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 2: Person Centered Care
“Focuses on the practice of person-centered care” (AACN, 2021, p. 29).
Domain 2: Essential Knowledge
To meet the objectives for Domain 2, knowledge is required in:
- Advanced communication skills and techniques applicable to psychiatric care:
- Populations across the lifespan and across the continuum of care
- Family/couples psychotherapy
- Group psychotherapy
- Individual psychotherapy
- Communication skills and psychoeducation techniques appropriate to the developmental, cognitive, cultural and health literacy level of populations across the lifespan.
- Comprehensive psychiatric assessment and diagnostic skills
- Psychiatric formulation and differential diagnosis
- Documentation of psychiatric evaluation and ongoing care and treatment
- Treatment planning for psychiatric disorders, including psychopharmacology and other somatic therapies, nonpharmacologic interventions, and psychotherapy
- Interventions used to promote optimal mental health in populations across the lifespan
- Appreciation for the centrality of the therapeutic relationship
- Development of self-reflective practice
- Promotion of quality-person-centered care to diverse populations
Domain 2: Leveling of the AACN Essential Objectives
“2.1 Engage with the individual in establishing a caring relationship” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.1d Promote caring relationships to effect positive outcomes.” | Describe process for development of caring, holistic, person-centered relationships based in foundational relationship theorists. | Demonstrate ability to develop caring, holistic, person-centered relationships to facilitate positive health outcomes. | Appraise the process for developing caring, holistic, person-centered relationships and nurse led therapeutic behaviors leading to positive outcomes. |
| “2.1e Foster caring relationships.” | Identify the phases/goals of the therapeutic relationship according to Peplau’s theory. | Demonstrate ability to develop caring relationships with individuals and families across the lifespan. | Analyze individual outcomes in response to development of caring relationship. |
“2.2 Communicate effectively with individuals.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.2g Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences.” | Describe the basic communication skills and techniques appropriate to the developmental, cognitive, cultural and health literacy level of populations across the lifespan. |
Apply knowledge and communication skills appropriate to the developmental, cognitive, cultural and health literacy level of populations across the lifespan. | Analyze performance of psychotherapeutic interventions to populations across the lifespan. |
| “2.2h Design evidence-based, person-centered engagement materials.” | Review evidence-based, person-centered engagement materials. | Analyze evidence-based, person-centered engagement materials. | Develop evidence-based, person-centered engagement materials. |
| “2.2i Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care.” | Explain the role of genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care. | Demonstrate use of genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care. | Formulate practice model for integration of genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care. |
| “2.2j Facilitate difficult conversations and disclosure of sensitive information.” | Identify difficult topics and common techniques to facilitate effective interactions. | Apply beginning knowledge and skill to facilitate difficult conversations and disclosure of sensitive information. | Select advanced psychotherapeutic skills to facilitate difficult conversations with individuals and families across the lifespan. |
“2.3 Integrate assessment skills in practice.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.3h Demonstrate that one’s practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice.” | Identify the biopsychosocial components of the individual assessment in PMH advanced nursing practice. | Demonstrate ability to conduct a psychiatric assessment and determine a diagnosis for individuals across the lifespan. | Evaluate ability to skillfully conduct a full comprehensive psychiatric assessment, diagnosis and formulation for individuals across the lifespan. |
“2.4 Diagnose actual or potential health problems and needs.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.4f Employ context driven, advanced reasoning to the diagnostic and decision-making process.” | Identify the biopsychosocial factors that influence clinical diagnostic decision-making process. | Apply beginning skills for advanced reasoning in the decision-making process. | Analyze expertise in assessment, diagnosis and decision making in the diagnosis and treatment plan. |
| “2.4g Integrate advanced scientific knowledge to guide decision making.” | Identify scientific knowledge and practice guidelines to determine diagnosis and treatment. | Apply scientific knowledge to clinical decision-making of diagnosis and treatment plans for individuals across the lifespan. | Critique ability to communicate scientific rationale guiding decision making for diagnosis and treatments for individuals across the lifespan. |
“2.5 Develop a plan of care” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.5h Lead and collaborate with an interprofessional team to develop a comprehensive plan of care.” | Explain components of a comprehensive plan of care. | Collaborate with interprofessional health care team to develop a comprehensive plan of care. | Appraise leadership skills with interprofessional team in development of comprehensive plans of care. |
| “2.5i Prioritize risk mitigation strategies to prevent or reduce adverse outcomes.” | Identify factors that contribute to adverse health care outcomes. | Utilize evidence-based strategies and assessment tools to mitigate or reduce adverse outcomes. | Formulate risk mitigation strategies based on individual verbalizations, change in individual usual behavior, use of common suicide evaluation scales, assessment for protective factors, development of plan of action and reporting safety concerns as appropriate. |
| “2.5j Develop evidence-based interventions to improve outcomes and safety.” | Identify evidence-based screening tools for individuals at risk.
