AACN Essentials Domain 1: Knowledge for Nursing Practice
“Focuses on the discipline of nursing knowledge and other disciplinary knowledge.” (AACN, 2021, p. 27).
AACN Essentials Domain 1: Knowledge for Nursing Practice
“Focuses on the discipline of nursing knowledge and other disciplinary knowledge.” (AACN, 2021, p. 27).
Domain 1: Essential Knowledge
To meet the objectives for Domain 1, knowledge is required in:
- Advanced psychiatric assessment and mental status examination
- Therapeutic communication and therapeutic use of self
- Human development
- Clinical neuroscience
- Psychopathology
- Psychopharmacology
- Psychotherapy models and techniques (theoretical frameworks)
- Mental health promotion interventions
- Mental health crisis intervention
- Trauma informed care
- Principles of socially responsible leadership in psychiatric care
- Social determinants of mental health
Domain 1: Leveling of the AACN Essential Objectives
“1.1 Demonstrate an understanding of the discipline of nursing’s distinct perspective and where shared perspectives exist with other disciplines.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “1.1e Translate evidence from nursing science as well as other sciences into practice.” | Explore concepts or elements that differentiate advanced practice nursing from other disciplines. | Evaluate differences and overlaps between nursing science and approaches from other disciplines in development of a treatment plan. | Design an age-appropriate treatment plan for psychiatric disorders based on biopsychosocial theories, evidence-based standard of care, and practice guidelines. |
| “1.1f Demonstrate the application of nursing science to practice.” | Apply the principles of nursing science to populations across the lifespan and conditions and identify additional perspectives. | Summarize the potential contributions of advanced practice psychiatric nursing to current/national/global mental health issues. | Integrate nursing science in advanced clinical practice to improve health outcomes. |
| “1.1g Integrate an understanding of nursing history in advancing nursing’s influence in health care.” | Explore psychiatric nursing role expansion in the historical context of the evolution of psychiatric care. | Applies nursing science-based frameworks, theories, and models in review of nursing’s influence in health care. | Evaluate nursing history of the PMH advanced practice nurse and influence in advancing health care. |
“1.2 Apply theory and research-based knowledge from nursing, the arts, humanities, and other sciences.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “1.2f Synthesize knowledge from nursing and other disciplines to inform education, practice, and research.” | Compare and contrast principles of psychodynamic, behavioral, cognitive, humanistic, biological, social/psychological, family, group, individual theory | Identify gaps in research/evidence for individual and systems levels of care and propose needed areas of research. | Develop and evaluate plans of care for individuals, families, populations, communities that integrate theory, evidence, and other patterns of knowing. |
| “1.2g Apply a systematic and defendable approach to nursing practice decisions.” | Discuss interviewing and assessment methods across the lifespan, practicing differential diagnosis, inclusion of individual preferences, family dynamics, holistic and comprehensive plans of care, areas of referral and consultation. | Appraise evidence, integrate clinical knowledge, consider individual preferences to make and implement nursing practice decisions. | Systematically integrate nursing practice decisions by critically analyzing evidence, adhering to ethical standards, and employing sound reasoning in clinical care. |
| “1.2h Employ ethical decision making to assess, intervene, and evaluate nursing care.” | Outline ethical principles, psychiatric practice issues, politics, health policy and social determinants of mental health. | Apply ethical principles to broader systems of psychiatric care (individuals, crisis services, public and private services) in the development of plan of care. | Evaluate the integration of ethical principles, person centered care and recovery model in developing plan of care and improving health outcomes. |
| “1.2i Demonstrate socially responsible leadership.” | Identify components of socially responsible leadership. | Analyze social determinants of health data to inform strategies for socially responsible leadership. | Formulate a plan to support ethical practice, inclusivity, and sustainability of socially responsible leadership to improve health outcomes. |
