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 9: Professionalism
“Focuses on development of professional identity” (AACN, 2021, p. 55).
Domain 9: Essential Knowledge
To meet Domain 9 objectives, knowledge is required in:
- Therapeutic engagement, transference and countertransference, and professional boundaries in psychiatric practice
- Ethical and legal standards affecting advanced psychiatric-mental health nursing
- Relevant laws, policies, and regulations for advanced psychiatric-mental health advanced nursing practice
- Professional identity development and professional comportment for advanced psychiatric-mental health nursing practice
- Engagement in professional organizations to advance the psychiatric-mental health nursing profession
Domain 9: Leveling of Objectives
“9.1 Demonstrate an ethical comportment in one’s practice reflective of nursing’s mission to society.” |
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Beginning of Program | Middle of Program | End of Program |
| “9.1h Analyze current policies and practices in the context of an ethical framework.” | Identifies policies or practices with ethical implications. | Analyzes policies and practices to assess ethical implications and potential conflicts. | Evaluates the ethical implications of policies and practices, proposing recommendations for improvement and alignment with ethical principles. |
| “9.1i Model ethical behaviors in practice and leadership roles.” | Adheres to ethical standards in practice interactions. | Demonstrates ethical behavior in leadership roles, guiding team members in ethical decision-making. | Serves as a role model for ethical behavior across all levels of practice and leadership, influencing organizational culture and promoting ethical excellence. |
| “9.1j Suggest solutions when unethical behaviors are observed.” | Review policies and procedures related to unethical behavior. | Proposes solutions or interventions to address unethical behaviors within the scope of practice. | Leads initiatives to address systemic unethical behaviors, advocating for changes in organizational policies and practices to promote ethical integrity. |
| “9.1k Assume accountability for working to resolve ethical dilemmas.” | Acknowledges personal responsibility in addressing ethical dilemmas. | Collaborates with interprofessional teams to develop and implement solutions to ethical dilemmas. | Assumes leadership in resolving complex ethical dilemmas, facilitating interdisciplinary collaboration and promoting ethical decision-making. |
“9.2 Employ participatory approach to nursing care.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “9.2h Foster opportunities for intentional presence in practice.” | Demonstrates presence and attentiveness during individual interactions. | Creates environments conducive to therapeutic presence, fostering trust and rapport with individuals. | Models intentional presence in clinical practice and leadership, enhancing therapeutic relationships and promoting individual well-being. |
| “9.2i Identify innovative and evidence-based practices that promote person-centered care.” | Identifies evidence-based practices to enhance individual care outcomes. | Implements innovative strategies to promote person-centered care, integrating individual preferences and values into care plans. | Leads quality improvement initiatives to identify and implement innovative practices, advancing person-centered care and improving individual outcomes. |
| “9.2j Advocate for practices that advance diversity, equity, and inclusion.” | Recognizes the importance of diversity, equity, and inclusion in nursing practice. | Appraise policies and practices that promote diversity, equity, and inclusion within the healthcare setting. | Leads efforts to create inclusive practice environments, advocating for systemic changes that advance diversity, equity, and inclusion across all levels of practice. |
| “9.2k Model professional expectations for therapeutic relationships.” | Establishes therapeutic relationships with individuals based on trust and respect. | Utilize effective communication skills and empathy in building therapeutic relationships with diverse individual populations. | Develop therapeutic communication and relationship-building skills in challenging situations, inspiring trust and confidence in individuals and colleagues. |
| “9.2l Facilitate communication that promotes a participatory approach.” | Communicates openly and transparently with individuals and families, encouraging active participation in care decisions. | Facilitates interdisciplinary communication and collaboration to ensure a participatory approach to individual care. | Leads initiatives to improve communication processes and foster collaborative decision-making, promoting individual engagement and empowerment in care delivery. |
“9.3 Demonstrate accountability to the individual, society, and the profession.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “9.3i Advocate for nursing’s professional responsibility for ensuring optimal care outcomes.” | Recognizes the importance of advocating for optimal care outcomes. | Actively engages in advocacy efforts to promote optimal care outcomes for individuals. | Leads initiatives to advance nursing’s professional responsibility in ensuring optimal care outcomes, advocating for systemic changes to improve individual safety and quality of care. |