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Demonstrate ability to assess and develop treatment plan for individuals at risk. | Critique pharmacological and non-pharmacological interventions for individuals at risk. |
| “2.5k Incorporate innovations into practice when evidence is not available.” | Identify situations where evidence-based practice is not currently available. | Review innovative practice strategies in the literature relevant to PMH advanced practice. | Outline an innovative practice strategy for clinical situation in which evidence is not available. |
“2.6 Demonstrate accountability for care delivery.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.6e Model best care practices to the team.” | Explain components of a comprehensive plan of care. | Collaborate with interprofessional health care team to develop a comprehensive plan of care. | Appraise leadership skills with interprofessional team in development of comprehensive plans of care. |
| “2.6f Monitor aggregate metrics to assure accountability for care outcomes.” | Identify factors that contribute to adverse health care outcomes. | Utilize evidence-based strategies and assessment tools to mitigate or reduce adverse outcomes. | Formulate risk mitigation strategies based on individual verbalizations, change in individual usual behavior, use of common suicide evaluation scales, assessment for protective factors, development of plan of action and reporting safety concerns as appropriate. |
| “2.6g Promote delivery of care that supports practice at the full scope of education.” | Identify evidence-based screening tools for individuals at risk.
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Demonstrate ability to assess and develop treatment plan for individuals at risk. | Critique pharmacological and non-pharmacological interventions for individuals at risk. |
| “2.6i Apply current and emerging evidence to the development of care guidelines/tools.” | Discuss evidence-based scholarly resources for the management of common psychiatric conditions. | Utilize guidelines/tools based on current and emerging evidence. | Evaluate emerging evidence of developing care guidelines/tools for use in treatment plans of care. |
| “2.6j Ensure accountability throughout transitions of care across the health continuum.” | Describe the PMH advanced practice nurse accountability in transitions of care across the health continuum. | Evaluate PMH advanced practice nurse accountability processes during transitions of care across the health continuum. | Design policies and practices to support PMH advanced practice nurse accountability for effective transitions care across the health continuum. |
“2.7 Evaluate outcomes of care.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.7d Analyze data to identify gaps and inequities in care and monitor trends in outcomes.” | Identify strategies to identify and analyze gaps in health care disparities and inequities and provide ongoing monitoring of trends in outcomes. | Contrast ongoing monitoring of trends in outcomes to health outcomes. | Evaluate collected data regarding interventions in health care disparities and inequities and evaluate increased improvement in trends and outcomes. |
| “2.7e Monitor epidemiological and system-level aggregate data to determine healthcare outcomes and trends.” | Identify strategies to improve epidemiological and system-level aggregate data to promote enhanced healthcare outcomes and trends. | Compare system-level and epidemiological data to health outcomes and trends. | Evaluate outcome of strategies to improve epidemiological and system-level aggregate data to enhanced healthcare outcomes and trends. |
| “2.2i Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care.” | Explain the role of genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care. | Demonstrate use of genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care. | Formulate practice model for integration of genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care. |
| “2.7f Synthesize outcome data to inform evidence-based practice, guidelines, and policies.” | Review outcome data which affect development of evidence-based practice, guidelines, and policies. | Utilize outcome data to further evaluate evidence-based practice, guidelines, and policies as applied to individual care. | Select advanced psychotherapeutic skills to facilitate difficult conversations with individuals and families across the lifespan. |
“2.8 Promote self-care management.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.8f Develop strategies that promote self-care management.” | Identify strategies that promotes self-care management. | Compare and contrast strategies for self-care management for efficacy, usability, and outcomes. | Develop a plan that will mitigate barriers to self-management and maximize successes. |
| “2.8g Incorporate the use of current and emerging technologies to support self-care management.” | Identify technologies that promote self-care management strategies. | Evaluate the effectiveness of self-care management technologies. | Develop plan to incorporate emerging technology to support self-care management. |
| “2.8h Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management.” | Describe key components of counseling techniques, including motivational interviewing. | Apply counseling strategies and motivational interviewing techniques to advance wellness and self-care management. | Evaluate effectiveness of counseling strategies and motivational interviewing techniques to advance wellness and self-care management. |
| “2.8i Evaluate adequacy of resources available to support self-care management.” | Identify resources available to support self-care management | Appraise evidence-based literature for resources to support self-care management. | Evaluate effectiveness of resources to support self-care management. |
| “2.8j Foster partnerships with community organizations to support self-care management.” | List community organizations which identify support self-care management as a component of organization mission. | Develop partnerships with community organizations to support self-care management. | Formulate strategic plan to sustain partnerships with community organizations to support self-care management. |
