Curr iculum Map p Illustratin for the Pe ng Integratio ediatric Clin on
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Curriculum Map p Illustratin ng Integratio on of Comp petency an nd Practice Standardss for the Pe ediatric Clin nical Nurse e Specialistt Role Inttroduction Witth the release of the Consen nsus Model forr APRN Regula lation: Licensu ure, Accreditatition, Certificatio on & Education on (LACE) in 200 08, programs offering o degrees for the clinical nurse spe ecialist (CNS) have appraise ed their curricu ulum to ensure e alignment with h one or morre of the six population p foc ci: family/indiviidual across the t life span, adult-gerontology, pediatricc, neonatal, wom men’s health/g gender-related d or psych/me ental health. Such S self-app praisal can be e challenging not only due to specific req quirements of the t Consensus Model but also a because of o specific com mpetency stand dards of vario ous organizatio ons that are inte egral to program accreditatio on. The e following three pages inclu ude a curriculu um map with recommended r d coursework tthat integratess Clinical Nurse se Specialist Cor ore Competenccies (2008), the e ANA Scope and Standard ds for Pediatricc Clinical Nurse se Specialist P Practice (2008), the AACN Sco ope and Stan ndards for Acu ute and Critica al Care Cliniccal Nurse Spe ecialist Practice ce (2010) and the requirem ments in the Con onsensus Mode el for APRN Regulation: R Liccensure, Accre editation, Certitification & Eduucation (2008)), as well as sstandards in The e Essentials of o Master’s Ed ducation in Nu ursing (2011) and a the Nation nal Council off State Boardss of Nursing’s Criteria for AP PRN Certificatio ion Programs (2009). The specific s course e titles provide ed in this currriculum map a are not a requ uirement for elig gibility to sit forr AACN Certifiication Corporation’s pediatrric (wellness th hrough acute ccare) clinical n nurse specialisst ACCNS-P exa am. The sample course desc criptions are presented p as examples e of co ourses that wo ould demonstra ate adequate d didactic and pra actical content of core APRN N, CNS role an nd population (pediatric) and d wellness thro ough acute ca are to the exte ent that was valiidated by AAC CN Certification n Corporation’s s 2011 Study of o Practice of th he Pediatric C NS. The e remainder off this documen nt consists of a table that de emonstrates the alignment off entry-level co ompetencies a and practice standards identifiied by contentt experts focus sed on the de evelopment needs and practtice requireme ents of the CN NS providing carre to the pediatric population n along the con ntinuum of wellness through acute care; a list of referen nce documentss and where the ey can be found d online (Guide e to the Table of Standards Alignment, A pag ge 5); and a G lossary of Term ms (pages 35--39). American Association of Critical‐Care Nurses AACN Certification Corporation Sample Curriculum for the Pediatric CNS Other than the three required core courses (the “3 Ps”*) listed in The Essentials of Master’s Education in Nursing (2011), the titles listed below are suggested. It is understood that programs may choose to organize curricula in a different manner. Required competencies should, however, be clearly evident within the course description, syllabus or detailed course outline. As the location of healthcare delivery is rapidly changing with technological innovations and reimbursement approaches, practicum sites are also suggested, not required. Clinical sites and preceptor/faculty supervision should appropriately reflect the population spectrum and align with content in the didactic course. Course *Advanced Pharmacology Course Content Pharmacological management of disease and symptom management, including pharmacokinetics, pharmacotherapeutics and prescriptive issues, pharmacogenomics, evidence-based efficacy studies, clinical case applications and patient-related factors such as age, socioeconomic status and behavioral aspects that support the selection of commonly used drugs A complete description of content can be found in The Essentials of Master’s Education in Nursing. *Advanced Pathophysiology Focus on understanding complex physiological concepts significant for advanced practice nursing. The interrelationships between clinical pathophysiology, physiology and genetics are included. A complete description of content can be found in The Essentials of Master’s Education in Nursing. *Advanced Physical Assessment and Diagnostic Reasoning Evidence-based advanced assessment skills including systematic collection, organization, interpretation, formulation of diagnostic hypothesis and communication of health data A complete description of content can be found in The Essentials of Master’s Education in Nursing. 2 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Course Course Content Conceptual, theoretical, ethical and empirical knowledge as a basis for nursing research Evidenced-Based Practice and Research Methodologies questions, identifying research designs, selecting sampling and data collection strategies, and proposing analytic methods to answer a research question and evaluate completed research for its scientific adequacy and applicability to practice. Approaches to understanding and expanding the scientific body of knowledge in nursing Role and Scope of the CNS Analysis of the spheres of influence and the practice domains of the CNS in relationship to current healthcare trends, models of care delivery and advanced nursing practice, evaluation of care and key issues influencing CNS practice including the CNS leadership role, interprofessional collaboration, healthcare policy and advocacy Principles of Healthcare Systems Organizational culture, organizational assessment, patient safety initiatives, problem identification, and quality improvement team building, change theory, process improvement techniques, product value analysis, quality and performance indicators (e.g., NDNQI, core measures, HCAP, etc.) as well as integration of healthcare technologies and informatics systems. Pediatric Care I: The Well Child (health promotion, disease prevention and wellness) CNS role in wellness (physical and mental), health promotion and disease prevention, risk assessment and reduction, individual and community screening measures, and alternative health practices through the life span from infancy through adolescent populations, including but not limited to growth and development, developmental milestones, lifestyle management (nutrition, weight, exercise, infection prevention), spinal disease, seizure disorders, fluid volume imbalances, child/parental/caregiver assessment for injury and risk prevention, congenital disorder and disease screening, vaccination scheduling, child abuse/neglect screening, etc. Pediatric Care I Practicum Possible clinical areas: primary care/family practices, special-needs day camps, day care centers, long-term care for pediatric populations, public health department, school health programs, wellness facilities that provide care to pediatric populations, etc. 3 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Course Course Content Pediatric Care II: The Acutely CNS role in acute care (emergent, trauma, acute disease management) including but not limited to the care needs of patients with structural heart defects, aspiration, traumatic Ill Child injuries, infectious diseases, systemic inflammatory response syndrome (SIRS)/sepsis/ septic shock/multiple organ dysfunction syndrome (MODS), etc. from infancy through adolescence populations. Pediatric Care II Practicum Possible clinical areas: acute care facilities that provide acute care to pediatric populations Pediatric Care III: The Chronically Ill Child (chronic and acute chronic care) CNS role in management of chronic problems as well as management/prevention of acute progression/exacerbation of chronic problems including but not limited to assessment and management of asthma and reactive airway disease, diabetes, chronic renal failure, sickle cell, oncological and hematological disorders, behavioral disorders, etc., from infancy through adolescence populations. ++ Pediatric Care III Practicum Possible clinical areas that provide care to pediatric populations: disease management (e.g. emergency facilities, community hospitals, teaching hospitals, children’s hospitals). clinics (diabetes, dialysis, sickle cell, etc.), outpatient facilities (oncology, short-term rehabilitation, adolescent drug and alcohol centers), parish nursing, home healthcare, hospice and palliative care facilities, special care needs facilities. ++ AACN Certification Corporation’s Study of Practice, Pediatric Acute Care Clinical Nurse Specialist Competencies and Patient Care Needs and the test plan for the ACCNS-P certification exam include those patient care problems that met a statistical level of significance common across major demographic areas. Program directors may, however, analyze survey or other pertinent community data results to drill down and incorporate additional content into the curriculum based on community/patient care needs. 