| “9.3j Demonstrate leadership skills when participating in professional activities and/or organizations.” | Engages in professional activities and organizations relevant to nursing. | Demonstrates leadership qualities in professional activities and organizations, contributing expertise and insights to initiatives. | Assumes leadership roles within professional activities and organizations, driving change and innovation to advance nursing practice and improve individual outcomes. |
| “9.3k Address actual or potential hazards and/or errors.” | Identifies potential hazards or errors in individual care and reports them appropriately. | Develops and implements strategies to address hazards or errors in individual care, prioritizing individual safety and well-being. | Leads efforts to proactively identify and mitigate hazards or errors in individual care, fostering a culture of safety and continuous improvement within the healthcare setting. |
| “9.3l Foster a practice environment that promotes accountability for care outcomes.” | Recognizes the importance of promoting accountability within the practice environment. | Participates in initiatives to promote accountability for care outcomes, encouraging colleagues to take responsibility for their actions. | Leads efforts to create a culture of accountability within the practice environment, establishing systems and processes to monitor and improve care outcomes. |
| “9.3m Advocate for policies/practices that promote social justice and health equity.” | Recognizes the role of policies and practices in promoting social justice and health equity. | Advocates for policies and practices that address social determinants of health and promote health equity for all individuals. | Leads advocacy efforts to address systemic inequities in healthcare, influencing policy changes and promoting equitable access to healthcare services for marginalized populations. |
| “9.3n Foster strategies that promote a culture of civility across a variety of settings.” | Acknowledges the importance of fostering a culture of civility in healthcare settings. | Participates in initiatives to promote respectful communication and collaboration across healthcare settings. | Leads initiatives to promote a culture of civility and respect, implementing strategies to address conflict and promote collaboration across diverse healthcare settings. |
| “9.3o Lead in the development of opportunities for professional and interprofessional activities.” | Engages in professional and interprofessional activities to enhance knowledge and skills. | Takes a leadership role in the development of professional and interprofessional activities, facilitating learning and collaboration among colleagues. | Initiates and leads the development of innovative professional and interprofessional activities, fostering collaboration and advancing knowledge and practice within the healthcare community. |
“9.4 Comply with relevant laws, policies, and regulations.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “9.4d Advocate for policies that enable nurses to practice to the full extent of their education.” | Recognizes the importance of advocating for policies that support nursing practice. | Actively engages in advocacy efforts to promote policies that enable nurses to practice to the full extent of their education and training. | Leads advocacy initiatives to influence policy changes that support nursing practice and improve individual care outcomes. |
| “9.4e Assess the interaction between regulatory agency requirements and quality, fiscal, and value-based indicators.” | Identifies the impact of regulatory requirements on quality, fiscal, and value-based indicators. | Analyzes the interaction between regulatory agency requirements and quality, fiscal, and value-based indicators, identifying areas for improvement and optimization. | Leads efforts to align regulatory requirements with quality, fiscal, and value-based indicators, advocating for policies that promote efficient and effective healthcare delivery. |
| “9.4f Evaluate the effect of legal and regulatory policies on nursing practice and healthcare outcomes.” | Recognizes the influence of legal and regulatory policies on nursing practice and healthcare outcomes. | Evaluates the impact of legal and regulatory policies on nursing practice and healthcare outcomes, identifying opportunities for improvement and optimization. | Leads efforts to align regulatory requirements with quality, fiscal, and value-based indicators, advocating for policies that promote efficient and effective healthcare delivery. |
| “9.4g Analyze efforts to change legal and regulatory policies that improve nursing practice and health outcomes.” | Recognizes the importance of advocating for changes in legal and regulatory policies to improve nursing practice and health outcomes. | Actively engages in advocacy efforts to promote changes in legal and regulatory policies that improve nursing practice and health outcomes. | Leads advocacy initiatives to influence policy changes that enhance nursing practice and improve health outcomes for individuals and populations. |
