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Domain 1: Knowledge for Nursing Practice

Descriptor: Integration, translation, and application of established and evolving disciplinary nursing knowledge and ways of knowing, as well as knowledge from other disciplines, including a foundation in liberal arts and natural and social sciences. This distinguishes the practice of professional nursing and forms the basis for clinical judgment and innovation in nursing practice.

Contextual Statement: Knowledge for Nursing Practice provides the context for understanding nursing as a scientific discipline. The lens of nursing, informed by nursing history, knowledge, and science, reflects nursing’s desire to incorporate multiple perspectives into nursing practice, leading to nursing’s unique way of knowing and caring.

Preparation in both liberal arts and sciences and professional nursing coursework provides graduates with the essential abilities to function as independent, intellectually curious, socially responsible, competent practitioners (Tobbell, 2018). A liberal education creates the foundation for the development of intellectual and practical abilities within the context of nursing. Further, liberal education is the key to understanding self and others; contributes to safe, quality care; and informs the development of clinical judgment.

Competencies, Sub-competencies, and Progression Indicators Table by Level

Below presents sub-competencies by entry-level and advanced-level, with associated progression indicators. Select a competency from the dropdown to view its corresponding table of developing and developed competence. 

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

  Sub-competency Progression Indicators (Observable Behaviors)
   

Developing

Developed (Competent)

Level 1: Entry-Level 1.1a Identify concepts, derived from theories from nursing and other disciplines which distinguish the practice of nursing.

Describe fundamental nursing theories and concepts that differentiate nursing from other healthcare disciplines.

Explain how theoretical concepts guide practice.

Explain nursing and interdisciplinary theories, highlighting their contributions to nursing practice and identifying how they distinguish nursing from other healthcare professions.

Develop and implement plans of care that integrate theoretical concepts from nursing and other relevant disciplines.

1.1b Apply knowledge of nursing science that develops a foundation for nursing practice. Discuss relevant research findings and their application in supporting nursing interventions. Integrate nursing science into clinical decision-making by accurately assessing patient conditions and formulating evidence-based plans of care.
1.1c Understand the historical foundation of nursing as the relationship developed between the individual and nurse.

Discuss the impact of key historical figures and their contributions to developing the nursing relationship.

Describe major historical events influencing nursing’s evolution and how these events have shaped current nurse-patient interactions.

Incorporate parallels between historical nursing practices and contemporary approaches to patient care and practice situations.
1.1d Articulate nursing's distinct perspective to practice.

Identify core nursing values and explain how they shape the nursing approach, distinguishing it from other health professions.

Explain how empathy, active listening, and culturally responsive care foster a deeper nursing-patient connection.

Explain how nursing’s emphasis on holistic care differentiates it from other healthcare disciplines.

Apply current, peer-reviewed nursing science and evidence-based practice guidelines to justify and inform nursing practice.

Employ empathy, active listening, and culturally responsive care while interacting with patients.

Level 2: Advanced-Level 1.1e Translate evidence from nursing sciences as well as other sciences into practice.

Explore relevant literature to identify evidence applicable to nursing practice.

Perform initial evidence appraisal by summarizing key findings from selected nursing and other scientific disciplines.

Analyze current clinical practices and integrate nursing science into practice to address identified gaps, evaluating patient and care-related outcomes.
1.1f Demonstrate the application of nursing science to practice.

Identify gaps in practice that impact care delivery and care outcomes.

Articulate the underlying nursing science principles guiding patient care.

Analyze current clinical practices and integrate nursing science into practice to address identified gaps, evaluating patient and care-related outcomes.
1.1g Integrate an understanding of nursing history in advancing nursing's influence in health care.

Identify significant historical events or leaders in nursing and discuss their impact on the profession and healthcare systems.

Describe nursing’s role in shaping modern healthcare systems.

Draw from nursing history to analyze current practices and propose solutions to contemporary healthcare challenges.

