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1. Philosophy of professional nursing: The philosophy of the College of Nursing is the education of nurses who become lifelong learners and critical thinkers. The philosophy reflects beliefs that education is a continuous process, occurring in phases throughout an individual’s lifetime. 2. Evolution from novice professional to advanced nursing practice: As you progress from one course to the next, changes will be taking place on a professional and personal level, document these changes in reflective summaries after each graduate course. 3. Professional goal: family nurse practitioner(FNP)- Diabetic educator (Develop at least five professional goals and evaluate progress towards achievement near the time of graduation; update and/or revise overtime but at least annually throughout your career. The goals need to have a date of completion, must be measureable and you must state briefly how you will attain those goals.) 4.highlights of excellence in clinical practice : teamwork, leadership,task organization OR prioritizing (Showcase your graduate level skills used in graduate school, selected superior papers, projects or end-of-course faculty theory or clinical evaluations which highlights your excellence in practice, knowledge, skills, etc.) 2nd page: 5. BSN essentials competence : choose 3 exemplars from AACN guideline and describe 6. Achieving program leanring outcomes and MSN essentials competence : choose 3 exemplars from AACN guideline and describe. Essential I: Scientific Background for Practice o Recognizes that the master’s-prepared nurse integrates scientific findings fromnursing, biopsychosocial fields, genetics, public health, quality improvement, and organizational sciences for the continual improvementof nursing care across diverse settings. The Essentials of Master’s Education in Nursing Essential I: Scientific Background for Practice Rationale Master’s-prepared nurses build on the competencies gained in a baccalaureate nursing program by developing a deeper understanding of nursing and the related sciences needed to fully analyze, design, implement, and evaluate nursing care. These nurses are well prepared to provide care to diverse populations and cohorts of patients in clinical and community-based systems. The master’s-prepared nurse integrates scientific findings from nursing, biopsychosocial fields, genetics, public health, quality improvement, health economics, translational science, and organizational sciences for the continual improvement of nursing care at the unit, clinic, home, or program level. Master’sprepared nursing care reflects a more sophisticated understanding of assessment, problem identification, design of interventions, and evaluation of aggregate outcomes than does baccalaureate-prepared nursing care. Students being prepared for direct care roles will have graduate-level content that builds upon an undergraduate foundation in health assessment, pharmacology, and pathophysiology. Having master’s-prepared graduates with a strong background in these three areas is seen as imperative from the practice perspective. Although not required, it is recommended that the Master’s curriculum preparing individuals for direct care roles include three separate graduate-level courses in these three content areas. In addition, the inclusion of these three separate courses facilitates the transition of these master’s program graduates into the DNP advanced practice register nurse programs. Master’s-prepared nurses understand the intersection between systems science and organizational science in order to serve as integrators within and across systems of care.Care coordination is based on systems science (Nelson et al., 2008). Care management incorporates an understanding of the clinical and community context, and the research relevant to the needs of the population. Nurses at this level use advanced clinical reasoning for ambiguous and uncertain clinical presentations, and incorporates concerns of family, significant others, and communities into the design and delivery of care. Master’s-prepared nurses use ethical theories in the analysis of clinical problems, illness prevention, and health promotion strategies. Knowledge from information sciences, health communication, and health literacy are used to provide care to multiple populations. These nurses are able to address complex cultural issues and design care that responds to the needs of multiple populations, who may have potentially conflicting cultural needs and preferences. As healthcare technology becomes more sophisticated and its use more widespread, master’s-prepared nurse are able to evaluate when its use is appropriate for diagnostic, educational, and therapeutic interventions. Master’s-prepared nurses use improvement science and quality processes to evaluate outcomes of the aggregate of patients, community members, or communities under their care, monitor trends in clinical data, and understand the implications of trends for changing nursing care. The master’s-degree program prepares the graduate to: 1. Integrate nursing and related sciences into the delivery of advanced nursing care to diverse populations. 2. Incorporate current and emerging genetic/genomic evidence in providing advanced nursing care to individuals, families, and communities, while accounting for patient values and clinical judgment. 