| “9.4h Participate in the implementation of policies and regulations to improve the professional practice environment and healthcare outcomes.” | Participates in the implementation of policies and regulations to enhance the professional practice environment and improve healthcare outcomes. | Takes an active role in implementing policies and regulations to improve the professional practice environment and healthcare outcomes, collaborating with colleagues to ensure successful implementation. | Leads efforts to implement policies and regulations that enhance the professional practice environment and improve healthcare outcomes, overseeing implementation processes and promoting collaboration across disciplines. |
“9.5 Demonstrate the professional identity of nursing.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “9.5f Articulate nursing’s unique professional identity to other interprofessional team members and the public.” | Recognizes the importance of articulating nursing’s professional identity to interprofessional team members and the public. | Engages in effective communication to articulate nursing’s unique professional identity to interprofessional team members and the public, promoting collaboration and understanding. | Leads initiatives to promote nursing’s unique professional identity, advocating for recognition and appreciation of nursing’s contributions to healthcare among interprofessional team members and the public. |
| “9.5g Evaluate practice environment to ensure that nursing core values are demonstrated.” | Recognizes the influence of the practice environment on the demonstration of nursing core values. | Evaluates the practice environment to ensure that nursing core values are demonstrated, identifying areas for improvement and alignment with nursing principles. | Leads efforts to assess and improve the alignment between the practice environment and nursing core values, advocating for changes that promote a culture of excellence and professionalism. |
| “9.5h Identify opportunities to lead with moral courage to influence team decision-making.” | Recognizes opportunities to lead with moral courage in influencing team decision-making. | Identifies and seizes opportunities to lead with moral courage, advocating for ethical principles and values in team decision-making processes. |
Leads by example in demonstrating moral courage, inspiring and empowering others to uphold ethical principles and values in all aspects of team decision-making. |
| “9.5i Engage in professional organizations that reflect nursing’s values and identity.” | Recognizes the importance of engaging in professional organizations that reflect nursing’s values and identity. | Actively participates in professional organizations that reflect nursing’s values and identity, contributing expertise and insights to advance nursing practice. | Assumes leadership roles in professional organizations, driving initiatives that advance nursing’s values and identity and promote professional growth and development. |
“9.6 Integrate diversity, equity, and inclusion as core to one’s professional identity.” |
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| Beginning of Program | Middle of Program | End of Program | |
| “9.6d Model respect for diversity, equity, and inclusion for all team members.” | Recognizes the importance of modeling respect for diversity, equity, and inclusion in interactions with team members. | Models respectful behavior and fosters an inclusive environment that values diversity, equity, and inclusion among team members. | Leads efforts to promote respect for diversity, equity, and inclusion, advocating for policies and practices that support diversity and foster inclusivity among all team members. |
| “9.6e Critique one’s personal and professional practices in the context of nursing’s core values.” | Engages in self-reflection to evaluate personal and professional practices in relation to nursing’s core values. | Critically evaluates personal and professional practices in the context of nursing’s core values, identifying areas for growth and alignment with nursing principles. | Leads by example in aligning personal and professional practices with nursing’s core values, fostering a culture of integrity and excellence within the healthcare setting. |
| “9.6f Analyze the impact of structural and cultural influences on nursing’s professional identity.” | Recognizes the influence of structural and cultural factors on nursing’s professional identity. | Analyzes the impact of structural and cultural influences on nursing’s professional identity, identifying opportunities for advancement and improvement. |
Leads initiatives to address systemic barriers and promote a culture that nurtures and sustains nursing’s professional identity, fostering a sense of pride and belonging among nurses. |