| “1.2j Translate theories from nursing and other disciplines to practice.” | Review nursing and other discipline theories relevant to advanced clinical practice. | Integrate a nursing theory, psychotherapeutic modalities, and biopsychosocial approaches to plan care. | Evaluate effectiveness of a specific theoretical framework to guide care (psychoanalytic, behavioral, cognitive, humanistic, biopsychosocial). |
“1. 3 Demonstrate clinical judgment founded on a broad knowledge base.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “1.3d Integrate foundational and advanced specialty knowledge into clinical reasoning.” | Identify foundational and advanced specialty knowledge for advanced clinical practice. | Apply evidence-based knowledge and clinical reasoning to develop individual clinical treatment plans. | Design evidence-based treatment plans for populations integrating advanced specialty knowledge and clinical reasoning. |
| “1.3e Synthesize current and emerging evidence to influence practice.” | Summarize standards of practice for a specific condition or diagnosis. | Apply evidence-based clinical practice guidelines to individualize plans of care. | Recommend emerging evidence-based interventions to advance clinical practice and improve health outcomes. |
| “1.3f Analyze decision models from nursing and other knowledge domains to improve clinical judgment.” | Review clinical decision-making models, evidence-based practice, decision support frameworks, diagnostic reasoning models, and nursing process to facilitate improvement of clinical judgement. | Evaluate multiple decision-making models for gaps in care and treatment. | Select decision making models based on evidence, priorities of care, and identified outcomes to improve clinical judgement. |
Domain 1: Teaching/Learning Strategies
Examples of Classroom and Clinical/Practicum Strategies
Example 1: Case Scenario
Application of Theoretical Frameworks to Case Scenario, Plan and Treatment
Instructions
Integrate two different theoretical frameworks into the case study. Apply the principles of the theory to understand the case, explaining the individual’s symptoms and plan of care. Integrate psychopharmacological interventions into the plan using established clinical practice guidelines (EBP).
- Choose two theoretical frameworks from the list provided. Highlight the key principles, concepts, and therapeutic approaches (One nursing theory and one psychological theory).
- Integrate the chosen frameworks into the assessment, formulation and interventions.
- Integrate psychopharmacological interventions using an established clinical practice guideline. Include considerations for individual preference/person-centered care.
- Reflect on personal values and biases that may affect communication and therapeutic relationship.
Case Scenario
Individual Demographics:
John 52-year-old widowed male. Has been four months since wife’s death due to heroin overdose. Lives in state-funded, transitional living home since discharged from a 30-day detox program. Is a high-school graduate. Skilled construction worker, currently unemployed. No children.
Present Problem/Chief Concern: “My wife is dead and it’s my fault. She didn’t use heroin until she met me. She trusted me and I killed her.” John reports chronic guilt, anxiety, and body aches. Does not envision a future without his wife. Reports ruminations about the night of wife’s overdose. Repeatedly states he is responsible for his wife’s death. Prescribed Methadone 20mg daily. Has had four admissions for heroin use over 15 years.
Precipitating Factors: (What factors lead up to the presenting problem?) Wife’s death due to heroin overdose four months ago. Feelings of overwhelming grief, guilt and self-hate.
Perpetuating Factors: (What keeps the present problem going?) Extensive substance use history including alcohol and marijuana (onset age 12) and has lived with opioid use disorder for 18 years. Low self-worth, insecure and anxious-avoidant attachment styles, lack of purposeful and meaningful being, few friends, “none I could count on”. He has no recovery support.
Predisposing Factors: (What historical, Adverse Childhood Experiences (ACEs), biopsychosocial factors contributed to the problem developing?) Closed-file adoption at age two. Minimal family contact since leaving home at age 17. Father a minister, described as a “closet alcoholic” who was physically and verbally abusive. Mother misused alcohol to deal with her anxiety and fear of father.
Protective Factors: (What factors are considered individual strengths?) Highschool graduate. Demonstrates profound remorse and empathy for deceased wife’s grieving family. Basic work skills with employment with brief periods of recovery. Committed to his recovery and seeking help for psychological pain.