3. Design nursing care for a clinical or community-focused population based on biopsychosocial, public health, nursing, and organizational sciences. 4. Apply ethical analysis and clinical reasoning to assess, intervene, and evaluate advanced nursing care delivery. 5. Synthesize evidence for practice to determine appropriate application of interventions across diverse populations. 6. Use quality processes and improvement science to evaluate care and ensure patient safety for individuals and communities. 7. Integrates organizational science and informatics to make changes in the care environment to improve health outcomes. Sample Content • Healthcare economics and finance models • Advanced nursing science, including the major streams of nursing scientific development • Scientific bases of illness prevention, health promotion, and wellness • Genetics, genomics, and pharmacogenomics • Public health science, such as basic epidemiology, surveillance, environmental science, and population health analysis and program planning • Organizational sciences • Systems science and integration, including microsystems, mesosystems, and macrolevel systems • Chaos theory and complexity science • Leadership science • Theories of bioethics • Information science • Quality processes and improvement science • Technology assessment Examples of Integrative Learning Strategies • Analyze a clinical case from the perspectives of two or more scientific foundations, such as nursing science and quality improvement science. • Debate with a group of student colleagues from multiple health professions how the ethical issues related to genetic/genomic information influence one’s perspectives on clinical practice. • Discuss with classmates the major scientific advances in nursing that relate most closely with the clinical care you are delivering. • Conduct a concept analysis of lateral integration and explain how a full understanding of the concept will help you engage most effectively in lateral integration of care delivery principles. • Interview community leader to obtain their perspectives on the major health and socioeconomic disparities in their area and approaches they recommend for eliminating those disparities. Select one of these issues and plan a debate with students in multiple health and social service disciplines about how to modify the social determinants of health with the goal of eliminating this health disparity. • Engage in a panel discussion with classmates about the similarities and differences between master’s-prepared nurse public health nursing practice and acute care nursing practice. • Collect data from clinical unit or practice setting about incidence trends in a particular clinical problem (e.g., falls, medication errors, STD rates) and recommend changes in practice based on scientific findings from nursing or other fields. • Debate with a group of student colleagues from multiple health professions regarding how ethical issues related to genetic/genomic information and technology influence clinical practice for each discipline. (From ISONG, p. 2) • Essential II: Organizational and Systems Leadership o Recognizes that organizational and systems leadership are critical to the promotion of high quality and safe patient care. Leadership skills are needed that emphasize ethical and critical decision making, effective working relationships, and a systems-perspective. Essential II: Organizational and Systems Leadership Rationale Organizational and systems leadership are critical to the promotion of high quality and safe patient care. Leadership skills are needed that emphasize ethical and critical decision making. The master’s-prepared nurse’s knowledge and skills in these areas are consistent with nursing and healthcare goals to eliminate health disparities and to promote excellence in practice. Master’s-level practice includes not only direct care but also a focus on the systems that provide care and needs of a panel of patients, a defined population, or community. To be effective, graduates must be able to demonstrate leadership by initiating and maintaining effective working relationships using mutually respectful communication and collaboration within interprofessional teams, demonstrating skills in care coordination, delegation, and initiating conflict resolution strategies. The master’sprepared nurse provides and coordinates comprehensive care for patients – individuals,families, groups, and communities – in multiple and varied settings. Using informationfrom numerous sources, these nurses navigate the patient through the healthcare systemand assume accountability for quality outcomes. Skills essential to leadership includecommunication, collaboration, negotiation, delegation, and coordination. Master’s-prepared nurses are members and leaders of healthcare teams that deliver a variety of services. These graduates bring a unique blend of knowledge, judgment, skills, and caring to the team. As a leader and partner with other health professionals, these nurses seek collaboration and consultation with other providers as necessary in the design, coordination, and evaluation of patient care outcomes. In an environment with ongoing changes in the organization and financing of health care, it is imperative that all master’s-prepared nurses have a keen understanding of healthcare policy, organization, and financing. The purpose of this content is to prepare a graduate to