Milwaukee,WI
WrightStateUniversity
Dayton,OH
60
XavierUniversity
Cincinnati,OH
YaleUniversity
NewHaven,CT
YorkCollegeofPennsylvania
York,PA
APPENDIXE
ProfessionalOrganizationsthatParticipatedintheRegionalMeetings(N=11)
AmericanHolisticNursesAssociation
Flagstaff,Arizona
AmericanNursesAssociation
SilverSpring,MD
AssociationofCommunityHealthNursingEducators
WheatRidge,CO
AssociationofPerioperativeRegisteredNurses
Denver,CO
AssociationofRehabilitationNurses
Glenview,IL
CommissiononGraduatesofForeignNursingSchoolsInternational
Philadelphia,PA
InternationalSocietyofNursesinGenetics
Pittsburgh,PA
KentuckyBoardofNursing
Louisville,KY
MinnesotaBoardofNursing
Minneapolis,MN
NationalCouncilofStateBoardsofNursing
Chicago,IL
NationalLeagueforNursing
NewYork,NY
OncologyNursingSociety
Pittsburgh,PA
61
SocietyofPediatricNurses
Pensacola,FL
APPENDIXF
HealthcareSystemsthatParticipatedintheRegionalMeetings(N=13)
AdvocateChristMedicalCenter
OakLawn,IL
BaptistMemorialHealthCareCorporation
Memphis,TN
BaptistMemorialHealthCareCorporationDeSoto
Southaven,MS
BonSecoursHamptonRoadsHealthSystem
Norfolk,VA
Children'sHealthcareofAtlanta
Atlanta,GA
DartmouthHitchcockMedicalCenter
Lebanon,NH
HospitalCorporationofAmerica
Nashville,TN
INOVAHealthSystems
FallsChurch,VA
Ovations/Evercare
Minnetonka,MN
SoutheastHealthDistrict
Waycross,GA
St.Mary'sHospital
Passaic,NJ
UPMCSt.Margaret's
Pittsburgh,PA
MiriamHospital
Providence,RI
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