Advocate for nursing’s influence in shaping healthcare systems and policies.

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

 

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level 1.2a Apply or employ knowledge from nursing science as well as the natural, physical, and social sciences to build an understanding of the human experience and nursing practice.

Explore knowledge from the natural and social sciences to identify health and illness patterns.

Identify physical, emotional, and environmental factors influencing the patient's health and experiences.

Integrate scientific knowledge with nursing principles to justify clinical decisions.

Develop care plans incorporating cultural, physical, environmental, and psychosocial considerations.

1.2b Demonstrate intellectual curiosity.

Explore topics relevant to patient care and discuss findings with peers and mentors.

Question healthcare practices and seek supporting rationale.

Seek and evaluate evidence to support patient care.

Develop care plans incorporating cultural, physical, environmental, and psychosocial considerations.

1.2c Demonstrate social responsibility as a global citizen who fosters the attainment of health equity for all.

Identify health disparities and the impact of social determinants on patient outcomes locally and globally.

Show respect for diverse beliefs and practices in patient interactions.

Apply knowledge of health equity principles to advocate for diverse patient populations.

Propose strategies to reduce barriers to care at both individual and community levels.

1.2d Examine influence of personal values in decision-making for nursing practice.

Recognize potential biases and take steps to mitigate their impact, seeking guidance as needed.

Describe how individual values influence clinical decision-making for the healthcare team and patients.

Collaborate with healthcare teams to address conflicts between personal values and professional responsibilities.

1.2e Demonstrate ethical decision-making.

Identify ethical principles relevant to nursing practice and professional ethical guidelines.

Describe ethical dilemmas in patient care, integrating ethical frameworks to guide decision-making.

Incorporate rationale related to ethical decisions into practice.

Collaborate with interprofessional teams to analyze and address ethical dilemmas, advocating for patient rights, autonomy, and well-being.

Level 2: Advanced-Level

1.2f Synthesize knowledge from nursing and other disciplines to inform education, practice, and research.

Discuss connections between advanced nursing practice and related disciplines, illustrating how interdisciplinary knowledge enhances nursing practice.

Reflect on how integrating diverse knowledge from various fields contributes to advanced nursing practice.

Demonstrate in practice the use of knowledge from nursing and other disciplines.

Analyze how the integration of nursing and other disciplinary knowledge impacts one’s practice and practice outcomes.

1.2g Apply a systematic and defendable approach to nursing practice decisions.

Explore decision-making frameworks and their applications as guides in advanced nursing practice.

Utilize an evidence-based approach to inform decision-making that aligns with healthcare quality standards.

Collaborate to analyze and refine decision-making approaches, fostering an environment of shared learning and continuous improvement.

Defend clinical and ethical decisions with well-supported rationales grounded in nursing evidence, professional standards, and core nursing values, ensuring accountability and high-quality patient care.

1.2h Employ ethical decision making to assess, intervene, and evaluate nursing care.

Discuss ethical dilemmas in practice.

Utilize ethical frameworks from nursing or social sciences to assess practice situations, guiding interventions and evaluations.

Evaluate nursing practice outcomes using a justified ethical framework.

Take accountability for ethical decisions by reflecting on their impact on client or population outcomes.

1.2i Demonstrate socially responsible leadership.

Discuss the importance of social responsibility in nursing leadership.

Examine the impact of social issues on clients, populations, and nursing practice.

Promote practices that ensure equity, respect, and person-centeredness in healthcare.

Use leadership skills to advocate for vulnerable populations, ensuring resources are accessible to all clients, regardless of social status.

1.2j Translate theories from nursing and other disciplines to practice.

Apply nursing theories and frameworks to guide clinical decision-making contextually.

Connect theoretical concepts to practice settings, making the connection between nursing frameworks and real-world clinical experiences.

Improve patient care by integrating knowledge from various disciplines.