provide quality cost-effective care, to participate in the implementation of care, and to assume a leadership role in the management of human, fiscal, and physical healthcare resources. Program graduates understand the economies of care, business principles, and how to work within and affect change in systems. The master’s-prepared nurse must be able to analyze the impact of systems on patient outcomes, including analyzing error rates. These nurses will be prepared with knowledge and expertise in assessing organizations, identifying systems’ issues, and facilitating organization-wide changes in practice delivery. Master’s-prepared nurses must be able to use effective interdisciplinary communication skills to work across departments identifying opportunities and designing and testing systems and programs to improve care. In addition, nurse practice at this level requires an understanding of complexity theory and systems thinking, as well as the business and financial acumen needed for the analysis of practice quality and costs. The master’s-degree program prepares the graduate to: 1. Apply leadership skills and decision making in the provision of culturally competent, high quality nursing care, healthcare team coordination, and the oversight and accountability for care delivery and outcomes. 2. Assume a leadership role in effectively implementing patient safety and quality improvement initiatives within the context of the interprofessional team using effective communication skills. 3. Develop an understanding of how healthcare delivery systems are organized and financed and how this affects patient care, and identify the economic, legal, and political factors that influence health care. 4. Demonstrate the ability to use complexity science and systems theory in the design, delivery, and evaluation of health care. 5. Apply business and economic principles and practices, including budgeting, cost/benefit analysis, and marketing, to develop a business plan. 6. Design and implement systems change strategies within that improve the care environment. 7. Participate in the design and implementation of new models of care delivery and coordination. Sample Content • Leadership, including theory, leadership styles, contemporary approaches, and strategies (organizing, managing, delegating, supervising, collaborating, coordinating) • Data-driven decision making based on an ethical framework to promote culturally competent, quality patient care in a variety of settings, including creative and imaginative strategies in problem solving • Communication, both interpersonal and organizational, including elements and channels, models, and barriers • Conflict, including conflict resolution, mediation, negotiation, and managing conflict • Change theory and social change theories • Systems theory and complexity science • Healthcare systems (organizational structure and finance) and organizational structures 9/30/2015 ACADEMIC ASSISTER’S BLOG http://academicassistersblog.com/page/9/ 17/39 and relationships (e.g., finance, organizational structure, and delivery of care, including mission/vision/philosophy and values) • Healthcare finance, including budgeting, cost/benefit analysis, variance analysis, and marketing • Operations research, e.g. queuing theory, supply chain management, and systems designs in health care • Teams and teamwork, including team leadership, building effective teams, and nurturing teams Examples of Integrative Learning Strategies • Conduct an organizational assessment describing the relationship between organizational structure, leadership, and decision making. • Analyze an integrative case study describing an organizational problem addressing communication and conflict within healthcare teams. • Engage in a formal debate and present to the class a contemporary issue in healthcare leadership. • Conduct a literature critique including a comprehensive summary and a critical analysis of contemporary healthcare leadership. • Analyze an organizational conflict and present a strategy to deal with the conflict. • Develop a business plan including a budget. • Present to an interdisciplinary team a cost-saving idea that improves patient outcomes and improves efficiency. • Analyze unit resources and set priorities for maximizing outcomes. • Design a program proposal including needs assessment, implementation, and evaluation plan. • Essential III: Quality Improvement and Safety o Recognizes that a master’s-prepared nurse must be articulate in the methods, tools, performance measures, and standards related to quality, as well as prepared to apply quality principles within an organization. Essential III: Quality Improvement and Safety Rationale Continuous quality improvement involves every level of the healthcare organization. A master’s-prepared nurse must be articulate in the methods, tools, performance measures, culture of safety principles, and standards related to quality, as well as prepared to apply quality principles within an organization to be an effective leader and change agent. The Institute of Medicine report (1998) To Err is Human defined patient safety as “freedom from accidental injury” and stated that patients should not be at greater risk for accidental injury in a hospital or healthcare setting than they are in their own home. Improvement in patient safety along with reducing and ultimately eliminating harm to patients is fundamental to