“2.9 Provide care coordination.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “2.9f Evaluate communication pathways among providers and others across settings, systems, and communities.” | Determine what the referral process is for common services that are not provided by your clinical site | Analyze the effectiveness of referral process through retrospective chart review/agency quality assurance data. | Evaluate of evidence-based effectiveness of this referral process, will also be evaluated through retrospective chart review. |
| “2.9h Guide the coordination of care across health systems.” | Identify coordination of care factors including potential referrals and resources to meet individual needs interfacing with multiple health systems. | Describe the process of communication regarding whether individual needs are being addressed to multiple levels of care within the health care team. | Evaluate efficacy of communication process throughout individual’s interface with various levels of care. |
| “2.9i Analyze system-level and public policy influence on care coordination.” | Explain the influence of public policy, system-level policy and reimbursement factors on care coordination. | Analyze both public policy and system-level policy on care coordination and health care access. | Evaluate system level and public policy insuring the provision of the highest level of care for individual and support for family. |
| “2.9j Participate in system-level change to improve care coordination across settings.” | Participate in system level care coordination from individual admission to discharge including post admission follow-up plans. | Evaluate individual centered care within and between all parts of the health care system from admission until discharge or transfer to another part health of the care setting or discharge home. | Plan system level care coordination from individual admission to discharge including post admission follow-up plans. |
Domain 2: Teaching/Learning Strategies
Examples of Classroom and Clinical/Practicum Strategies
Example 1: Simulation
Description: Students will demonstrate assessment/interviewing skills during a simulated encounter.
Conduct a psychiatric evaluation with mental status examination, history, diagnosis and case formulation.
Sally is a 29-year-old accountant who presented for a psychiatric/mental health evaluation and treatment for depression. She has been married for 4 years and has a 3-year-old daughter. Despite still being legally married, she has been separated and living apart from her husband for the past month. She reports that her husband asked for a divorce, simply stating “things are not working out.” Since then, she and her daughter moved in with her parents. She acknowledges that “things were not good” in the marriage and she had been feeling increasingly sad and hopeless for approximately 2 months in anticipation of the separation. About a month ago, she began seeing a new therapist who told her she had depression, situational mood swings, and possible borderline personality disorder.
During the past 5-7 weeks, Sally’s mood has been moderately depressed throughout the day, with intact mood reactivity. She reported recently gaining about 15 pounds from “overeating junk food.” She denied prominent irritability or argumentativeness. She described her self-esteem as “inexistent” and finds it hard to feel motivation or to concentrate on all tasks, including simple and routine ones. She stated that she stopped attending her spinning classes or going out with her friends. By contrast, she reported that sometimes she perseverates and keeps thinking about her soon to be ex-husband – at times thinking of ways to “get him back,” and at other times “grieving his loss.” She reported regularly staying up late thinking about her husband and the life they had together, sometimes not being able to sleep until 4 or 5 am. She reported then “feeling exhausted” and “dragging myself through the day.” She reported being concerned about keeping her job, stating “I know that I haven’t been performing to the standards that I should.” She reports that these symptoms began prior to the separation. She denied drug or alcohol misuse and self-injurious behavior. She denied a history of particularly intense or chaotic relationships, as well as a history of suicidal thoughts or gestures. She also denies any current thoughts or plans of harming herself or others, stating “I have a 3-year-old daughter…she is my only consistent light.”
In the past, Sally had seen a counselor in high school for “moodiness” and poor grades. She reported first becoming “depressed” in college. She reported being unsure of her diagnosis at that time but stated that she was prescribed citalopram and began psychotherapy sessions. She reported she improved quickly and stopped both after a couple months. She denied past psychiatric hospitalizations but admitted to contacting a crisis hotline the day that she and her husband separated. “I was a mess…I was angry, depressed, crying…all at once. I didn’t think of killing myself but didn’t feel like living either. I needed to talk to someone.”
Sally was the youngest of three children who grew up in a middle-class suburban home – “it was a normal family…mom, dad, siblings.” She reported having “just a few” friends and being bullied in middle school – “I was into theater and played in the band…I wasn’t one of the cool kids.” She recounts a particular instance bullying, in which other kids created a webpage mocking her appearance. She attended public school and a state college and stated she was “an average B student” and hoped to someday get a MBA. She described herself as having been a “quiet…nervous and anxious” child and “not causing any trouble.” Aside from her struggles with being bullied, she denied other traumatic experiences. Her older brother used multiple illicit substances, although Sally said she herself had never tried any drugs. She reported she was charged and found guilty of driving under the influence of alcohol when she was a 21-year-old. She stated, “It was a poor choice after a night of partying,” and consequently she had to complete community service and probation. Her younger brother was treated for “panic attacks and depression,” and Sally knew of several aunts, uncles and cousins whom she thought were “depressed.” She describes her parents as supportive and identifies a strong network. She acknowledges not being “very social lately,” stating, “it makes me feel guilty that I am not staying in touch with people that care about me…I really want to get back to my regular self.”