4 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Guide to the Table of Standards Alignment National CNS Competency Task Force Core Competencies 10/31/2008 American Nurses Association (ANA) Scope and Standards for Pediatric Nursing Practice* 2008 American Association of Critical-Care Nurses (AACN) Scope and Standards for Acute and Critical Care Clinical Nurse Specialist Practice 4/7/2010 Available online at: www.nacns.org/docs/CNSC oreCompetenciesBroch.pdf Available online at www.nursesbooks.org/MainMenu/Standards/O-Z/Pediatric-Nursing-Scopeand-Standards-ofPractice.aspx Available online at www.aacn.org/APRNresources *Includes only the Additional Measurement Criteria for the Advanced Practice Pediatric Nurse 5 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric (wellness through acute care) Clinical Nurse Specialist Competencies and Patient Care Needs 6/10/2011 Available online at www.aacn.org/APRNresources American Association of Critical‐Care Nurses AACN Certification Corporation Table of Standards Alignment National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) DIRECT CARE/CLINICAL JUDGMENT Study of Practice – 61% related to Direct Care/Clinical Judgment competencies Direct Care Competency A.1. Conducts comprehensive, holistic wellness and illness assessments using known or innovative evidencebased techniques, tools and direct and indirect methods A.2. Obtains data about context and etiologies (including both non-disease and disease-related factors) necessary to formulate differential diagnoses and plans of care, and to identify and evaluate outcomes A.3. Employs evidencebased clinical practice guidelines to guide screening and diagnosis A.4. Assesses the effects of interactions among the individual, family, Standards of Practice Clinical Judgment (61%) Assessment Clinical Judgment 1. Conducts comprehensive, holistic assessments using evidence-based techniques and tools 2. Elicits comprehensive history and performs physical exams based on patient’s presenting signs and symptoms 3. Obtains data (including both non-disease and diseaserelated factors) necessary to formulate differential diagnoses 4. Assesses impact of multiple variables (e.g., among the individual patient, community, hospital and social systems) that affect health and illness 1. Conduct comprehensive, holistic wellness/illness assessments 2. Obtain data necessary to formulate differential diagnoses/plans of care and evaluate outcomes 3. Use evidence base to guide clinical practice 4. Synthesize data/advanced knowledge/experience using critical thinking to formulate differential diagnoses 5. Determine diagnoses considering: a. physiologic/pathophysiologic changes b. morbidities/co-morbidities c. events across life span d. patient’s pharmacologic history with particular attention to issues of polypharmacy 6. Use reliable and valid age-appropriate Standard 1. Assessment Initiates and interprets ageappropriate and conditionspecific laboratory tests and diagnostic procedures Standard 2. Diagnosis Systematically compares and contrasts clinical findings with normal and abnormal variations and developmental events in formulating a differential diagnosis Determines diagnoses related to disease and injury prevention and health promotion, restoration and maintenance Utilizes complex data and information obtained during 6 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies community and social systems on health and illness A.5. Identifies potential risks to patient safety, autonomy and quality of care based on assessments across the patient, nurse and system spheres of influence A.6. Assesses the impact of environmental/system factors on care A.7. Synthesizes assessment data, advanced knowledge and experience, using critical thinking and clinical judgment to formulate differential diagnoses for clinical problems amenable to CNS intervention A.8. Prioritizes differential diagnoses to reflect those conditions most relevant to signs, symptoms and patterns amenable to CNS interventions A.9. Selects interventions that may include, but are not limited to: A.9.a. Application of ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) 5. Identifies potential risks to patient safety, autonomy and quality of care based on assessments 6. Performs system-level assessments to identify variables that influence patient outcomes and nursing practice 7. Assesses interdisciplinary practice for collaboration and use of evidence based on best practice guidelines assessment instruments to assess acute and chronic health concerns, including but not limited to mental status, delirium, dementia and pain 7. Assess for manifestation of health disorders/disruptions, e.g., infection, adverse drug effect, dehydration, ischemia 8. Evaluate for mental health disorders such as depression, dementia, anxiety or substance-related disorders 9. Conduct pharmacologic assessment including polypharmacy, drug interactions, over-the-counter and herbal product use and the ability to safely and correctly store and selfadminister medications 10. Interpret values/results of lab/diagnostic tests with consideration of age, ethnicity and health status 11. Assess patient/caregiver/family ability to implement complex plans of care 12. Assess patient/caregiver/family preferences in relation to cultural/spiritual/quality of life/lifestyle choices 13. Prioritize differential diagnoses 14. Design strategies to meet multifaceted needs of complex patients/groups of patients 15. According to legal restrictions in the Additional Measurement Criteria for the AP Pediatric Nurse interview, examination and diagnostic procedures Revises diagnoses as appropriate to the ongoing evaluation Conforms diagnoses to an accepted classification system Assists staff in developing and maintaining competency in the diagnostic process Standard 3. Outcomes Identification Identifies expected outcomes with consideration of the associated risks, benefits and costs for the child and family Identifies expected outcomes that incorporate cost and clinical effectiveness, the child’s and family’s satisfaction, and continuity and consistency among providers Supports the use of the clinical guidelines linked to positive outcomes for the child 1. 2. 3. 4. 5. Diagnosis Synthesizes data from relevant sources to formulate differential diagnosis for clinical problems Makes decisions and recommendations based on data that range from simple to complex Analyzes benefits and costs of care for programs, organizations and society Collaborates with patients, families and other disciplines to prioritize diagnosis Identifies gaps in translation 7 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies advanced nursing therapies A.9.b. Initiation of interdisciplinary team meetings, consultations and other communications to benefit patient care A.9.c. Management of patient medications, clinical procedures and other interventions A.9.d. Psychosocial support including patient counseling and spiritual interventions A.10. Designs strategies, including advanced nursing therapies, to meet the multifaceted needs of complex patients and groups of patients A.11. Develops evidencebased clinical interventions and systems to achieve defined patient and system outcomes A.12. Uses advanced communication skills within therapeutic relationships to improve patient outcomes A.13. Prescribes nursing therapeutics, pharmacologic and nonpharmacologic ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice Additional Measurement Criteria for the AP Pediatric Nurse Standard 4. Planning Identifies assessment, diagnostic strategies and therapeutic interventions within the plan of care that reflect current pediatric healthcare practice, including data, research, literature and expert clinical knowledge Devises a comprehensive plan of care that reflects the responsibilities of the advanced practice nurse, the child and the family; may include delegation of responsibilities and consultation to assist others in implementing the plan of care Participates in the design and development of multidisciplinary and interdisciplinary processes to address the situation or issue Formulates the comprehensive plan of care that includes educational interventions related to the 1. 2. 3. 4. 5. of evidence into practice Outcome Identification Identifies expected outcomes that incorporate scientific evidence and translational research and are achievable through implementation of evidencebased practices Collaborates with patients and other healthcare providers to identify expected outcomes that are consistent with the patient’s present and potential capabilities, as well as his or her values, culture and environment Establishes incremental indicators of progress in achieving expected outcomes Identifies expected outcomes for nurse and system Identifies and prioritizes clinical and systems problems using education, evidence, expertise and experiential knowledge 8 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) state, prescribe and/or recommend: a. pharmacologic interventions b. nonpharmacologic interventions c. diagnostic measures d. equipment e. procedures f. treatments 16. Provide direct care to selected patients based on needs of patient and CNS’s specialty knowledge and skills 17. Evaluate nursing practice that considers safety, timeliness, effectiveness, efficiency, efficacy and patient/family centered care 18. Determine when evidence-based guidelines/policies/procedures/plans of care need to be tailored to individual 19. Manage or refer patient with signs/symptoms of physical/mental health disorders across the life span 20. Intervene to prevent/minimize iatrogenesis 21. Differentiate between outcomes that require care process modification at the patient vs. system-level 22. Lead development of evidence-based plans for meeting individual, family, community and population needs 23. Provide leadership for collaborative, evidence-based plans for meeting individual, family, community and American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies interventions, diagnostic measures, equipment, procedures and treatments to meet the needs of patients, families and groups, in accordance with professional preparation, institutional privileges, state and federal laws and practice acts A.14. Provides direct care to selected patients based on the needs of the patient and the CNS’s specialty knowledge and skills A.15. Assists staff in the development of innovative, cost-effective programs or protocols of care A.16. Evaluates nursing practice that considers safety, timeliness, effectiveness, efficiency, efficacy and patientcentered care A.17. Determines when evidence-based guidelines, policies, procedures and plans of care need to be tailored to the individual A.18. Differentiates between ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice Additional Measurement Criteria for the AP Pediatric Nurse child’s health status, conventional and alternative therapies, self-care activities, and appropriate referrals and coordination of comprehensive services to ensure continuity of care Documents the comprehensive plan of care in a manner that allows access by the child, the family, and healthcare providers, and provides direction for the family and the healthcare team as they focus on attaining expected outcomes Selects or designs strategies to meet the multifaceted needs of the complex pediatric patient Includes the synthesis of the child’s and family’s values and beliefs regarding nursing and medical therapies within the plan of care Contributes to the development and continuous improvement of the organizational systems that 6. Identifies and analyzes factors that enhance or hinder the achievement of desired outcomes 1. 