quality care. Skills are needed that assist in identifying actual or potential failures in processes and systems that lead to breakdowns and errors and then redesigning processes to make patients safe. Knowledge and skills in human factors and basic safety design principles that affect unsafe practices are essential. Graduates of master’s-level programs must be able to analyze systems and work to create a just culture of safety in which personnel feel comfortable disclosing errors—including their own—while maintaining professional accountability. Learning how to evaluate, calculate, and improve the overall reliability of processes are core skills needed by master’s-prepared nurses. Knowledge of both the potential and the actual impact of national patient safety resources, initiatives, and regulations and the use of national benchmarks are required. Changes in healthcare reimbursement with the introduction of Medicare’s list of “never events” and the regulatory push for more transparency on quality outcomes require graduates to be able to determine if the outcomes of standards of practice, performance, and competence have been met and maintained. The master’s-prepared nurse provides leadership across the care continuum in diverse settings using knowledge regarding high reliability organizations. These organizations achieve consistently safe and effective performance records despite unpredictable operating environments or intrinsically hazardous endeavors (Weick, 2001). The master’s- prepared nurse will be able to monitor, analyze, and prioritize outcomes that need to be improved. Using quality improvement and high reliability organizational principles, the master’s- prepared nurse will be able to quantify the impact of plans of action. The master’s-degree program prepares the graduate to: 1. Analyze information about quality initiatives recognizing the contributions of individuals and inter-professional healthcare teams to improve health outcomes across the continuum of care. 2. Implement evidence-based plans based on trend analysis and quantify the impact on quality and safety. 3. Analyze information and design systems to sustain improvements and promote transparency using high reliability and just culture principles. 4. Compare and contrast several appropriate quality improvement models. 5. Promote a professional environment that includes accountability and high-level communication skills when involved in peer review, advocacy for patients and families, reporting of errors, and professional writing. 6. Contribute to the integration of healthcare services within systems to affect safety and quality of care to improve patient outcomes and reduce fragmentation of care. 7. Direct quality improvement methods to promote culturally competent, safe, timely, 9/30/2015 ACADEMIC ASSISTER’S BLOG http://academicassistersblog.com/page/9/ 19/39 effective, efficient, equitable, and patient-centered care. 8. Lead quality improvement initiatives that integrate socio-cultural factors affecting the delivery of nursing and healthcare services. Sample Content • Quality improvement models differentiating structure, process, and outcome indicators • Principles of a just culture and relationship to analyzing errors • Quality improvement methods and tools: Brainstorming, Fishbone cause and effect diagram, flow chart, Plan, Do Study, Act (PDSA), Plan, Do, Check, Act (PDCA),Find, Organize, Clarify, Understand, Select-Plan, Do, Check, Act (FOCUS-PDCA), Six Sigma, Lean • High-Reliability Organizations (HROs) / High-reliability techniques • National patient safety goals and other relevant regulatory standards (e.g., CMS core measures, pay for performance indicators, and never events) • Nurse-sensitive indicators • Data management (e.g., collection tools, display techniques, data analysis, trend analysis, control charts) •Analysis of errors (e.g., Root Cause Analysis [RCA], Failure Mode Effects Analysis [FMEA], serious safety events) • Communication, (e.g., hand-off communication, chain-of-command, error disclosure) • Participate in executive patient safety rounds • Simulation training in a variety of settings (e.g., disasters, codes, and other high-risk clinical areas) • RN fit for duty/impact of fatigue and distractions in care environment on patient safety Examples of Integrative Learning Strategies • Participate in an interprofessional team that is performing a root cause analysis on a failure-to-rescue patient scenario when the chain-of-command was not utilized. • Participate in an interprofessional team that is performing an FMEA, such as the administration of heparin. • Write part of the organization’s patient safety plan related to just culture. • Mentor/Coach a new graduate who has made a medication error that resulted in an adverse patient outcome. • Participate in an interprofessional team that is trying to improve processes related to the CMS core measure, such as for heart failure. • Participate in analysis and plan for improvement for an associate safety related events (e.g.) back injuries, needle sticks. • Explore other industries (airline) and apply learning to proactive healthcare system changes. • Interview patient and/or family members impacted by a patient safety error.