| “9.6g Ensure that care provided by self and others is reflective of nursing’s core values.” | Recognizes the importance of ensuring that care provided aligns with nursing’s core values. | Ensures that care provided by self and others reflects nursing’s core values, holding oneself and colleagues accountable to ethical and professional standards. | Leads efforts to promote a culture of excellence and integrity in care delivery, ensuring that all care provided within the healthcare setting is reflective of nursing’s core values. |
| “9.6h Structure the practice environment to facilitate care that is culturally and linguistically appropriate.” | Recognizes the importance of structuring the practice environment to facilitate culturally and linguistically appropriate care. | Implements strategies to promote a culturally and linguistically inclusive practice environment, ensuring that care is responsive to the needs of diverse individual populations. | Leads efforts to create a practice environment that embraces cultural diversity and linguistic inclusivity, advocating for policies and practices that support culturally responsive care delivery. |
| “9.6i Ensure self and others are accountable in upholding moral, legal, and humanistic principles related to health.” | Recognizes the importance of upholding moral, legal, and humanistic principles related to health. | Promotes accountability among self and others in upholding moral, legal, and humanistic principles related to health, fostering a culture of integrity and professionalism. | Leads by example in upholding moral, legal, and humanistic principles related to health, inspiring and empowering others to do the same in all aspects of practice. |
Domain 9: Teaching/Learning Strategies
Examples of Classroom and Clinical/Practicum Strategies
Example 1: Simulation-Based Workshop: Ethical Leadership in Psychiatric Mental Health Nursing
Description: Simulation Workshop consisting of three scenarios related to ethical leadership and development of professional identity.
Overview: The simulation-based workshop on ethical leadership in psychiatric mental health nursing offers PMHNP students an immersive learning experience to navigate ethical dilemmas and promote inclusivity in clinical and leadership roles. Through interactive scenarios and reflective discussions, students will explore and apply ethical comportment, professional identity, diversity, equity, and inclusion principles in various contexts relevant to psychiatric mental health advanced nursing practice.
By actively participating in the simulation-based workshop, PMHNP students will enhance their ethical reasoning skills, develop a deeper understanding of professional identity, and gain practical experience in promoting diversity, equity, and inclusion in psychiatric mental health advanced nursing practice. The workshop will serve as a valuable opportunity for students to apply theoretical knowledge to real-world scenarios, preparing them to navigate complex ethical challenges and contribute to positive change within healthcare systems.
Learning Objectives:
- Analyze current policies and practices through an ethical framework (9.1h).
- Model ethical behaviors in clinical and leadership roles (9.1i).
- Advocate for ethical practices and solutions to ethical dilemmas (9.1j, 9.1k).
- Foster intentional presence and participatory approach in nursing care (9.2h, 9.2l).
- Demonstrate accountability to individuals, society, and the profession (9.3i, 9.3l).
- Advocate for policies and practices promoting social justice and health equity (9.3m).
- Engage in professional activities and organizations (9.3j, 9.5i).
- Model respect for diversity, equity, and inclusion in nursing practice (9.6d).
- Ensure care is reflective of nursing’s core values (9.6g).
- Structure the practice environment to facilitate culturally appropriate care (9.6h)
Workshop Structure:
1. Introduction (30 minutes):
- Welcome and overview of workshop objectives and structure.
- Brief review of ethical leadership concepts and principles.
- Explanation of simulation format and expectations for participation.
2. Simulation Scenarios (120 minutes):
- Students will be divided into small groups and assigned to different simulation scenarios, each designed to address specific aspects of ethical leadership in psychiatric mental health nursing.
Scenario 1: Confidentiality and Autonomy
- Description: An individual with severe depression confides in the PMHNP about suicidal ideation but explicitly requests that this information not be shared with other healthcare providers or family members.
- Objective: Students will grapple with the tension between respecting individual confidentiality and ensuring individual safety, considering legal and ethical obligations to disclose potential harm.
Scenario 2: Cultural Understanding and Informed Consent
- Description: A non-English-speaking individual presents to the emergency department with acute psychosis. The individual’s family insists on traditional healing practices, while the medical team recommends psychiatric hospitalization and medication. The PMHNP is called to consult.
- Objective: Students will explore culturally sensitive approaches to informed consent and treatment decision-making, considering the balance between respecting cultural beliefs and ensuring individual well-being.