2. 3. 4. Planning Designs evidence-based strategies to meet the multifaceted needs of patients (e.g., safety, cost, quality) Develops age- and population-specific clinical standards, algorithms, policies, procedures, protocols and guidelines Designs or selects health information and patient education appropriate to developmental level, health literacy level, learning needs, readiness to learn, preferred learning style and cultural values and beliefs Develops, implements and modifies plans of care or projects within all spheres Implementation 1. Prescribes, orders and/or 9 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) population needs 24. Provide consultation to interdisciplinary colleagues 25. Provide consultation to the interdisciplinary team regarding the patient’s mental status, home environment, mobility, functional status, self-care and caregiver’s abilities 26. Coordinate care with other healthcare providers and community resources, with special attention to the needs of the non-verbal, developmentally and cognitively impaired patient 27. Initiate consultation to obtain resources to facilitate progress toward achieving identified outcomes 28. Design a comprehensive, individualized, age- and diseaseappropriate plan for health promotion 29. Develop age-specific, individualized treatment plans and interventions with consideration of cognitive status, sensory function, perception and the environment Patient Care Problems A. Cardiovascular 1. Acute inflammatory disease (e.g., myocarditis, endocarditis, American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies outcomes that require care process modification at the individual patient level and those that require modification at the systemlevel A.19. Leads development of evidence-based plans for meeting individual, family, community and population needs A.20. Provides leadership for collaborative, evidencebased revision of diagnoses and plans of care, to improve patient outcomes ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice Additional Measurement Criteria for the AP Pediatric Nurse support the plan of care process Supports the integration of clinical, human, and financial resources to enhance and complete the decisionmaking processes Standard 5. Implementation Facilitates utilization of systems and community resources to implement the plan of care Supports collaboration with nursing colleagues and other disciplines to implement the plan of care Incorporates new knowledge and strategies to initiate change in nursing care practices if desired outcomes are not achieved Implements interventions and treatments that are based on current clinical evidence and theory Performs interventions and treatments for which the nurse has received appropriate training and has 2. 3. 4. 5. 6. 7. implements pharmacologic and nonpharmacologic interventions, treatments and procedures as identified in the plan of care within the framework of state licensure, credentials and privileges Facilitates implementation of an integrated plan of care collaboratively with patients and the healthcare team Documents consultations, assessments, recommendations, interventions and evaluations in the patient record Leads system change to promote health outcomes, system efficiency and a healthy work environment through evidence-based practice Initiates appropriate referrals and performs consultations Implements evidence-based algorithms, clinical guidelines, protocols and pathways for populations Facilitates learning among patients, staff, other 10 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) pericarditis) Cardiac surgery Cardiac tamponade Cardiogenic shock Cardiomyopathies (e.g., hypertrophic, dilated, restrictive, idiopathic) 6. Decompensated heart failure 7. Dysrhythmias 8. Heart failure 9. Hypertension 10. Hypertensive crisis 11. Pulmonary edema 12. Structural heart defects and diseases (acquired and congenital) B. Pulmonary 1. Acute life-threatening events (ALTE) 2. Acute respiratory failure 3. Air-leak syndromes (e.g., pneumothorax, pulmonary interstitial emphysema [PIE], pneumopericardium) 4. Acute lung injury (ALI) (e.g., ARDS) 5. Aspirations 6. Asthma and reactive airway disease 7. Chronic lung disease 8. Exacerbation of chronic lung disease 2. 3. 4. 5. American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice Additional Measurement Criteria for the AP Pediatric Nurse demonstrated competency in the skill or procedure being performed Implements the plan of care using principles and concepts of project or systems management Fosters organizational systems that support implementation of the plan of care Standard 5 A. Coordination of Care and Case Management Provides leadership in the coordination of multidisciplinary healthcare for integrated delivery of pediatric care services Delegates appropriate monitoring, assessments and interventions according to the condition of the child and the relative skill and scope of practice of the caregiver Provides case management and clinical coordination of care using sophisticated data synthesis with disciplines and organizational leaders 1. 2. 3. 4. 5. Evaluation Bases the evaluation process on advanced knowledge, expertise, quality indicators, benchmarking and research Evaluates all spheres to ensure care is safe, timely, effective, efficient, equitable and patient-centered Revises diagnoses, expected outcomes and interventions based on information gained in the evaluation process Formally and informally evaluates the clinical practice of other healthcare team members (e.g., nursing staff, medical staff, other healthcare providers) Evaluates evidence-based algorithms, clinical guidelines, protocols and pathways for populations 11 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) 9. Pulmonary hypertension 10. Pulmonary infections 11. Thoracic surgery (e.g., fractured ribs, hemothorax, lobectomy, tracheal surgery) 12. Thoracic and pulmonary trauma 13. Upper airway obstruction C. Endocrine 1. Diabetes insipidus 2. Diabetes mellitus 3. Diabetic ketoacidosis/ hyperglycemic hyperosmolar nonketotic coma (HHNK) 4. Hyperglycemia 5. Hypoglycemia 6. Inborn errors of metabolism 7. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) D. Musculoskeletal 1. Congenital abnormalities 2. Functional issues (e.g., immobility, gait disorders) 3. Infections 4. Spinal disease (e.g., scoliosis, kyphosis, disc disease) 5. Sports injuries 6. Traumatic fractures E. Hematology/Immunology/Oncology 1. Anemia American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice 2. Autoimmune diseases 3. Coagulopathies (including thrombocytopenia) 4. Congenital and acquired immunosuppression 5. Leukemia and tumors 6. Sickle cell disease F. Neurology 1. Encephalopathy 2. Head and brain trauma 3. Hydrocephalus 4. Increased intracranial pressure 5. Intracranial and intraventricular hemorrhage 6. Neurologic infectious diseases 7. Neuromuscular disorders 8. Seizure disorders 9. Space-occupying lesions 10. Spinal cord injury 11. Stroke 12. Vascular malformation G. Gastrointestinal 1. Abdominal trauma 2. Acute GI hemorrhage 3. Bowel infarction, obstruction, perforation 4. Gastro-esophageal reflux 5. Gastrointestinal infectious diseases 6. GI motility disorders 7. GI surgeries consideration of the child’s and family’s complex needs and desired outcomes Coordinates system and community resources to achieve optimal quality of care, delivered in a costeffective manner within an interdisciplinary team approach Negotiates health-related services and additional specialized care with the child, the family, appropriate systems, agencies and providers across continuums of care Standard 5B. Health-Teaching and Health Promotion, Restoration and Maintenance The pediatric nurse employs strategies to promote health and a safe environment Employs diverse and complex strategies, interventions, and teaching with the child and the family to promote, maintain, restore, and improve health, 12 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice 8. Hepatic failure and coma 9. Hepatitis 10. Malnutrition 11. Nausea and vomiting H. Renal/Genitourinary 1. Acute renal failure 2. Chronic renal failure 3. Electrolyte imbalances 4. Fluid volume imbalances 5. Infections (e.g., UTI, PID, STDs) I. Integumentary 1. Pressure ulcers 2. Wounds (surgical and non-surgical) J. Multisystem 1. Burns (e.g., management of superficial, pre-transport of partial/full thickness) 2. Compartment syndrome 3. Distributive shock (e.g., anaphylaxis, neurogenic) 4. End-of-life issues 5. Hypovolemic shock 6. Hypoxic ischemic encephalopathy 7. Infectious diseases (e.g., viral, bacterial, hospital-acquired) 8. Multisystem trauma 9. Near-drowning 10. Pain (e.g., pharmacologic/therapeutic interventions) and to prevent illness and injury Synthesizes empirical evidence on risk behaviors, learning theories, behavioral change theories, motivational theories, epidemiology, and other related theories and frameworks when designing health information and pediatric education Bases anticipatory guidance and teaching on current scientific knowledge, research, epidemiological principles and the family’s health beliefs and practices Provides the child and the family information regarding the interventions including potential benefits, risks, complications and alternatives Standard 5C: Consultation Bases consultative activities on theoretical frameworks, including those that focus on family systems and family13 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice 11. Palliative care issues (e.g., symptom management) 12. Patient safety issues 13. Sensory impairment (e.g., hearing loss) 14. Systemic