• Explore transitional care strategies to home or other setting to prevent avoidable readmissions. • Essential IV: Translating and Integrating Scholarship into Practice o Recognizes that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results. Rationale Professional nursing practice at all levels is grounded in the ethical translation of current evidence into practice. Fundamentally, nurses need a questioning/inquiring attitude toward their practice and the care environment. The master’s-prepared nurse examines policies and seeks evidence for every aspect of practice, thereby translating current evidence and identifying gaps where evidence is lacking. The master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems (individually or as a member of the healthcare team), and disseminates results both within the setting and in wider venues in order to advance clinical practice. Changing practice locally, as well as more broadly, demands that the master’s-prepared nurse is skilled at challenging current practices, procedures, and policies. The emerging sciences referred to as implementation or improvement sciences are providing evidence about the processes that are effective when making needed changes where the change processes and context are themselves evidence based (Damschroder et al., 2009; Sobo, Bowman, & Gifford, 2008; van Achterberg, Schoonhoven, & Grol, 2008). Master’s-prepared nurses, therefore, must be able to implement change deemed appropriate given context and outcome analysis, and to assist others in efforts to improve outcomes. Master’s-prepared nurses lead continuous improvement processes based on translational research skills. The cyclical processes in which these nurses are engaged includes identifying questions needing answers, searching or creating the evidence for potential solutions/innovations, evaluating the outcomes, and identifying additional questions. Master’s-prepared nurses, when appropriate, lead the healthcare team in the implementation of evidence-based practice. These nurses support staff in lifelong learning to improve care decisions, serving as a role model and mentor for evidencebased decision making. Program graduates must possess the skills necessary to bring evidence-based practice to both individual patients for whom they directly care and to those patients for whom they are indirectly responsible. Those skills include: knowledge acquisition and dissemination; working in groups; and change management. The master’s-degree program prepares the graduate to: 1. Integrate theory, evidence, clinical judgment, research, and interprofessional perspectives using translational processes to improve practice and associated health outcomes for patient aggregates. 2. Advocate for the ethical conduct of research and translational scholarship (with particular attention to the protection of patient rights). 3. Articulate to a variety of audiences the evidence base for practice decisions, including the credibility of sources of information and the relevance to the practice problem confronted. 4. Participate, leading when appropriate, in collaborative teams to improve care outcomes and support policy changes through knowledge generation, knowledge dissemination, and planning and evaluating knowledge implementation. 5. Apply practice guidelines to improve practice and the care environment. 6. Perform rigorous critique of databases to generate meaningful evidence for nursing practice. Sample Content: • Research process • Implementation/Improvement science • Evidence-based practice: _ Clinical decision making _ Critical thinking _ Problem identification _ Outcome measurement • Translational research: _ Data collection in nursing practice _ Design of databases that generate meaningful evidence for nursing practice _ Data analysis in practice _ Evidence-based interventions _ Prediction and analysis of outcomes _ Patterns of behavior and outcomes _ Gaps in evidence for practice _Importance of cultural relevance • Scholarship: _ Application of research to the clinical setting _ Resolution of clinical problems _ Appreciative inquiry _ Dissemination of results • Advocacy in research • Research ethics • Knowledge acquisition • Group process • Management of change • Evidence-based policy development in practice • Quality improvement models/methodologies • Safety issues in practice • Innovation processes Examples of Integrative Learning Strategies • Identify practice dilemmas related to cultural values and beliefs that will lead or lend themselves to collaborative research among practitioners and researchers • Investigate and apply evidence that challenges current policies and procedures in a practice environment and incorporates evidence into practice situations. • Create an educational experience for health team members using sample data and data mining techniques focused on a clinical issue that has evidence-based guidelines. • Disseminate clinical knowledge in grand rounds, case presentations, and journal clubs. • Help a clinical population access and interpret the meaning and validity of health information available through multiple and varied sources and formats. • Manage a group process to meet care objectives and complete healthcare team responsibilities. • Use an existing database to evaluate aggregate care outcomes for designated care environments with focus on specific nursing interventions. • Contribute to an interdisciplinary plan of care based on best practice guidelines and evidence-based practice. • Coordinate care for a group of patients based on desired outcomes consistent with evidence-based