Scenario 3: Advocacy and Resource Allocation
- Description: A psychiatric unit faces budget cuts, leading to reduced staffing levels and limited access to essential resources. Nurses must advocate for individual safety and quality care while navigating organizational constraints. The PMHNP unit manager is responsible for the new budget.
- Objective: Students will engage in advocacy efforts to address systemic barriers to care, demonstrating leadership in promoting ethical practice within healthcare organizations.
3. Debriefing and Reflective Discussions (60 minutes):
- Facilitators will lead reflective discussions on the ethical, cultural, and leadership dimensions of the scenarios, prompting students to analyze their decision-making processes and consider alternative approaches. Each group will share their scenario, discussion take-aways, and lead peer reflection.
- Emphasis will be placed on identifying ethical principles and values relevant to psychiatric mental health advanced nursing practice, such as beneficence, autonomy, nonmaleficence, and justice.
- Reflective discussions will also focus on strategies for promoting ethical leadership and fostering a culture of respect, compassion, and accountability in practice.
4. Action Planning and Application (30 minutes):
- In small groups, students will develop an action plan outlining concrete steps for integrating workshop learnings into their current clinical and future leadership roles. Action plans may include strategies for advocating for policy changes, implementing cultural competence training programs, or initiating quality improvement projects within healthcare settings.
- Students will present their action plans to the larger group, receiving feedback and insights from peers and facilitators.
5. Conclusion and Wrap-Up (10 minutes):
- Summary of key takeaways and insights gained from the workshop.
- Encouragement for continued reflection and application of ethical leadership principles in practice.
- Distribution of resources and references for further exploration of ethical leadership in psychiatric mental health nursing.
Domain 9: Resources
Articles/Textbooks
American Nurses Association (2015). Code of ethics for nurses with interpretive statements.
American Association of Nurse Practitioners. (2019). Standards of practice for nurse practitioners.
International Society of Psychiatric-Mental health Nurses, American Nurses Association & American Psychiatric Nurses Association. (2021). Psychiatric Mental Health Nursing: Scope and Standards of Practice (3rd ed.). American Nurses Association.
International Council of Nurses. (2021). The ICN code of ethics for nurses. Author.
Bradley E. H. (2020). Diversity, inclusive leadership, and health outcomes. International Journal of Health Policy and Management, 9(7), 266-268.
Buettner-Schmidt, K., & Lobo, M. L. (2011). Social justice: A concept analysis. Journal of Advanced Nursing, 68(4), 948–958.
Dolan, C. (2017). Moral, ethical, and legal decision-making in controversial NP practice situations. The Journal for Nurse Practitioners, 13(2), 57-65.
Farmer, L., & Lunday, A. (2017). Informed consent: Ethical and legal considerations for advanced practice nurses. The Journal for Nurse Practitioners, 13(2), 124-130.
Godfrey, N., & Young, E. (2021). Professional identity. In J. F. Giddens (Ed.) Concepts for Nursing Practice (3rd ed., pp. 363-71). Elsevier.
Grace, P. J. (2018). Nursing ethics and professional responsibility in advanced practice (3rd ed.). Jones & Bartlett Learning.
Hinkley, T., Kuhl, L., & Liebig, D. (2023). Professional identity in nursing: The role of efficacy in navigating the work environment. Nurse Leader, 21(2), 174-178.
Hite, A. & Godfrey, N. (2019). Professional identity in nursing: Why does it matter? Kansas Nurse, 94(3), 14-16.
National Academy of Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. doi:10.17226/25982
Nickitas, D. M., Middaugh, D. J., & Feeg, V. D. (2020). Policy and politics for nurses and other health professionals: Advocacy and action. Jones & Bartlett Learning.
Owens, R. A., & Godfrey, N. (2022). Fostering professional identity: How to wholly support nurse well-being. American Nurse, 17(9), 12.
Websites
American Nurses Association
Health Policy Brief
SAMHSA – Laws and regulations