inflammatory response syndrome (SIRS)/sepsis/septic shock/multiple organ dysfunction syndrome (MODS) 15. Toxic ingestions and inhalations K. Psychosocial/Behavioral/Cognitive Health 1. Age-related developmental issues 2. Anxiety disorders (e.g., PTSD, OCD, fears) 3. Attention Deficit–Hyperactivity Disorder (ADHD) 4. Failure to thrive 5. Maltreatment (abuse/neglect) 6. Medical nonadherence 7. Mood disorders (e.g., depression) 8. Substance abuse 9. Suicidal behavior centered care, and on evidence for best practice Bases consultation on mutual respect among the child, the family and other primary caregivers Initiates consultation through mutual identification of the needs for intervention and problem identification Initiates appropriate consultation to implement the interdisciplinary plan of care for the child with consideration given to the child’s unique developmental needs and abilities and the family’s level of adaptation and ability to cope with the child’s health concerns Communicates consultation recommendations in terms that facilitate change Supports the child and the family in their decision making regarding implementation of the plan of care 14 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice Standard 5D: Prescriptive Authority and Treatment Skills and Procedures If skills or procedures are incorporated into exam items, knowledge about the skill or procedure would be limited to its purpose and would not require in-depth knowledge of the performance of the skill or procedure. Prescribes evidence-based treatments, therapies and procedures considering the child’s comprehensive healthcare needs and based on current pediatric knowledge, research and practice Prescribes appropriate nonpharmacological interventions, including complementary and alternative therapies Performs procedures as needed in the delivery of comprehensive care to the child Prescribes pharmacologic agents based on current knowledge of pharmacological and physiological principles that are both universal and unique to the care of children at each stage in their development Prescribes specific pharmacologic agents and I. 15 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) Cardiovascular Interpret ECG rhythms Interpret 12-lead ECGs Determine lead selection for ECGs Interpret hemodynamic values Interpret noninvasive hemodynamic values Manage transcutaneous (external) pacemakers Manage temporary transvenous pacemakers Manage permanent transvenous pacemakers Manage epicardial pacemakers Manage implantable cardioverter defibrillators (ICDs) Manage cardiac assist devices (e.g., RVAD, BVAD, LVAD, ECMO) Direct cardiopulmonary resuscitation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice treatments based on clinical indicators, the child’s status and needs, and the results of diagnostic and laboratory tests Provides the child and family with information about diagnostic and laboratory results, as well as effects and potential adverse effects of proposed prescriptive therapies Evaluates therapeutic and potential adverse effects of pharmacological and nonpharmacological treatments Provides information to the family regarding agents the child should refrain from taking because of the potential adverse effects on the child Provides the child and family with information about costs, alternative treatments and procedures as appropriate Monitors current issues related to pharmacological agents, including off-label use and pediatric safe Insert pulmonary artery pressure catheters Adjust pulmonary artery pressure catheters Perform elective cardioversion Disconnect pacer wire 16 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) II. Pulmonary Order nasal/facial CPAP/BiPAP Initiate mechanical ventilation Manage mechanical ventilation Wean mechanical ventilation Interpret pulmonary function tests Disconnect chest tube III. Gastrointestinal Remove PEG/JT/drainage catheters IV. Renal/Genitourinary Initiate renal replacement therapies V. Integumentary Provide wound care VI. Multisystem Interpret diagnostic imaging American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice Provide nonpharmacological interventions for pain Manage (i.e., recommend/ prescribe) pharmaceutical interventions Prescribe durable medical equipment dosage for medications Standard 5E: Referral Discusses referrals with the child and family Makes referrals to other healthcare providers and community service agencies as appropriate to the needs of the child with consideration of benefits and costs Ensures continuity of care throughout the healthcare referral process by implementing recommendations from referral sources Identifies and coordinates access to appropriate community resources Standard 6: Evaluation Evaluates the accuracy of the diagnosis and effectiveness of the interventions in relationship to the child’s attainment of expected outcomes Bases the evaluation 17 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice process on advanced knowledge, practice and research about child healthcare Utilizes results of evaluation analyses to revise or resolve the diagnoses, expected outcomes and plan of care Synthesizes the results of the evaluation analyses to determine the impact of the plan of care on the affected child, family, groups, communities, institutions, networks and organizations Utilizes the results of the evaluation analyses to make or recommend process or structural changes including policy, procedure or protocol documentation as appropriate 18 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) STANDARDS OF PROFESSIONAL PERFORMANCE Study of Practice – 39% related to Professional Practice competencies Consultation Competency B.1. Provides consultation to staff nurses, medical staff and interdisciplinary colleagues B.2. Initiates consultation to obtain resources as necessary to facilitate progress toward achieving identified outcomes B.3. Communicates consultation findings to appropriate parties consistent with professional and institutional standards B.4. Analyzes data from consultations to implement practice improvements Standard 10: Collegiality Models expert practice to interdisciplinary team members and healthcare consumers Participates on interdisciplinary teams that contribute to role development, advanced pediatric nursing practice and healthcare Contributes to an environment that is conducive to clinical education of other healthcare providers, including teaching, mentoring and precepting Contributes to the professional development of others to improve child healthcare and to foster the profession’s growth Collegiality Caring Practices 1. Contributes to the advancement of the profession as a whole by disseminating outcomes of practice through presentations and publications 2. Promotes career development in students, nurses and other healthcare providers 3. Promotes the role and scope of practice of the CNS (e.g., to legislators, regulators, other healthcare providers, the public) 4. Facilitates development of clinical judgment in healthcare team members through role modeling, teaching, coaching and/or mentoring 1. Use advanced communication skills to improve patient outcomes 2. Assess the effects of interactions among the individual/family/community/social systems 3. Identify potential risks to patient safety/autonomy and quality of care based on assessments across all spheres of influence 4. Determine nursing practice and system interventions that promote patient/family/community safety 5. Select interventions that may include, but are not limited to: a. application of advanced nursing therapies b. initiation of interdisciplinary team meetings/consults/other communications to benefit patient care c. management of pain meds/clinical procedures/other interventions d. psychosocial support including 19 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) patient counseling and spiritual interventions 6. Create therapeutic health-promoting, aging-friendly environments 7. Provide leadership to address threats to healthcare safety/quality 8. Use behavioral, communication and environmental-modification strategies with individuals who have cognitive/psychiatric impairments Quality of Care, Resource Utilization, Authentic Leadership Research Competency C.1. Facilitates the provision of clinically competent care by staff/team through education, role modeling, team building and quality monitoring C.2. Performs system-level assessments to identify variables that influence nursing practice and outcomes, including but not limited to: C.2.a. Population variables (age distribution, health status, income distribution, culture) Standard 14. Resource Utilization Utilizes organizational and community resources to formulate multidisciplinary or interdisciplinary plans of care Develops innovative solutions for child healthcare problems that address effective resource utilization and maintenance of quality Develops evaluation strategies to demonstrate cost effectiveness, cost 1. 2. 3. 