guidelines and quality care standards. • Revise patient care based on an analysis of outcomes and evidence-based knowledge. • Conduct a patient-care team research review seminar. • Use a research article as the basis for explicating the many potential ethical concerns, from conceptualizing the research problem through initiating the project, and even in the reporting of the outcomes. • Essential V: Informatics and Healthcare Technologies o Recognizes that the master’s-prepared nurse uses patient-care technologies to deliver and enhance care and uses communication technologies to integrate and coordinate care. Essential V: Informatics and Healthcare Technologies Rationale Informatics and healthcare technologies encompass five broad areas: • Use of patient care and other technologies to deliver and enhance care;• Communication technologies to integrate and coordinate care; • Data management to analyze and improve outcomes of care; • Health information management for evidence-based care and health education; and • Facilitation and use of electronic health records to improve patient care. Knowledge and skills in each of these four broad areas is essential for all master’sprepared nurses. The extent and focus of each will vary depending upon the nurse’s role, setting, and practice focus. Knowledge and skills in information and healthcare technology are critical to the delivery of quality patient care in a variety of settings (IOM, 2003a). The use of technologies to deliver, enhance, and document care is changing rapidly. In addition, information technology systems, including decision-support systems, are essential to gathering evidence to impact practice. Improvement in cost effectiveness and safety depend on evidence-based practice, outcomes research, interprofessional care coordination, and electronic health records, all of which involve information management and technology (McNeil et al., 2006). As nursing and healthcare practices evolve to better meet patient needs, the application of these technologies will change as well. As the use of technology expands, the master’s-prepared nurse must have the knowledge and skills to use current technologies to deliver and coordinate care across multiple settings, analyze point of care outcomes, and communicate with individuals and groups, including the media, policymakers, other healthcare professionals, and the public. Integral to these skills is an attitude of openness to innovation and continual learning, as information systems and care technologies are constantly changing, including their use at the point of care. Graduates of master’s-level nursing programs will have competence to determine the appropriate use of technologies and integrate current and emerging technologies into one’s practice and the practice of others to enhance care outcomes. In addition, the master’s-prepared nurse will be able to educate other health professionals, staff, patients, and caregivers using current technologies and about the principles related to the safe and effective use of care and information technologies. Graduates ethically manage data, information, knowledge, and technology to communicate effectively with healthcare team, patients, and caregivers to integrate safe and effective care within and across settings. Master’s-prepared nurses use research and clinical evidence to inform practice decisions. Master’s-degree graduates are prepared to gather, document, and analyze outcome data that serve as a foundation for decision making and the implementation of interventions or strategies to improve care outcomes. The master’s-prepared nurse uses statistical and epidemiological principles to synthesize these data, information, and knowledge to evaluate and achieve optimal health outcomes. The usefulness of electronic health records and other health information management systems to evaluate care outcomes is improved by standardized terminologies. Integration of standardized terminologies in information systems supports day-to-day nursing practice and also the capacity to enhance interprofessional communication and generate standardized data to continuously evaluate and improve practice (American Nurses Association, 2008). Master’s-prepared nurses use information and communication technologies to provide guidance and oversight for the development and implementation of health education programs, evidence-based policies, and point-of-care practices by members of the interdisciplinary care team. Health information is growing exponentially. Health literacy is a powerful tool in health promotion, disease prevention, management of chronic illnesses, and quality of life–all of which are hallmarks of excellence in nursing practice. Master’s-prepared nurses serve as information managers, patient advocates, and educators by assisting others(including patients, caregivers and healthcare professionals) in accessing, understanding, evaluating, and applying health-related information. The master’s-prepared nurse designs and implements education programs for cohorts of patients or other healthcare providers using information and communication technologies. The master’s-degree program prepares the graduate to: 1. Analyze current and emerging technologies to support safe practice environments, and to optimize patient safety, cost-effectiveness, and health outcomes. 2. Evaluate outcome data using current communication technologies, in