Develop innovative solutions for healthcare challenges by utilizing nursing and interdisciplinary theories.

Table Legend:

Level 1: Entry-Level
Level 2: Advanced-Level

 

  Sub-competency Progression Indicators (Observable Behaviors)
    Developing (Developing Competence) Developed (Competent)
Level 1: Entry-Level

1.3a Demonstrate clinical reasoning.

Identify key patient problems and articulate the nursing knowledge and logical steps for clinical decisions.

Recognize gaps in knowledge that affect clinical decisions and use appropriate resources to support sound clinical judgments during clinical rotations or simulations.

Re-prioritize patient problems based on changes in the patient's condition and severity, initiating appropriate interventions promptly to prevent complications and improve outcomes during clinical practice.

Develop and revise a comprehensive patient plan of care, incorporating a critical analysis of changes in the patient's condition, integrating new clinical information, and adjusting interventions to optimize patient outcomes.

1.3b Integrate nursing knowledge (theories, multiple ways of knowing, evidence) and knowledge from other disciplines and inquiry to inform clinical judgment.

Identify how different nursing theories and evidence-based guidelines can be used to develop and implement plans of care that address different patient needs and preferences.

Discuss and evaluate how nursing knowledge informs clinical judgments.

Apply relevant nursing theories and evidence-based guidelines to develop and implement plans of care tailored to the individual patient’s unique needs and preferences.

Incorporate feedback into clinical decision making.

1.3c Incorporate knowledge from nursing and other disciplines to support clinical judgment.

Describe how patient and environmental factors influence clinical decision-making.

Provide an evidence-based rationale for adjusting plans of care to reflect contextual challenges and opportunities.

Integrate patient and environmental factors into the decision-making process.

Incorporate knowledge of cultural, ethical, and legal considerations into one’s clinical reasoning to make informed clinical judgments.

       
Level 2: Advanced-Level

1.3d Integrate foundational and advanced specialty knowledge into clinical reasoning.

Identify patient problems and propose interventions using foundational and advanced specialty concepts.

Identify areas of strength and opportunities for improvement for integrating foundational and advanced specialty knowledge while making clinical decisions.

Analyze data and outcomes by applying clinical reasoning and integrating evidence to develop or revise guidelines or practice plans.

Apply foundational and specialty knowledge to decision-making when managing complex cases or addressing challenges identified in practice.

Articulate the rationale for clinical decisions, linking foundational science and advanced specialty knowledge to care outcomes.

1.3e Synthesize current and emerging evidence to Influence practice.

Summarize findings from research articles, clinical guidelines, or quality improvement reports that inform practice.

Incorporate emerging evidence and rationale into plans of care, action plans, or interventions.

Appraise and integrate quality research, clinical guidelines, and other forms of evidence to address care challenges.

Propose and test practice changes or innovations using recent findings from research, quality improvement projects, or technological advancements.

1.3f Analyze decision models from nursing and other knowledge domains to improve clinical judgment.

Discern the applicability and appropriateness of decision-making frameworks in practice.

Utilize appropriate decision models to analyze patient care situations in clinical practice.

Assess the impact of applied decision models on patient care quality, safety, and efficiency.

Implementing the Progression Indicators
Videos & Guides

 

Progression Indicators:
An Overview

In this video, Drs. Bimbola Akintade and Cynthia O'Neal from AACN's Assessment Expert Working Group introduce the progression indicators and how incorporating them into nursing curricula can improve competency assessment strategies.

PI Overview One-Pager PDF

Clarifying Expectations & Advancing Competency With PIs

Dr. Mary Fey discusses the importance of aligning descriptive, observable behaviors with the Essentials sub-competencies for student assessment.


Clarifying Expectations with PIs PDF Guide

Clustering Competencies During Assessment

Dr. Dana Tschannen provides an overview of how faculty can cluster Essentials competencies to ensure alignment throughout program curricula.



Clustering Competencies PDF Guide