4. Quality of Care Leads clinical inquiry through quality improvement activities Uses systems thinking and theoretical frameworks to initiate changes in practice, process and delivery Identifies and develops strategies to enhance quality care and promote a healthy work environment Synthesizes quality improvement data and formulates evidence-based 20 Copyright ©2012 AACN Certification Corporation Systems Thinking 1. Perform system-level assessments to identify variables that influence nursing practice and outcomes, including but not limited to: a. population variables (age distribution, health status, income distribution, culture) b. environment (schools, community support services, housing availability, employment opportunities) c. system of healthcare delivery d. regulatory requirements e. internal and external political influences/stability f. healthcare financing American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies C.2.b. Environment (schools, community-support services, housing availability, employment opportunities) C.2.c. System of healthcare delivery C.2.d. Regulatory requirements C.2.e. Internal and external political influences/stability C.2.f. Healthcare financing C.2.g. Recurring practices that enhance or compromise patient or system outcomes C.3. Determines nursing practice and system interventions that will promote patient, family and community safety C.4. Uses effective strategies for changing clinician and team behavior to encourage adoption of evidence-based practices and innovations in care delivery C.5. Provides leadership in maintaining a supportive and healthy work environment ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice Additional Measurement Criteria for the AP Pediatric Nurse benefit and efficiency factors associated with pediatric nursing practice Develops evaluation methods to measure safety and effectiveness for interventions and outcomes Promotes activities that assist others, as appropriate, in becoming informed about costs, risks and benefits of care or the plan of care and solution Initiates ongoing activities to analyze patient care systems in an effort to improve the quality of care provided to children and their families Uses aggregate data, in cooperation with others, to develop or revises systems to avoid duplication of or gaps in service Advocates for the removal of barriers to care and for optimal care for the child and family Develops innovative solutions and applies recommendations to improve quality care and practice 5. Conveys the tangible benefits of advanced practice nursing to the organization, system and community 2. 3. 1. 2. 3. 4. 5. 6. Resource Utilization Considers fiscal and budgetary implications in decision making regarding practice and system modifications Conducts cost/benefit and cost avoidance analysis of programs, processes and technologies Evaluates impact of introduction or withdrawal of products, services and technologies Facilitates access for patients to appropriate healthcare services Assists staff in the development of innovative, cost-effective programs or protocols of care Interprets and facilitates 21 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) 4. 5. 6. 7. 8. 9. g. recurring practices that enhance or compromise patient or system outcomes Use effective strategies for changing clinician and team behavior to encourage adoption of evidence-based practices and innovations in care delivery Provide leadership in maintaining a supportive and healthy work environment Evaluate use of products and services for appropriateness and cost/benefit in meeting care needs Conduct cost/benefit analysis of new clinical technologies Evaluate impact of introduction or withdrawal of products, services and technologies Assess the impact of environmental/system factors on care Coordinate the care of patients with use of system and community resources to assure successful health/illness/wellness transition, enhance delivery of care and achieve optimal patient outcomes Manage patient’s transitions of care in collaboration with individual/family/ caregivers/interdisciplinary team members including: American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies C.6. Provides leadership in promoting interdisciplinary collaboration to implement outcome-focused patient care programs meeting the clinical needs of patients, families, populations and communities C.7. Develops age-specific clinical standards, policies and procedures C.8. Uses leadership, team building, negotiation and conflict resolution skills to build partnerships within and across systems, including communities, system modifications C.9. Coordinates the care of patients with use of system and community resources to assure successful health/illness/wellness transitions, enhance delivery of care and achieve optimal patient outcomes C.10. Considers fiscal and budgetary implications in decision making regarding practice and system modifications: ANA Scope and Standards for Pediatric Nursing Practice AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) integration of organizational mission, goals and systems into patient care practices 7. Role models and mentors innovative systems thinking and resource use among the healthcare team 8. Develops strategies to facilitate transition of patients through the healthcare system 9. Assesses and facilitates understanding of the impact of social, political, regulatory and economic forces on the delivery of care a. analyzing the readiness of the patient and family to transition b. determining the appropriate level and/or setting of care c. coordinating implementation of transition 10. Provide leadership in conflict management/negotiation to address problems in the healthcare system 11. Lead system change to improve health outcomes through evidence-based practice by: a. specifying expected clinical and system-level outcomes b. designing programs to improve clinical and system-level processes and outcomes c. facilitating the adoption of practice change 12. Evaluate impact of CNS and other nursing practice on systems of care using nurse-sensitive outcomes 13. Disseminate outcomes of system-level change internally and externally 14. Assess system barriers and facilitators to adoption of evidence-based practices 15. Promote healthcare policy and system changes that facilitate access to care and address biases (e.g., socioeconomic, ethnic, ageism, Additional Measurement Criteria for the AP Pediatric Nurse strategies to obtain appropriate resources for nursing initiatives Secures organizational resources to ensure a work environment conducive to completing the identified plan of care and outcomes Standard 15: Leadership The pediatric nurse provides leadership in the professional practice setting and the profession. Works to influence decisionmaking bodies to improve child healthcare, health services and policies Provides direction to enhance the effectiveness of the multidisciplinary healthcare team Initiates and revises protocols or guidelines to reflect evidence-based practice, accepted changes in care management or to address emerging problems Promotes communication of information and 1. 2. 3. 4. Authentic Leadership Uses authentic leadership, team building, negotiation and conflict-resolution skills Leads system-level change Provides leadership in implementation of quality improvement and innovation Understands the requirements and dynamics at the point of care and, within this context, successfully translates the vision of a healthy work 22 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies C.10.a. Evaluates use of products and services for appropriateness and cost/benefit in meeting care needs C.10.b. Conducts cost/benefit analysis of new clinical technologies C.10.c. Evaluates impact of introduction or withdrawal of products, services and technologies C.11. Leads system change to improve health outcomes through evidence-based practice: C.11.a. Specifies expected clinical and system-level outcomes C.11.b. Designs programs to improve clinical and systemlevel processes and outcomes C.11.c. Facilitates the adoption of practice change C.12. Evaluates impact of CNS and other nursing practice on systems of care using nurse-sensitive outcomes C.13. Disseminates ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse advancement of the profession through writing, publishing and presentations for professional or lay audiences Designs innovations to effect change in practice and improve health outcomes AACN Scope and Standards for Acute and Critical Care CNS Practice environment 5. Role models standards for healthy work environment 23 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) sexism, cultural, mental health stigma) 16. Integrate information technology into systems of care to enhance safety and monitor health outcomes American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) True Collaboration Collaboration 1. Facilitates the provision of clinically competent care 2. Promotes a culture of collaboration 3. Masters and employs skilled communication 4. Effectively partners with interdisciplinary colleagues in the care of patients and patient populations 5. Fosters an intra/interdisciplinary approach to safety, quality improvement, evidencebased practice, research and translation of research into practice 6. Provides mentoring to nursing students, specifically in the area of acute and critical care and CNS preparation in collaboration with schools of nursing 7. Mentors healthcare team 1. Communicate consultation findings, as appropriate 2. Facilitate the provision of clinically competent care through education, role modeling, team building and quality monitoring 3. Provide leadership in promoting interdisciplinary collaboration to implement outcome-focused patient care programs 4. Use leadership, team building, negotiation and conflict resolution skills to build partnerships within and across systems, including communities 5. Establish collaborative relationships within and across departments that promote patient safety, culturally competent care and clinical excellence 6. Provide leadership for establishing, improving and sustaining collaborative relationships 7. Practice collegially with members of the healthcare team 8. Facilitate intra-agency and inter- outcomes of system-level change internally and externally Collaboration Competency D.1. Assesses the quality and effectiveness of interdisciplinary, intraagency and interagency communication and collaboration D.2. Establishes collaborative relationships within and across departments that promote patient safety, culturally competent care and clinical excellence D.3. Provides leadership for establishing, improving and sustaining collaborative relationships to meet clinical needs D.4. Practices collegially with medical staff and other members of the healthcare team so that all providers’ unique contributions to health outcomes will be Standard 11: Collaboration Partners with other disciplines to enhance pediatric healthcare through interdisciplinary activities, such as education, consultation, development of new management and therapeutic strategies or research Facilitates an interdisciplinary process with other members of the healthcare team Documents plans, communication, management plan changes and collaborative discussion to improve pediatric healthcare 24 