Grading Rubric
Integrating theory, evidence, and patterns of knowing for advanced practice psychiatric-mental health nursing.
| Criteria | 4 Points | 3 Points | 2 Points | 1 Point |
|---|---|---|---|---|
| Integrates Nursing Theory in the individual’s plan of care. (Aesthetic knowing) | Synthesizes Nursing Theory into a complex, holistic plan and justifies the theory choice by linking symptoms with basic principles of the theory. | Nursing Theory is integrated into most aspects of care. | Nursing Theory is included in the plan in the most basic way. | Nursing theory is identified without integration into care. |
| Integrates “borrowed” theory or models into individual’s plan of care (existential, trauma informed care, recovery, etc.). |
Integrates Substance use and behavioral health theories (or from other fields) into a comprehensive plan. | Demonstrates strong link between theory and individual condition/experience though some elements are missing. | Some symptoms that cause suffering are not addressed in the plan. | Borrowed theories are only identified but not integrated. |
| Uses Evidenced-Based Practice to determine psychopharmacological approach to care. (Empirical knowing) |
Synthesizes psychiatric, biological symptoms and individual’s preference into an evidence-based plan of care. | Plan is based on empirical evidence without individual’s preference included. | Plan fails to synthesize either biological or psychiatric symptoms into treatment. | Plan is based on what they’ve seen others do in practice. |
| Integrates societal, cultural, and political aspects into clinical formulation and plan.(Emancipatory knowing) |
Systems, societal, cultural and political elements are integrated in the formulation and plan. | Elements of one of these aspects is omitted: cultural formulary, political, and societal environment from formulation/plan. | Elements of two of these aspects is omitted from the formulation and plan. | Awareness of societal, cultural, political aspects to care expressed though not integrated. |
| Reflections on personal biases that may affect communication and or relationship. (Personal knowing) |
Envisions a future self with planned life-long learning to address personal growth. | Evaluates response/changes to learning over time and recognizes complexity of each case/situation. | Able to identify strengths and challenges and plan to address challenges. | Describes own past performance in these situations including successes and failures. |
Domain 1: Resources
Articles/Textbooks
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders DSM-5-TR (5th ed.). American Psychiatric Association. ISBN: 978-0-89042-575-3
Boland, R., Verduin, M. L., & Ruiz, P. (2021) Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Wolters Kluwer. ISBN: 9781975145569
Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1, 13-24.
Chinn, P. L., Kramer, M. K., & Sitzman, K. (2021). Knowledge development in nursing (11th ed.). Elsevier. ISBN: 9780323793001
Dulcan, M.K. (2022). Dulcan’s textbook of child and adolescent psychiatry (3rd ed.). American Psychiatric Association Publishing. ISBN: 978-1-58562-493-5
International Society of Psychiatric-Mental Health Nurses, American Nurses Association, & American Psychiatric Nurses Association, (2022). Psychiatric mental health nursing: Scope and standards of practice (3rd ed.). American Nurses Association. ISBSN: 978-1947800977
Morrison, J. (2018). The mental health clinician’s workbook. Guildford Press. ISBN: 9781462534845
Osser, D. N. (2020). Psychopharmacology algorithms. Wolters Kluwer.
Peplau, H. (2004). Interpersonal relations in nursing a conceptual frame of reference of psychodynamic nursing. Springer. ISBN:9780826179111
Shea, S. C. (2017). Psychiatric interviewing: The art of understanding. Elsevier. ISBN:9781437716986
Stahl, S.M. & Muntner, N. (2020). Prescriber’s guide: Stahl’s essential psychopharmacology (7th ed.). Cambridge University Press. ISBN:978-1-10892-601-0
Tusaie, K. R., & Fitzpatrick, J. J. (2023). Advanced practice psychiatric nursing:Iintegrating psychotherapy, psychopharmacology, and complementary and alternative approaches across the life span (3rd ed.). Springer Publishing Company, LLC. ISBN: 978-0-8261-8553-4
Wheeler, K. (2021). Psychotherapy for the advanced practice psychiatric nurse (3rd ed.). Springer. ISBN: 9780826193797
Websites
Beck Institute: Cognitive Behavior Therapy
Behavioral Tech Institute
Existential-Humanistic Institute
Neuroscience Education Institute (NEI)
Psychwire
PsychDB
Positive Psychology
Psychology Tools
Psychotherapy.Net
Substance Abuse and Mental Health Services Administration-Evidence-Based Practices Resource Center
The Accountable Health Communities Health Related Social Needs Screening Tool
The Bowen Institute for the Study of the Family