Sally reports a history of asthma and Celiac disease but denies a recent physical exam. She denies any other history of surgeries, chronic medical conditions or allergies.
Example 2: Group Theory/Therapy
Instructions: Group Experience and Reflection
Use your class notes, and power point on group, and assigned readings on group therapy. You will attend a group this term to reinforce group theory content.
Grading Rubric
| Evaluation Criteria | Points |
| Describe type of group or purpose: activities, support, therapy, medication, substance abuse, Narcotic Anonymous. (name of group and where it was located). | 2 |
| Phase of group: initial, working, termination and why. | 2 |
| Identify 2 norms of the group. | 2 |
| Task function(s) of the group. | 2 |
| Maintenance function(s) of group. | 2 |
| Was it an effective group or ineffective and why. | 2 |
| Name 3 group roles in your chosen group. | 2 |
| What went well in the group and name some barriers in group. | 2 |
| Feelings about how you participated in the group. | 2 |
| If you attended the group again, what would you do differently or the same? | 2 |
| What was group therapist(s) discipline such as nursing, pharmacy, social work, or other? | 2 |
| Did group Leaders/therapists seem to support each other: a. How many group members? b. Were therapists able to guide group? |
2 |
| Did the group start and end on time? | 2 |
| Was the environment comfortable (temperature, furniture, privacy)? | 2 |
| How did therapist handle problems such as silence, hostility, disruptive persons? | 2 |
| How often does the group meet? | 2 |
| Draw diagram as to where everyone sat in the group. | 2 |
| Did communication pass from group member to group member or group leader to individual? Did people talk freely or only when spoken to by the leader? | 2 |
| Was the group cohesive and effective or not? | 2 |
| How did group reflect theory of group dynamics as discussed in PMH class and from Dr. Irvin Yalom information on group therapy: | 2 |
| Based on your experience in group, would you choose to conduct group treatment as PMHNP and overall feelings about group as a treatment? | 6 |
| Total Points | 50 |
Example 3
Description: Classroom Assignment Annotated Bibliographies
Assignment: Identify three evidence-based care articles published within the last five years and write an annotated bibliography for each one to share with colleagues.
Example 4
Description: Classroom Assignment Population Based
Assignment: Older Adult (could adapt for populations across the life span)
Instructions: Paper-presentation worth 10% presented by group with PowerPoint discussions.
- The faculty member will assign each student to a group by the second week of class.
- A team leader should be chosen for each group and the faculty should be notified via email as to who is the team leader/group #.
- The topic for the presentation must be emailed to faculty by the student for approval. The topic must be related to older adult psychiatric issues.
- A case study relating to the topic must be submitted to all class members and the faculty at least one week prior to the scheduled presentation, either electronic link or copy of the case study.
- Students will be evaluated by:
- Own group members, which will be 33% of the overall group project grade. See linked Team Member Participation Grading Rubric
- All other class members, which will be 33% of the overall group project grade. See linked Peer Review Grading Rubric
- Faculty, which will be 34% of the overall group project grade.
- Group Project details
- PowerPoint presentation presented to the class on the assigned date.
- A case study relating to the topic must be submitted to all class members & the faculty at least one week prior to the scheduled presentation, either electronic link or copy of the case study. The case study should be incorporated into the presentation.
- Citation and references are to be included in APA format.
Ideas for presentation topics:
- Polypharmacy in the older adult
- CRE of special and vulnerable older adult populations
- Alternative therapies & older adult
- Use of OTCs, illicit drugs, caffeine, alcohol, nicotine
- Substance use disorders
- Intimate partner violence relationships
- Sexuality and aging
- New drugs available to treat problems & interventions for smoking cessation, alcohol marijuana use
- Depression, anxiety, delirium, dementia and older adult
- Cost of medications
- End of life care
Domain 2: Resources
Articles/Textbooks
Wheeler, K. (2022). Psychotherapy for the advanced practice psychiatric nurse: A how-to-guide for evidence-based practice (3rd ed.). Springer Publishing.
Websites
Agency for Healthcare Research and Quality (AHRQ)
AHRQ: Guidelines and Measures
CDC: Guidelines and Recommendations
Registered Nurses’ Association of Ontario (RNAO) Best Practice Guidelines
National Heart, Lung, and Blood Institute: About Systematic Evidence Reviews and Clinical Practice Guidelines
Americans Health Rankings
American Association of Colleges of Nursing: The Essentials
Nursing Theory: Jean Watson Nursing Theorist
SAMHSA: Columbia-Suicide Severity Rating Scale (C-SSRS)
Irvin D. Yalom, MD