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse enhanced D.5. Facilitates intra-agency and inter-agency communication AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) members to understand and use the expertise of others 8. Role models professional leadership and accountability for nursing’s role within the healthcare team and community 9. Facilitates the creation of a common vision for care within the healthcare team or system agency communication 9. Foster an interdisciplinary approach to quality improvement, evidence-based practice, research and translation of research into practice Education Facilitation of Learning 1. Proactively seeks and participates in professional development and learning opportunities on an ongoing basis 2. Uses information gained in educational activities to improve professional performance 3. Develops and refines skills in teaching and mentoring others 4. Acquires and maintains professional certifications 5. Maintains professional records that provide 1. Design health information and patient education appropriate to the patient’s developmental level, health literacy level, learning needs, readiness to learn and cultural values and beliefs 2. Provide education to individuals, families, groups and communities to promote knowledge, understanding and optimal functioning across the wellness-illness continuum 3. Mentor staff nurses, graduate students and others to acquire new knowledge and skills, and develop their careers 4. Mentor health professionals in applying the principles of evidence-based care 5. Coordinate formal and informal Coaching Competency E.1. Coaches patients and families to help them navigate the healthcare system E.2. Designs health information and patient education appropriate to the patient’s developmental level, health literacy level, learning needs, readiness to learn and cultural values and beliefs E.3. Provides education to individuals, families, groups and communities to promote knowledge, understanding Standard 9. Education (cont.) Supports the education and role development of other practitioners by serving as preceptor, role model and mentor 25 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies and optimal functioning across the wellness-illness continuum E.4. Participates in preprofessional, graduate and continuing education of nurses and other healthcare providers: E.4.a. Completes a needs assessment as appropriate to guide interventions with staff E.4.b. Promotes professional development of staff nurses and continuing education activities E.4.c. Implements staff development and continuing education activities E.4.d. Mentors nurses to translate research into practice E.5. Contributes to the advancement of the profession as a whole by disseminating outcomes of CNS practice through presentations and publications E.6. Mentors staff nurses, graduate students and ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice evidence of competency and lifelong learning 26 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) education for healthcare providers to improve pediatric healthcare outcomes 6. Advise patients/families/caregivers on how to address sensitive issues such as STDs, suicide prevention, substance use, driving, independent living, potential for abuse, end-of-life concerns, advance care planning and finances 7. Participate in pre-professional, graduate and continuing education of nurses and other healthcare providers by: a. completing a needs assessment as appropriate to guide interventions with staff b. promoting professional development of staff nurses and continuing education activities c. implementing staff development and continuing education activities d. mentoring others to use research findings in practice 8. Modify health information, patient education programs and interventions for patients with sensory, perceptual, cognitive and physical and mental illness limitations American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) Research/Clinical Inquiry, Individual Practice Evaluation Clinical Inquiry others to acquire new knowledge and skills and develop their careers E.7. Mentors health professionals in applying the principles of evidence-based care E.8. Uses coaching and advanced communication skills to facilitate the development of effective clinical teams E.9. Provides leadership in conflict management and negotiation to address problems in the healthcare system Research Competency (cont.) I. Interpretation, Translation and Use of Evidence F.I.1. Analyzes research findings and other evidence for their potential application to clinical practice F.I.2. Integrates evidence into the health, illness and wellness management of Standard 9. Education (cont.) Utilizes current healthcare research findings and other evidence to expand clinical knowledge, enhance role performance and increase knowledge of professional issues Research/Clinical Inquiry 1. Analyzes research findings and other evidence for potential application to practice 2. Synthesizes evidence to determine the need for practice and/or process improvement 27 Copyright ©2012 AACN Certification Corporation 1. Assess the quality and effectiveness of interdisciplinary, intra-agency and inter-agency communication and collaboration 2. Contribute to the advancement of the profession by disseminating outcomes of CNS practice 3. Analyze research findings and other evidence for potential application to American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies patients, families, communities and groups F.I.3. Applies principles of evidence-based practice and quality improvement to all patient care F.I.4. Assesses system barriers and facilitators to adoption of evidence-based practices F.I.5. Designs programs for effective implementation of research findings and other evidence in clinical practice F.I.6. Cultivates a climate of clinical inquiry across spheres of influence: F.I.6.a. Evaluates the need for improvement or redesign of care delivery processes to improve safety, efficiency, reliability and quality F.I.6.b. Disseminates expert knowledge ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) 3. Participates in conducting or implementing research/clinical inquiry 4. Evaluates existing and innovative patient care practices based on current research findings and experiential knowledge and integrates changes into practice 5. Chooses, applies or withholds interventions in a manner that is substantiated by evidence and appropriate to the needs of the patient, nurse, or system 6. Identifies clinical problems amenable to research 7. Role models and mentors staff regarding the use, implementation and evaluation of research findings 8. Communicates research results, and develops a means to incorporate research findings into practice 9. Evaluates and facilitates incorporation of new products, techniques and clinical practice 4. Integrate evidence into the health, illness and wellness management of patients, families, communities and groups 5. Apply principles of evidence-based practice and quality improvement to all patient care 6. Design programs for effective implementation of research findings and other evidence in clinical practice 7. Develop evidence-based clinical interventions to achieve defined patient and system outcomes 8. Assist staff in the development of innovative, cost-effective programs or protocols of care 9. Cultivate a climate of clinical inquiry across spheres of influence by: a. evaluating the need for improvement or redesign of care delivery processes to improve safety, efficiency, reliability and quality b. disseminating expert knowledge 10. Participate in establishing quality improvement agenda for unit, department, program, system or population 11. Provide leadership in planning data collection and quality monitoring 28 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice technologies into practice 10. Advances the science of nursing practice II. Evaluation of Clinical Practice F.II.1. Fosters an interdisciplinary approach to quality improvement, evidence-based practice, research and translation of research into practice F.II.2. Participates in establishing quality improvement agenda for unit, department, program, system or population F.II.3. Provides leadership in planning data collection and quality monitoring F.II.4. Uses quality monitoring data to assess the quality and effectiveness of clinical programs in meeting outcomes F.II.5. Develops quality improvement initiatives based on assessments F.II.6. Provides leadership in the design, implementation and evaluation of process Standard 7: Quality of Practice The pediatric nurse systematically enhances the quality and effectiveness of nursing practice. Designs quality improvement initiatives Implements initiatives to evaluate the need for change Evaluates the practice environment and quality of nursing care rendered in relation to existing evidence, identifying opportunities for the generation and translation of research findings Obtains and maintains professional certification in advanced practice pediatric nursing Provides leadership in establishing and monitoring standards of practice to improve care of children and Individual Practice Evaluation 1. Evaluates his or her own clinical and professional performance according to the CNS role competencies and standards of the appropriate professional and regulatory agencies 2. Leads the development and evaluation of criteria for CNS practice within the 3 spheres 3. Seeks feedback of individual clinical practice from others to facilitate professional growth 4. Engages in reflective learning of individual practice and role performance on a routine basis 5. Complies with the credentialing and privileging process within the organization or system 29 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) 12. Use data to assess the quality and effectiveness of clinical programs in meeting outcomes 13. Develop quality improvement initiatives based on assessments 14. Provide leadership in the design, integration and evaluation of process improvement initiatives 15. Provide leadership in the system-wide integration of quality improvement and innovation 