Domain 2: Person-Centered Care

Person-centered care focuses on the individual within multiple complicated contexts, including family and/or important others. Person-centered care is holistic, individualized, just, respectful, compassionate, coordinated, evidence-based, and developmentally appropriate. Person-centered care builds on a scientific body of knowledge that guides nursing practice regardless of specialty or functional area.

2.1 Engage with the individual in establishing a caring relationship.

d. Promote caring relationships to effect positive outcomes.

e. Foster caring relationships.

2.2 Communicate effectively with individuals.

g. Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences.

h. Design evidence-based, person-centered engagement materials.

i. Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care.

j. Facilitate difficult conversations and disclosure of sensitive information.

2.3 Integrate assessment skills in practice.

h. Demonstrate that one’s practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice.

2.4 Diagnose actual or potential health problems and needs.

f. Employ context driven, advanced reasoning to the diagnostic and decision-making process.

g. Integrate advanced scientific knowledge to guide decision making.

2.5 Develop a plan of care.

h. Lead and collaborate with an interprofessional team to develop a comprehensive plan of care.

i. Prioritize risk mitigation strategies to prevent or reduce adverse outcomes.

j. Develop evidence-based interventions to improve outcomes and safety

k. Incorporate innovations into practice when evidence is not available.

2.6 Demonstrate accountability for care delivery.

e. Model best care practices to the team.

f. Monitor aggregate metrics to assure accountability for care outcomes.

g. Promote delivery of care that supports practice at the full scope of education.

h. Contribute to the development of policies and processes that promote transparency and accountability

i. Apply current and emerging evidence to the development of care guidelines/tools.

j. Ensure accountability throughout transitions of care across the health continuum.

2.7 Evaluate outcomes of care.

d. Analyze data to identify gaps and inequities in care and monitor trends in outcomes.

e. Monitor epidemiological and system-level aggregate data to determine healthcare outcomes and trends.

f. Synthesize outcome data to inform evidence-based practice, guidelines, and policies.

2.8 Promote self-care management.

f. Develop strategies that promote self-care management.

g. Incorporate the use of current and emerging technologies to support self-care management.

h. Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management.

i. Evaluate adequacy of resources available to support self-care management.

j. Foster partnerships with community organizations to support self-care management.

2.9 Provide care coordination.

f. Evaluate communication pathways among providers and others across settings, systems, and communities.

g. Develop strategies to optimize care coordination and transitions of care.

h. Guide the coordination of care across health systems.

i. Analyze system-level and public policy influence on care coordination.

j. Participate in system-level change to improve care coordination across settings.