16. Engage in a formal self-evaluation process, seeking feedback regarding own practice from patients, peers, professional colleagues and others 17. Analyze data from consultations to implement practice improvements 18. Participate in conduct/implementation of research by: a. identifying questions for clinical inquiry b. critiquing literature during literature reviews c. synthesizing literature during literature reviews d. designing and implementing studies e. collecting data f. analyzing data g. disseminating findings 19. Apply ethical principles in safeguarding American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies improvement initiatives F.II.7. Provides leadership in the system-wide implementation of quality improvements and innovations ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice their families in collaboration with other healthcare team members Participates in efforts to minimize costs and unnecessary duplication of tests and diagnostic services, and facilitates the timely provision of services for the child and the family Analyzes factors related to safety, satisfaction, effectiveness and costbenefit options with the child, family and other healthcare providers as appropriate Identifies and works to remove barriers in organizational systems that may hinder the quality of pediatric nursing care the confidentiality, dignity and safety of all research participants including the vulnerable and those with impaired decision-making capacity Standard 8. Professional Practice Evaluation The pediatric nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations. 30 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse III. Conduct of Research F.III.1. Participates in conduct and implementation of research, which includes one or more of the following: F.III.1.a. Identification of questions for clinical inquiry F.III.1.b. Conduct of literature reviews F.III.1.c. Study design and implementation F.III.1.d. Data collection F.III.1.e. Data analysis F.III.1.f. Dissemination of findings AACN Scope and Standards for Acute and Critical Care CNS Practice Engages in a formal process seeking feedback regarding one’s own practice from the child, family, peers, professional colleagues and others Standard 13. Research, evidence-based practice and clinical scholarship Contributes to nursing knowledge by conducting or synthesizing research that discovers, examines, and evaluates knowledge, theories, criteria and creative approaches to improve healthcare practice Formally and informally disseminates research findings through practice, education, presentations, publications, consultations and journal clubs 31 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) Ethics Advocacy/Moral Agency, Response to Diversity Ethical Decision Making, Moral Agency and Advocacy G.1. Engages in a formal self-evaluation process, seeking feedback regarding own practice from patients, peers, professional colleagues and others G.2. Fosters professional accountability in self or others G.3. Facilitates resolution of ethical conflicts: G.3.a. Identifies ethical implications of complex care situations G.3.b. Considers the impact of scientific advances, cost, clinical effectiveness, patient and family values and preferences and other external influences G.3.c. Applies ethical principles to resolving concerns across the three spheres of influence G.4. Promotes a practice climate conducive to Standard 12: Ethics Ensures that the care provided is consistent with the child’s and family’s needs and values, and with codes of ethical practice Informs the child and family of the risks, benefits and outcomes of healthcare regimens Makes decisions and initiates actions on behalf of children and their families in an ethical manner, taking into consideration the values of the child and family Ensures informed consent or age-appropriate assent for procedures, treatment and research, as appropriate Serves as an advocate for the child and family in developing policies and in providing care to the child and family Contributes to the creation of 1. Fosters the establishment and maintenance of an ethical environment 2. Facilitates resolution of ethical conflicts and moral distress to promote a healthy work environment 3. Serves as a mentor and role model to others in developing moral agency 4. Fosters professional accountability in self and others 5. Implements interventions that consider the impact of scientific advances, cost, clinical effectiveness, patient values and preference, diversity and other external influences on healthcare 2. 3. 4. 5. 6. 7. 8. 32 Copyright ©2012 AACN Certification Corporation 1. Advocacy/Moral Agency Coach patients and families to help them navigate the healthcare system Use coaching and advanced communication skills to facilitate the development of effective clinical teams Foster professional accountability in self and others Promote a practice climate conducive to providing ethical care Facilitate interdisciplinary teams to address ethical concerns, risks or considerations, benefits and outcomes of patient care Promote the role and scope of practice of the CNS to legislators, regulators, other healthcare providers and the public Communicate information that promotes nursing, the role of the CNS and outcomes of nursing and CNS practice through the use of the media, advanced technologies and community networks Facilitate patient/family understanding of risks/benefits/outcomes of proposed American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies providing ethical care G.5. Facilitates interdisciplinary teams to address ethical concerns, risks or considerations, benefits and outcomes of patient care G.6. Facilitates patient and family understanding of the risks, benefits and outcomes of proposed healthcare regimen to promote informed decision making G.7. Advocates for equitable patient care by: G.7.a. Participating in organizational, local, state, national or international level of policy-making activities for issues related to their expertise G.7.b. Evaluating the impact of legislative and regulatory policies as they apply to nursing practice and patient or population outcomes G.8 Promotes the role and scope of practice of the CNS to legislators, regulators, other healthcare providers and the public: ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice individual and system responses to resolution of ethical dilemmas Advocates for a process of ongoing ethical inquiry into patient care practices where varying perspectives are acknowledged and validated healthcare regimens to promote informed decision making 9. Facilitate decision making regarding treatment options with the patient/family/caregivers/healthcare proxy 10. Advocate for equitable patient care by: a. participating in organizational, local, state, national or international level of policy-making activities for issues related to their expertise b. evaluating the impact of legislative and regulatory policies as they apply to nursing practice and patient or population outcomes 11. Facilitate resolution of ethical conflicts by: a. identifying ethical implications of complex care situations b. considering the impact of scientific advances/cost/clinical effectiveness/patient and family values and preferences/other external influences c. applying ethical principles to resolve concerns 12. Advocate for access to hospice and palliative care services for patients across the age spectrum Standard 16. Advocacy The pediatric nurse is an advocate for the pediatric client and family. Advances the profession through enhancing public awareness and health professional familiarity with advanced practice pediatric nursing role and scope of practice 33 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation National CNS Competency Task Force Core Competencies ANA Scope and Standards for Pediatric Nursing Practice Additional Measurement Criteria for the AP Pediatric Nurse AACN Scope and Standards for Acute and Critical Care CNS Practice Response to Diversity 1. Develop age-specific clinical standards, policies and procedures 2. Promote system-wide policies and protocols that address cultural, ethnic, spiritual and intergenerational/age differences among patients, healthcare providers and caregivers 3. Design educational programs that enhance the knowledge of families and caregivers regarding normal developmental changes G.8.a. Communicates information that promotes nursing, the role of the CNS and outcomes of nursing and CNS practice through the use of the media, advanced technologies and community networks G.8.b. Advocates for the CNS/APRN role and for positive legislative response to issues affecting nursing practice 34 Copyright ©2012 AACN Certification Corporation AACN Certification Corporation Study of Practice Pediatric CNS (wellness through acute care) American Association of Critical‐Care Nurses AACN Certification Corporation GLOSSARY OF TERMS Advanced Nursing Practice – Builds on the competencies of the registered nurse and is characterized by the integration and application of a broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education. American Nurses Association. Nursing’s Social Policy Statement: The Essence of the Profession. Silver Spring, MD: American Nurses Association; 2010:18. Advocacy and Moral Agency - Working on another’s behalf and representing the concerns of the patient/family and nursing staff; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within and outside the clinical setting. Hardin S, Kaplow R. In: Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:64-65. Authentic Leadership - A pattern of leader behavior that draws upon and promotes both positive psychological capacities and a positive ethical climate, to foster greater self-awareness, an internalized moral perspective, balanced processing of information, and relational transparency on the part of leaders working with followers, fostering positive self-development. Walumbwa FO, Avolio BJ, Gardner WL, Wernsing TS, Peterson SJ. Authentic leadership: development and validation of a theory-based measure. J Manage. 2008;34(1):89–126. Kernis MH. Toward a conceptualization of optimal self-esteem. Psychol Inquiry. 2003;14:1-26. Caring Practices - Nursing interventions that create a compassionate, supportive and therapeutic environment for patients and staff, with the aim of promoting comfort and healing and preventing unnecessary suffering. Includes compassion, vigilance, engagement and responsiveness to the patient, family and healthcare personnel. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:7. Clinical Inquiry (Innovator/Evaluator) - The ongoing process of questioning and evaluating practice, providing informed practice and creating practice changes through evidence-based practice, research utilization and experiential knowledge. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:227. 35 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Clinical Judgment - Clinical reasoning, which includes clinical decision-making, critical thinking and global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence-based guidelines. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:59. Coaching – Skillful guidance and teaching to advance the care of patients, families, groups of patients and the profession of nursing. Spross JA. Expert coaching and guidance. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier; 2008:159-190. Collaboration - Working with others in a way that promotes/encourages each person’s contributions toward achieving optimal/realistic patient/family goals. Involves intra- and interdisciplinary work with colleagues and community. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:228. Collaboration – A dynamic, interpersonal process in which two or more individuals make a commitment to each other to interact authentically and constructively to solve problems and to learn from each other to accomplish identified goals, purposes or outcomes. The individuals recognize and articulate the shared values that make this commitment possible. Hanson CM, Spross JA. Collaboration. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier; 2008:283-314. Collegiality – Professional relationships, which are characterized by equal trust, power and respect. Schmalenberg C, Kramer M. Nurse-physician relationships in hospitals: 20 000 nurses tell their story. Crit Care Nurse. 2009;29(1):74-83. Competency – An expected and measurable level of nursing performance that integrates knowledge, skills, abilities, and judgment that is based on established scientific knowledge and expectations for nursing practice. American Nurses Association. Nursing’s Social Policy Statement: The Essence of the Profession. Silver Spring, MD: American Nurses Association; 2010:40. Consultation – Patient, staff or system-focused interaction between professionals in which the consultant is recognized as having specialized expertise and assists consultee with problem solving. Barron AM, White PA. Consultation. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier; 2008:191-216. 36 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Direct Clinical Practice – Direct interaction with patients, families and groups of patients to promote health or well-being and improve quality of life. Characterized by a holistic perspective, formation of therapeutic partnerships with patients, expert clinical thinking and skillful performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches in the advanced nursing management of health, illness, and disease states. Tracy MF. Direct clinical practice. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier; 2008:126. Ethical Decision-Making, Moral Agency and Advocacy – The process of identifying, articulating and taking action on ethical concerns at the patient, family, healthcare provider, system, community and public policy levels. Hamric AB, Delgado SA. Ethical decision making. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier; 2008:315-346. Evidence-Based Practice – A problem-solving approach to clinical practice that integrates the conscientious use of the best available research evidence, clinical expertise, and patient preferences and values. Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:10. Facilitation of Learning - The ability to promote the education of patients/families, nursing staff, other members of the healthcare team and community. Includes both formal and informal facilitation of learning. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:6. Indirect Care – The provision of care through activities that influence the care of patients, but do not involve direct engagement with patients. Examples include developing evidence-based guidelines or protocols for care and staff development activities. Tracy MF. Direct clinical practice. In: Hamric AB, Spross JA, Hanson CM, eds. Advanced Practice Nursing: An Integrative Approach. 4th ed. St Louis, MO: Elsevier; 2008:123-126. Nonpharmacologic (and Integrative) Interventions - Nonpharmacologic and integrative interventions includes a range of conventional and less commonly used non-medication, complementary and alternative therapies for the alleviation of symptoms, stress, suffering and other human responses. National Center for Complementary and Alternative Medicine. What Is Complementary and Alternative Medicine? http://nccam.nih.gov/health/whatiscam. Accessed April 25, 2010. 37 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Nurse Characteristics – As described in the AACN Synergy Model, nursing care reflects an integration of knowledge, skills, experience and attitudes needed to meet the needs of patients and families. Thus, continuua of nurse characteristics are derived from patient needs. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:5-9. Nurses/Nursing Practice – The CNS advances nursing practice and improves patient outcomes by updating and improving norms of care and by using standards of care that direct actions of nurses and nursing personnel. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: National Association of Clinical Nurse Specialists; 1998. Nurse Sensitive Outcomes – Expected changes that reflect nursing care or care rendered in collaboration with other healthcare providers. Oncology Nursing Society. Nursing-Sensitive Patient Outcomes. http://www.ons.org/Research/NursingSensitive/. Accessed April 25, 2010. Organization/System – The CNS articulates the value of nursing care at the organizational, decision-making level and influences system changes that facilitate improvement of quality cost-effective patient outcomes. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: National Association of Clinical Nurse Specialists; 1998. Outcomes - Refers to the expected changes in predetermined factors such as the patient’s behavior, health status or knowledge following the completion of nursing care. Redfern SJ, Norman IJ. Measuring the quality of nursing care: a consideration of different approaches. J Adv Nurs. 1990;15(11):1260-1271. Patient Outcomes – An immensely complex construct. Spans a range of effects or presumed effects of nursing and, in a broader conceptualization, healthcare interventions. Outcomes are measured both directly and indirectly, over different periods of time and from vastly different sources of information. They vary according to perspective and have different degrees of reliability and validity. Bond S, Thomas LH. Issues in measuring outcomes of nursing. J Adv Nurs. 1991;16(12):1492-1502. Response to Diversity - The sensitivity to recognize, appreciate and incorporate differences into the provision of care. Differences may include but are not limited to cultural differences, spiritual beliefs, gender, race, ethnicity, lifestyle, socioeconomic status, age and values. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:6. 38 Copyright ©2012 AACN Certification Corporation American Association of Critical‐Care Nurses AACN Certification Corporation Sphere of Influence – A model for CNS practice, articulated by the National Association of Clinical Nurse Specialists, based on three spheres of influence (Patient, Nurse, System) to reflect CNS practice as consistently targeted toward achieving quality, cost-effective outcomes through patient/client care, by influencing the practice of other nurses and nursing personnel, and by influencing the healthcare organization to support nursing practice. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: National Association of Clinical Nurse Specialists; 2004:17-18. Synergy - Results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004. Systems Leadership – The ability to manage change and empower others to influence clinical practice and political processes both within and across the system. Hamric AB, Spross JA, Hanson CM. Advanced Practice Nursing: An Integrative Approach. St Louis, MO: Elsevier; 2008:252. System Outcomes - The observed effects of interventions, healthcare practices, procedures or programs on departments, institutions, agencies or health systems on costs (savings, avoidance, reimbursement or revenue), resource use, risk avoidance or reduction, meeting quality and accreditation benchmarks and other institutional/agency/system impacts. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004. Systems Thinking - Body of knowledge and tools that allow the nurse to manage whatever environmental and systems resources exist for the patient/family and staff, within or across healthcare and non-healthcare systems. Hardin S, Kaplow R. Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. Sudbury, MA: Jones & Bartlett; 2004:86. True Collaboration – An ongoing process that builds over time, eventually resulting in a work culture where joint communication and decision making between nurses and other disciplines and among nurses themselves becomes the norm. In true collaboration, the unique knowledge and abilities of each professional are respected to achieve safe, quality care for patients. Skilled communication, trust, knowledge, shared responsibility, mutual respect, optimism and coordination are integral to successful collaboration. American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2005:20. 39 Copyright ©2012 AACN Certification Corporation
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